{"id":6398,"date":"2025-05-08T14:19:49","date_gmt":"2025-05-08T18:19:49","guid":{"rendered":"https:\/\/outbreaktools.ca\/?page_id=6398"},"modified":"2025-05-08T14:19:49","modified_gmt":"2025-05-08T18:19:49","slug":"phac-travel-acquired-enteric-illness-questionnaire","status":"publish","type":"page","link":"https:\/\/outbreaktools.ca\/fr\/tools\/toolkit-questionnaire-repository\/phac-travel-acquired-enteric-illness-questionnaire\/","title":{"rendered":"Questionnaire sur les maladies ent\u00e9riques contract\u00e9es en voyage"},"content":{"rendered":"

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

Num\u00e9ro de dossier :\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00a0<\/p>\n\n\n\n\n
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Contexte pour l\u2019intervieweur\u00a0:<\/strong><\/p>\n<\/td>\n<\/tr>\n

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Ce questionnaire a \u00e9t\u00e9 con\u00e7u pour recueillir de l\u2019information sur les facteurs de risque possibles de maladie ent\u00e9rique contract\u00e9e en voyage. Peut \u00eatre utilis\u00e9 pour les enqu\u00eates sur les grappes ou pour les maladies sporadiques.<\/p>\n

Donn\u00e9es recueillies\u00a0:\u00a0\u00a0\u00a0\u00a0 \u2013 Caract\u00e9ristiques d\u00e9mographiques du cas\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u2013 Expositions \u00e0 des animaux\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u2013 Facteurs de risque<\/p>\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\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u2013 Renseignements cliniques\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 \u2013 D\u00e9tails sur le voyage\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u2013 Expositions \u00e0 l\u2019eau<\/p>\n

\u2013 Expositions dans des h\u00f4tels tout compris (SEULEMENT pour les cas rapportant un voyage dans des h\u00f4tels avec formule tout compris)<\/p>\n

\u00c9tant donn\u00e9 que ces renseignements pourraient \u00eatre transmis \u00e0 des autorit\u00e9s de sant\u00e9 publique des pays de destination, il est important de recueillir autant de d\u00e9tails que possible. En g\u00e9n\u00e9ral, les renseignements d\u00e9mographiques et des renseignements d\u00e9taill\u00e9s sur l\u2019exposition sont n\u00e9cessaires pour les mesures en sant\u00e9 publique.<\/p>\n

Il faut de 10 \u00e0 15\u00a0minutes pour r\u00e9pondre \u00e0 ce questionnaire.<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n\n\n
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Section 1. Renseignements sur l\u2019intervieweur\u00a0:<\/strong><\/p>\n<\/td>\n<\/tr>\n

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Cas interrog\u00e9 par\u00a0:<\/p>\n<\/td>\n

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Date de l\u2019entrevue (jj-mm-aaaa)\u00a0: ______ \/ ______ \/ _______<\/p>\n<\/td>\n<\/tr>\n

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Le r\u00e9pondant \u00e9tait\u00a0: o Le cas\u00a0\u00a0 o Un parent\u00a0\u00a0 o Le\/la conjoint(e)\u00a0\u00a0 o L\u2019aidant\u00a0\u00a0 o Autre (veuillez pr\u00e9ciser)\u00a0:<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n\n\n
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Section 2. Renseignements sur le cas\u00a0:<\/strong><\/p>\n<\/td>\n<\/tr>\n

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

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Genre:\u00a0\u00a0 \u2610\u00a0 M\u00a0\u00a0\u00a0 \u2610\u00a0 F\u00a0\u00a0\u00a0 \u2610\u00a0 Autre\u00a0\u00a0\u00a0 \u2610\u00a0 Pas demand\u00e9\/Inconnu\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\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\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0<\/p>\n<\/td>\n<\/tr>\n

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Province\u00a0ou territoire\u00a0:<\/p>\n<\/td>\n

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Unit\u00e9 de services de sant\u00e9\u00a0:<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

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

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Section 3. Donn\u00e9es cliniques\u00a0:<\/strong><\/p>\n<\/td>\n<\/tr>\n

