AUTHORITY
These Rules and Regulations Pertaining to Communicable Disease
Control are duly adopted and promulgated by the Arkansas State Board of Health
pursuant to the authority expressly conferred by the Laws of the State of
Arkansas including, without limitation, Act 96 of 1913 (Ark. Code Ann. §
20-7-101
et seq.).
PURPOSE
The purpose of the Rules and Regulations Pertaining to the
Control of Communicable Diseases is to provide for the prevention and control
of communicable diseases and to protect the public health, welfare and safety
of the citizens of Arkansas.
SECTION
I. DEFINITIONS:
A.
Board
means the Arkansas State Board of Health.
B.
Complete quarantine means
the limitation of freedom of movement of such well persons or domestic animals
as have been exposed to a communicable disease, for a period of time not longer
than the longest usual incubation period of the disease, in such manner as to
prevent effective contact with those not so exposed.
C.
Director means the Director
of the Arkansas Department of Health.
D.
Department means the
Arkansas Department of Health.
E.
Emergency response employee means firefighters, law enforcement
officers, emergency medical technicians, first responders, and other
individuals including employees of volunteer organizations without regard to
whether such employees receive compensation who, in the performance of
professional duties, respond to emergencies in the State of Arkansas.
F.
Medical provider means any
hospital, physician, nurse, hospital employee, nursing home, nursing home
employee, or other health care provider.
G.
Modified quarantine means a
selective, partial limitation of freedom of movement of persons or domestic
animals, commonly on the basis of known or presumed differences in
susceptibility, but sometimes because of danger of disease transmission. It may
be designed to meet particular situations. Examples are exclusion of children
from school; exemption of immune persons from provisions required of
susceptible persons (e.g., contacts acting as food handlers); restriction of
military populations to the post or quarters.
H.
Personal surveillance means
the practice of close medical or other supervision of contacts in order to
promote prompt recognition of infection or illness, but without restricting
their movements.
I.
Segregation means the separation for special consideration,
control or observation of some part of a group of persons or domestic animals
from the others to facilitate control of a communicable disease (e.g., removal
of susceptible children to homes of immune persons, or establishments of a
sanitary boundary to protect uninfected from infected portions of a
population.)
SECTION II.
GENERAL MEASURES FOR THE CONTROL OF COMMUNICABLE DISEASES.
The current edition of "Control of Communicable Disease in
Man," published by the American Public Health Association, will be accepted for
applying general control measures for communicable diseases.
SECTION III. RESPONSIBILITY FOR REPORTING.
A. It shall be the duty of every physician,
practitioner, nurse; every superintendent or manager of a dispensary, hospital,
clinic, nursing or extended care home; any person in attendance on a case of
any of the diseases or conditions declared notifiable; or the local health
department to report the disease or condition to the Department utilizing the
Toll Free Communicable Disease Reporting System ( 1-800-482 -8888) within
twenty-four (24) hours.
B. Any
person who determines by laboratory examination that a specimen derived from
the human body yields evidence suggestive of a communicable disease shall
report, within twenty-four (24) hours, to the Department on the Toll Free
Communicable Disease Reporting System microscopical, cultural or other evidence
of the presence of any of the diseases declared notifiable.
C. It shall be the duty of every
superintendent of a public school district or such person(s) he designates, to
report immediately to the Department on the Toll Free Communicable Disease
Reporting System any outbreak of three (3) or more cases of any of the
conditions declared notifiable.
SECTION IV. NOTIFIABLE DISEASES AND
CONDITIONS
A. Notifiable diseases and
conditions are to be reported to the Department utilizing the Toll Free
Communicable Disease Reporting System ( 1-800-482 -8888) within 24 hours of
diagnosis. Reports should include:
1. The
reporter's name, location and phone number.
2. The name of the disease reported and the
onset date.
3. The patient's name,
address, phone number, age, sex and race. (PLEASE spell the patient's
name.)
4. The attending physician's
name, location and phone number.
5.
Any treatment information, if known.
6. Any pertinent laboratory or other
information used in the diagnosis.
A. Additional disease-specific information
may be requested. Any person desiring to further discuss reportable diseases
may phone the Division of Epidemiology at (501) 661-2893 during normal business
hours or 1-800-554 -5738 after hours, holidays and weekends.
