Babesia-Exposure Rapid Survey of Blood Donors

Babesia Survey Questions

1. In 2014, about how much time did you spend in woodlands, fields, forests, yards, gardens or other areas where deer have been known to be present, during the months of April through September?

• None (skip to Q3)

• daily

• a few times a week

• a few times a month

• Less than a few times a month

2. What best describes the way you spent your time outdoors in these types of areas during April through September of 2014? (Check all that apply)

• Camping

• Hunting

• Fishing

• Gardening

• Golfing

• Hiking

• Walking

• Working

• Other, specify _______________

3. Were you ever told by a healthcare professional that you had any of the following tick-borne infections?

				If Yes
				Was this within the last year?
	No	Yes		No	Yes
Babesiosis			
Lyme Disease			
Rocky Mountain Spotted Fever			
Erlichiosis			
Other, Specify ________________			

4. Do you currently or did you in 2014 reside in one of the following states (NY, NJ, PA, MA, ME, CT, RI, VT, NH, DC, DE, MD, WI, MN)?

• Yes (Skip to Q9)

• No (continue survey)

5. In 2014, did you travel to these states (NY, NJ, PA, MA, ME, CT, RI, VT, NH, DC, DE, MD, WI, MN) between April and September?

• Yes

• No (Skip to Q9)

6. During your visit to NY, NJ, PA, MA, ME, CT, RI, VT, NH, DC, DE, MD, WI, or MN did you spend time outdoors in woodlands, fields, forests, yards, and/or gardens?

• Yes

• No (go to Q8)

7. What best describes the way you spent your time outdoors last year while visiting NY, NJ, PA, MA, ME, CT, RI, VT, NH, DC, DE, MD, WI, MN? (Check all that apply)

• Camping

• Hunting

• Fishing

• Gardening

• Golfing

• Hiking

• Walking

• Working

• Other, specify ____________________________

8. During any visit to these areas, do you remember pulling a tick off or having one pulled off of you?

• Yes

• No

9. In what state do you currently live?

________ (can do dropdown menu)

9. What is your sex?

• Male

• Female

9. What is your current age?

• 18-20 years of age

• 21-25

• 26-30

• 31-35

• 36-40

• 41-45

• 46-50

• 51-55

• 56-60

• 61-65

• 66-70

• 71-75

• Over 75

 

9. Was your first blood donation in 2014?

• Yes, I have only donated once

• I am a repeat donor with my first donation in 2014

• I am a repeat donor, my first donation was prior to 2014

9. Was your most recent donation whole blood or apheresis? 

• Whole blood

• Apheresis

• Don’t know

Thank you!!