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 <\/p>\n<\/td>\n

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Pathog\u00e8ne\u00a0: o Cholera<\/em> o E. coli<\/em> o Salmonella<\/em> o Giardia<\/em> o Cyclospora<\/em> o H\u00e9p.\u00a0A o Autre, veuillez pr\u00e9ciser\u00a0:<\/p>\n<\/td>\n<\/tr>\n

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 <\/p>\n<\/td>\n

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S\u00e9rotype\/G\u00e9notype\u00a0:<\/p>\n<\/td>\n

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Code d\u2019agr\u00e9gat par s\u00e9quen\u00e7age du g\u00e9nome entier\u00a0:<\/p>\n<\/td>\n<\/tr>\n

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 <\/p>\n<\/td>\n

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Type(s) d\u2019\u00e9chantillon positif(s)\u00a0:\u00a0 o Selles\u00a0\u00a0 o Sang\u00a0\u00a0\u00a0 o Urine\u00a0\u00a0 o Autre\u00a0:<\/p>\n<\/td>\n<\/tr>\n

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 <\/p>\n<\/td>\n

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Date d\u2019apparition du premier sympt\u00f4me (jj-mm-aaaa): ______ \/ ______ \/ _______\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Heure approximative d\u2019apparition de la maladie\u00a0: ________ o matin\u00a0 o midi o soir\u00a0 o minuit<\/p>\n<\/td>\n<\/tr>\n

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 <\/p>\n<\/td>\n

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Sympt\u00f4mes\u00a0:\u00a0\u00a0\u00a0\u00a0 Diarrh\u00e9e\u00a5<\/sup>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 o O\u00a0\u00a0 o N\u00a0\u00a0 o 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\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Vomissement\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 o O\u00a0\u00a0 o N\u00a0\u00a0 o 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<\/p>\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 Fi\u00e8vre\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 o O\u00a0\u00a0 o N\u00a0\u00a0 o 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\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Naus\u00e9es\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 o O\u00a0\u00a0 o N\u00a0\u00a0 o 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<\/p>\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 Crampes abdominales \u00a0 o O\u00a0\u00a0 o N\u00a0\u00a0 o 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\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Autre\u00a0:\u00a0 _____________________________________<\/p>\n

\u00a5<\/sup>3\u00a0selles molles ou plus en 24\u00a0heures<\/em><\/p>\n<\/td>\n<\/tr>\n

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 <\/p>\n<\/td>\n

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Hospitalisation\u00a5<\/sup> \u00e0 cause de la maladie? o O\u00a0\u00a0 o N\u00a0\u00a0 o NSP<\/p>\n

\u00a5<\/sup>Ne pas inclure les sujets qui se sont rendus au service d\u2019urgence ou dans une clinique de consultation externe.<\/p>\n<\/td>\n

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Date de l\u2019hospitalisation (jj-mm-aaaa)\u00a0: _____ \/ ______ \/ _______<\/p>\n

Date du cong\u00e9 (jj-mm-aaaa)\u00a0: ______ \/ ______ \/ _______\u00a0<\/p>\n

o Toujours hospitalis\u00e9<\/p>\n<\/td>\n<\/tr>\n

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 <\/p>\n<\/td>\n

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(Intervieweur) Cas d\u00e9c\u00e9d\u00e9?\u00a0\u00a0 o O\u00a0\u00a0 o N\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dans l\u2019affirmative, l\u2019infection \u00e9tait-elle la cause sous-jacente ou la cause qui a contribu\u00e9 au d\u00e9c\u00e8s?\u00a0\u00a0\u00a0\u00a0 o O\u00a0\u00a0 o N\u00a0\u00a0 o NSP<\/p>\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\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 Dans l\u2019affirmative, cette r\u00e9ponse repose-t-elle sur les renseignements du certificat de d\u00e9c\u00e8s?\u00a0\u00a0 o O\u00a0\u00a0 o N\u00a0\u00a0 o NSP<\/p>\n<\/td>\n<\/tr>\n

