Details of changes to form 52.13

Changes/differences from Form 52.13 (eFORS) to NORS form
In order as presented in NORS form.
Report Type section from Form 52.13 has been deleted. Question A was deleted because the
new electronic system will be able to maintain a log of which outbreaks have been finalized and
which person at the reporting agency finalized it. Question B was deleted because reporting
agencies noted it as a source of confusion. It was originally presented so that local agencies
could indicate to state agencies that the report was ‘final’ and ready for ‘finalization’ by the state
agency, but it was not used as intended.

General Section
This section is a shared section with animal contact, foodborne, person-to-person, and
waterborne outbreak reporting systems. This form does not intend to collect information
regarding waterborne outbreaks.
Primary Mode of Transmission
This section, formally identified as “Mode of Transmission,” allows agencies to indicate an
additional mode of disease transmission (environmental contamination other than food/water)
that was not captured by the previous foodborne reporting form. An agency indicating
‘environmental contamination other than food/water’ will not complete a new section. The
NORS form contains additional sections to collect outbreak information for animal contact and
person-to-person disease transmissions.
Investigation Methods
An open text ‘comment’ field has been added to allow agencies to report additional information
regarding investigation methods.
Dates
Two date variables added. The additional variables can be used to identify when reporting
agencies requested assistance and provide an approximate timeframe for the length of the
outbreak investigation.
Primary Cases
This section, formally identified as ‘Number of Cases’ has been expanded to obtain separate
information regarding primary and secondary cases (if, applicable). Outbreaks can have more
than one mode of transmission; Form 52.13 did not explicitly allow for a distinction.
□ The ‘# Visited health care provider (excluding ER visits)’ added will allow a better
approximation of case severity because cases may not visit an ER, instead a primary care
physician or urgent care physician may be visited.
□ Under Approximate percent of primary cases in each age group, ‘≥ 50 years’ has been
expanded to 50–74 years and ≥ 75 years, which allows a better examination of the age
distribution among the elderly.

Changes/differences from Form 52.13 (eFORS) to NORS form
Page 1 of 4

□ Due to outbreaks from agencies reporting etiologies with quick incubation and/or
duration of illness, ‘minutes’ is now available as a unit of measure for Incubation Period
and Duration of Illness. This is not a new question.
□ Under Signs or Symptoms, ‘HUS or TTP’ was replaced with ‘HUS.’ HUS (Hemolytic
Uremic Syndrome) is similar to TTP (Thrombotic Thrombocytopenic Purpura); both are
rare blood-coagulation disorders. TTP is no longer believed to be a possible symptom of
foodborne disease, and no longer relevant for outbreak reporting.
Secondary Mode of Transmission
Previously discussed. This section was formally apart of Form 52.13 “Number of Cases,” and
this section asks agencies to identify the ‘Mode of Secondary Transmission.’
Environmental Health Specialists Network
If applicable, this new section allows agencies to identify up to three Environmental Health
Specialists Network (EHS-Net) identification numbers. The web-based reporting system will
integrate EHS-Net data, thereby, linking NORS outbreak reports to multiple EHS-Net reports.
Such linkage is essential in continual efforts to integrate outbreak data with laboratory data
within and across CDC divisions.
Recall
An open text ‘Type of item recalled’ added to allow agencies to identify additional information
regarding recalls.

Laboratory Section
If etiology is unknown, two new questions are presented. Outbreaks that identify a known
etiology are used for publications, as well as essential for our stakeholders when establishing
legislations. Outbreaks with unknown etiology makes-up more than 60% of foodborne outbreak
data, so additional information regarding such outbreaks will improve data quality and permit
enhanced assessment of outbreak trends.
Etiology
One additional question is presented, which will allow effective data cleaning. The data will
ensure that the etiology classification definitions are achieved.
Isolates
Two additional questions are presented. These new questions permit agencies to identify
laboratory identification numbers related to the outbreak and allow a link between outbreak data
and laboratory data. Such linkage is essential in continual efforts to integrate outbreak data with
laboratory data within and across CDC divisions.

Changes/differences from Form 52.13 (eFORS) to NORS form
Page 2 of 4

Person to Person
This is a new section. This mode of transmission was not explicitly collected by Form 52.13.
This section improves data collection for person-to-person disease transmission, which is
essential for monitoring outbreak trends.
Major setting of exposure and Other settings of exposure
This question is presented in Form 52.13, but now we would like the same information for
person-to-person transmission; data collected from this question will improve data quality, and
allow the observation of exposure trends among outbreaks.
Attack rates for major settings of exposure
This is not a new question; however, multiple attack rates now can be entered. Attack rates may
be different among groups; therefore, obtaining data for these distinctions are important while
conducting and reporting outbreak investigations.

Animals and their environment
This new section presents two questions and offers a comment/remark field. This section, allows
agencies to indicate animal contact as a mode of disease transmission, which was not captured by
Form 52.13. Recent multi-state outbreaks investigated by our Branch have increased awareness
of animals and their environment as a transmission source. The data is essential to monitor
trends in animal contact disease outbreaks.

Food-specific data
□ To improve data quality for foods associated with an outbreak, two new questions are
presented. These new questions will provide additional information regarding food
processing and preparation that will be used to improve food classifications for more
accurate data dissemination; Form 52.13 does not explicitly capture such precise
information.
□ Information about imported contaminated foods was presented on Form 52.13, and is
expanded by two questions. The additional data will improve data quality and allow
examination of possible food importation concerns and/or deficiencies.
Location where food was prepared and Location of exposure (where food was eaten)
This is not a new section. One option has been expanded to allow greater detail among
selections to improve data quality. Two options were deleted as they are no longer relevant for
outbreak reporting, and one option was expanded (contaminated food imported into US,
previously discussed).
The confirmed or suspected point of contamination
This is new section to improve data collection, allowing an answer for ‘how and when food
became contaminated.’ Contamination trends now can be examined to allow local, state, and
federal agencies to suggest more precise preventions measures.

Changes/differences from Form 52.13 (eFORS) to NORS form
Page 3 of 4

Additional Salmonella Questions
If applicable, only complete this section given particular etiology-associated outbreak. This new
section allows multiple responses for one question. Agencies can provide additional laboratory
data related to the outbreak and allow a link between outbreak data and laboratory data. Such
linkage is essential in continual efforts to integrate outbreak data with laboratory data within and
across CDC divisions.

Changes/differences from Form 52.13 (eFORS) to NORS form
Page 4 of 4