SECTION V. DISEASES AND CONDITIONS
A. NOTIFIABLE DISEASES AND CONDITIONS
AIDS*
Anthrax
Blastomycosis
Botulism (including Infant Botulism)
Brucellosis
CD4+ T-Lymphocyte Count
Campylobacteriosis
Chancroid
Chlamydial Infections
Cholera
Congenital Rubella syndrome
Congenital Syphilis
Creutzfeld-Jakob Disease**
Cryptosporidiosis
Cyclosporiasis
Diphtheria
Ehrlichiosis
Encephalitis, all types
Enterohemorrhagic E. coli O 157:H7
Food Poisoning, all types
Giardiasis
Gonorrhea
Haemophilus influenzae Invasive Disease
Hantavirus Pulmonary Syndrome
Hemolytic-Uremic Syndrome
Hepatitis (Type A, B, C, non-A-non B, or unspecified)
Histoplasmosis
H.I.V. (Human Immunodeficiency Virus)*
Influenza (Indicate viral type if known)
Kawasaki Disease
Legionellosis
Leprosy
Listeriosis
Lyme Disease
Malaria
Measles (Rubeola)
Meningitis, all types
Meningococcal Infections
Mumps
Pertussis (Whooping Cough)
Plague
Poliomyelitis
Psittacosis
Rabies, Animal
Rabies, Human
Rheumatic Fever
Rocky Mountain Spotted Fever
Rubella
Salmonellosis (Including Typhoid)
Shigellosis
Streptococcal Disease, Invasive Group A
Strep. Pneumoniae, Invasive, drug-resistant
Strep. Pneumoniae, Invasive, not resistant
Syphilis*
Tetanus
Toxic Shock Syndrome
Toxoplasmosis
Tuberculosis
Tularemia
Vancomycin-resistant enterococci
Varicella (Chickenpox), deaths only
Variola (Smallpox)
West Nile Virus
Yellow Fever
* Any woman infected with ADDS, HIV or Syphilis, who is
pregnant, must be so reported indicating the trimester of pregnancy. This
applies each time the woman becomes pregnant.
B. REPORTABLE OCCUPATIONAL DISEASES AND OTHER
CONDITIONS
Asbestosis
Blood Lead Levels*
Byssinosis
Chemical poisoning, All Types **
Pesticide Poisoning
Pneumoconiosis (Coal Workers)
Mesothelioma
Silicosis
* Blood lead levels over 10 ug/dl for patients 14 years old or
younger and levels over 25 ug/dl for patients 15 years old and up.
** Includes chemical agents of terrorism
C. REPORT ANY UNUSUAL DISEASES OR OUTBREAKS
THAT MAY REQUIRE PUBLIC HEALTH ASSISTANCE
D. The following bacterial isolates must be
submitted upon request to the Department laboratory for
identification/fingerprinting. In addition, the results of any Pulsed Field Gel
Electrophoresis tests involving the following bacterial isolates must be
submitted.
Neisseria Meningitidis
Salmonella sp
Campylobacter sp.
E. coli0157:H7
Listeria sp.
Shigella sp.
Staph, aureus, vancomycin resistant or intermediate
susceptible
SECTION
VI. OTHER DISEASES.
Other diseases not named in these lists may at any time be
declared notifiable as the necessity and public health demand, and these
regulations shall apply when so ordered by the Director.
SECTION VII. RESPONSIBILITY OF THE DIRECTOR.
When the Director has knowledge, or is informed of the
existence of a suspected case or outbreak of a communicable disease:
A. The Director shall take whatever steps
necessary for the investigation and control of the disease.
B. If the Director finds that the nature of
the disease and the circumstances of the case or outbreak warrant such action,
the Director shall make, or cause to be made, an examination of the patient in
order to verify the diagnosis, make an investigation to determine the source of
the infection, and take appropriate steps to prevent or control spread of the
disease.
SECTION VIII.
CEASE AND DESIST ORDERS.
If the Director has reasonable cause to suspect that any person
who is HIV positive is intentionally engaging in conduct that is likely to
cause the transmission of the virus, the Director may issue an order to said
person to cease and desist such conduct. Failure to comply immediately shall
constitute a violation of these rules and regulations. Such violation shall be
promptly reported to the prosecuting attorney in the county where the person
resides for appropriate action.