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 <\/p>\n<\/td>\n

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\u00c9tats sous-jacents (p.\u00a0ex. grossesse, diab\u00e8te, cancer)\u00a0 ou prise de m\u00e9dicaments immunosuppresseurs (p.\u00a0ex., st\u00e9ro\u00efdes)?\u00a0 o O\u00a0\u00a0 o N\u00a0\u00a0 o NSP<\/p>\n

Dans l\u2019affirmative, veuillez pr\u00e9ciser\u00a0:<\/p>\n<\/td>\n<\/tr>\n

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 <\/p>\n<\/td>\n

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Avez-vous consult\u00e9 un professionnel de la sant\u00e9 avant votre voyage pour obtenir des renseignements m\u00e9dicaux? o O\u00a0\u00a0 o N\u00a0\u00a0 o NSP\u00a0\u00a0<\/p>\n<\/td>\n<\/tr>\n

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 <\/p>\n<\/td>\n

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

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 <\/p>\n<\/td>\n

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Section 4. Aper\u00e7u du voyage\u00a0:<\/strong><\/p>\n<\/td>\n<\/tr>\n

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 <\/p>\n<\/td>\n

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Pays de destination\u00a0:<\/p>\n<\/td>\n<\/tr>\n

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 <\/p>\n<\/td>\n

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Date du d\u00e9part (jj-mm-aaaa)\u00a0: ______ \/ ______ \/ _______<\/p>\n<\/td>\n

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Date du retour (jj-mm-aaaa)\u00a0: ______ \/ ______ \/ _______<\/p>\n<\/td>\n<\/tr>\n

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 <\/p>\n<\/td>\n

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But du voyage\u00a0:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 o Tourisme\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\u00a0\u00a0 o Tourisme m\u00e9dical\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 o Affaires<\/p>\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\u00a0\u00a0 o Missionnaire\/b\u00e9n\u00e9voles\/travail d\u2019aide\u00a0\u00a0\u00a0\u00a0\u00a0 o Visite d\u2019amis et de proches\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 o Autre, veuillez pr\u00e9ciser\u00a0:\u00a0\u00a0\u00a0\u00a0<\/p>\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\u00a0\u00a0 o \u00c9tudiant\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\u00a0\u00a0\u00a0 o Militaire\u00a0<\/p>\n<\/td>\n<\/tr>\n

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 <\/p>\n<\/td>\n

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Avez-vous voyag\u00e9 avec un groupe (par exemple, groupe d\u2019excursion, mariage, groupe de mission)? o O\u00a0\u00a0 o N\u00a0\u00a0 o NSP\u00a0<\/p>\n

Dans l\u2019affirmative, veuillez pr\u00e9ciser le nom du groupe\/de l\u2019organisme\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<\/p>\n<\/td>\n<\/tr>\n

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Dans quel type d\u2019\u00e9tablissement avez-vous log\u00e9? (NOTE \u00c0 L\u2019INTERVIEWEUR\u00a0:<\/strong> Si le cas a log\u00e9 dans un h\u00f4tel tout compris, veuillez remplir la section\u00a05 ci-dessous. Tous les autres cas doivent omettre la section\u00a05 et passer directement \u00e0 la section\u00a06). <\/em><\/p>\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 o H\u00f4tel tout compris\u00a0\u2013 Dans l\u2019affirmative, pr\u00e9ciser le nom et le lieu, et remplir la section\u00a05\u00a0: ______________________________\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/p>\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 o H\u00f4tel \u2013 Dans l\u2019affirmative, pr\u00e9ciser le nom et le lieu\u00a0: ___________________________________________________________<\/p>\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 o Avec de la famille\/des amis\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\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 o Location d\u2019un logement priv\u00e9 (p.\u00a0ex., condo, maison)\u00a0\u00a0\u00a0\u00a0\u00a0<\/p>\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 o Bateau de croisi\u00e8re \u2013 Dans l\u2019affirmative, veuillez pr\u00e9ciser\u00a0: __________________ o Autre, veuillez pr\u00e9ciser\u00a0: ______________<\/p>\n<\/td>\n<\/tr>\n

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Section 5. H\u00f4tel tout compris (\u00e0 remplir UNIQUEMENT par les voyageurs qui ont log\u00e9 dans des h\u00f4tels avec formule tout compris)\u00a0:<\/strong><\/p>\n<\/td>\n<\/tr>\n

