No. 39952 (Amendment): Rule R386-702. Communicable Disease Rule

(Amendment)

DAR File No.: 39952
Filed: 11/18/2015 04:59:07 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

This amendment will provide for updates related to 2015 Council of State and Territorial Epidemiologists (CSTE) approved position statements; address changes in support of improved use of informatics; incorporate general edits and updates to improve format and accuracy of language; and will include additional changes as recommended by Department leadership. Proposed changes were sent to local health department, infection control, and laboratory partners informally prior to finalizing this revision in order to solicit, and include input from these critical partners.

Summary of the rule or change:

The proposed changes reflect suggestions and requests from staff, leadership and stakeholders, including: 1) in Section R386-702-1, the revised purpose statement to update language regarding emerging infections; previous language was outdated; 2) in Section R386-702-2, added a definition for "Good Samaritan"; 3) in Section R386-702-3, updated language for "Acinetobacter species" to ensure consistency with other drug-resistant organism reporting language; 4) added "Acute Flaccid Myelitis (AFM)", this condition is emerging and of interest nationally, and while it is not nationally-notifiable, CSTE approved standardized criteria for reporting and case classification in 2015; 5) removed "Amebiasis", this condition is not nationally notifiable, and its occurrence is rare in Utah. Most investigated cases lack symptoms and do not end up meeting case definition. Removing it will allow public health resources to remain available for more critical investigations; 6) added "Clostridium difficile" through electronic laboratory reporting (ELR). This will allow for establishment of baseline incidence in Utah, which will allow for better characterization of, and response to, morbidity and mortality associated with this infection; 7) added "Cytomegalovirus (CMV), congenital" via ELR. This is already reportable as per Section R398-4-5. Inclusion in Rule R386-702 will reinforce the reporting requirement, and facilitate laboratory reporting that is indicative of this condition; 8) removed "Echinococcosis", this condition is not nationally notifiable, and is very rare. In Utah, almost all cases are imported. Removing it will allow public health resources to remain available for more critical investigations; 9) updated language for drug-resistant "Escherichia coli" to be consistent with language approved in a CSTE position statement; 10) updated language for drug-resistant "Enterobacter species" to be consistent with language approved in a CSTE position statement; 11) added "(Sin Nombre virus)" to "Hantavirus pulmonary syndrome" in order to clarify that they are associated; 12) simplified language for "Hepatitis C" by removing "acute and chronic infection". This is consistent with language approved in a CSTE position statement; 13) updated language for drug-resistant "Klebsiella species" to be consistent with language approved in a CSTE position statement; 14) clarified language for "Staphylococcus aureus" to indicate reports of this organism, with drug-resistance to vancomycin, from any clinical specimen, are reportable; 15) separated "Streptococcal disease" into two reporting categories: a) streptococcal disease, invasive, due to Streptococcus pneumoniae and Groups A and B isolated from a normally sterile site, and b) streptococcal disease, invasive, other, reported via ELR only. Applicable only to laboratories and hospitals currently participating in ELR; 16) added "meningitis" and "encephalitis" to the list of examples of conditions of interest for "(cccc) Any outbreak, epidemic, or unusual or increased occurrence of illness... "; 17) in Section R386-702-4, made changes in format and minor edits throughout to improve readability; 18) updated language to clarify requirements for ELR; 19) modified the list of conditions for which negative laboratory result reporting is required as follows: a) added "Cytomegalovirus (CMV)", b) removed "Salmonellosis", c) removed "STEC", d) added "Lyme disease", and e) added "Syphilis"; 20) added "Creutzfelt-Jakob Disease and other suspected prion diseases" to the list of "Immediately Reportable Conditions"; 21) modified language under "Confidentiality of Reports" to clarify allowance of information sharing with attending clinicians and public health workers, and to address sharing of information related to good Samaritans who may aid a person with an infectious disease; 22) in Section R386-702-6, added language regarding fees for testing based on new criteria and procedures for charging for rabies-related testing; and 23) in Section R386-702-13, updated links and references as needed.

State statutory or constitutional authorization for this rule:

• Section 26-1-30
• Title 26, Chapter 23b
• Section 26-6-3

This rule or change incorporates by reference the following material:

• Updates Control of Communicable Diseases Manual, published by American Public Health Association, 11/07/2015
• Updates Red Book: 2012 Report of the Committee on Infectious Diseases, published by American Academy of Pediatrics, 05/01/2015

Anticipated cost or savings to:

the state budget:

The majority of proposed changes provide clarification, or improve language and formatting overall, and do not represent additional costs or savings beyond some small savings since less time will be required to review and interpret the rule. Of the three conditions being added to the list of reportable conditions, one is already reportable (CMV), two will be reportable by electronic laboratory reporting only (CMV and Clostridium difficile), and one is emerging and rare (AFM). CMV will continue to be managed as it currently is, without local health department investigation; Clostridium difficile cases will not be investigated individually, rather, they will be monitored in aggregate over time, unless an outbreak is identified and investigated. Two conditions are being removed. While some minimal costs will be required to facilitate programming in order to add new conditions into the communicable disease database, and remove conditions as well, and a disease plan will be developed for AFM, overall, changes in the reportable disease list will likely be approximately cost-neutral. Changes for electronic reporting are minimal since they entail minor programming changes in order to modify data feeds from reporting facilities, and to modify UDOH's ability to receive data feeds. In terms of volume of data to be received and stored, costs should be approximately neutral since the addition of CMV and Clostridium difficile data will be offset by removal of negative result reporting of Salmonella and STEC tests, both of which were high-volume reporting streams. Adding information regarding rabies testing will result in some savings since tests that do not meet listed criteria will result in a fee being paid for testing to UPHL vs. public health covering costs for all requested tests. This may end up cost neutral, though, when taking staff time into account for processing and managing any appeals that may be received.

