Newly Proposed Variables for the
National Notifiable Diseases Surveillance System
July 11, 2012
Introduction:
This document includes two sections describing newly proposed variables for
the National Notifiable Diseases Surveillance System (NNDSS). Section one
includes descriptions for seven newly proposed Generic variables. Section two
includes a description of a newly proposed disease-specific variable for measles,
mumps, rubella, and congenital rubella syndrome, related to the subclassification of US-acquired cases, as per the national surveillance case
definition for the specified conditions. This document also demonstrates
modeling of vocabulary and message construct using HL7 Case Notification for
Nationally Notifiable Conditions specifications.
Section 1: Newly Proposed Generic Variables
The newly proposed generic variables we want your comments on include: Birth
Country (DEM126); Country of Usual Residence (INV501), Binational reporting
criteria (INV515), and four location of potential exposure questions which are
included in a repeating block (INV502, INV503, INV504, INV505). Descriptions of
these variables are as follows:
Birth Country:
PHIN UID
Label/Short
Name
DEM126
Birth
(cannot
Country
repeat)
Description
Patient’s
country of
Birth
Data
type
CWE
Value Set Name and Notes
PHVS_CountryOfBirth_CDC
(will include all current and
former countries and U.S.
territories)
Country of Usual Residence:
This variable replaces the Foreign Resident variable mentioned in CSTE Position
Statement 11-SI-04 titled “Revised Guidelines for Determining Residency for Disease
Reporting” located at: http://www.cste.org/ps2011/11-SI-04.pdf.
PHIN
Label/Short Description
Data Value Set Name
UID
Name
type
INV501 Country of
Where does the person
CW PHVS_CountryOfBirth_C
(cannot Usual
usually* live (defined as
E
DC
repeat) Residence
their residence)
(will include all current
1
*For the definition of
‘usual residence’ refer to
CSTE position statement
# 11-SI-04 titled “Revised
Guidelines for
Determining Residency for
Disease Reporting” at
http://www.cste.org/ps201
1/11-SI-04.pdf .
countries, US territories,
and an Unknown value )
NOTE: The following algorithm will be used to identify the cases to be included in
state-specific counts and rates in the MMWR: Cases with country of usual
residence equal to the US, Puerto Rico, and U.S. Virgin Islands as well as
unknown and null responses will be included in the state-specific counts and
rates. In the MMWR, the US total for the condition will include all cases, including
those excluded because they were non-US residents (in other words, they resided
in any Country outside of the US, Puerto Rico and U.S. Virgin Islands, which
collectively represent the US).
Binational Reporting Criteria (single PHIN UID with repeating observation value)
NOTE: The binational reporting criteria field (INV515) has not been approved by CSTE
and won’t be implemented until CSTE approves it. We would, however, like to receive
local and state comments about this field, in preparation for submission of a revised
CSTE position statement about binational reporting.”
PHIN
UID
INV515
Label/Short
Name
Binational
Reporting
Criteria
Description
For cases
meeting the
binational
criteria,
select all the
criteria
which are
met
Data Value Set Name and Notes
type
CWE PHVS_BinationalReportingCriteria_CDC
New value set with the following:
 Potential exposure in Mexico or
Canada
 Resident of Mexico or Canada
 Has case contacts from Mexico or
Canada
 Exposure to a suspected product
from Mexico or Canada
 Other reason (all criteria not fitting
into the categories listed above)
Example HL7 message using this implementation.
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Example HL7 message using Binational Reporting Criteria: single observation
value; new value set
OBX|1|CWE|INV515^Binational Reporting
Criteria^2.16.840.1.114222.4.5.232||xxx^Potential exposure in another
country^xxxOID^4^5^L^7^8^9||||||F
Example HL7 message using Binational Reporting Criteria: single observation
value; new value set; use of the 9th component
OBX|1|CWE|INV515^Binational Reporting
Criteria^2.16.840.1.114222.4.5.232||xxx^Other Reason^xxxOID^4^5^L^7^8^Other
reason free text goes here||||||F
Example HL7 message using Binational Reporting Criteria: repeating
observation value denoted by ~; new value set
OBX|1|CWE|INV515^Binational Reporting
Criteria^2.16.840.1.114222.4.5.232||xxx^Potential exposure in another
country^xxxOID~xxx^ Resident of another country ^xxxOID ||||||F
Exposure Questions (where was disease acquired)
For the question regarding exposure, the below summarizes the recommendation at this
point. The information would be presented as a repeating block in the generic guide.
This series of questions about location of potential exposure would NOT replace the
imported fields currently in the Generic guide.
Note: A repeating block is more desirable in this situation than a repeating observation
because the only way to tie the specific variables together would be manual, if it could
be done at all (and subject to human error). In addition, it is better to do a more generic
question with a specific answer as a repeating block instead of asking specific question
with generic responses. An example of a specific question and a generic response is
as follows: Was the patient exposed in the US? Y/N, Was the patient exposed in
Canada? Y/N, was the patient exposed in Mexico? Y/N, etc.). With the number of
countries in existence, asking specific questions would be very tedious.
