DSHS Region 2/3 Community Preparedness Resources
Texas State Laws Regarding Outbreaks
Several Texas laws (Health & Safety Code, Chapters 81, 84, and 87) require specific information regarding notifiable conditions to be provided to the Texas Department of State Health Services (DSHS). Healthcare providers, hospitals, laboratories, schools, and others are required to report patients who are suspected of having a notifiable condition (Chapter 97, Title 25, Texas Administrative Code).
Cases or suspected cases of illness that are considered to be public health emergencies, outbreaks, exotic diseases, or unusual group expressions of disease must be reported to the local health department or DSHS immediately.
Defining an Outbreak
Determination of an outbreak depends on the specific disease (see disease-specific guidelines - redirects to IDCU webpage) but in general is defined by:
- Most conditions: Three or more non-household, non-familial cases for all disease conditions
- Enteric diseases require 2 or more cases
- Varicella requires 3 or more cases
When an Outbreak is suspected
To ensure overall situational awareness, upon identification of a suspected outbreak, the lead investigator or Chief Epidemiologist should contact the DSHS PHR 2/3 Epidemiology Branch 24/7 on-call Epidemiologist or the Lead Epidemiologist as well as send an email to the DSHS PHR 2/3 Epidemiology Branch and any jurisdiction that might be affected or associated.
Foodborne and Waterborne Outbreaks
If an outbreak is waterborne (enteric and non-enteric including Legionellosis) or is characterized by acute gastroenteritis and is foodborne, person-to-person and any other enteric disease outbreaks of other environmental source or unknown modes, it should be reported via the National Outbreak Reporting System (NORS). See information about NORS below.
Foodborne Outbreak Online Database (FOOD) tool https://www.cdc.gov/fdoss/nors-dashboard.html
The Respiratory Outbreak Form should be used for outbreaks caused (or suspected to be caused) by influenza, Streptococcus species, unknown pathogens causing respiratory symptoms, and any pathogen that is not reportable but either causes respiratory symptoms or is spread primarily through a respiratory route. Please note: This form is not required for pertussis.
Norovirus is the most common cause of gastrointestinal illness, estimated to cause more than half of all cases and outbreaks recorded annually. Outbreaks of norovirus are common as viral particles are readily transmitted person-to-person due to a low infectious dose required to cause illness. While sporadic cases are not reportable, norovirus outbreaks are reportable to DSHS and to the CDC.
Regional Outbreak Tracking Spreadsheet
Please send the outbreak spreadsheet to DSHS Central Office: DSHS.TXOUTBREAKS@dshs.state.tx.us and DSHS PHR 2/3 Office: HSR2-3.EpiReporting@dshs.state.tx.us
Outbreak Reporting Responsibilities
The reporting county or jurisdiction in which the exposure occurred is responsible for requesting an outbreak name in NEDSS, adding it within investigations, as well as entering the outbreak(s) into NORS. The Council to Improve Foodborne Outbreak Response (CIFOR) acknowledges that determining the end of an outbreak can be difficult due to delays in reporting (Guidelines for Foodborne Disease Outbreak Response, 2nd edition). As a general guideline, DSHS PHR 2/3 determines whether an outbreak has ended after two incubation periods or one month from the most recent report date, whichever is the longest.
CIFOR recommends that every effort should be made to complete Part 1: Basic Information and Part 2: Additional Information in NORS as soon as possible and submission of preliminary reports of outbreaks while an investigation is ongoing.
Naming an Outbreak
Outbreak name requests must be sent to NEDSS@dshs.state.tx.us and should be named utilizing the NEDSS outbreak name format of Organism/date/Location/Accession number.
- The Organism may be genus alone (example Salmonella), genus and species abbreviation (example E. coli), disease (example Amebiasis), or common disease abbreviation (example SARS)
- The Date is in MMYY format and should reflect the month and year of the first onset date associated with the outbreak
- Location may be PHR##, County, or City. This location should reflect where the outbreak began.
- Accession number is a two-digit number for outbreaks with the same condition, month, and location starting with 01 for the first, etc.
- Examples: Salmonella/1010/Parker/01, Salmonella/1010/Parker/02, Salmonella/1110Parker/01
The NEDSS Policy on naming outbreaks can be found here (Word)
The National Outbreak Reporting System (NORS) is a web-based platform designed to support reporting to CDC by local, state, and territorial health departments in the United States of all waterborne disease outbreaks and enteric disease outbreaks transmitted by food, contact with environmental sources, infected persons or animals, or unknown modes of transmission. NORS is utilized for all food and waterborne outbreaks including Norovirus and any enteric outbreak (regardless of an agent or whether an agent is identified). Legionellosis outbreaks are reported via NORS as well, even if the water source has not been confirmed or identified.
To request access to NORS and have an active account, simply send an email to: FoodborneTexas@dshs.state.tx.us Type “NORS User Account Request” in the subject line. Include the requestor’s Name, Email Address, and Agency Name. Please note: the "State ID" within NORS is the same as the NEDSS outbreak name.
Questions? Contact us at 817-264-4541 or via e-mail at: HSR2-3.EpiReporting@dshs.state.tx.us