local governments:

The main cost that may be incurred by local health departments is personnel time required to manage AFM cases, or to assist with investigation of outbreaks of C. difficile that may be detected. AFM is rare, and has already been reported under Subsection R386-702-3(1)(bbbb). UDOH has provided support as needed for investigating suspect cases and will continue to do so. Outbreaks of any condition have always been reportable, so investigating outbreaks of C. difficile would not be a new expectation, or incur new costs. Also, savings will accrue removing amebiasis and echinococcosis. This should result in overall costs associated with the proposed changes being neutral.

small businesses:

Electronic laboratory reporting is optional, so modifications to electronic laboratory reporting should not incur significant costs for small laboratories unless they are using it already and need to modify codes in order to add in/modify reporting according to proposed changed in conditions. In that case, costs associated with updating programming to identify and report new conditions and remove conditions will be incurred, but it is anticipated that this will result in significant savings over time since reporting is automated, ultimately requiring significantly less personnel time to manage.

persons other than small businesses, businesses, or local governmental entities:

As noted above, the main cost that may be incurred by local health departments is personnel time required to manage AFM cases, or to assist with investigation of outbreaks of C. difficile that may be detected. AFM is rare, and has already been reported under Subsection R386-702-3(1)(bbbb). UDOH has provided support as needed for investigating suspect cases and will continue to do so. Outbreaks of any condition have always been reportable, so investigating outbreaks of C. difficile would not be a new expectation, or incur new costs. Also, savings will accrue removing amebiasis and echinococcosis. This should result in overall costs associated with the proposed changes being neutral. Electronic laboratory reporting is optional, so modifications to electronic laboratory reporting should not incur significant costs for laboratories unless they are using it already and need to modify codes in order to add in/modify reporting according to proposed changed in conditions. In that case, costs associated with updating programming to identify and report new conditions and remove conditions will be incurred, but it is anticipated that this will result in significant savings over time since reporting is automated, ultimately requiring significantly less personnel time to manage.

Compliance costs for affected persons:

There are no direct compliance costs associated with this amendment.

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

This rule is being amended to include updates relating to the 2015 Council of State and Territorial Epidemiologists (CSTE) approved position statements. It also addresses changes to improve the use of informatice and include addition changes as recommended by Department leadership. LHD's, infection control and laboratory partners have already reviewed the proposed changes.

Joseph Miner, MD, Executive Director

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

Health
Disease Control and Prevention, Epidemiology
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Melissa Stevens Dimond at the above address, by phone at 801-538-6810, by FAX at 801-538-9923, or by Internet E-mail at [e-mail]

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:

01/14/2016

This rule may become effective on:

01/21/2016

Authorized by:

Joseph Miner, Executive Director

RULE TEXT

R386. Health, Disease Control and Prevention, Epidemiology.

R386-702. Communicable Disease Rule.

R386-702-1. Purpose Statement.

(1) The Communicable Disease Rule is adopted under authority of Sections 26-1-30, 26-6-3, and 26-23b.

(2) This rule outlines a multidisciplinary approach to communicable and infectious disease control and emphasizes reporting, surveillance, isolation, treatment and epidemiological investigation to identify and control preventable causes of infectious diseases. Reporting requirements and authorizations are specified for communicable and infectious diseases, outbreaks, and unusual occurrence of any disease. Each section has been adopted with the intent of reducing disease morbidity and mortality through the rapid implementation of established practices and procedures.

(3) The successes of medicine and public health dramatically reduced the risk of epidemics and early loss of life due to infectious agents during the twentieth century. However, the emergence of diseases[,] such as [Human Immunodeficiency Virus, Hantavirus, and Severe Acute Respiratory Syndrome] Middle Eastern Respiratory Syndrome (MERS), and the rapid spread of diseases such as West Nile virus to the United States from other parts of the world[, such as West Nile virus], made possible by advances in transportation, trade, food production, and other factors , highlight the continuing threat to health from infectious diseases. Continual attention to these threats and cooperation among all health care providers, government agencies , and other entities that are partners in protecting the public's health are crucial to maintain and improve the health of the citizens of Utah.

 

R386-702-2. Definitions.

(1) Terms in this rule are defined in Section 26-6-2 and 26-23b-102, except that for purposes of this rule, "Department" means the Utah Department of Health.

(2) In addition, for purposes of this rule:

(a) "Outbreak" means an increase in incidence of disease, or two or more cases of disease with a common exposure.

(b) "Case" means a person identified as having a disease, health disorder, or condition that meets criteria for being reportable under this rule, or that is otherwise under public health investigation.