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Avez-vous particip\u00e9 \u00e0 des activit\u00e9s\/excursions \u00e0 l\u2019ext\u00e9rieur de l\u2019h\u00f4tel?\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 oO\u00a0\u00a0 oN\u00a0\u00a0 oNSP – Dans l\u2019affirmative, veuillez pr\u00e9ciser ci-dessous.<\/p>\n<\/td>\n<\/tr>\n

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Description de l\u2019excursion<\/p>\n<\/td>\n

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Date (jj-mm-aaaa)<\/p>\n<\/td>\n

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Aliment ou boisson?<\/p>\n<\/td>\n

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Dans l\u2019affirmative, veuillez pr\u00e9ciser l\u2019aliment\/la collation\/la boisson.<\/p>\n<\/td>\n<\/tr>\n

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oO oN oNSP<\/p>\n<\/td>\n

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oO oN oNSP<\/p>\n<\/td>\n

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oO oN oNSP<\/p>\n<\/td>\n

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oO oN oNSP<\/p>\n<\/td>\n

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oO oN oNSP<\/p>\n<\/td>\n

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Avez-vous consomm\u00e9 tout autre repas\/collation\/boisson \u00e0 l\u2019ext\u00e9rieur de l\u2019h\u00f4tel? o O\u00a0\u00a0 o N\u00a0\u00a0 o NSP\u00a0 \u2013 Dans l\u2019affirmative, veuillez pr\u00e9ciser ci-dessous.<\/p>\n<\/td>\n<\/tr>\n

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Lieu<\/p>\n<\/td>\n

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Date (jj-mm-aaaa)<\/p>\n<\/td>\n

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Veuillez pr\u00e9ciser l\u2019aliment\/la collation\/la boisson.<\/p>\n<\/td>\n<\/tr>\n

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\u00a0Section 6. Facteurs de risque (\u00e0 remplir par TOUS les cas)\u00a0:<\/strong><\/p>\n

Pendant votre s\u00e9jour, avez-vous \u00e9t\u00e9 expos\u00e9 \u00e0 l\u2019un des facteurs de risque suivants?<\/p>\n<\/td>\n<\/tr>\n

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Avez-vous consomm\u00e9 des aliments achet\u00e9s chez des vendeurs ambulants? o O\u00a0\u00a0 o N\u00a0\u00a0 o NSP\u00a0\u00a0 Si oui, pr\u00e9cisez\u00a0: ___________________<\/em><\/p>\n<\/td>\n<\/tr>\n

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Avez-vous consomm\u00e9 de la viande ou du poisson cru ou pas suffisamment cuit (cru), y compris des crustac\u00e9s et des mollusques? o O\u00a0\u00a0 o N\u00a0\u00a0 o NSP\u00a0\u00a0 Si oui, pr\u00e9cisez\u00a0: ___________________<\/em><\/p>\n<\/td>\n<\/tr>\n

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Avez-vous consomm\u00e9 des salades ou d\u2019autres aliments contenant des fruits ou des l\u00e9gumes frais ou crus? o O\u00a0\u00a0 o N\u00a0\u00a0 o NSP\u00a0\u00a0 Si oui, pr\u00e9cisez\u00a0: ___________________<\/em><\/p>\n<\/td>\n<\/tr>\n

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Avez-vous consomm\u00e9 des fruits sans pelure (par exemple des baies) ou des fruits que vous n\u2019avez pas pel\u00e9s vous-m\u00eame? o O\u00a0\u00a0 o N\u00a0\u00a0 o NSP\u00a0\u00a0 Si oui, pr\u00e9cisez\u00a0: ___________________<\/em><\/p>\n<\/td>\n<\/tr>\n

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Avez-vous consomm\u00e9 des produits laitiers ou des jus de fruit non pasteuris\u00e9s? o O\u00a0\u00a0 o N\u00a0\u00a0 o NSP\u00a0\u00a0 Si oui, pr\u00e9cisez\u00a0: ___________________<\/em><\/p>\n<\/td>\n<\/tr>\n

