{"id":2631,"date":"2017-03-07T14:59:01","date_gmt":"2017-03-07T18:59:01","guid":{"rendered":"http:\/\/phac.hyperinteractive.ca\/?page_id=2631"},"modified":"2019-03-12T11:43:37","modified_gmt":"2019-03-12T15:43:37","slug":"invasive-listeriosis-questionnaire","status":"publish","type":"page","link":"https:\/\/outbreaktools.ca\/fr\/tools\/toolkit-questionnaire-repository\/invasive-listeriosis-questionnaire\/","title":{"rendered":"Questionnaire sur la list\u00e9riose invasive"},"content":{"rendered":"

T\u00e9l\u00e9charger le format de rechange<\/a><\/p>\n

Contexte du questionnaire pour l’intervieweur<\/h2>\n

Veuillez remplir le questionnaire pour tous les cas de list\u00e9riose invasive qui r\u00e9pondent \u00e0 la d\u00e9finition de cas suivante :<\/p>\n

Manifestation clinique : La maladie clinique invasive se caract\u00e9rise par une m\u00e9ningite ou une bact\u00e9ri\u00e9mie. D\u2019une infection durant une grossesse peut d\u00e9couler une perte f\u0153tale par fausse couche, mortinaissance, m\u00e9ningite n\u00e9onatale ou bact\u00e9ri\u00e9mie.<\/p>\n

Crit\u00e8res d\u2019analyse pour le diagnostic (confirmation en laboratoire d\u2019une infection avec sympt\u00f4mes) :<\/p>\n

\u00b7 Isolement de la bact\u00e9rie Listeria monocytogenes d\u2019un site normalement st\u00e9rile (p. ex. sang, liquide c\u00e9phalorachidien, articulation, liquide pleural ou p\u00e9ricardique) OU<\/p>\n

\u00b7 Dans le cadre d\u2019une fausse couche ou d\u2019une mortinaissance, isolement de la bact\u00e9rie L. monocytogenes du tissu placentaire ou f\u0153tal (y compris le liquide amniotique et le m\u00e9conium)<\/p>\n

Pour les cas d\u2019infections caus\u00e9es par la bact\u00e9rie Listeria chez les femmes enceintes ou les nouveau-n\u00e9s \u00e2g\u00e9s d\u2019un mois ou moins, la M\u00c8RE est le cas.<\/p>\n

R\u00c9SERV\u00c9 \u00c0 L’USAGE LOCAL \u2013 VEUILLEZ SUPPRIMER CETTE PAGE EN CAS D’ENVOI DU FORMULAIRE \u00c0 L’ASPC<\/h3>\n

I. Renseignements sur le cas<\/h4>\n\n\n\n\n\n
\n

Nom du cas :<\/p>\n<\/td>\n

\n

Nom de l’enqu\u00eat\u00e9-substitut :<\/p>\n<\/td>\n<\/tr>\n

\n

Adresse municipale :<\/p>\n

Ville\/Village :<\/p>\n

Code postal :<\/p>\n<\/td>\n

\n

T\u00e9l\u00e9phone \u00e0 domicile :<\/p>\n

T\u00e9l\u00e9phone au travail :<\/p>\n

T\u00e9l\u00e9phone cellulaire :<\/p>\n<\/td>\n<\/tr>\n

\n

M\u00e9decin :<\/p>\n<\/td>\n

\n

T\u00e9l\u00e9phone du m\u00e9decin :<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Questionnaire sur la list\u00e9riose invasive<\/h2>\n

Section 1 : Renseignements sur le cas<\/h3>\n\n\n\n\n\n\n\n
\n

Num\u00e9ro d\u2019identification national du cas<\/p>\n

(ASPC seulement) :<\/p>\n

Num\u00e9ro d\u2019identification provincial<\/p>\n

du cas :<\/p>\n<\/td>\n

\n

Num\u00e9ro d\u2019identification<\/p>\n

de laboratoire provincial du cas :<\/p>\n<\/td>\n<\/tr>\n

\n

Cas interrog\u00e9 par :<\/p>\n<\/td>\n

\n

Date de l\u2019entrevue (jj\/mm\/aa) :<\/p>\n<\/td>\n<\/tr>\n

\n

R\u00e9pondant : \u25a2 Cas \u25a2 Parent \u25a2 Conjoint \u25a2 Fournisseur de soins \u25a2 Autre (pr\u00e9cisez) :<\/p>\n<\/td>\n<\/tr>\n

\n

\u00c2ge :\u00a0<\/p>\n<\/td>\n

\n

Sexe : \u25a2 M \u25a2 F<\/p>\n<\/td>\n<\/tr>\n

\n

Bureau de sant\u00e9 ou autorit\u00e9 sanitaire :<\/p>\n<\/td>\n

\n

Province :<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Section 2 : Cas associ\u00e9 \u00e0 une grossesse<\/h3>\n\n\n\n
\n

Le cas d\u2019infection caus\u00e9e par la bact\u00e9rie Listeria est-il associ\u00e9 \u00e0 une grossesse? (Maladie chez une femme enceinte, un f\u0153tus ou un nouveau-n\u00e9 d\u2019un mois ou moins)<\/p>\n

