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.
PUBLISHER'S NOTE: The secretary of state has determined that publication of the entire text of the material that is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive. This material as incorporated by reference in this rule shall be maintained by the agency at its headquarters and shall be made available to the public for inspection and copying at no more than the actual cost of reproduction. This note applies only to the reference material. The entire text of the rule is printed here.
(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:
Anthrax
Botulism
Coronavirus Disease 2019 (COVID-19)
Paralytic poliomyelitis
Plague
Rabies (Human)
Ricin toxin
Severe Acute Respiratory Syndrome-associated 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);
(B) Instances, clusters, or outbreaks of unusual diseases or manifestations of illness and clusters or instances of unexplained deaths which appear to be a result of a terrorist act or the intentional or deliberate release of biological, chemical, radiological, or physical agents, including exposures through food, water, or air;
(C) Instances, clusters, or outbreaks of unusual, novel, and/or emerging diseases or findings not otherwise named in this rule, appearing to be naturally occurring, but posing a substantial risk to public health and/or social and economic stability due to their ease of dissemination or transmittal, associated mortality rates, or the need for special public health actions to control.
(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, byssinosis, 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 anti-microbial sensitivity(ies). Intermediate methicillin or vancomycin sensitivity shall be reported as resistant (i.e., methicillin-resistant
Staphylococcus aureus (MRSA) or vancomycin-resistant 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.