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Avez-vous consomm\u00e9 ou utilis\u00e9 ce qui suit (qu\u2019il s\u2019agisse de boissons ou d\u2019eau pour se brosser les dents, etc.) pendant votre s\u00e9jour?<\/p>\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\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Eau embouteill\u00e9e oO oN oNSP\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0Autre oO oN oNSP \u2013 Dans l\u2019affirmative, veuillez pr\u00e9ciser\u00a0: _____________________<\/p>\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\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Eau du robinet\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 oO oN oNSP<\/p>\n<\/td>\n<\/tr>\n

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Avez-vous consomm\u00e9 des boissons contenant des gla\u00e7ons?\u00a0 o O\u00a0\u00a0 o N\u00a0\u00a0 o NSP\u00a0\u00a0<\/p>\n<\/td>\n<\/tr>\n

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Avez-vous nag\u00e9 dans une piscine? oO oN oNSP<\/p>\n<\/td>\n<\/tr>\n

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Avez-vous nag\u00e9 dans une mer\/un lac\/une rivi\u00e8re? oO oN oNSP<\/p>\n<\/td>\n<\/tr>\n

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Avez-vous eu des contacts avec des animaux\/des d\u00e9chets d\u2019origine animale? oO\u00a0\u00a0 o N\u00a0\u00a0 o NSP \u2013 Dans l\u2019affirmative, veuillez pr\u00e9ciser ci-dessous.<\/p>\n<\/td>\n<\/tr>\n

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1<\/p>\n<\/td>\n

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Type d\u2019animal\u00a0:<\/p>\n

O\u00f9? __________________________________________________ Quand? ________________________________________<\/p>\n<\/td>\n<\/tr>\n

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2<\/p>\n<\/td>\n

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Type d\u2019animal\u00a0:<\/p>\n

O\u00f9? __________________________________________________ Quand? ________________________________________<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Voulez-vous ajouter autre chose dont nous n\u2019avons pas parl\u00e9 et qui, selon vous, pourrait \u00eatre important (par exemple, fermeture des piscines, vomissement dans un lieu public, etc.)?<\/p>\n\n\n\n
\u00a0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

C\u2019est la fin du sondage. Merci du temps que vous y avez consacr\u00e9.<\/p>\n

Nous permettez-vous de vous rappeler ult\u00e9rieurement si nous avons d\u2019autres questions? o O o N<\/p>\n

 <\/p>\n

Veuillez envoyer le questionnaire rempli \u00e0 votre repr\u00e9sentant provincial\/territorial. Les repr\u00e9sentants doivent \u00e0 leur tour le transmettre \u00e0 l\u2019Agence de la sant\u00e9 publique du Canada par courriel au enteric.outbreak-eclosion.enterique@phac-aspc.gc.ca. Merci. <\/em><\/p>\n

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

T\u00e9l\u00e9charger le format de rechange Num\u00e9ro de dossier :\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00a0 Contexte pour l\u2019intervieweur\u00a0: Ce questionnaire a \u00e9t\u00e9 con\u00e7u pour recueillir de l\u2019information sur les facteurs de risque possibles de maladie ent\u00e9rique contract\u00e9e en voyage. Peut \u00eatre utilis\u00e9 pour les enqu\u00eates sur les grappes ou pour les […]<\/p>\n","protected":false},"author":33,"featured_media":0,"parent":417,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"fullpage.php","meta":{"footnotes":""},"class_list":["post-6398","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/outbreaktools.ca\/fr\/wp-json\/wp\/v2\/pages\/6398","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\/33"}],"replies":[{"embeddable":true,"href":"https:\/\/outbreaktools.ca\/fr\/wp-json\/wp\/v2\/comments?post=6398"}],"version-history":[{"count":3,"href":"https:\/\/outbreaktools.ca\/fr\/wp-json\/wp\/v2\/pages\/6398\/revisions"}],"predecessor-version":[{"id":6404,"href":"https:\/\/outbreaktools.ca\/fr\/wp-json\/wp\/v2\/pages\/6398\/revisions\/6404"}],"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=6398"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}