\u25a2 Oui\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Si la r\u00e9ponse est \u00ab Oui \u00bb, passez \u00e0 la section 4<\/p>\n

\u25a2 Non\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Si la r\u00e9ponse est \u00ab Non \u00bb, passez \u00e0 la section 3<\/p>\n

\u25a2 Inconnu\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Si la r\u00e9ponse est \u00ab Inconnu \u00bb, passez \u00e0 la section 3<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Section 3 : Donn\u00e9es cliniques (adultes [sauf les femmes enceintes] et enfants \u00e2g\u00e9s de plus d\u2019un mois)<\/h3>\n\n\n\n\n\n\n\n\n\n
\n

Type(s) d\u2019\u00e9chantillon positif :<\/p>\n

\u25a2 Liquide c\u00e9phalorachidien\u00a0 \u00a0 \u25a2 Sang\u00a0 \u00a0 \u00a0\u25a2 Urine\u00a0 \u00a0 \u00a0\u25a2 Autre :<\/p>\n<\/td>\n

\n

Profil \u00e9lectrophor\u00e9tique (ECP):<\/p>\n<\/td>\n<\/tr>\n

\n

Date du signalement \u00e0 l\u2019autorit\u00e9 sanitaire (jj\/mm\/aa):<\/p>\n<\/td>\n

\n

Date du pr\u00e9l\u00e8vement d\u2019\u00e9chantillon positif (jj\/mm\/aa) :<\/p>\n<\/td>\n<\/tr>\n

\n

Date d\u2019apparition du premier sympt\u00f4me (jj\/mm\/aa) :<\/p>\n

Quand les sympt\u00f4mes ont-ils disparu (date du r\u00e9tablissement)? (jj\/mm\/aa):
\n\u25a2 Encore malade \u25a2 Ne sait pas (NSP)<\/p>\n<\/td>\n

\n

Type de maladie :<\/p>\n

\u25a2 Bact\u00e9ri\u00e9mie\/septic\u00e9mie\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u25a2 M\u00e9ningite<\/p>\n

\u25a2 Infection urinair\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u25a2 Autre :<\/p>\n<\/td>\n<\/tr>\n

\n

Sympt\u00f4mes :<\/p>\n

Diarrh\u00e9e* \u25a2 O \u25a2 N \u25a2 NSP\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Crampes abdominales \u25a2 O \u25a2 N \u25a2NSP\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Raideur au cou \u25a2 O \u25a2 N \u25a2 NSP<\/p>\n

Maux de t\u00eate \u25a2 O \u25a2 N \u25a2 NSP\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Douleurs musculaires \u25a2 O \u25a2 N \u25a2 NSP\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Confusion \u25a2 O \u25a2 N \u25a2 NSP<\/p>\n

Vomissements \u25a2 O \u25a2 N \u25a2 NSP\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Fi\u00e8vre \u25a2 O \u25a2 N \u25a2 NSP\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Faiblesse \u25a2 O \u25a2 N \u25a2 NSP<\/p>\n

Frissons \u25a2 O \u25a2 N \u25a2 NSP\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Naus\u00e9es \u25a2 O \u25a2 N \u25a2 NSP\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Asymptomatique \u25a2 O \u25a2 N \u25a2 NSP<\/p>\n

* Trois selles molles ou plus en 24 heures\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/em>Autre (pr\u00e9cisez) :<\/p>\n<\/td>\n<\/tr>\n

\n

Hospitalisation? * \u25a2 O \u25a2 N \u25a2 NSP<\/p>\n

\u25a2 Non hospitalis\u00e9\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u25a2 Hospitalis\u00e9 en raison de la list\u00e9riose<\/p>\n

\u25a2 Ne sait pas\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u25a2 Hospitalis\u00e9 pour une autre raison<\/p>\n

* Ne comprend pas les personnes qui se rendent \u00e0 une salle d\u2019urgence ou \u00e0 une consultation externe<\/p>\n<\/td>\n

\n

Date de l\u2019admission(jj\/mm\/aa) :<\/p>\n

Date de cong\u00e9 de l\u2019h\u00f4pital (jj\/mm\/aa) :<\/p>\n

\u25a2 Encore hospitalis\u00e9 au moment de l\u2019entrevue<\/p>\n<\/td>\n<\/tr>\n

\n

Cas d\u00e9c\u00e9d\u00e9? \u25a2 O \u25a2 N\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Date du d\u00e9c\u00e8s (jj\/mm\/aa) :<\/p>\n

Si oui, l\u2019infection caus\u00e9e par la bact\u00e9rie Listeria<\/em> est-elle la cause initiale de d\u00e9c\u00e8s ou une cause ayant contribu\u00e9 au d\u00e9c\u00e8s? \u25a2 O \u25a2 N \u25a2 NSP<\/p>\n

Si oui, la d\u00e9termination est-elle fond\u00e9e sur le certificat de d\u00e9c\u00e8s? \u25a2 O \u25a2 N \u25a2 NSP<\/p>\n<\/td>\n<\/tr>\n