SECTION
IX. ISOLATION.
It shall be the duty of the attending physician, immediately
upon discovering a disease requiring isolation, to cause the patient to be
isolated pending official action by the Director. Such physician also shall
advise other members of the household regarding precautions to be taken to
prevent further spread of the disease, and shall inform them as to appropriate,
specific, preventive measures. He shall, in addition, furnish the patient's
attendant with such detailed instructions regarding the disinfection and
disposal of infective secretions and excretions as may be prescribed by the
Director of the Arkansas Department of Health.
SECTION X. STATE AND LOCAL QUARANTINE
A. The Director shall impose such quarantine
restrictions and regulations upon commerce and travel by railway, common
carriers, or any other means, and upon all individuals as in his judgment may
be necessary to prevent the introduction of communicable disease into the
State, or from one place to another within the State.
B. No quarantine regulations of commerce or
travel shall be instituted or operated by any place, city, town or county
against another place or county in this or in any other State except by
authority of the Director.
C. No
person shall interfere with any health authority having jurisdiction, or carry
or remove from one building to another, or from one locality to another within
or without the State, any patient affected with a communicable disease
dangerous to the public health except as provided under the rules governing the
transportation of same.
SECTION
XI TERMINAL DISINFECTION.
Each person released from quarantine or isolation shall take
such measures as are required by the Department for that particular disease.
The area of isolation shall be disinfected according to the instructions of the
Department.
SECTION XII.
IDENTIFICATION OF THE BODY OF A DECEASED PERSON WHO HAS BEEN INFECTED BY A
COMMUNICABLE DISEASE
Any physician or any other person who has reason to believe
that a deceased person may have been infected by Creutzfeldt-Jakob Disease
(CJD) shall immediately after death attach to the large digit of the right
foot, a red indicator tag furnished by the Department or, if not available, a
tag measuring no less than 3 inches by 5 inches, which clearly states that the
patient may have been infected with Creutzfeldt-Jakob Disease (CJD). If the
body is wrapped in plastic sheets or other covering material and the toe tag is
not visible, a duplicate clearly visible tag shall be applied to the outside
covering material.
SECTION
XIII. PROTECTION OF EMERGENCY RESPONSE EMPLOYEES
A. Any emergency response employee who fears
that he or she has been exposed to a communicable disease may notify the
Department. Upon notification, the Department shall determine if the exposure
requires additional investigation. In the event that it is determined that the
exposure is one which should not create the risk of transmission of a
communicable disease, the emergency response employee shall be so notified. If
requested, he or she will be instructed as to additional steps that may be
taken to confirm that no exposure to actual disease has occurred. If the
Department determines that the exposure was one that could have caused the
transmission of a communicable disease, the Department shall immediately
contact the treating physician to determine if the patient was infected with a
communicable disease. If it is determined that the individual was infected with
a communicable disease, the emergency response employee shall be contacted
immediately by the Department and counseled concerning the recommended course
of action.
B. Any medical provider
who has knowledge that an emergency response employee has been exposed to a
communicable disease shall notify the Department immediately. The Department
shall contact the emergency response employee immediately and provide
appropriate counseling concerning the appropriate course of action.
C. Any medical provider who has knowledge
that a patient with a communicable disease is being transferred, transported or
treated by an emergency response employee shall, prior to said transfer,
transportation or treatment notify the emergency response employee of the
patient's communicable condition.
SECTION XIV. EXCLUSION AND READMISSION TO
SCHOOL OR CHILD CARE FACILITIES.
It shall be the duty of the principal or other person in charge
of any public or private schools, or child care facilities, at the direction of
the Department, to exclude therefrom any child, teacher or employee affected
with a communicable disease until the individual is certified free of disease,
by written notice from a physician, school nurse, public health nurse or the
Department.
SECTION XV.
TUBERCULOSIS.
Refer to the Amendment to the Rules and Regulations Pertaining
to the Control of Communicable Diseases, Arkansas State Board of Health, filed
with the Secretary of State March 10, 1994.