(c) "Suspect case" means a person who a reporting entity, local health department, or Department believes might be a case, but for whom it has not been established that the criteria necessary to become a case have been met.

(d) "Good Samaritan" means a person who gives reasonable aid to strangers in grave physical distress.

 

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 public health and reportable as required or authorized by Section 26-6-6 and Title 26, Chapter 23b of the Utah Health Code.

(a) Acinetobacter species, from any clinical specimen, that is resistant to at least one carbapenem-class antibiotic, or that has demonstrated carbapenemase production [with resistance or intermediate resistance to carbapenems (specifically, meropenem and imipenem) from any anatomical site]

(b) Acquired Immunodeficiency Syndrome

(c) Acute Flaccid Myelitis (AFM)

( d[c]) Adverse event resulting from smallpox vaccination

[(d) Amebiasis]

(e) Anaplasmosis

(f) Anthrax

(g) Arbovirus infection, including Saint Louis encephalitis and West Nile virus infection

(h) Babesiosis

(i) Botulism

(j) Brucellosis

(k) Campylobacteriosis

(l) Chancroid

(m) Chickenpox

(n) Chlamydia trachomatis infection

(o) Cholera

(p) Clostridium difficile, reported via electronic laboratory reporting (ELR) only. Applicable only to laboratories and hospitals currently participating in ELR.

( q[p]) Coccidioidomycosis

( r[q]) Colorado tick fever

( s[r]) Creutzfeldt-Jakob disease and other transmissible human spongiform encephalopathies

( t[s]) Cryptosporidiosis

( u[t]) Cyclospora infection

(v) Cytomegalovirus (CMV), congenital, via ELR (see Utah Administrative Rule R398-4-5 and R386-702-4 (2)(b)

( w[u]) Dengue fever

( x[v]) Diphtheria

[(w) Echinococcosis]

( y[x]) Ehrlichiosis, human granulocytic, human monocytic, or unspecified

( z[y]) Encephalitis

([z]aa)(1) Escherichia coli, [with resistance or intermediate resistance to carbapenems (meropenem, ertapenem, and imipenem) from any site]from any clinical specimen, that is resistant to at least one carbapenem-class antibiotic, or that has demonstrated carbapenemase production

([z]aa)(2) Shiga toxin-producing Escherichia coli (STEC) infection

(bb) Enterobacter species, from any clinical specimen, that is resistant to at least one carbapenem-class antibiotic, or that has demonstrated carbapenemase production

( cc[aa]) Giardiasis

( dd[bb]) Gonorrhea: sexually transmitted and ophthalmia neonatorum

( ee[cc]) Haemophilus influenzae, invasive disease

( ff[dd]) Hansen Disease (Leprosy)

( gg[ee]) Hantavirus pulmonary syndrome (Sin Nombre virus)

( hh[ff]) Hemolytic Uremic Syndrome, postdiarrheal

( ii[gg]) Hepatitis A

( jj[hh]) Hepatitis B, acute, chronic, and perinatal

( kk[ii]) Hepatitis C[, acute and chronic infection]

( ll[jj]) Hepatitis, other viral

( mm[kk])(1) Human Immunodeficiency Virus Infection. Special measures for the control of HIV/AIDS are included in R386-702-9.

( nn[kk])(2) Pregnancy in a HIV case

( oo[ll]) Influenza-associated hospitalization

( pp[mm]) Influenza-associated death, in a person less than 18 years of age

( qq[nn]) Klebsiella species, [with resistance or intermediate resistance to carbapenems (meropenem, ertapenem, and imipenem) from any site]from any clinical specimen, that is resistant to at least one carbapenem-class antibiotic, or that has demonstrated carbapenemase production

( rr[oo]) Legionellosis

( ss[pp]) Leptospirosis

( tt[qq]) Listeriosis

( uu[rr]) Lyme Disease

( vv[ss]) Malaria

( ww[tt]) Measles

([uu]xx) Meningitis (aseptic, bacterial, fungal, parasitic, protozoan, and viral)

( yy[vv]) Meningococcal Disease

( zz[ww]) Mumps

( aaa[xx]) Mycobacteria other than tuberculosis

( bbb[yy]) Norovirus, outbreaks only

( ccc[zz]) Pertussis

( ddd[aaa]) Plague

( eee[bbb]) Poliomyelitis, paralytic and nonparalytic

( fff[ccc]) Psittacosis

( ggg[ddd]) Q Fever (Coxiella infection)

( hhh[eee]) Rabies, human and animal

( iii[fff]) Relapsing fever, tick-borne and louse-borne

( jjj[ggg]) Rubella, including congenital syndrome

( kkk[hhh]) Salmonellosis

( lll[iii]) Severe Acute Respiratory Syndrome (SARS)

( mmm[jjj]) Shigellosis

( nnn[kkk]) Smallpox

( ooo[lll]) Spotted fever rickettsioses (including Rocky Mountain Spotted Fever)

( ppp[mmm]) Staphylococcus aureus from any clinical specimen with resistance or intermediate resistance to vancomycin isolated from any site

( qqq[nnn]) (1) Streptococcal disease, invasive, due to [including] Streptococcus pneumoniae and Groups A[,] and B[, C, and G streptococci] isolated from a normally sterile site

(qqq)(2) Streptococcal disease, invasive, other, reported via ELR only. Applicable only to laboratories and hospitals currently participating in ELR.