\n

Conditions m\u00e9dicales et traitements sous-jacents? \u25a2 O \u25a2 N \u25a2 NSP\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Si oui, pr\u00e9cisez :<\/p>\n

\u25a2 cancer\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u25a2 greffe d\u2019organe\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u25a2 maladie du foie\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u25a2 m\u00e9dicament immunosuppresseur<\/p>\n

\u25a2 maladie cardiaque\u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u25a2 n\u00e9phropathie\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u25a2 maladie pulmonaire obstructive chronique (MPOC)\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u25a2 autre (pr\u00e9cisez) :<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Section 4 : Donn\u00e9es cliniques (femme enceinte, foetus ou nouveau-n\u00e9 \u00e2g\u00e9 d\u2019un mois ou moins)<\/h3>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

Type(s) d\u2019\u00e9chantillon positif :<\/p>\n

\u25a2 Liquide c\u00e9phalorachidien (m\u00e8re)\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u25a2 Sang (m\u00e8re)<\/p>\n

\u25a2 Liquide c\u00e9phalorachidien (nouveau-n\u00e9)\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u25a2 Sang (nouveau-n\u00e9)<\/p>\n

\u25a2 Autre : _________<\/p>\n<\/td>\n

\n

Profil \u00e9lectrophor\u00e9tique (ECP):<\/p>\n<\/td>\n<\/tr>\n

\n

Date du signalement \u00e0 l\u2019autorit\u00e9 sanitaire (jj\/mm\/aa) :<\/p>\n<\/td>\n

\n

Date du premier pr\u00e9l\u00e8vement d\u2019\u00e9chantillon positif (jj\/mm\/aa) :<\/p>\n<\/td>\n<\/tr>\n

\n

Renseignements cliniques sur la M\u00c8RE :<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Date d\u2019apparition du premier sympt\u00f4me (jj\/mm\/aa):\u00a0<\/p>\n

Quand les sympt\u00f4mes ont-ils disparu (date du r\u00e9tablissement)? (jj\/mm\/aa):\u00a0<\/p>\n

\u25a2Encore malade\u00a0 \u25a2 Ne sait pas (NSP)<\/p>\n<\/td>\n

\n

Type de maladie :<\/p>\n

\u25a2 Bact\u00e9ri\u00e9mie\/septic\u00e9mie\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u25a2 M\u00e9ningite<\/p>\n

\u25a2 Infection urinaire\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00a0 \u25a2 Aucune<\/p>\n

\u25a2 Autre :\u00a0<\/p>\n<\/td>\n<\/tr>\n

\n

Sympt\u00f4mes :<\/p>\n

Diarrh\u00e9e* \u25a2 O \u25a2 N \u25a2 NSP\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Crampes abdominales \u25a2 O \u25a2 N \u25a2NSP\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Raideur au cou \u25a2 O \u25a2 N \u25a2 NSP<\/p>\n

Maux de t\u00eate \u25a2 O \u25a2 N \u25a2 NSP\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Douleurs musculaires \u25a2 O \u25a2 N \u25a2 NSP\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Confusion \u25a2 O \u25a2 N \u25a2 NSP<\/p>\n

Vomissements \u25a2 O \u25a2 N \u25a2 NSP\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Fi\u00e8vre \u25a2 O \u25a2 N \u25a2 NSP\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Faiblesse \u25a2 O \u25a2 N \u25a2 NSP<\/p>\n

Frissons \u25a2 O \u25a2 N \u25a2 NSP\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Naus\u00e9es \u25a2 O \u25a2 N \u25a2 NSP\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Asymptomatique \u25a2 O \u25a2 N \u25a2 NSP<\/p>\n

* Trois selles molles ou plus en 24 heures\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/em>Autre (pr\u00e9cisez) :<\/p>\n<\/td>\n<\/tr>\n

\n

Hospitalisation? * \u25a2 O \u25a2 N \u25a2 NSP<\/p>\n

\u25a2 Non hospitalis\u00e9\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u25a2 Hospitalis\u00e9 en raison de la list\u00e9riose<\/p>\n

\u25a2 Ne sait pas\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u25a2 Hospitalis\u00e9 pour une autre raison<\/p>\n

* Ne comprend pas les personnes qui se rendent \u00e0 une salle d\u2019urgence ou \u00e0 une consultation externe<\/p>\n<\/td>\n

\n

Date de l\u2019admission (jj\/mm\/aa):<\/p>\n

Date de cong\u00e9 de l\u2019h\u00f4pital (jj\/mm\/aa):<\/p>\n

\u25a2 Encore hospitalis\u00e9 au moment de l\u2019entrevue<\/p>\n<\/td>\n<\/tr>\n

\n

Cas d\u00e9c\u00e9d\u00e9? \u25a2 O \u25a2 N\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Date du d\u00e9c\u00e8s (jj\/mm\/aa) :<\/p>\n

Si oui, l\u2019infection caus\u00e9e par la bact\u00e9rie Listeria<\/em> est-elle la cause initiale de d\u00e9c\u00e8s ou une cause ayant contribu\u00e9 au d\u00e9c\u00e8s? \u25a2 O \u25a2 N \u25a2 NSP<\/p>\n

