19 CSR 20-20.020 - [Effective until 2/24/2023] Reporting Infectious, Contagious, Communicable, or Dangerous Diseases

PURPOSE: This amendment adds monkeypox virus (orthopoxvirus/non-variola orthopoxvirus) to the list of diseases or findings that must be reported within one (1) day.

PURPOSE: This rule designates the diseases which are infectious, contagious, communicable or dangerous and must be reported to the local health authority or the Department of Health and Senior Services. It also establishes when they must be reported.

EMERGENCY STATEMENT: The Department of Health and Senior Services ("DHSS") determined that this emergency amendment is necessary to protect the public health, safety, and welfare of Missouri residents and visitors.

This emergency amendment is necessary to ensure that Monkeypox (Orthopoxvirus, non-variola Orthopoxvirus) is reported to the local health authority or DHSS within one day of detection. The Center for Disease Control and Prevention (CDC) is closely monitoring an outbreak of disease caused by the Monkeypox virus. There are currently over 8,900 cases linked to Monkeypox in the United States, and more than 30,000 worldwide. There have been ten (10) deaths linked to the current Monkeypox virus outbreak.

Reporting of the Monkeypox virus has not been required in the past, but due to its severity and the rapid increase in the number of cases, it is imperative for the local health authority or DHSS to be notified within one day of detection in order to take appropriate measures. Finally, since 19 CSR 20-20.040 assigns duties, responsibilities, and actions to the DHSS director as well as local health authorities that are explicitly triggered by the detection of a condition listed in 19 CSR 20-20.020, Monkeypox (Orthopoxvirus, non-variola Orthopoxvirus) must be immediately added to 19 CSR 20-20.020.

This rule designates the diseases which are infectious, contagious, communicable or dangerous and must be reported to the local health authority or the Department of Health and Senior Services. It also establishes when they must be reported. DHSS needs this emergency amendment to ensure that the presence of Monkeypox virus (Orthopoxvirus/non-variola Orthopoxvirus) is reported to the local health authority or the Department within one day of detection.

DHSS finds that there is an immediate danger to the public health, safety or welfare, which requires this emergency action. A proposed amendment, which covers the same material, is published in this issue of the Missouri Register. The scope of this emergency amendment is limited to the circumstances creating the emergency and complies with the protections extended in the Missouri and United States Constitutions. DHSS believes this emergency amendment is fair to all interested persons and parties under the circumstances. This emergency amendment was filed August 15, 2022, becomes effective August 29, 2022, and expires February 24, 2023.

(1) The diseases within the immediately reportable disease category pose a risk to national security because they: can be easily disseminated or transmitted from person to person; result in high mortality rates and have the potential for major public health impact; might cause public panic and social disruption; and require special action for public health preparedness. Immediately reportable diseases or findings shall be reported to the local health authority or to the Department of Health and Senior Services immediately upon knowledge or suspicion by telephone (1 (800) 392-0272), facsimile, or other rapid communication. Immediately reportable diseases or findings are-
(A) Selected high priority diseases, findings or agents that occur naturally, from accidental exposure, or as the result of a bioterrorism event:

2019 Novel Coronavirus (2019-nCoV)

Anthrax

Botulism

Coronavirus Disease 2019 (COVID-19)

Paralytic poliomyelitis

Plague

Rabies (Human)

Ricin toxin

Severe Acute Respiratory syndromeassociated Coronavirus (SARS-CoV) Disease

Smallpox

Tularemia (suspected intentional release)

Viral hemorrhagic fevers, suspected intentional (e.g., Viral hemorrhagic fever diseases: Ebola, Marburg, Lassa, Lujo, new world Arenavirus (Guanarito, Machupo, Junin, and Sabia viruses), or Crimean-Congo);

(2) Reportable within one (1) day, diseases or findings shall be reported to the local health authority or to the Department of Health and Senior Services within one (1) calendar day of first knowledge or suspicion by telephone, facsimile, or other rapid communication. Reportable within one (1) day, diseases or findings are-
(A) Diseases, findings, or agents that occur naturally, or from accidental exposure, or as a result of an undetected bioterrorism event:

Animal (mammal) bite, wound, humans

Brucellosis

Chikungunya

Cholera

Dengue virus infection

Diphtheria

Glanders (Burkholderia mallei)