( rrr[ooo]) Syphilis, all stages and congenital

( sss[ppp]) Tetanus

( ttt[qqq]) Toxic-Shock Syndrome, staphylococcal or streptococcal

( uuu[rrr]) Trichinellosis

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

( www[ttt]) Tularemia

( xxx[uuu]) Typhoid, cases and carriers

( yyy[vvv]) Vibriosis

( zzz[www]) Viral hemorrhagic fever

( aaaa[xxx]) Yellow fever

( bbbb[yyy]) Any unusual occurrence of infectious or communicable disease or any unusual or increased occurrence of any illness that may indicate a [B]bioterrorism event or public health hazard, including any single case or multiple cases of a newly recognized, emergent or re-emergent disease or disease-producing agent, including newly identified multi-drug resistant bacteria or a novel influenza strain such as a pandemic influenza strain.

( cccc[zzz]) Any outbreak, epidemic, or unusual or increased occurrence of any illness that may indicate an outbreak or epidemic. This includes suspected or confirmed outbreaks of foodborne disease, waterborne disease, meningitis, encephalitis, disease caused by antimicrobial resistant organisms, any infection that may indicate a bioterrorism event, or of any infection that may indicate a public health hazard.

(2) In addition to the reportable conditions set forth in R386-702-3(1) the Department declares the following reportable emergency illnesses, health conditions, and patient encounter information to be of public health importance 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;

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

(m) patient encounter data including, but not limited to, chief complaint and discharge diagnosis data from healthcare settings which support early identification and ruling out of public health threats, disasters, disease outbreaks, suspected incidents, and acts of bioterrorism; assist in characterizing population groups at greatest risk for disease or injury; support assessment of the severity and magnitude of possible threats; or satisfy syndromic surveillance objectives of the Federal Centers for Medicaid and Medicare Meaningful Use incentive program.

 

R386-702-4. Reporting.

(1) Who must report: Each reporting entity shall report each confirmed case , and any [case]individual, who the reporting entity believes, in its professional judgment, is likely to harbor an illness, infection, or condition reportable under R386-702-3(1), and each outbreak, epidemic, or unusual occurrence described in R386-702-3(1)([yyy]bbbb) or ([zzz]cccc) to the local health department or to the Bureau of Epidemiology, Utah Department of Health. Unless otherwise specified, the report of these diseases to the local health department or to the Bureau of Epidemiology, Utah Department of Health shall provide the following information: name, age, sex, address, date of onset, and all other information as prescribed by the Department. A standard report form has been adopted and is supplied to physicians and other reporting entities by the Department. Upon receipt of a report, the local health department shall promptly forward a written or electronic copy of the report to the Bureau of Epidemiology, Utah Department of Health.

(2) Time frames for reporting:

(a) Manual reporting:

(i) Where immediate reporting is required as noted in R386-702-4 (4), the reporting entity shall report as soon as possible, but not later than 24 hours after identification. Immediate reporting shall be made by telephone to the local health department or to the Bureau of Epidemiology, Utah Department of Health at 801-538-6191 or 888-EPI-UTAH (888-374-8824).

([b]ii) All diseases not required to be reported immediately shall be reported within three working days from the time of identification. Reporting entities shall send reports to the local health department by phone, secured fax, secured email, or mail; or to the Bureau of Epidemiology by phone [phone]), secured fax [phone]), secured email (please contact the Bureau of Epidemiology at 801-538-6191 for information on this option), or by mail (288 North 1460 West, P. O. Box 142104, Salt Lake City, Utah 84114-2104).

(b) Electronic reporting:

([c]i) Hospitals and [L]laboratories are encouraged to report case information electronically in a manner approved of by the Department if the laboratory has the capacity to do so. [Laboratories should r]Refer to https://health.utah.gov/phaccess/public/elr/ for information about this option. Please contact the Bureau of Epidemiology at 801-538-6191 for questions regarding this option.

([d]ii) When more than one licensed laboratory or hospital is involved in testing a specimen, all [laboratories]entities involved are required to report results.

(iii) All entities that report electronically shall either choose to report on demand (as each report is released) or batch reports every 24 hours (including holidays and weekends if the entity is open).

([e]iv) The following requirements apply to laboratories that are reporting information electronically:

([i]1) Laboratories reporting electronically shall send the following information with all reports:

([1]A) First and last name of the patient;

([2]B) Patient date of birth;

([3]C) Patient hospitalization status;

([4]D) Name [and telephone number] of the reporting facility;

([5]E) Name [and telephone number] of the testing laboratory;

([6]F) Patient address (including street address, unit/apartment number, city, state, and zip code);

([7]G) Name and [address]phone number of the requesting health care provider;

([8]H) Pregnancy status;

([9]I) Specimen source;

([10]J) The laboratory's name for, or description of, the test;

(K) Testing results;

([11]L) Test reference range; and

([12]M) Test status (e.g. preliminary, final, amended and/or corrected).

