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Enteric disease outbreaks in the US: Analysis of a dataset from the National Outbreak Reporting System

Meng, Brandon (2021) Enteric disease outbreaks in the US: Analysis of a dataset from the National Outbreak Reporting System. Master's Thesis, University of Pittsburgh. (Unpublished)

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With approximately 179 million cases occurring annually in the United States, acute gastroenteritis is a major public health issue. Cases are characterized by diarrhea and often followed by nausea, vomiting, fever, and abdominal pain. The Centers for Disease Control and Prevention tracks acute gastroenteritis outbreak data in the United States via the National Outbreak Reporting System (NORS). This thesis concerns the relationship between various factors of interest (year, season, region, setting, and etiology) and outcomes of illness, hospitalization, and death from person-to-person transmitted outbreaks of acute gastroenteritis in the United States. A relevant outbreak dataset was extracted from NORS. A negative binomial model was used to examine the various factors of interest on the number of illnesses and logistic regression models were used to examine the relationship between those factors and chance of hospitalization. Death in these outbreaks was compared with descriptive statistics due to sparsity. To account for missing values in setting and etiology, outbreaks with complete records and similar characteristics in other factors and number of illnesses were identified and the hot-deck method was used to impute missing values. Multiple imputation was used to summarize analysis results from datasets created with the hot-deck method. It was shown that that setting and etiology were by far the most influential factors on all three outcomes. Additionally, multiple imputation substantially reduced the variance estimates of some regression model parameters. Cases of acute gastroenteritis cause significant health and economic damage, so an examination of factors that are associated with larger outbreaks is relevant to public health. Our results have important public health implications that mitigation of acute gastroenteritis outbreaks should be directed towards the school setting and Norovirus in particular. If policies are aimed at reducing severe outcomes, we should target Salmonella, Clostridium, and Escherichia, as these etiologies had the highest probabilities of hospitalization in this study.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Meng, Brandonbxm2@pitt.edubxm2
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairTang, Gonggot1@pitt.edugot1
Committee MemberBuchanich, Jeaninejeanine@pitt.edujeanine
Committee MemberMartinson, Jeremyjmartins@pitt.edujmartins
Date: 29 June 2021
Date Type: Publication
Defense Date: 16 June 2021
Approval Date: 29 June 2021
Submission Date: 24 June 2021
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 72
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Biostatistics
Degree: MS - Master of Science
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: Enteric Disease Outbreaks, Acute Gastroenteritis, Risk Factors, Trends, Negative Binomial Regression, Logistic Regression, Hot-Deck Imputation, Multiple Imputation
Date Deposited: 29 Jun 2021 13:10
Last Modified: 29 Jun 2021 13:10


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