DAR File No. 28152

Health, Epidemiology and Laboratory Services, Epidemiology

R386-702

Communicable Disease Rule

NOTICE OF PROPOSED RULE

DAR File No.: 28152
Filed: 08/15/2005, 05:19
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

It is proposed that "Kawasaki syndrome" be removed from the list of reportable conditions in the Communicable Disease Rule, and that "Influenza, laboratory confirmed" be replaced to require reporting of hospitalized influenza cases only. The reason behind this proposal is that Kawasaki syndrome is a syndrome rather than a disease, and identification and reporting of this syndrome is difficult and poses a significant burden for medical providers. Further, the public health role in managing cases of this syndrome is not clear. This syndrome is not a nationally-notifiable disease. Decreasing the reporting burden for influenza from requiring report of all laboratory-confirmed cases to hospitalized cases only will significantly reduce the amount of cases that must be reported. Characterization of the influenza season is supplemented by other surveillance methods so this change will not impact the ability of the Department of Health to monitor and characterize trends over time. Influenza is not a nationally-notifiable disease. Requirements for the treatment and release from supervision for Typhoid patients are clarified to meet current practice standards.

Summary of the rule or change:

The changes in the Communicable Disease Rule include removal of one reportable condition (Kawasaki syndrome) and modification of another (influenza, laboratory-confirmed) that will result in decreased reporting requirements for health care providers and laboratories. Requirements for the treatment and release from supervision for Typhoid patients are clarified to meet current practice standards.

State statutory or constitutional authorization for this rule:

Sections 26-1-30 and 26-6-3, and Title 26, Chapter 23b

Anticipated cost or savings to:

the state budget:

There will be a small, unquantifiable savings in resources used to track and monitor these diseases.

local governments:

There will be a small, unquantifiable savings to local health departments in resources used to track and monitor these diseases.

other persons:

There will be some savings for medical providers, including laboratories and private clinician offices due to decreased reporting requirements; however, those savings are small and difficult to quantify.

Compliance costs for affected persons:

There are no anticipated compliance costs since the change should result in savings for most affected entities.

Comments by the department head on the fiscal impact the rule may have on businesses:

The minor changes in disease reporting requirements should not have a significant fiscal impact on business. David N. Sundwall, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Direct questions regarding this rule to:

Robert Rolfs at the above address, by phone at 801-538-6386, by FAX at 801-538-9923, or by Internet E-mail at rrolfs@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

10/03/2005

This rule may become effective on:

10/04/2005

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

R386. Health, Community Health Services, Epidemiology.

R386-702. Communicable Disease Rule.

R386-702-3. Reportable Diseases, Emergency Illnesses, and Health Conditions.

(1) The Utah Department of Health declares the following conditions to be of concern to the public health and reportable as required or authorized by Section 26-6-6 and Title 26, Chapter 23b of the Utah Health Code.

(a) Acquired Immunodeficiency Syndrome

(b) Adverse event resulting after smallpox vaccination

(c) Amebiasis

(d) Anthrax

(e) Arbovirus infection

(f) Botulism

(g) Brucellosis

(h) Campylobacteriosis

(i) Chancroid

(j) Chickenpox

(k) Chlamydia trachomatis infection

(l) Cholera

(m) Coccidioidomycosis

(n) Colorado tick fever

(o) Creutzfeldt-Jakob disease and other transmissible human spongiform encephalopathies

(p) Cryptosporidiosis

(q) Cyclospora infection

(r) Dengue fever

(s) Diphtheria

(t) Echinococcosis

(u) Ehrlichiosis, human granulocytic, human monocytic, or unspecified

(v) Encephalitis

(w) Enterococcal infection, vancomycin-resistant

(x) Enterohermorrhagic Escherichia coli (EHEC) infection, including Escherichia coli O157:H7

(y) Giardiasis

(z) Gonorrhea: sexually transmitted and ophthalmia neonatorum

(aa) Haemophilus influenzae, invasive disease

(bb) Hansen Disease (Leprosy)

(cc) Hantavirus infection and pulmonary syndrome

(dd) Hemolytic Uremic Syndrome, postdiarrheal

(ee) Hepatitis A

(ff) Hepatitis B, cases and carriers

(gg) Hepatitis C, acute and chronic infection

(hh) Hepatitis, other viral

(ii) Human Immunodeficiency Virus Infection. Reporting requirements are listed in R388-803.