Si oui, la d\u00e9termination est-elle fond\u00e9e sur le certificat de d\u00e9c\u00e8s? \u25a2 O \u25a2 N \u25a2 NSP<\/p>\n<\/td>\n<\/tr>\n

\n

Conditions m\u00e9dicales et traitements sous-jacents? \u25a2 O \u25a2 N \u25a2 NSP\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Si oui, pr\u00e9cisez :<\/p>\n

\u25a2cancer\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u25a2\u00a0greffe d\u2019organe\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u25a2\u00a0maladie du foie\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u25a2\u00a0m\u00e9dicament immunosuppresseur
\n\u25a2 maladie cardiaque\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u25a2\u00a0n\u00e9phropathie\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u25a2\u00a0maladie pulmonaire obstructive chronique (MPOC)\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u25a2\u00a0Autre (pr\u00e9cisez) :\u00a0<\/p>\n<\/td>\n<\/tr>\n

\n

R\u00e9sultat de la grossesse :\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u25a2 Toujours enceinte \u25a2 Mort foetale (fausse couche\/mortinaissance) \u25a2 Avortement provoqu\u00e9 \u25a2 Naissance vivante
\nNombre de semaines de grossesse:\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Date (jj\/mm\/aa):\u00a0<\/p>\n<\/td>\n<\/tr>\n

\n

Renseignements cliniques sur le NOUVEAU-N\u00c9 :<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

\u00c2ge au moment de l\u2019apparition de la maladie (jours):\u00a0<\/p>\n<\/td>\n<\/tr>\n

\n

Date d\u2019apparition du premier sympt\u00f4me (jj\/mm\/aa):\u00a0<\/p>\n

Quand les sympt\u00f4mes ont-ils disparu (date du r\u00e9tablissement)? (jj\/mm\/aa):\u00a0<\/p>\n

\u25a2Encore malade\u00a0 \u25a2 Ne sait pas\u00a0<\/p>\n<\/td>\n

\n

Type de maladie :<\/p>\n

\u25a2 Aucune\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u25a2 Bact\u00e9ri\u00e9mie<\/p>\n

\u25a2 M\u00e9ningite\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u25a2 Gastroent\u00e9rite f\u00e9brile<\/p>\n

\u25a2 Autre :\u00a0<\/p>\n<\/td>\n<\/tr>\n

\n

Hospitalisation? * \u25a2 O \u25a2 N \u25a2 NSP<\/p>\n

\u25a2 Non hospitalis\u00e9\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u25a2 Hospitalis\u00e9 en raison de la list\u00e9riose<\/p>\n

\u25a2 Ne sait pas\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u25a2 Hospitalis\u00e9 pour une autre raison<\/p>\n

* Ne comprend pas les personnes qui se rendent \u00e0 une salle d\u2019urgence ou \u00e0 une consultation externe<\/p>\n<\/td>\n

\n

Date de l\u2019admission (jj\/mm\/aa):<\/p>\n

Date de cong\u00e9 de l\u2019h\u00f4pital (jj\/mm\/aa):<\/p>\n

\u25a2 Encore hospitalis\u00e9 au moment de l\u2019entrevue<\/p>\n<\/td>\n<\/tr>\n

\n

Nouveau-n\u00e9 d\u00e9c\u00e9d\u00e9? \u25a2 O \u25a2 N\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Date du d\u00e9c\u00e8s (jj\/mm\/aa):\u00a0
\n\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Si oui, l\u2019infection caus\u00e9e par la bact\u00e9rie Listeria est-elle la cause initiale de d\u00e9c\u00e8s ou une cause ayant contribu\u00e9 au d\u00e9c\u00e8s? \u25a2 O \u25a2 N \u25a2 NSP
\n\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Si oui, la d\u00e9termination est-elle fond\u00e9e sur le certificat de d\u00e9c\u00e8s? \u25a2 O \u25a2 N \u25a2 NSP<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Section 5 : Sources d\u2019exposition<\/h3>\n

Dans les quatre semaines<\/u> pr\u00e9c\u00e9dant l\u2019apparition de la maladie, avez-vous ou le cas a-t-il : <\/strong><\/p>\n\n\n\n\n
\n

habit\u00e9 dans une institution r\u00e9sidentielle? \u25a2 O \u25a2 N \u25a2 NSP\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Type \/ nom de l\u2019institution :<\/p>\n

(p. ex. maison de soins infirmiers, \u00e9tablissement de soins de longue dur\u00e9e, h\u00f4pital, centre de convalescence, prison, pensionnat)<\/p>\n<\/td>\n<\/tr>\n

\n

voyag\u00e9? \u25a2 O \u25a2 N \u25a2 NSP\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Si la r\u00e9ponse est oui :<\/p>\n

\u25a2 \u00c0 l\u2019int\u00e9rieur de la province ou du territoire<\/p>\n

\u25a2 Autre province ou territoire \u25a2 \u00c0 l\u2019ext\u00e9rieur du Canada<\/p>\n

