BACKGROUND: The National Outbreak Reporting System (NORS) was launched by the Centers for Disease Control and Prevention (CDC) in 2009 to collect information on foodborne, waterborne, and enteric disease outbreaks transmitted by contact with environmental sources, infected persons or animals, or unknown modes of transmission using an integrated, web-based platform. To reduce data entry burden, CDC introduced NORSDirect, a feature that allows users to upload outbreak data from existing databases into NORS, in February 2015. To determine the impact of NORSDirect, an evaluation was conducted.
METHODS: Data on all finalized reports of non-waterborne outbreaks, submitted to NORS by manual data entry (MDE) or NORSDirect during January 1, 2009 – September 30, 2016 were analyzed. Report completeness based on number of variables entered and timeliness from health department report date to NORS report creation were compared before and after NORSDirect implementation using the Mann-Whitney U test. Per capita reporting rates among states using NORSDirect were calculated and compared before and after NORSDirect implementation and to those states using only MDE.
RESULTS: In total, 28,559 reports were submitted to NORS, with 6,013 reported using NORSDirect. MDE reports were significantly more complete than NORSDirect for nearly all transmission modes (Animal 93% MDE vs 88% NORSDirect, p<0.001; Environmental 91% vs 84%, p=0.043; Person-to-person 89% vs 73%, p<0.001; Unknown 91% vs 86%, p<0.001), except foodborne reports (67% MDE vs 71%; p<0.001). Additionally, median MDE reporting was significantly more timely (32 days) than NORSDirect reporting (49 days; p<0.001). However, among NORSDirect states, the reporting rate was significantly higher after NORSDirect implementation compared to before (19 reports/ 1,000,000 PY vs 4 reports/ 1,000,000 PY; p<0.001). Furthermore, after NORSDirect release, the reporting rate among NORSDirect states (19 reports/ 1,000,000 person-years [PY]) was significantly higher than that among MDE states (8 reports/ 1,000,000 PY; p<0.001).
CONCLUSIONS: NORSDirect significantly increased reporting rates, yet completeness and timeliness were lower for NORSDirect reports compared to MDE reports, suggesting areas for further improvement. Less complete NORSDirect reports may be due to incomplete mapping of variables between state databases and NORS, since only five variables are required to create a NORS report. The reporting lag may be due to users waiting to upload reports in batches. However, the number of reports submitted to NORS has increased significantly since the release of NORSDirect. Increased reporting can provide better understanding of the burden of enteric disease outbreaks in order to develop and target effective interventions.