(jj) Influenza[, laboratory confirmed]-associated hospitalization

(kk) [Kawasaki syndrome]Influenza-associated death if the individual was less than 18 years of age

(ll) Legionellosis

(mm) Listeriosis

(nn) Lyme Disease

(oo) Malaria

(pp) Measles

(qq) Meningitis, aseptic and bacterial (specify etiology)

(rr) Meningococcal Disease, invasive

(ss) Mumps

(tt) Norovirus, formerly called Norwalk-like virus, infection

(uu) Pelvic Inflammatory Disease

(vv) Pertussis

(ww) Plague

(xx) Poliomyelitis, paralytic

(yy) Psittacosis

(zz) Q Fever

(aaa) Rabies, human and animal

(bbb) Relapsing fever, tick-borne and louse-borne

(ccc) Reye syndrome

(ddd) Rheumatic fever

(eee) Rocky Mountain spotted fever

(fff) Rubella

(ggg) Rubella, congenital syndrome

(hhh) Saint Louis encephalitis

(iii) Salmonellosis

(jjj) Severe Acute Respiratory Syndrome (SARS)

(kkk) Shigellosis

(lll) Smallpox

(mmm) Staphylococcal diseases, all outbreaks

(nnn) Staphylococcus aureus with resistance or intermediate resistance to vancomycin isolated from any site

(ooo) Staphylococcus aureus with resistance to methicillin isolated from any site

(ppp) Streptococcal disease, invasive, isolated from a normally sterile site

(qqq) Streptococcus pneumoniae, drug-resistant, isolated from a normally sterile site

(rrr) Syphilis, all stages and congenital

(sss) Tetanus

(ttt) Toxic-Shock Syndrome, staphyloccal or streptococcal

(uuu) Trichinosis

(vvv) Tuberculosis. Special Measures for the Control of Tuberculosis are listed in R388-804.

(www) Tularemia

(xxx) Typhoid, cases and carriers

(yyy) Viral hemorrhagic fever

(zzz) West Nile virus infection

(aaaa) Yellow fever

(bbbb) Any outbreak or epidemic, including suspected or confirmed outbreaks of foodborne or waterborne disease. Any unusual occurrence of infectious or communicable disease or any unusual or increased occurrence of any illness that may indicate an outbreak, epidemic, Bioterrorism event, or public health hazard, including any newly recognized, emergent or re-emergent disease or disease producing agent, including newly identified multi-drug resistant bacteria.

(2) In addition to the reportable conditions set forth in R386-702-3(1) the Department declares the following reportable emergency illnesses or health conditions to be of concern to the public health and reporting is authorized by Title 26, Chapter 23b, Utah Code, unless made mandatory by the declaration of a public health emergency.

(a) respiratory illness (including upper or lower respiratory tract infections, difficulty breathing and Adult Respiratory Distress Syndrome);

(b) gastrointestinal illness (including vomiting, diarrhea, abdominal pain, or any other gastrointestinal distress);

(c) influenza-like constitutional symptoms and signs;

(d) neurologic symptoms or signs indicating the possibility of meningitis, encephalitis, or unexplained acute encephalopathy or delirium;

(e) rash illness;

(f) hemorrhagic illness;

(g) botulism-like syndrome;

(h) lymphadenitis;

(i) sepsis or unexplained shock;

(j) febrile illness (illness with fever, chills or rigors);

(k) nontraumatic coma or sudden death; and

(l) other criteria specified by the Department as indicative of disease outbreaks or injurious exposures of uncertain origin.

R386-702-7. Special Measures for Control of Typhoid.