Pr\u00e9cisez la destination (pays\/ville\/centre de vill\u00e9giature) :<\/p>\n<\/td>\n

\n

D\u00e9part (jj\/mm\/aa):<\/p>\n

Retour (jj\/mm\/aa):<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Section 6 : Achat d\u2019aliments pour la maison \u2013 Veuillez joindre une feuille s\u00e9par\u00e9e au besoin<\/h3>\n

O\u00f9 avez-vous achet\u00e9 ou le cas a-t-il achet\u00e9 les aliments\u00a0consomm\u00e9s \u00e0 la maison<\/strong> durant les quatre derni\u00e8res semaines<\/strong> (comprend les \u00e9piceries, les march\u00e9s de fermiers, les magasins sp\u00e9cialis\u00e9s, les march\u00e9s ethniques, les banques alimentaires, etc.)?<\/p>\n\n\n\n\n\n\n
Nom du magasin<\/th>\nEndroit\/Adresse<\/th>\n<\/tr>\n
\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Section 7 : Place \u00e0 manger \u00e0 l\u2019exterieur du domicile \u2013 Veuillez joindre une feuille s\u00e9par\u00e9e au besoin<\/h3>\n

Dans les quatre semaines<\/strong> pr\u00e9c\u00e9dant le d\u00e9but de la maladie, avez-vous ou le cas a-t-il mang\u00e9 dans un restaurant, un restaurant-minute, un caf\u00e9 ou une caf\u00e9t\u00e9ria, ou lors d\u2019une activit\u00e9 sociale? \u25a2 O \u25a2 N \u25a2 NSP<\/p>\n\n\n\n\n\n\n
Nom de l\u2019endroit<\/th>\nLieu<\/th>\nDate<\/th>\n<\/tr>\n
\u00a0<\/td>\n\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\u00a0<\/td>\n\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\u00a0<\/td>\n\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\u00a0Section 8 : R\u00e9gimes particuliers<\/h3>\n\n\n\n\n
\n

\u00cates-vous ou le cas est-il v\u00e9g\u00e9tarien? \u25a2 O \u25a2 N \u25a2 NSP<\/p>\n<\/td>\n

\n

\u00cates-vous ou le cas est-il allergique \u00e0 des aliments? \u25a2 O \u25a2 N \u25a2 NSP<\/p>\n

Si oui, pr\u00e9cisez les aliments :<\/p>\n<\/td>\n<\/tr>\n

\n

Dans les quatre semaines pr\u00e9c\u00e9dant la maladie, suiviez-vous ou le cas suivait-il un r\u00e9gime sp\u00e9cial ou restreint?
\n(p. ex. r\u00e9gime pour diab\u00e9tique, kasher, halal) \u25a2 O \u25a2 N \u25a2 NSP<\/p>\n

Si la r\u00e9ponse est \u00ab Oui \u00bb, veuillez d\u00e9crire :<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Section 9 : Ant\u00e9c\u00e9dents alimentaires<\/h3>\n

Avez-vous ou le cas a-t-il consomm\u00e9 certains des aliments suivants au cours des quatre semaines<\/strong> pr\u00e9c\u00e9dant l\u2019apparition de la maladie?<\/p>\n

Directives \u00e0 l\u2019intention de l\u2019enqu\u00eateur : <\/em> Pour chaque aliment consomm\u00e9 par le cas, questionnez-le au sujet de la marque et du lieu de l\u2019achat du produit. Pour chaque cat\u00e9gorie, veuillez donner toutes les options au cas. Dans le cas d\u2019une mortinaissance ou d\u2019une infection n\u00e9onatale (nouveau-n\u00e9 \u00e2g\u00e9 de moins d\u2019un mois), la M\u00c8RE est le cas. Questionnez-la sur ses ant\u00e9c\u00e9dents alimentaires pendant les quatre semaines pr\u00e9c\u00e9dant l\u2019ACCOUCHEMENT. <\/em><\/strong><\/p>\n

DIRECTIVES \u00c0 LIRE AU CAS :<\/em><\/strong><\/p>\n

J\u2019aimerais conna\u00eetre les aliments que vous avez consomm\u00e9s au cours des quatre semaines pr\u00e9c\u00e9dant le d\u00e9but de la maladie. Je vais vous poser des questions sur les quatre semaines pr\u00e9c\u00e9dant cette date<\/strong>, c\u2019est-\u00e0-dire du\u00a0j ____ \/ m _____ \/ a _____<\/strong> au\u00a0\u00a0j ____ \/ m ____ \/ a ____<\/strong>.
\nPour chaque aliment, veuillez me donner votre meilleure estimation \u00e0 savoir si vous avez CONSOMM\u00c9 l\u2019aliment, si vous n\u2019\u00eates pas s\u00fbr de l\u2019avoir consomm\u00e9, mais que vous l\u2019avez PROBABLEMENT fait ou si vous NE L\u2019AVEZ PAS CONSOMM\u00c9. Veuillez inclure les aliments mang\u00e9s seuls, dans un sandwich ou dans un autre mets, y compris les salades.<\/p>\n