SECTION XVI. PUBLIC FOOD HANDLERS
No person known to be infected with a communicable disease, or
suspected of being infected with a communicable disease, or who has been found
to be a carrier of disease-producing organisms, shall engage in the commercial
handling of food, or be employed on a dairy or on premises handling milk or
milk products, until he is determined by the Department to be free of such
disease, or incapable of transmitting the infection.
SECTION XVII. COMMUNICABLE DISEASES IN
DAIRIES
A. When the Department has good cause
to believe that a milk supply is suspected to be the source of infection for
any one of the communicable diseases known to be transmitted through milk, the
Department shall prohibit the use, sale, or disposal of such milk except by a
method approved by the Director until such time as he deems it to be safe for
human consumption.
B. When a case
of Typhoid Fever, Salmonella infection, Brucellosis, Shigellosis, Respiratory
Streptococcal infection, Diphtheria, or any other disease capable of being
transmitted through milk is confined on the premises where a dairy is
maintained, the Department shall prohibit the use, sale or disposal of such
milk except by a method approved by the Director until he is satisfied that
such is safe for human consumption.
SECTION XVIII. LABORATORY TESTS FOR THE
RELEASE OF CASES OR CARRIERS OF COMMUNICABLE DISEASES
When laboratory tests are required for the release of cases, or
carriers, the tests shall be performed by the Public Health Laboratory or by
another laboratory approved by the State Epidemiologist. A specimen may be sent
to a laboratory not so approved, provided that it is divided and a portion of
the specimen is sent to an approved laboratory. Release shall be considered on
the basis of the report of the approved laboratory only.
SECTION XIX. DIPHTHERIA LABORATORY SPECFMENS
FOR DIAGNOSIS AND RELEASE
A. Cultures should
be obtained separately from the nose and throat by means of sterile swab and
test tube as provided by the Department for aid in diagnosis.
B. A case or carrier of Diphtheria shall not
be released until two cultures from the throat and two from the nose, taken not
less than twenty-four (24) hours apart, fail to show the presence of Diphtheria
bacilli. The first of such cultures shall be taken not less than one week from
the day of the onset of the disease. A virulence test should be made in any
case where positive cultures are reported three weeks or longer after the onset
of the disease or discovery of a carrier. If the organisms are non-virulent,
the patient may be released.
SECTION
XX. TYPHOID FEVER
A. Laboratory
Specimens for Diagnosis of Cases and Release
1. Samples of feces and whole blood submitted
to the Public Health Laboratory for culture within the first week of the
suspected case of Typhoid Fever give the greatest probability of obtaining a
positive result insofar as the culture is concerned. Such cultures when
positive are the only proof of diagnosis of Typhoid Fever.
2. A specimen of both feces and urine shall
be collected about one week after the onset of the disease and sent to the
Public Health Laboratory to determine whether Typhoid organisms are being
passed from the bowel or kidney.
3.
Patients who have been determined to have Typhoid Fever shall be isolated for
such period as required, and shall be released from isolation and from
supervision by the health authority after three specimens of both feces and
urine, collected not less than twenty-four (24) hours apart and not earlier
than seven (7) days after the patient becomes afebrile, shall have been
examined by the Public Health Laboratory and found to be negative.
A. Typhoid Carriers
1. Any person who has recovered from Typhoid
Fever and in whose feces or urine Typhoid bacilli are present one year or
longer after such recovery shall be declared to be a chronic carrier. Any
person who has recently recovered from Typhoid Fever and from whose feces or
urine Typhoid organisms are cultured by the Public Health Laboratory during the
first year from such recovery shall be considered a convalescent, or temporary
carrier, and shall conform to all the Regulations regarding the control of
Typhoid carriers. Any person found in the investigation of a case or cases of
Typhoid Fever from whose feces or urine Typhoid bacilli are cultured by the
Public Health Laboratory shall be declared to be a chronic carrier except that
such person be one who has recently recovered from Typhoid Fever.