([ii]2) Hospitals reporting electronically shall use HL7 2.5.1 message structure and standard LOINC and SNOMED terminology in accordance with Meaningful Use regulations. Laboratories reporting electronically shall use HL7 2.3.1 or 2.5.1 message structure for all fields and appropriate LOINC codes designating the test performed.

([iii]3) Laboratories reporting electronically shall submit all local vocabulary codes with translations to UDOH, if applicable.

[(iv) Laboratories reporting electronically must send reports within 24 hours of finalization of test results.]

([v]4) Laboratories reporting electronically must report preliminary positive results for immediately notifiable conditions as specified in R386-702-4 (4).

([vi]c) Electronic reporting of negative results:

([1]i) Electronic reporting shall include negative as well as positive results [for tests ordered ]for the following conditions:

([a]1) Chlamydia

(2) Cytomegalovirus (CMV), congenital (see Utah Administrative Rule R398-4-5 and R386-702-4 (2)(b)(i))

( 3[b]) Gonorrhea

( 4[c]) Hepatitis A

( 5[d]) Hepatitis B

( 6[e]) Hepatitis C, including viral loads

( 7[f]) Human Immunodeficiency Virus (HIV), including viral loads and confirmatory tests

[(g) Salmonellosis]

[(h) STEC]

(8) Lyme disease

(9) Syphilis

([i]10) Tuberculosis

([2]ii) Negative test results reported for these conditions will be used for the following purposes as authorized in Utah Health Code Section 26-1-30(2)(c),(d), and (f):

([a]1) To determine when a previously reported case becomes non-infectious;

([b]2) To identify newly acquired infections through identification of a seroconversion window; or

([c]3) To provide information critical for assignment of a case definition.

([3]iii) Information associated with a negative test result will be retained by the Utah Department of Health for a period of 18 months.

([a]1) At the end of the 18 month period, if the result has not been appended to an existing case, personal identifiers will be stripped and expunged from the result.

([b]2) The de-identified result will be added to a de-identified, aggregate dataset which will be retained for use by public health to analyze trends associated with testing patterns and case distribution, enabling identification and establishment of prevention and intervention efforts for at-risk populations, and assessment of trends over time in those populations, as authorized by Utah Health Code 26-1-30(2)(f).

(3) Entities Required to Report Communicable Diseases: Title 26, Chapter 6, Section 6 Utah Code lists those individuals and facilities required to report diseases known or suspected of being communicable.

(a) Physicians, hospitals, health care facilities, home health agencies, health maintenance organizations, and other health care providers shall report details regarding each case.

(b) Schools, child care centers, and citizens shall provide any relevant information.

(c) Laboratories and other testing sites shall report laboratory evidence [confirming]of any of the reportable diseases. Laboratories and other testing sites shall also report any test result[s] that provide s presumptive evidence of infection, which may include positive tests for HIV, syphilis, measles, viral hepatitis, and tuberculosis.[,] This would also include reporting ordered tests for[and]Creutzfeldt-Jakob disease and other [transmissible human spongiform encephalopathies]prion diseases.

(i) Detailed lists of reportable laboratory events, e.g. laboratory tests and results that signify a reportable condition, are found at: https://health.utah.gov/phaccess/public/elr/; click on "Spreadsheet of Reportable Events and Vocabulary" to access this list.

(ii) Events noted within the "Spreadsheet of Reportable Events and Vocabulary" constitute those that are reportable according to this Rule, and as such are considered mandatory for laboratories to report.

(iii) The "Spreadsheet of Reportable Events and Vocabulary" defines, for laboratory reporting purposes, those unusual occurrences of conditions as noted in R386-702-3 (1)([yyy]bbbb) and ([zzz]cccc).

(d) Pharmacists shall report unusual prescriptions or patterns of prescribing as specified in section 26-23b-105.

(4) Immediately Reportable Conditions: Case and suspect case reports of anthrax, botulism (except for infant botulism), cholera, Creutzfeldt-Jakob disease and other suspected prion diseases, diphtheria, Haemophilus influenzae (invasive disease), hepatitis A, measles, meningococcal disease, plague, poliomyelitis, rabies, rubella (excluding congenital syndrome), Severe Acute Respiratory Syndrome (SARS), smallpox, Staphylococcus aureus with resistance (VRSA) or intermediate resistance (VISA) to vancomycin isolated from any site, tuberculosis, tularemia, typhoid, viral hemorrhagic fever, yellow fever, and any condition described in R386-702-3(1)([yyy]bbbb) or ([zzz]cccc) are to be made immediately as provided in R386-702-4(2).

(5) Mandatory Submission of Clinical Material:

(a) Laboratories shall submit clinical material from all cases identified with organisms listed in (5)(c) below to the Utah Department of Health, Utah Public Health Laboratory (UPHL). Clinical material is defined as:

(i) A clinical isolate containing the infectious organism for which submission of material is required, or

(ii) If an isolate is not available, material containing the infectious organism for which submission of material is required, in the following order of preference:

(A) a patient specimen;

(B) nucleic acid; or

(C) other laboratory material.

(b) Laboratories should alert UPHL via telephone during business hours at [phone], or after hours at [phone], of all bioterrorism (BT) agents that are being submitted. BT agents are marked below (as (BT)) with other organisms mandated for submission.

