xml Pandemic Risk Profile Full Form Personalized Pandemic Risk Profile 1. Age Why? Age is one of the strongest predictors for severe illness in many outbreaks. Older adults generally have higher risk even if healthy otherwise. Under 18 18–29 30–49 50–64 65–74 75+ Prefer not to answer 2. Sex Assigned at Birth Why? Sex and gender can affect susceptibility and immune response to infections. Male Female Other / Prefer not to say 3. Are you currently pregnant or breastfeeding? Why? Pregnancy and breastfeeding can influence infection risk and guide specific precautions or treatments. Pregnant Breastfeeding Both Neither Prefer not to answer 4. Any relevant health conditions? Why? Chronic diseases or immune conditions increase risk of severe illness. Obesity Diabetes Heart disease or hypertension Chronic lung disease (e.g., asthma, COPD) Immunocompromised (e.g., cancer, transplant) No known conditions Prefer not to answer 5. Household risk Why? Living with at-risk persons affects recommended precautions and exposure risk. Yes, I live with high-risk individuals No Unsure / Prefer not to answer 6. ZIP / Postal Code Why? Location determines local outbreak intensity and alerts. 7. Transportation habits Why? Public or shared transportation increases exposure risk. Personal vehicle Public transportation (bus/train/subway) Rideshare / Taxi Bicycle / Walking Prefer not to answer 8. Mental health / Behavioral factors Why? Mental health and addiction influence infection risk and mitigation adherence. Depression or anxiety Alcohol or drug addiction None of the above Prefer not to answer Sexual orientation (optional) Heterosexual Homosexual Bisexual Other / Prefer not to say Additional behavioral risk factors History of intravenous (IV) drug use Hemophilia or blood disorder None of the above Prefer not to answer 9. Political Affiliation Why? Political beliefs influence health behaviors and can help tailor communication styles. Democrat Republican Independent Other / Prefer not to say 10. Planned or recurring activity (optional) Why? Upcoming events have variable infection risks and targeted guidance can reduce risk. Location: SelectIndoorsOutdoorsBoth Estimated number of people: 11. Vaccination & Prior Infection History Why? Vaccination and prior infection affect immunity and risk levels. Select disease: Select diseaseCOVID-19Influenza (Flu)HPVHepatitis BOther Vaccination status: Not vaccinated Partially vaccinated Fully vaccinated including boosters Don’t know / Prefer not to answer Date of last vaccine dose (if known): Have you had a confirmed past infection of this disease? Yes No Don’t know / Prefer not to answer Approximate infection date(s) (if known): Severity of prior infection: Mild or asymptomatic Moderate illness Severe illness/hospitalization Unknown / Prefer not to answer 12. Current Symptoms & Recent Exposure Why? Current symptoms and recent exposures help provide timely advice. Symptoms you are experiencing (select all that apply): Fever or chills Cough Shortness of breath Rash or skin lesions Fatigue or muscle aches Loss of taste or smell None of the above Prefer not to answer Close contact with confirmed/suspected case (past 14 days): Yes No Prefer not to answer / Unsure 13. Occupation & Work Environment Why? Workplace exposure can impact infection risk and needed protections. Occupation category: Select oneHealthcare / First responderRetail or service industryEducation / SchoolFood service / RestaurantDelivery / TransportationOffice / AdministrativeManufacturing / FactoryOther / None Work environment: Mostly indoors Mostly outdoors Both Prefer not to answer Approximate number of close contacts per day at work: Are masks or protective measures enforced at your workplace? Yes, enforced Optional No policy Prefer not to answer 14. Ventilation at Home and Workplace Why? Good ventilation reduces airborne transmission risk for respiratory illnesses. Typical ventilation at home: Windows frequently open / good airflow Mechanical ventilation / air filtration Mostly closed windows / limited airflow Prefer not to answer Typical ventilation at workplace: Windows frequently open / good airflow Mechanical ventilation / air filtration Mostly closed windows / limited airflow Prefer not to answer 15. Travel History and Planned Travel Why? Travel may increase risk through new exposures. Have you traveled out of your local area in the last 14 days? Yes No Prefer not to answer If yes, type of travel (select all that apply): Domestic International Public transport (bus/train/plane) Planned trips in the next 30 days? Yes No Prefer not to answer 16. Contact with Animals Why? Contact with animals can influence risk for zoonotic infections. Contact with animals regularly? (Select all that apply) Pets (cats, dogs, etc.) Livestock (cattle, poultry, etc.) Wildlife (birds, rodents, bats) None Prefer not to answer 17. Contact with Children or Institutional Settings Why? Exposure to daycare, schools, or care homes can impact risk for you and household. Do you or household members attend or work in: (Select all that apply) Daycare or preschool School (student or staff) Nursing home or long-term care None Prefer not to answer 18. Immune System Status Why? Certain treatments or conditions affect your immune health and infection risk. Do you take immunosuppressive meds or have immune conditions? (Select all that apply) Cancer therapy Organ transplant recipient HIV positive Autoimmune disease treatment None Prefer not to answer 19. Disease-Specific Questions Why? Targeted questions for current active threats will appear here. This dynamic section adjusts for current epidemic context and disease. 20. Ethnicity / Race (Optional) Why? Helps improve public health interventions and communication without discrimination. Select (optional)Hispanic or LatinoWhiteBlack or African AmericanAsianNative American or Alaska NativeNative Hawaiian or Other Pacific IslanderOtherPrefer not to say 21. Technology & Healthcare Access (Optional) Why? Access to devices and healthcare resources impacts ability to follow recommendations. Reliable access to smartphone or internet? Yes No Prefer not to answer Reliable transportation to healthcare or vaccination centers? Yes No Prefer not to answer 22. Medication and Treatment Contraindications Why? Allergies or contraindications help tailor safer recommendations. Allergies or contraindications to vaccines/medications? Yes No Prefer not to answer If yes, please specify (optional): 23. Caregiver Status Why? Caregivers need tailored guidance to protect themselves and those under their care. Are you a primary caregiver for a child, elderly person, or someone immunocompromised? Yes No Prefer not to answer Submit — Save / Update Profile You may skip any question you prefer and return later to update your responses. Honest answers improve your personalized guidance and help the community. How to Use