*<\/strong> Probablement (Prob.) = Le cas croit avoir mang\u00e9 cet aliment ou mange habituellement cet aliment, mais n\u2019est pas certain d\u2019en avoir mang\u00e9 au cours de la p\u00e9riode en question.<\/p>\n

**<\/strong> Ne sait pas (NSP) = Le cas ne sait pas s\u2019il a consomm\u00e9 l\u2019aliment au cours de la p\u00e9riode en question.<\/p>\n

Charcuterie<\/h4>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\u00a0<\/td>\nR\u00e9ponse<\/th>\nMarque\/D\u00e9tails<\/th>\nO\u00f9 l\u2019aliment a \u00e9t\u00e9 achet\u00e9 ou consomm\u00e9 :<\/th>\n<\/tr>\n<\/thead>\n
\n

Charcuterie de dinde<\/p>\n

\u25a2 pr\u00e9emball\u00e9e<\/p>\n

\u25a2 tranch\u00e9e au comptoir charcuterie<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Charcuterie de poulet<\/p>\n

\u25a2 pr\u00e9emball\u00e9e<\/p>\n

\u25a2 tranch\u00e9e au comptoir charcuterie<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Charcuterie de b\u0153uf (p. ex. r\u00f4ti de boeuf)<\/em><\/p>\n

\u25a2 pr\u00e9emball\u00e9e<\/p>\n

\u25a2 tranch\u00e9e au comptoir charcuterie<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Charcuterie de jambon<\/p>\n

\u25a2 pr\u00e9emball\u00e9e<\/p>\n

\u25a2 tranch\u00e9e au comptoir charcuterie<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Bologne<\/p>\n

\u25a2 pr\u00e9emball\u00e9<\/p>\n

\u25a2 tranch\u00e9 au comptoir charcuterie<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Pastrami<\/p>\n

\u25a2 pr\u00e9emball\u00e9<\/p>\n

\u25a2 tranch\u00e9 au comptoir charcuterie<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Salami<\/p>\n

\u25a2 pr\u00e9emball\u00e9<\/p>\n

\u25a2 tranch\u00e9 au comptoir charcuterie<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Pepperoni<\/p>\n

\u25a2 pr\u00e9emball\u00e9<\/p>\n

\u25a2 tranch\u00e9 au comptoir charcuterie<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Autre produit de charcuterie\u00a0(p. ex. b\u0153uf sal\u00e9 <\/em> kielbasa, prosciutto, mortadelle)<\/em><\/p>\n

Pr\u00e9cisez :<\/p>\n

\u25a2 pr\u00e9emball\u00e9<\/p>\n

\u25a2 tranch\u00e9 au comptoir charcuterie<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Sandwichs\/sandwichs roul\u00e9s pr\u00e9emball\u00e9s<\/p>\n

(provenant d\u2019un distributeur automatique, d\u2019une caf\u00e9t\u00e9ria, d\u2019une station-service, d\u2019une \u00e9picerie, etc.) <\/em><\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Autres viandes<\/h3>\n\n\n\n\n\n\n\n\n\n\n\n
\u00a0<\/td>\nR\u00e9ponse<\/th>\nMarque\/D\u00e9tails<\/th>\nO\u00f9 l\u2019aliment a \u00e9t\u00e9 achet\u00e9 ou consomm\u00e9 :<\/th>\n<\/tr>\n
\n

P\u00e2t\u00e9\/viande \u00e0 tartiner (pas en conserve)<\/em><\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Hot dogs<\/p>\n

Si la r\u00e9ponse est \u00ab Oui \u00bb, les hot dogs ont-ils \u00e9t\u00e9 r\u00e9chauff\u00e9s avant d\u2019\u00eatre mang\u00e9s?<\/p>\n

\u25a2O \u25a2 N \u25a2NSP<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Viandes sal\u00e9es ou s\u00e9ch\u00e9es
\n(p. ex. charqui, pepperettes)<\/em><\/p>\n

\u25a2 pr\u00e9emball\u00e9es<\/p>\n

\u25a2 d\u00e9ball\u00e9es au comptoir charcuterie<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Poulet mang\u00e9 froid (p. ex. en morceaux ou en lani\u00e8res, r\u00f4tisserie, restes de poulet cuit, poulet froid en salade) <\/em><\/p>\n

\u25a2 achet\u00e9 cuit, pr\u00eat \u00e0 manger<\/p>\n

\u25a2 cuit \u00e0 la maison et mang\u00e9 froid
\nplus tard<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Jambon mang\u00e9 froid (pas de la viande charcuterie)<\/em><\/p>\n

\u25a2 achet\u00e9 cuit, pr\u00eat \u00e0 manger<\/p>\n

\u25a2 cuit \u00e0 la maison et mang\u00e9 froid
\nplus tard<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Dinde mang\u00e9e froide (p. ex. en morceaux ou en lani\u00e8res, restes de dinde cuite) <\/em><\/p>\n