(c) Organisms that are mandated for clinical submission in Utah include:

(i) Bacillus anthracis (BT);

(ii) Brucella species (BT);

(iii) Campylobacter species;

(iv) Clostridium botulinum (BT);

(v) Corynebacterium diphtheriae;

(vi) Shiga toxin-producing Escherichia coli (STEC) (including enrichment and/or MacConkey broths that tested positive by enzyme immunoassay for Shiga toxin);

(vii) Francisella tularensis (BT);

(viii) Haemophilus influenzae, from normally sterile sites;

(ix) Influenza virus (hospitalized cases only);

(x) Legionella species;

(xi) Listeria monocytogenes;

(xii) Measles (rubeola);

(xiii) Mycobacterium tuberculosis complex;

(xiv) Neisseria gonorrhoeae;

(xv) Neisseria meningitidis, from normally sterile sites;

(xvi) Salmonella species;

(xvii) Shigella species;

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

(xix) Vibrio species;

(xx) West Nile virus;

(xxi) Yersinia species (Yersinia pestis, BT); and

(xxii) any organism implicated in an outbreak when instructed by authorized local or state health department personnel.

(6) Full reporting of all relevant patient information related to laboratory-confirmed influenza is authorized and may be required by local or state health department personnel for purposes of public health investigation of a documented threat to public health.

(7) Reports of emergency illnesses, health conditions, and patient encounter information under R386-702-3(2) shall be made as soon as practicable using a process and schedule approved by the Department. Full reporting of all relevant patient information is authorized. The report shall include at least, if known:

(a) name of the facility;

(b) a patient identifier;

(c) date of visit;

(d) time of visit;

(e) patient's age;

(f) patient's sex;

(g) zip code of patient's residence;

(h) chief complaint(s), reason for visit, and/or diagnosis; and

(i) whether the patient was admitted to the hospital.

(8) An entity reporting emergency illnesses, health conditions, and patient encounter information under R386-702-3(2) is authorized to report on other encounters during the same time period that do not meet definition for a reportable emergency illness, health condition, or patient encounter. Submission of an isolate does not replace the requirement to report the case also to the local health department or Bureau of Epidemiology, Utah Department of Health. The report shall include the following information for each such encounter:

(a) facility name;

(b) date of visit;

(c) time of visit;

(d) patient's age;

(e) patient's sex; and

(f) patient's zip code for patient's residence.

(9) Epidemiological Review: The Department or local health department may conduct an investigation, including review of the hospital and health care facility medical records and contacting the individual patient to protect the public's health.

(10) Confidentiality of Reports:

(a) All reports required by this rule are confidential and are not open to public inspection. [Nothing in this rule, however, precludes the discussion of case information with the attending physician or public health workers.] All information collected pursuant to this rule may not be released or made public, except as provided by Section 26-6-27. Penalties for violation of confidentiality are prescribed in Section 26-6-29.

(b) Nothing in this rule precludes the discussion of case information with an attending clinician or public health workers.

(c) Good Samaritans:

(i) The Department or local health department shall disclose communicable disease-related information regarding the person who was assisted to the medical provider of a good Samaritan when that medical provider submits a request to the Department or local health department. The request must include:

(A) information regarding the occurrence of the accident, fire, or other life-threatening emergency,

(B) a description of the exposure risk to the good Samaritan, and

(C) contact information for the good Samaritan and their medical provider.

(ii) Information shall be provided to the medical provider of the good Samaritan only in order to ensure that:

(A) appropriate education and follow-up is provided, and

(B) confidentiality is maintained for the person who was aided.

(iii) No identifying information will be shared regarding the person who was assisted with the good Samaritan or their medical provider. The good Samaritan shall receive written information warning them that information regarding the person who was assisted is protected by state law.

(11) If public health conducts a retrospective surveillance project, such as to assess completeness of case finding or assess another measure of data quality, the department may, at its discretion, waive any penalties for participating facilities, medical providers, laboratories, or other reporters if cases are found that were not originally reported for whatever reason.

 

R386-702-5. General Measures for the Control of Communicable Diseases.

(1) The local health department shall maintain all reportable disease records as needed to enforce Chapter 6 of the Health Code and this rule, or as requested by the Utah Department of Health.

(2) General Control Measures for Reportable Diseases.

(a) The local health department shall, when an unusual or rare disease occurs in any part of the state or when any disease becomes so prevalent as to endanger the state as a whole, contact the Bureau of Epidemiology, Utah Department of Health for assistance, and shall cooperate with the representatives of the Utah Department of Health.

(b) The local health department shall investigate and control the causes of epidemic, infectious, communicable, and other disease affecting the public health. The local health department shall also provide for the detection, reporting, prevention, and control of communicable, infectious, and acute diseases that are dangerous or important or that may affect the public health. The local health department may require physical examination and measures to be performed as necessary to protect the health of others.

(c) If, in the opinion of the local health officer it is necessary or advisable to protect the public's health that any person shall be kept from contact with the public, the local health officer shall establish, maintain and enforce involuntary treatment, isolation and quarantine as provided by Section 26-6-4. Control measures shall be specific to the known or suspected disease agent. Guidance is available from the Bureau of Epidemiology, Utah Department of Health or official reference listed in R386-702-12.