Repeating Block (uses OBX -4 Observation Sub-ID ) to relate the observations to
one another – see sample message below
PHIN UID
Label/Short
Description
Dat Value Set Name and
Name
a
Notes
type
INV502
Country of
Indicates the country in
CW PHVS_CountryOfBirth
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New PHIN
UID
INV503
new PHIN
UID
Exposure or
Country
Where
Disease was
Acquired
Note: use
exposure or
acquired
consistently
across
variables
State or
Province of
Exposure
INV504
new PHIN
UID
City of
Exposure
INV505
new PHIN
UID
County of
Exposure
which the disease was
potentially acquired.
E
_CDC
Note: US Territories
are treated as
countries for the
purpose of this
question.
Indicates the state in
which the disease was
potentially acquired.
Business Rule: If Country
of exposure was US,
populate with US State. If
Country of exposure was
Mexico, populate with
Mexican State. If country
of exposure was Canada,
populated with Canadian
Province. For all other
countries, leave null.
Indicates the city in which
the disease was
potentially acquired.
Business Rule: If country
of exposure is US,
populate with US city. For
all other cities, can be
populated but not
required.
Note: Since value set only
includes US cities, would
allow states to populate
the CWE 9th component
with another city.
Indicates the county in
which the disease was
potentially acquired.
Business Rule: If country
of exposure is US,
populate with US county.
Otherwise, leave null.
CW
E
PHVS_State_FIPS_52
Note: Need to expand
value set to include
Mexican States and
Canadian Provinces
Free text field
Text
Text
Free text field
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Example HL7 message using this implementation.
A patient was potentially exposed in the following locations:
In Ontario, Canada
OBX|30|CWE|INV502^Country of Exposure or Country Where Disease was Acquired
^2.16.840.1.114222.4.5.232||CAN^Canada^2.16.840.1.113883.12.136^4^5^L^7^8^9||||||
F
OBX|31|CWE|INV503^State or Province of
Exposure^2.16.840.1.114222.4.5.232||224020003^Ontario^SNOMEDCT^4^5^L^7^8^9||||||F
OBX|32|ST|INV504^City of Exposure^2.16.840.1.114222.4.5.232||City of Exposure
Free text field||||||F
OBX|33|ST|INV505^County of Exposure^2.16.840.1.114222.4.5.232||County of
Exposure Free text field||||||F
In US, Georgia, Macon, Bibb
In US, Georgia, Warner Robbins, Houston
OBX|30|CWE|INV502^Country of Exposure or Country Where Disease was Acquired
^2.16.840.1.114222.4.5.232|1|USA^United
States^2.16.840.1.113883.12.136^4^5^L^7^8^9||||||F
OBX|31|CWE|INV503^State or Province of
Exposure^2.16.840.1.114222.4.5.232|1|13^Georgia^2.16.840.1.113883.6.92^4^5^L^7^
8^9||||||F
OBX|32|ST|INV504^City of Exposure^2.16.840.1.114222.4.5.232|1|Macon||||||F
OBX|33|ST|INV505^County of Exposure^2.16.840.1.114222.4.5.232|1|Bibb||||||F
OBX|34|CWE|INV502^Country of Exposure or Country Where Disease was Acquired
2.16.840.1.114222.4.5.232|2|USA^United
States^2.16.840.1.113883.12.136^4^5^L^7^8^9||||||F
OBX|35|CWE|INV503^State or Province of
Exposure^2.16.840.1.114222.4.5.232|2|13^Georgia^2.16.840.1.113883.6.92^4^5^L^7^
8^9||||||F
OBX|36|ST|INV504^City of Exposure^2.16.840.1.114222.4.5.232|2|Warner
Robins||||||F
OBX|37|ST|INV505^County of Exposure^2.16.840.1.114222.4.5.232|2|Houston||||||F
In Some Mexican State, Mexico (shows use of the 9th component)
OBX|26|CWE|INV502^Country of Exposure or Country Where Disease was Acquired
^2.16.840.1.114222.4.5.232||MEX^Mexico^2.16.840.1.114222.4.11.828^4^5^L^7^8^9|||
|||F
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OBX|27|CWE|INV503^State or Province of Exposure^2.16.840.1.114222.4.5.232||MXCol^Colima^ 2.16.840.1.114222.4.11.3286^4^5^L^7^8^9||||||F
OBX|28|ST|INV504^City of Exposure^2.16.840.1.114222.4.5.232||A small town near
Mexico City||||||F
OBX|29|ST|INV505^County of Exposure^2.16.840.1.114222.4.5.232||County of
Exposure Free text field||||||F
Section 2: Newly Proposed Variable for the Sub-classification of US Acquired
Cases, as per the National Surveillance Case Definitions for Measles, Mumps,
Rubella, and Congenital Rubella Syndrome
PHIN UID
INV516
New PHIN
UID
Label/Short
Name
US Acquired
Description
Sub-classification of
disease or condition
acquired in the US
Business Rule: this
variable should only
appear if the answer to
INV152
(Case Disease
Imported Code) is one
of the following:
Data Value Set Name and
type Notes
CWE PHVS_CaseClassification
ExposureSource_NND:
Import-linked case,
Imported-virus case,
Endemic case,
Unknown source case
PHC244 (Indigenous,
within jurisdiction),
PHC245 (out of
jurisdiction, from
another jurisdiction
within state), or
PHC246 (out of state),
or
The NETSS imported
variable is
Coded 1 (Indigenous –
acquired in the USA in
reporting jurisdiction) or
Coded 3 (Out of State –
but in the USA and
outside the reporting
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state).
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