About NORS

What are enteric illnesses?

Enteric illnesses are characterized by symptoms such as diarrhea, nausea, or vomiting. Some microbes such as Escherichia coli (E. coli) cause enteric illness and may also cause other types of symptoms or conditions, such as hemolytic uremic syndrome, or HUS.

The National Outbreak Reporting System (NORS) supports outbreak reporting by partners in state, local, and territorial public health agencies.

The Centers for Disease Control and Prevention (CDC) launched NORS in 2009 as a web-based platform into which health departments enter outbreak information. Through NORS, CDC collects reports of enteric disease outbreaks caused by bacterial, viral, parasitic, chemical, toxin, and unknown agents, as well as foodborne and waterborne outbreaks of non-enteric disease. Starting in 2023, NORS also collects reports of certain fungal disease outbreaks.

If you are a member of the general public and would like to report an outbreak, please contact your local or state health department. Contact information can be found at Public Health Resources: State Health Departments.

Improved reporting of outbreaks

National foodborne and waterborne disease outbreak surveillance has been a core function of CDC since the 1970s. Two surveillance systems handle this responsibility: the Waterborne Disease and Outbreak Surveillance System (1971-present) and the Foodborne Disease Outbreak Surveillance System (1973-present). Foodborne disease outbreak data have been collected electronically since 1998. NORS was designed to integrate the outbreak reporting systems and enhance national outbreak reporting with new components.

NORS collects data on these types of outbreaks in the United States:
  • Waterborne disease outbreaks – all outbreaks of respiratory, skin, enteric or other types of illness spread through water, including water that people drink, swim in, or use for other purposes
  • Foodborne disease outbreaks – all outbreaks spread through food
  • Person-to-person transmitted disease outbreaks – all outbreaks of enteric illness spread directly from one person to another through direct contact, such as by handshake
  • Animal contact disease outbreaks – all outbreaks of enteric illness spread to humans from contact with animals, such as a chicken or pet turtle, or their environments
  • Environmental contamination outbreaks – all outbreaks of enteric illness spread through contact with other environmental sources, such as dirty linens or surfaces that people touch in bathrooms, as well as outbreaks of blastomycosis, coccidioidomycosis, histoplasmosis, or sporotrichosis
  • Other enteric illness outbreaks – all outbreaks of enteric illness spread through other, unknown, or indeterminate means

NORS is a valuable tool for collecting outbreak data needed to improve public health

Outbreak investigations are most often initiated by state, local, and territorial public health agencies and by CDC. These agencies report outbreaks through NORS, which collects information such as date and location of the outbreak, the number of people who became ill and their symptoms, and the pathogen that caused the outbreak.

Reporting Outbreak Data Through NORS:

  1. During an outbreak, people get sick from norovirus.
  2. State, local, and territorial health departments notified of outbreak.
  3. Health departments begin investigation and collect and test specimens.
  4. Health departments report data through NORS.
  5. Clinical data and epidemiological data reported to NORS.
  6. Through NORS, CDC collects aggregate data on foodborne, waterborne, enteric disease, and certain fungal disease outbreaks (including date, location, number of people sick and their symptoms, and the pathogen that caused the outbreak).
  7. CDC verifies and analyses data, identifies national trends, and disseminates online at https://wwwn.cdc.gov/norsdashboard/.

In addition to state, territorial, and local health departments, other organizations that collaborate with CDC on outbreak surveillance and prevention include the Council of State and Territorial Epidemiologists (CSTE), the United States Environmental Protection Agency (EPA), the United States Food and Drug Administration (FDA), and the United States Department of Agriculture (USDA).

NORS improves on over 45 years of outbreak surveillance at CDC, helping to integrate and streamline surveillance systems, enhance state and local health department outbreak reporting, and provide needed information to CDC, health departments, and policy makers for prevention of future outbreaks.