Haemophilus influenzae, invasive disease

Hantavirus pulmonary syndrome

Hemolytic uremic syndrome (HUS), postdiarrheal

Hepatitis A

Influenza-associated mortality

Influenza-associated public and/or private school closures

Lead (blood) level greater than or equal to forty-five micrograms per deciliter (>=45 µg/dl) in any person

Legionellosis

Measles (rubeola)

Melioidosis (Burkholderia pseudomallei)

Meningococcal disease, invasive

Monkeypox virus (Orthopoxvirus/non-variola Orthopoxvirus)

Novel Influenza A virus infections, human

Outbreaks (including nosocomial) or epidemics of any illness, disease, or condition that may be of public health concern, including any illness in a food handler that is potentially transmissible through food

Pertussis

Poliovirus infection, nonparalytic

Q fever (acute and chronic)

Rabies (animal)

Rubella, including congenital syndrome

Shiga toxin-producing Escherichia coli (STEC)

Shiga toxin positive, unknown organism

Shigellosis

Staphylococcal enterotoxin B

Syphilis, including congenital syphilis

T-2 mycotoxin

Tetanus

Tuberculosis disease

Tularemia (all cases other than suspected intentional release)

Typhoid fever (Salmonella typhi)

Vancomycin-intermediate Staphylococcus aureus (VISA), and Vancomycin-resistant Staphylococcus aureus (VRSA)

Venezuelan equine encephalitis virus neuroinvasive disease

Venezuelan equine encephalitis virus nonneuroinvasive disease

Viral hemorrhagic fevers other than suspected intentional (e.g., Viral hemorrhagic fever diseases: Ebola, Marburg, Lassa, Lujo, new world Arenavirus (Guanarito, Machupo, Junin, and Sabia viruses), or Crimean-Congo)

Yellow fever

Zika;

(B) Diseases, findings or adverse reactions that occur as a result of inoculation to prevent smallpox, including, but not limited to, the following:

Accidental administration

Contact transmission (i.e., vaccinia virus infection in a contact of a smallpox vaccinee)

Eczema vaccinatum

Erythema multiforme (roseola vaccinia, toxic urticaria)

Fetal vaccinia (congenital vaccinia)

Generalized vaccinia

Inadvertent autoinoculation (accidental implantation)

Myocarditits, pericarditis, or myopericarditis

Ocular vaccinia (can include keratitis, conjunctivitis, or blepharitis)

Post-vaccinial encephalitis or encephalamyelitis

Progressive vaccinia (vaccinia necrosum, vaccinia gangrenosa, disseminated vaccinia)

Pyogenic infection of the vaccination site

Stevens-Johnson Syndrome.

(3) Reportable within three (3) days diseases or findings shall be reported to the local health authority or the Department of Health and Senior Services within three (3) calendar days of first knowledge or suspicion. These diseases or findings are-

Acquired immunodeficiency syndrome (AIDS)/Human immunodeficiency virus (HIV) infection, Stage 3

Babesiosis

California serogroup virus neuroinvasive disease

California serogroup virus non-neuroinvasive disease

Campylobacteriosis

Carbon monoxide exposure

CD4+ T cell count and percent

Chancroid

Chemical poisoning, acute, as defined in the most current ATSDR CERCLA Priority List of Hazardous Substances; if terrorism is suspected, refer to subsection (1)(B)

Chlamydia trachomatis, infections

Coccidioidomycosis

Creutzfeldt-Jakob disease

Cryptosporidiosis

Cyclosporiasis

Eastern equine encephalitis virus neuroinvasive disease

Eastern equine encephalitis virus non-neuroinvasive disease

Ehrlichiosis/Anaplasmosis (Ehrlichia chaffeensis infection, Ehrlichia ewingii infection, Anaplasma phagocytophilum infection, and Ehrlichiosis/Anaplasmosis, human, undetermined)

Giardiasis

Gonorrhea

Hansen's disease (Leprosy)

Heavy metal poisoning including, but not limited to, arsenic, cadmium, and mercury

Hepatitis B, acute

Hepatitis B, chronic

Hepatitis B surface antigen (prenatal HBsAg) in pregnant women

Hepatitis B Virus Infection, perinatal (HBsAg positivity in any infant aged equal to or less than twenty-four (<=24) months who was born to an HBsAg-positive mother)

Hepatitis C, acute

Hepatitis C, chronic

Human immunodeficiency virus (HIV) infection, exposed newborn infant (i.e., newborn infant whose mother is infected with HIV)

Human immunodeficiency virus (HIV) infection, including any test or series of tests used for the diagnosis or periodic monitoring of HIV infection. For series of tests which indicate HIV infection, all test results in the series (both positive and negative) must be reported.