2. Control of Typhoid Carriers
a. The urine and feces of a Typhoid carrier
shall be disposed of in such a manner that they will not endanger any public or
private water supply, or be accessible to flies.
b. No Typhoid carrier shall prepare or handle
any food or drink to be consumed by persons other than members of the household
with whom he resides.
c. No Typhoid
carrier shall conduct or be employed in any restaurant, hotel or boarding
house, or conduct a lodging house in which, prior to taking lodgers, a separate
toilet and bathroom have not been installed for the use solely of the Typhoid
carrier. Said toilet shall be located in a part of the house separate from any
part that may be occupied by a lodger.
d. Any person determined to be a Typhoid
carrier as defined in these Regulations shall sign an AGREEMENT, to be
witnessed by at least two persons. Said AGREEMENT shall read as follows:
TYPHOID CARRIER AGREEMENT
In view of the fact that I have been proven to be a
Typhoid carrier, I do solemnly swear to abide by the following regulations as
long as I remain a Typhoid carrier, which I understand will probably be for the
remainder of my life:
1.
Under no circumstances will I handle milk or milk
products such as cream, ice cream, butter or cheese, nor any other foodstuffs,
nor will I do any cooking of food except for my own individual consumption and
for those members of my immediate family who have been immunized against
typhoid fever within the past three years.
2. Following each visit to the
toilet I will wash my hands thoroughly with soap and water.
3.
I will inform the Arkansas
Department of Health, Division of Communicable Diseases, 4815 West Markham
Street, Little Rock, Arkansas 72205-3867, in advance of any change in address
from that listed below.
Signature of Carrier
Complete Address of Carrier
Signatures and addresses of two
witnesses
Name Address 2. Name Address Date of
Signing
1. Release of Chronic
Typhoid Carriers from Control Restrictions
a.
A chronic Typhoid carrier may be released from restrictions only on approval of
the Director and only after submitting proof of a minimum of six (6)
consecutive negative feces cultures (for urinary carriers, urine cultures)
taken at least one (1) month apart and at least ten (10) days after taking any
antibiotic, and performed by the Division of Laboratories of the Department. At
least two (2) of the specimens must be liquid stools obtained after
administration of a cathartic such as magnesium sulfate. At least two (2) of
the specimens must be validated by collection under close supervision as having
come from the carrier. For fecal carriers, the identity of the specimen may be
confirmed by oral administration of a suitable marker material under
supervision and finding this material in a specimen. Cultures of duodenal fluid
may be substituted for stool cultures, if desired.
b. A released chronic carrier who wishes to
work in a food handling or other occupation from which carriers are excluded
must present evidence from a Local Health Department that he has received
instruction in methods of food handling and personal hygiene. While employed in
such a restricted occupation he must submit evidence of a negative stool (or
urine if appropriate) culture and additional food handling instruction every
year.
SECTION XXI. VENEREAL DISEASE (SYPHILIS,
GONORRHEA, CHANCROID, LYMPHOGRANULOMA VENEREUM, GRANULOMA INGUINALE) AND
OPHTHALMIA NEONATORUM (GONORRHEAL OPHTHALMIA)
A. Testing of pregnant women.
1. Every physician attending a pregnant woman
shall take, or cause to be taken, a sample of venous blood at the time of first
examination and submit such sample to an approved laboratory for a standard
serologic test for Syphilis; a standard test for Human Immunodeficiency virus;
and a standard test for Hepatitis B. Any person other than a physician
permitted by law to attend pregnant women but not permitted by law to take
blood samples, shall cause a specimen of blood to be taken by, or under the
direction of a physician duly licensed to practice medicine and surgery, and
have such specimen submitted to an approved laboratory for testing.
2. Any person reporting a birth or stillbirth
shall state on the certificate whether a blood test for Syphilis had been made
upon a specimen of blood taken from the woman who bore the child for which a
birth or stillbirth certificate is filed and the approximate date when the
specimen was taken.
A.
Ophthalmia Neonatorum (Gonorrhea Ophthalmia)
1. Ophthalmia Neonatorum is to be reported to
the Epidemiology Program, Arkansas Department of Health, as soon as the disease
is suspected.
2. It shall be the
duty of the attending physician to prescribe appropriate medication for the
prevention of infant blindness, to be administered within one (1) hour of the
time of birth. Effective prophylaxis against gonococcal ophthalmia and
chlamydial conjunctivitis is provided by either erthromycin (0.5%) ophthalmic
ointment or tetracycline (1%) ophthalmic ointment given as a single application
into each conjunctival sac with no rinsing of the eyes.
3. It shall be the duty of the local health
authority in whose jurisdiction the case occurs to investigate the case to
confirm the diagnosis by bacteriological examination and, if of Gonococcal
origin, to determine if the attendant at delivery used prophylactic medication
in the eyes of the infant.