(3) Prevention of the Spread of Disease From a Case.

The local health department shall take action and measures as may be necessary within the provisions of Section 26-6-4; Title 26, Chapter 6b; and this rule, to prevent the spread of any communicable disease, infectious agent, or any other condition which poses a public health hazard. Action shall be initiated upon discovery of a case or upon receipt of notification or report of any disease.

(4) Prevention of the Spread of Disease or Other Public Health Hazard.

A case, suspected case, carrier, contact, other person, or entity (e.g. facility, hotel, organization) shall, upon request of a public health authority, promptly cooperate during:

(a) An investigation of the circumstances or cause of a case, suspected case, outbreak, or suspected outbreak.

(b) The carrying out of measures for prevention, suppression, and control of a public health hazard, including, but not limited to, procedures of restriction, isolation, and quarantine.

(5) Public Food Handlers.

A person known to be infected with a communicable disease that can be transmitted by food or drink products, or who is suspected of being infected with such a disease, may not engage in the commercial handling of food or drink products, or be employed on any premises handling those types of products, unless those products are packaged off-site and remain in a closed container until purchased for consumption, until the person is determined by the local health department to be free of communicable disease, or incapable of transmitting the infection.

(6) Communicable Diseases in Places Where Food or Drink Products are Handled or Processed.

If a case, carrier, or suspected case of a disease that can be conveyed by food or drink products is found at any place where food or drink products are handled or offered for sale, or if a disease is found or suspected to have been transmitted by these food or drink products, the local health department may immediately prohibit the sale, or removal of drink and all other food products from the premises. Sale or distribution of food or drink products from the premises may be resumed when measures have been taken to eliminate the threat to health from the product and its processing as prescribed by R392-100.

(7) Request for State Assistance.

If a local health department finds it is not able to completely comply with this rule, the local health officer or his representative shall request the assistance of the Utah Department of Health. In such circumstances, the local health department shall provide all required information to the Bureau of Epidemiology. If the local health officer fails to comply with the provisions of this rule, the Utah Department of Health shall take action necessary to enforce this rule.

(8) Approved Laboratories.

Laboratory analyses that are necessary to identify the causative agents of reportable diseases or to determine adequacy of treatment of patients with a disease shall be ordered by the physician or other health care provider to be performed in or referred to a laboratory holding a valid certificate under the Clinical Laboratory Improvement Amendments of 1988.

 

R386-702-6. Special Measures for Control of Rabies.

(1) Rationale of Treatment.

A physician must evaluate individually each exposure to possible rabies infection. The physician shall also consult with local or state public health officials if questions arise about the need for rabies prophylaxis.

(2) Management of Biting Animals.

(a) A healthy dog, cat, or ferret that bites a person shall be confined and observed at least daily for ten days from the date of bite, regardless of vaccination status, as specified by local animal control ordinances. It is recommended that rabies vaccine not be administered during the observation period. Such animals shall be evaluated by a veterinarian at the first sign of illness during confinement. A veterinarian or animal control officer shall immediately report any illness in the animal to the local health department. If signs suggestive of rabies develop, a veterinarian or animal control officer shall direct that the animal be euthanized, its head removed, and the head shipped under refrigeration, not frozen, for examination of the brain by a laboratory approved by the Utah Department of Health.

(b) If the dog, cat, or ferret shows no signs of rabies or illness during the ten day period, the veterinarian or animal control officer shall direct that the unvaccinated animal be vaccinated against rabies at the owner's expense before release to the owner. If a veterinarian is not available, the animal may be released, but the owner shall have the animal vaccinated within 72 hours of release. If the dog, cat, or ferret was appropriately vaccinated against rabies before the incident, the animal may be released from confinement after the 10-day observation period with no further restrictions.

(c) Any stray or unwanted dog, cat, or ferret that bites a person may be euthanized immediately by a veterinarian or animal control officer, if permitted by local ordinance, and the head submitted, as described in R386-702-6(2)(a), for rabies examination. If the brain is negative by fluorescent-antibody examination for rabies, one can assume that the saliva contained no virus, and the person bitten need not be treated.

(d) Wild animals include raccoons, skunks, coyotes, foxes, bats, the offspring of wild animals crossbred to domestic dogs and cats, and any carnivorous animal other than a domestic dog, cat, or ferret.

(e) Signs of rabies in wild animals cannot be interpreted reliably. If a wild animal bites or scratches a person, the person or attending medical personnel shall notify an animal control or law enforcement officer. A veterinarian, animal control officer or representative of the Division of Wildlife Resources shall kill the animal at once, without unnecessary damage to the head, and submit the brain, as described in R386-702-6(2)(a), for examination for evidence of rabies. If the brain is negative by fluorescent-antibody examination for rabies, one can assume that the saliva contained no virus, and the person bitten need not be treated.

(f) Rabbits, opossums, squirrels, chipmunks, rats, and mice are rarely infected and their bites rarely, if ever, call for rabies prophylaxis or testing. Unusual exposures to any animal should be reported to the local health department or the Bureau of Epidemiology, Utah Department of Health.