Human immunodeficiency virus (HIV) infection, including any negative, undetectable, or indeterminate test or series of tests used for the diagnosis or periodic monitoring of HIV infection conducted within one hundred eighty (180) days prior to the test result used for diagnosis of HIV infection

Human immunodeficiency virus (HIV) infection, pregnancy in newly identified or pre-existing HIV positive women

Human immunodeficiency virus (HIV) infection, test results (including both positive and negative results) for children less than two (2) years of age whose mothers are infected with HIV

Human immunodeficiency virus (HIV) infection, viral load measurement (including undetectable results)

Hyperthermia

Hypothermia

Lead (blood) level less than forty-five micrograms per deciliter (<45 µg/dl) in any person

Leptospirosis

Listeriosis

Lyme disease

Malaria

Methemoglobinemia, environmentally induced

Mumps

Non-tuberculosis mycobacteria (NTM)

Occupational lung diseases including silicosis, asbestosis, byssi-nosis, farmer's lung, and toxic organic dust syndrome

Pesticide poisoning

Powassan virus neuroinvasive disease

Powassan virus non-neuroinvasive disease

Psittacosis

Rabies Post-Exposure Prophylaxis (Initiated)

Respiratory diseases triggered by environmental contaminants including environmentally or occupationally induced asthma and bronchitis

Rickettsiosis, Spotted Fever

Saint Louis encephalitis/virus neuroinvasive disease

Saint Louis encephalitis virus non-neuroinvasive disease

Salmonellosis

Streptococcus pneumoniae, Invasive disease (IPD-Invasive Pneumococcal Disease)

Streptococcal toxic shock syndrome (STSS)

Toxic shock syndrome, non-streptococcal

Trichinellosis

Tuberculosis infection

Varicella (Chickenpox)

Varicella deaths

Vibriosis (non-cholera Vibrio species infections)

West Nile virus neuroinvasive disease

West Nile virus non-neuroinvasive disease

Western equine encephalitis virus neuroinvasive disease

Western equine encephalitis virus non-neuroinvasive disease

Yersiniosis.

(4) Reportable weekly diseases or findings shall be reported directly to the Department of Health and Senior Services weekly. These diseases or findings are:

Influenza, laboratory-confirmed

(5) Reportable quarterly diseases or findings shall be reported directly to the Department of Health and Senior Services quarterly. These diseases or findings are-

Carbapenem-resistant enterobacteriaceae (CRE), nosocomial

Methicillin-resistant Staphylococcus aureus (MRSA), nosocomial

Vancomycin-resistant enterococci (VRE), nosocomial.