\u25a2 achet\u00e9e cuite, pr\u00eate \u00e0 manger<\/p>\n

\u25a2 cuite \u00e0 la maison et mang\u00e9e froide
\nplus tard<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Saucisse mang\u00e9e froide (p. ex. saucissons au jambon, saucisses \u00e0 d\u00e9jeuner, saucisses de Francfort, saucissons secs, restes) <\/em><\/p>\n

\u25a2 achet\u00e9e cuite, pr\u00eate \u00e0 manger<\/p>\n

\u25a2 cuite \u00e0 la maison et mang\u00e9e froide
\nplus tard<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

B\u0153uf hach\u00e9<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Fromage<\/h3>\n\n\n\n\n\n\n\n\n\n\n\n\n
\u00a0<\/td>\nR\u00e9ponse<<\/th>\nMarque\/D\u00e9tails<\/th>\nO\u00f9 l\u2019aliment a \u00e9t\u00e9 achet\u00e9 ou consomm\u00e9 :<\/th>\n<\/tr>\n
\n

Brie<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Camembert<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Fromage bleu (p. ex. roquefort, gorgonzola, stilton)<\/em><\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

F\u00e9ta<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Fromage de ch\u00e8vre<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Fromage frais de style mexicain ou latino-am\u00e9ricain (p. ex. queso fresco, queso blanco, queso panela)<\/em><\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Autres fromages \u00e0 p\u00e2te molle ou semi-molle (p. ex. havarti, bocconcini)<\/em><\/p>\n

Pr\u00e9cisez :<\/em><\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Autres fromages, de tous types (p. ex. fromage cottage, ricotta, gouda, fromage vendu en bloc, halloumi) <\/em><\/p>\n

Pr\u00e9cisez :<\/em><\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Fromage non pasteuris\u00e9<\/p>\n

Pr\u00e9cisez :<\/em><\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\u00a0Produits laitiers<\/h3>\n\n\n\n\n\n\n\n
\u00a0<\/td>\nR\u00e9ponse<\/th>\nMarque\/D\u00e9tails<\/th>\nO\u00f9 l\u2019aliment a \u00e9t\u00e9 achet\u00e9 ou consomm\u00e9 :<\/th>\n<\/tr>\n
\n

Lait non pasteuris\u00e9 (cru)<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Lait pasteuris\u00e9<\/p>\n

Pr\u00e9cisez (p. ex. entier, \u00e9cr\u00e9m\u00e9, 1 %, 2 %, aromatis\u00e9) <\/em><\/p>\n

 <\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Cr\u00e8me glac\u00e9e\/yogourt glac\u00e9\/gelato (y compris le lait frapp\u00e9, les barres et sandwichs glac\u00e9s, et autres) <\/em><\/p>\n

Si la r\u00e9ponse est \u00ab Oui \u00bb, l\u2019aliment a-t-il \u00e9t\u00e9 servi mou d\u2019une machine?<\/p>\n

\u25a2O \u25a2 N \u25a2NSP<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Autres produits laitiers (p. ex. beurre, yogourt, cr\u00e8me sure, cr\u00e8me fouett\u00e9e) <\/em><\/p>\n

Pr\u00e9cisez :<\/em><\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Fruits de mer<\/h3>\n\n\n\n\n\n\n\n\n
\u00a0<\/td>\nR\u00e9ponse<\/th>\nMarque\/D\u00e9tails<\/th>\nO\u00f9 l\u2019aliment a \u00e9t\u00e9 achet\u00e9 ou consomm\u00e9 :<\/th>\n<\/tr>\n
\n

Poisson cru (p. ex. sushi, sashimi, tartare)<\/em><\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Poisson fum\u00e9 ou sal\u00e9 (pas en conserve ou sachet st\u00e9rilisable [p. ex. saumon fum\u00e9, gravlax, charqui, lox]) <\/em><\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Crevettes pr\u00e9cuites consomm\u00e9es froides (p. ex. couronne de crevettes, cocktail de crevettes, en salade, restes consomm\u00e9s froids) <\/em><\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Crabe pr\u00e9cuit consomm\u00e9 froid (y compris le simili-crabe)<\/em><\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Autres mollusques ou crustac\u00e9s pr\u00eats \u00e0 manger et servis froids (p. ex. moules, hu\u00eetres, palourdes)<\/em><\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Salades et trempettes<\/h3>\n\n\n\n\n\n\n\n\n\n\n
\u00a0<\/td>\nR\u00e9ponse<\/th>\nMarque\/D\u00e9tails<\/th>\nO\u00f9 l\u2019aliment a \u00e9t\u00e9 achet\u00e9 ou consomm\u00e9 :<\/th>\n<\/tr>\n
\n

Salade verte pr\u00e9par\u00e9e (p. ex. salade jardini\u00e8re, salade grecque, salade c\u00e9sar [achet\u00e9e en magasin, au restaurant ou dans une caf\u00e9t\u00e9ria]) <\/em><\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Salade de pommes de terre<\/p>\n

\u25a2 maison \u25a2 achet\u00e9e<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Salade de p\u00e2tes<\/p>\n

\u25a2 maison \u25a2 achet\u00e9e<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Salade de haricots<\/p>\n

