Ottawa County Gastrointestinal Event—Summer, 2004
Ottawa County Gastrointestinal Event—Summer, 2004
Control Questionnaire
Hello. My name is _________ and I am working with the Ottawa County and Ohio Departments of Health. May I please speak with _________________(or parent)? We are investigating an outbreak of diarrhea among people who traveled to South Bass Island, OH during July or August, 2004. Your name was provided to us by someone who traveled with you to the island this summer. At this time, we are collecting additional information from both ill and well people in order to better understand what caused this outbreak. We would like to ask you some very specific questions about places you went and things you did during your visit to the island.
The interview will take about 8-10 minutes. Your participation is voluntary, and all of the information you provide will be kept confidential. You may skip any questions you choose not to answer, and you may stop the interview at any time.
Would you like to continue? Y N
If yes, please thank the control and proceed with interview.
If no, May I call you back some other time? Y (date/time___________) N
If no, please thank the control and terminate the interview.
We have already spoken with your companion who traveled with you to South Bass Island. We understand that you did not become ill after your trip.
1. On what dates did you visit South Bass Island? ____/____/____ to ____/____/____
2. Can we confirm that you did not become ill with vomiting or diarrhea within 2 weeks of your visit to South Bass Island? Y (I did not become ill) N (I became ill)
3. Were you taking any antibiotics recently?
Y N
If yes, what______________________ when did you start___/___/____
4. What is your age? ________years Sex?__________
EXPOSURE INFORMATION
Now we would like to ask you some questions about the food and water you consumed on the island.
5. Did you fill up and drink any water bottles with tap water while on South Bass Island?
Y N DK
6. Did you drink any commercially bottled water while on South Bass Island?
Y N DK
7. How much tap water did you drink on South Bass Island? I will read you a list of choices: (interviewer please tick)
a. None (
b. ................
................
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