(6) A physician, physician's assistant, nurse, hospital, clinic, or other private or public institution providing diagnostic testing, screening or care to any person with any disease, condition or finding listed in sections (1)-(4) of this rule or who is suspected of having any of these diseases, conditions or findings, shall make a case report to the local health authority or the Department of Health and Senior Services, or cause a case report to be made by their designee, within the specified time.
(A) A physician, physician's assistant, or nurse providing care in an institution to any patient with any disease, condition or finding listed in sections (1)-(4) of this rule may authorize, in writing, the administrator or designee of the institution to submit case reports on patients attended by the physician, physician's assistant, or nurse at the institution. But under no other circumstances shall the physician, physician's assistant, or nurse be relieved of this reporting responsibility.
(B) Duplicate reporting of the same case by health care providers in the same institution is not required.
(7) Except for influenza, laboratory-confirmed and Varicella (Chickenpox); a case report as required in section (6) of this rule shall include the patient's name, home address with zip code, date of birth, age, sex, race, home phone number, name of disease, condition or finding diagnosed or suspected, the date of onset of the illness, name and address of the treating facility (if any) and the attending physician, any appropriate laboratory results, name and address of the reporter, treatment information for sexually transmitted diseases, and the date of report.
(A) A report of an outbreak or epidemic as required in subsections (1)(B) and (1)(C) of this rule shall include the diagnosis or principal symptoms, the approximate number of cases, the local health authority jurisdiction within which the cases occurred, the identity of any cases known to the reporter, and the name and address of the reporter.
(B) Influenza, laboratory-confirmed reporting as required in section (4) of this rule shall include the patient's age group (i.e., 0-4, 5-24, 25-64, and 65+ years) and serology/serotype (i.e., A, B, and unknown), the local health authority jurisdiction within which the cases occurred, and the date of report. Aggregate patient data shall be reported weekly.
(C) Varicella (Chickenpox) reporting as required in section (3) of this rule shall include the patient's name, date of birth, vaccination history, and severity of illness; the local health authority jurisdiction within which the cases occurred, and the date of report.
(8) Any person in charge of a public or private school, summer camp or child or adult care facility shall report to the local health authority or the Department of Health and Senior Services the presence or suspected presence of any diseases or findings listed in sections (1)-(4) of this rule according to the specified time frames.
(9) All local health authorities shall forward to the Department of Health and Senior Services reports of all diseases or findings listed in sections (1)-(4) of this rule. All reports shall be forwarded according to procedures established by the Department of Health and Senior Services director as listed in sections (1)-(4). Reports will be forwarded immediately if a terrorist event is suspected or confirmed. The local health authority shall retain from the original report any information necessary to carry out the required duties in 19 CSR 20-20.040(2) and (3).
(10) Information from patient medical records received by local public health agencies or the Department of Health and Senior Services in compliance with this rule is to be considered confidential records and not public records.
(11) Reporters specified in section (6) of this rule will not be held liable for reports made in good faith in compliance with this rule.
(12) The following material is incorporated into this rule by reference:
(A) 2005 Agency for Toxic Substances and Disease Registry (ATSDR) 1825 Century Blvd., Atlanta, GA 30345, Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) Priority List of Hazardous Substances, available at: http://www.atsdr.cdc.gov/cercla. This rule does not incorporate any subsequent amendments or additions.
(13) Each hospital and ambulatory surgical center shall report on a quarterly basis antibiogram data for infection, not colonization, from all body sites monitored by that health care facility. Antibiogram data to be reported shall include nosocomial methicillin sensitive Staphylococcus aureus (S. aureus), nosocomial S. aureus, nosocomial vancomycin sensitive enterococci, and nosocomial enterococci isolates. Data shall be reported directly to the Department of Health and Senior Services. Reporting shall include only a patient's first diagnostic nosocomial isolate per admission of Staphylococcus aureus (S. aureus) and enterococci and the isolates corresponding methicillin or vancomycin sensitivity; irrespective of location or of other antimicrobial sensitivity(ies). Intermediate methicillin or vancomycin sensitivity shall be reported as resistant (i.e., methicillin resistant Staphylococcus aureus (MRSA) or vancomycinresistant enterococci (VRE), respectively).
(A) Isolates from cultures performed for routine surveillance purposes are excluded from the requirement to report. Methicillin resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) nosocomial infections to be reported to the Department of Health and Senior Services are limited to those body sites monitored by the individual hospital or ambulatory surgical center.
(B) Aggregate antibiogram data for patients' non-duplicative isolates, per admission, of nosocomial MRSA and VRE infections shall reflect susceptibility patterns and shall be reported as the:
1. Number of nosocomial isolates of S. aureus sensitive to methicillin (oxacillin, etc.);
2. Number of nosocomial isolates S. aureus;
3. Number of nosocomial isolates of enterococci sensitive to vancomycin; and
4. Number of nosocomial isolates enterococci.
(C) Aggregate data shall be reported for the quarters January-March, April-June, July-September, and October-December within ten (10) days of the end of the quarter. Each quarter's aggregate report shall include only those data that are available within a ten (10)-day reporting period from the end of that quarter.

Notes

19 CSR 20-20.020
Amended by Missouri Register September 15, 2022/Volume 47, Number 18, effective 8/29/2022

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