Infectious Disease Guidelines & Resources

Please report ALL outbreaks of enteric illness to the Colorado Department of Public Health and Environment and/or the appropriate local public health agency within 24 hours after the outbreak is detected. Local public health agencies should call the department at 303-692-2700 to report outbreaks and obtain an outbreak ID number, especially before submitting specimens to the state public health laboratory for testing.

Here are some examples of outbreaks that should be reported to the department:

• Suspected C. perfringens after a wedding meal

• E. coli O157 associated with visiting a petting zoo

• Shigella at a childcare center

• Cryptosporidium at swimming pool

• Suspected Norovirus outbreak at a long term care facility or summer camp

Resources to use during the investigation

• Questionnaire for Retail Food Establishment Food Handlers  (For use with outbreaks where the suspected setting is a retail food establishment, like a restaurant, caterer, grocery store, etc.) Spanish     

• Questionnaire for Managers of Retail Food Establishments  (For use with outbreaks where the suspected setting is a retail food establishment, like a restaurant, caterer, grocery store, etc.)  Spanish   

• Generic Foodborne Outbreak Questionnaire       (For use with outbreaks in a defined group of people such as a wedding party or picnic group - adapt questionnaire by adding exposure questions to specific to the event).

• Guidelines for Stool Testing at CDPHE Laboratory   (algorithm for testing covered by department funds at no cost to local public health agencies) 

• CDPHE Specimen Collection and Shipping Guidelines     

• Isolate submission to the state public health laboratory     

• CDC's OutbreakNet website (sample questionnaires, outbreak data, many other resources)

• Council to Improve Foodborne Outbreak Response (CIFOR) and the       Guidelines for Foodborne Disease Outbreak Response  developed by CIFOR

• FDA "Bad Bug Book" (This is online handbook developed by the FDA provides basic facts about foodborne pathogens and toxins)

Outbreak Reporting Forms

When the outbreak is over, it is very important to complete an outbreak report form with appropriate summary data so the outbreak can be officially reported to CDC. When the outbreak is over, please fax the appropriate form to the department at 303-782-0338. The department will report the data to CDC. Depending on the route of transmission, use one of the following 3 forms:

1. Most outbreaks of enteric illness should be reported using the  Enteric Illness Report Form (NORS Form)  This includes outbreaks with following routes of transmission:

• Foodborne

• Animal contact

• Environmental contamination

• Person to person transmission*(e.g. norovirus at a summer camp, or Salmonella in child care center)

CDC guidance for using the NORS form:

•   NORS Appendix   (key to codes used in the NORS form)

• CDC instructions for completing the NORS form

2. Outbreaks that meet the all three of the following criteria can be reported using the shorter    CDPHE Gastroenteritis (Norovirus) Outbreak Report Form for Long Term Care or Healthcare      

• Known or suspected viral gastroenteritis, and

• That occur at a long term care facility or other residential setting, such as a group home, and

• Where the primary route of transmission is person to person.

3. Any waterborne outbreak should be reported using a special NORS-water form, available on the CDC website. This would include outbreaks related to drinking water or to recreational water, such as a lake or swimming pool.

• Guidelines for Stool Testing at CDPHE Laboratory
• CDPHE Specimen Collection and Shipping Guidelines     
• Guidelines for Collection of Measles Specimens
• Pertussis specimen collection instructions
• Rabies specimen submission guidelines
• Plague specimen collection instructions
• Isolate submission to the state public health laboratory