\u25a2 maison \u25a2 achet\u00e9e<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Salade de chou<\/p>\n

\u25a2 maison \u25a2 achet\u00e9e<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Hoummous<\/p>\n

\u25a2 maison \u25a2 achet\u00e9<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Autres salades\/trempettes (p. ex. salade de poulet, salade d\u2019\u0153ufs, salade de thon, salade de fruits de mer, salade de riz, taboul\u00e9) <\/em><\/p>\n

Pr\u00e9cisez <\/em> :<\/p>\n

\u25a2 maison \u25a2 achet\u00e9es<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

L\u00e9gumes frais (consomm\u00e9s crus, non cuits)<\/h3>\n\n\n\n\n\n\n\n\n\n\n\n\n
\u00a0<\/td>\nR\u00e9ponse<\/th>\nMarque\/D\u00e9tails<\/th>\nO\u00f9 l\u2019aliment a \u00e9t\u00e9 achet\u00e9 ou consomm\u00e9 :<\/th>\n<\/tr>\n<\/thead>\n
\n

Germes de luzerne<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Germes de soja<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Laitue ou salade achet\u00e9e pr\u00e9emball\u00e9e en sachet ou dans un contenant en plastique<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Laitue enti\u00e8re<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

\u00c9pinards, achet\u00e9s en vrac ou emball\u00e9s<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Champignons (crus, non cuits)<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Herbes fra\u00eeches (p. ex. basilic, cilantro, persil)<\/em><\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

L\u00e9gumes pr\u00e9coup\u00e9s emball\u00e9s (p. ex. sur un plateau ou une barquette, oignon en d\u00e9s, c\u00e9leri en d\u00e9s, etc.) <\/em><\/p>\n

Pr\u00e9cisez <\/em> :<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Fruits frais<\/h3>\n\n\n\n\n\n\n\n\n\n
\u00a0<\/td>\nR\u00e9ponse<\/th>\nMarque\/D\u00e9tails<\/th>\nO\u00f9 l\u2019aliment a \u00e9t\u00e9 achet\u00e9 ou consomm\u00e9 :<\/th>\n<\/tr>\n<\/thead>\n
\n

Melon miel<\/p>\n

\u25a2 entier, coup\u00e9 \u00e0 la maison
\n\u25a2 pr\u00e9coup\u00e9<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Cantaloup<\/p>\n

\u25a2 entier, coup\u00e9 \u00e0 la maison
\n\u25a2 pr\u00e9coup\u00e9<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Melon d\u2019eau<\/p>\n

\u25a2 entier, coup\u00e9 \u00e0 la maison
\n\u25a2 pr\u00e9coup\u00e9<\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Fruits pr\u00e9coup\u00e9s emball\u00e9s (p. ex. sur un plateau ou une barquette, morceaux de pomme, salade de fruits) <\/em><\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

Jus de fruits ou de l\u00e9gumes non pasteuris\u00e9 (p. ex. jus d\u2019orange fraichement press\u00e9) <\/em><\/p>\n<\/td>\n

\n

\u25a2O \u25a2P \u25a2N \u25a2NSP<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Commentaires \u00e0 l\u2019\u00e9chelle locale\/provinciale\/territoriale (joindre des pages suppl\u00e9mentaires au besoin) :<\/h2>\n\n\n\n
\u00a0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Commentaires de l\u2019Agence de la sant\u00e9 publique du Canada (joindre des pages suppl\u00e9mentaires au besoin) :<\/h2>\n\n\n\n
\u00a0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

T\u00e9l\u00e9charger le format de rechange<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

T\u00e9l\u00e9charger le format de rechange Contexte du questionnaire pour l’intervieweur Veuillez remplir le questionnaire pour tous les cas de list\u00e9riose invasive qui r\u00e9pondent \u00e0 la d\u00e9finition de cas suivante : Manifestation clinique : La maladie clinique invasive se caract\u00e9rise par une m\u00e9ningite ou une bact\u00e9ri\u00e9mie. D\u2019une infection durant une grossesse peut d\u00e9couler une perte f\u0153tale […]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":417,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"fullpage.php","meta":{"footnotes":""},"class_list":["post-2631","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/outbreaktools.ca\/fr\/wp-json\/wp\/v2\/pages\/2631","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/outbreaktools.ca\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/outbreaktools.ca\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/outbreaktools.ca\/fr\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/outbreaktools.ca\/fr\/wp-json\/wp\/v2\/comments?post=2631"}],"version-history":[{"count":17,"href":"https:\/\/outbreaktools.ca\/fr\/wp-json\/wp\/v2\/pages\/2631\/revisions"}],"predecessor-version":[{"id":3697,"href":"https:\/\/outbreaktools.ca\/fr\/wp-json\/wp\/v2\/pages\/2631\/revisions\/3697"}],"up":[{"embeddable":true,"href":"https:\/\/outbreaktools.ca\/fr\/wp-json\/wp\/v2\/pages\/417"}],"wp:attachment":[{"href":"https:\/\/outbreaktools.ca\/fr\/wp-json\/wp\/v2\/media?parent=2631"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}