(1) Because typhoid control measures depend largely on sanitary precautions and other health measures designed to protect the public, the local health department shall investigate each case of typhoid and strictly manage the infected individual according to the following outline:

(2) Cases: [Enteric precautions are required during hospitalization]Standard precautions are required during hospitalization. Use contact precautions for diapered or incontinent children under 6 years of age for the duration of illness. Hospital care is desirable during acute illness. Release of the patient from supervision by the local health department shall be based on [not less that ]three or more negative cultures of feces, and of urine in patients with schistosomiasis, taken at least 24 hours apart. Cultures must have been taken at least 48 hours after antibiotic therapy has ended and not earlier than one month after onset of illness as specified in R386-702-7(6). If any of these cultures is positive, repeat cultures at intervals of one month during the 12-month period following onset until at least three consecutive negative cultures are obtained as specified in R386-702-7(6). The patient shall be restricted from food handling and from providing patient care during the period of supervision by the local health department.

(3) Contacts: Administration of typhoid vaccine is required for all household members of known typhoid carriers. Household and close contacts shall not be employed in occupations likely to facilitate transmission of the disease, such as food handling, during the period of contact with the infected person until at least two negative feces and urine cultures, taken at least 24 hours apart, are obtained from each contact.

(4) Carriers: If a laboratory or physician identifies a carrier of typhoid, the attending physician shall immediately report the details of the case by telephone to the local health department or the Office of Epidemiology, Utah Department of Health using the process described in R386-702-4. Each infected individual shall submit to the supervision of the local health department. Carriers are prohibited from food handling and patient care until released in accordance with R386-702-7(4)(a) or R386-702-7(4)(b). All reports and orders of supervision shall be kept confidential and may be released only as allowed by Subsection 26-6-27(2)(c).

(a) Convalescent Carriers: Any person who harbors typhoid bacilli for three but less than 12 months after onset is defined as a convalescent carrier. Release from occupational and food handling restrictions may be granted at any time from three to 12 months after onset, as specified in R386-702-7(6).

(b) Chronic Carriers: Any person who continues to excrete typhoid bacilli for more than 12 months after onset of typhoid is a chronic carrier. Any person who gives no history of having had typhoid or who had the disease more than one year previously, and whose feces or urine are found to contain typhoid bacilli is also a chronic carrier.

(c) Other Carriers: If typhoid bacilli are isolated from surgically removed tissues, organs, including the gallbladder or kidney, or from draining lesions such as osteomyelitis, the attending physician shall report the case to the local health department or the Office of Epidemiology, Utah Department of Health. If the person continues to excrete typhoid bacilli for more than 12 months, he is a chronic carrier and may be released after satisfying the criteria for chronic carriers in R386-702-7(6).

(5) Carrier Restrictions and Supervision: The local health department shall report all typhoid carriers to the Office of Epidemiology, and shall:

(a) Require the necessary laboratory tests for release;

(b) Issue written instructions to the carrier;

(c) Supervise the carrier.

(6) Requirements for Release of Convalescent and Chronic Carriers: The local health officer or his representative may release a convalescent or chronic carrier from occupational and food handling restrictions only if at least one of the following conditions is satisfied:

(a) For carriers without schistosomiasis, three consecutive negative cultures obtained from fecal specimens authenticated by the attending physician, hospital personnel, laboratory personnel, or local health department staff taken at least one month apart and at least 48 hours after antibiotic therapy has stopped;

(b) for carriers with schistosomiasis, three consecutive negative cultures obtained from both fecal and urine specimens authenticated by the attending physician, hospital personnel, laboratory personnel, or local health department staff taken at least one month apart and at least 48 hours after antibiotic therapy has stopped; or

(c) the local health officer or his representative determine that additional treatment such as cholecystectomy or nephrectomy has terminated the carrier state.

KEY: communicable diseases, rules and procedures

[May 16, ]2005

Notice of Continuation August 20, 2002

26-1-30

26-6-3

26-23b

ADDITIONAL INFORMATION

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For questions regarding the content or application of this rule, please contact Robert Rolfs at the above address, by phone at 801-538-6386, by FAX at 801-538-9923, or by Internet E-mail at rrolfs@utah.gov

For questions about the rulemaking process, please contact the Division of Administrative Rules (801-538-3764). Please Note: The Division of Administrative Rules is NOT able to answer questions about the content or application of these administrative rules.