4. Due
to the nature of the infection and its communicability, and inasmuch as
Gonorrheal Ophthalmia is amenable to penicillin therapy, it shall be the duty
of every physician to administer adequate penicillin therapy at once. It shall
be the duty of every midwife attending such cases, or suspected cases, to refer
all such cases to a licensed physician for treatment.
5. Conjunctival discharges and articles
soiled therewith shall be disinfected.
A. It shall be the duty of every physician to
report, as soon as diagnosed, every case of venereal disease on the
Confidential Case Report, as provided by the Department, or by utilizing the
Toll Free Communicable Disease Reporting System , to the Venereal Disease
Program, Arkansas Department of Health. Physicians shall report the patient by
name, address, age, sex, race and date of birth within twenty-four (24) hours
of the diagnosis in case of primary, secondary and congenital Syphilis and
Syphilis in pregnant women.
B.
Whenever the Director has reasonable grounds to believe that any person is
suffering from Syphilis, Gonorrhea, Chancroid, Lymphogranuloma Venereum or
Granuloma Inguinale in a communicable state, he is authorized to cause such
person to be apprehended and detained for the necessary tests and examination,
including an approved blood serologic test and other approved laboratory tests,
to ascertain the existence of said disease or diseases: provided, that any
evidence so acquired shall not be used against such person in any criminal
prosecution.
C. The Director may,
when in the exercise of his discretion he believes that the public health
requires it, commit any commercial prostitute, or other persons apprehended and
examined and found afflicted with said diseases, or either of them who refuses
or fails to take treatment adequate for the protection of the public health, to
a hospital or other place in the State of Arkansas for such treatment even over
the objection of the person so diseased and treated provided the commitment can
be done without endangering the life of the patient.
D. It shall be the duty of a physician on the
occasion of the first visit to or by a person suffering from Syphilis,
Gonorrhea, Chancroid, Lymphogranuloma Venereum or Granuloma Inguinale to
instruct said person in the precautions to be taken to prevent communication of
the disease to others, and to inform him of the necessity of continued
uninterrupted treatment until such adequate treatment has been
administered.
E. It shall be the
duty of every physician to administer appropriate and adequate treatment to any
individual regardless of age, sex, or race whom he has reasonable grounds to
believe is suffering from Syphilis, Gonorrhea, Chancroid, Lymphogranuloma
Venereum or Granuloma Inguinale in a communicable state, to render the disease
non-communicable to others for the protection of the public health. Likewise,
it shall be the duty of every physician to treat, prophylactically or
therapeutically, any individual regardless of age, sex or race whom he has
reasonable grounds to believe has been exposed to a communicable case of
Syphilis, Gonorrhea, Chancroid, Lymphogranuloma Venereum or Granuloma Inguinale
for the protection of the public health. Consent to the provision of medical
and surgical care or services by a physician licensed to practice medicine in
this State, when executed by a minor who is or believes himself to be afflicted
with a venereal disease, shall be valid and binding as if the minor had
achieved his majority.
SECTION
XXII. RABIES CONTROL.
Refer to the Rules and Regulations Pertaining to Rabies
Control, Arkansas State Board of Health, July 1975, and the Rabies Control Act,
Act 11 of 1968 as amended by Act 725 of 1975.
SEVERABILITY
If any provision of these Rules and Regulations, or the
application thereof to any person or circumstances is held invalid, such
invalidity shall not affect other provisions or applications of these Rules and
Regulations which can give effect without the invalid provisions or
applications, and to this end the provisions hereto are declared to be
severable.
REPEAL
All Rules and Regulations and any parts of Rules and
Regulations in conflict herewith are hereby repealed.
CERTIFICATION
This will certify that the foregoing Rules and Regulations
Pertaining to Communicable Disease Control in Arkansas were adopted by the
Arkansas State Board of Health at a regular session of the Board held in Little
Rock, Arkansas on the 25th day of April,
2002.
/Signed by Dr. Fay Boozman/
Secretary
Arkansas Board of Health
The foregoing Rules and Regulations, a copy having been filed
in my office, are hereby approved on the 16th day of May, 2002.
/Signed by Mike Huckabee/
Governor