(g) When rare, valuable, captive wild animals maintained in zoological parks approved by the United States Department of Agriculture or research institutions, as defined by Section 26-26-1, bite or scratch a human, the Bureau of Epidemiology, Utah Department of Health shall be notified. The provisions of subsection R386-702-6(2)(e) may be waived by the Bureau of Epidemiology, Utah Department of Health if zoological park operators or research institution managers can demonstrate that the following rabies control measures are established:

(i) Employees who work with the animal have received preexposure rabies immunization.

(ii) The person bitten by the animal voluntarily agrees to accept postexposure rabies immunization provided by the zoological park or research facility.

(iii) The director of the zoological park or research facility shall direct that the biting animal be held in complete quarantine for a minimum of 180 days. Quarantine requires that the animal be prohibited from direct contact with other animals or humans.

(h) Any animal bitten or scratched by a wild, carnivorous animal or a bat that is not available for testing shall be regarded as having been exposed to rabies.

(i) For maximum protection of the public health, unvaccinated dogs, cats, and ferrets bitten or scratched by a confirmed or suspected rabid animal shall be euthanized immediately by a veterinarian or animal control officer. If the owner is unwilling to have the animal euthanized, the local health officer shall order that the animal be held in strict isolation in a municipal or county animal shelter or a veterinary medical facility approved by the local health department, at the owner's expense, for at least six months and vaccinated one month before being released. If any illness suggestive of rabies develops in the animal, the veterinarian or animal control officer shall immediately report the illness to the local health department and the veterinarian or animal control officer shall direct that the animal be euthanized and the head shall be handled as described in subsection R386-702-6(2)(a).

(j) Dogs, cats, and ferrets that are currently vaccinated and are bitten by rabid animals, shall be revaccinated immediately by a veterinarian and confined and observed by the animal's owner for 45 days. If any illness suggestive of rabies develops in the animal, the owner shall report immediately to the local health department and the animal shall be euthanized by a veterinarian or animal control officer and the head shall be handled as described in subsection R386-702-6(2)(a).

(k) Livestock exposed to a rabid animal and currently vaccinated with a vaccine approved by the United States Department of Agriculture for that species shall be revaccinated immediately by a veterinarian and observed by the owner for 45 days. Unvaccinated livestock shall be slaughtered immediately. If the owner is unwilling to have the animal slaughtered, the animal shall be kept under close observation by the owner for six months.

(l) Unvaccinated animals other than dogs, cats, ferrets, and livestock bitten by a confirmed or suspected rabid animal shall be euthanized immediately by a veterinarian or animal control officer.

(3) Testing Fees at Utah Public Health Laboratory (UPHL).

(a) Animals being submitted to UPHL for rabies testing must follow criteria defined in The Compendium of Animal Rabies Prevention and Control to be eligible for testing without a fee. Testing of animals that fit this criteria will be eligible for a waived fee for testing. Testing of animals that do not meet this criteria will incur a testing fee as set forth by UPHL.

(b) The following situations will not incur a rabies testing fee if testing is ordered for them through UPHL:

(i) Any bat in an instance where a person or animal has had an exposure, or reasonable probability of exposure, including, but not limited to: known bat bites, exposure to bat saliva, a bat found in a room with a sleeping person or unattended child, or a bat found near a child or mentally impaired or intoxicated person.

(ii) Dogs, cats, or ferrets, regardless of rabies vaccination status, if signs suggestive of rabies are documented in them.

(iii) Wild mammals and hybrids that expose persons, pets, or livestock (e.g., skunks, foxes, coyotes, and raccoons) may be tested.

(iv) Livestock may be tested if signs suggestive of rabies are documented.

(v) UDOH Bureau of Epidemiology staff are available to discuss additional situations that may warrant testing at (801) 538-6191.

(c) The following situations will incur a $95 testing fee if testing is ordered for them through UPHL:

(i) Any stray with unknown or undocumented vaccination history that exposes a person, if signs suggestive of rabies are not documented, or if the animal has not been confined and observed for at least 10 days.

(ii) Dogs, cats, and ferrets: currently vaccinated animals that expose a person, if signs suggestive of rabies are not documented, or animals have not been confined and observed for at least 10 days.

(iii) Regardless of rabies vaccination status, a healthy dog, cat, or ferret that has not exposed a person.

(iv) Small rodents (e.g., rats, mice, squirrels, chipmunks, voles, or moles) and lagomorphs (rabbits and hares).

(v) Incomplete paperwork accompanying the sample will also result in a fee for testing; a thorough description of the situation must be included with each sample submission.

(vi) UDOH Bureau of Epidemiology staff are available to discuss additional situations that may not warrant testing at [phone].

(d) If the submitting party feels they are charged inappropriately for rabies testing, they may send a letter describing the situation and requesting a waiver for fees to the: Utah Department of Health, Bureau of Epidemiology, P.O. Box 142104, Salt Lake City, UT 84114, attention: Zoonotic Diseases Epidemiologist. Information may be submitted electronically via email to: [e-mail], with a note in the subject line "Attention: Zoonotic Diseases Epidemiologist".

(i) The submitting party has 30 days from receipt of the testing fee invoice to file an appeal. The letter must include copies of the original paperwork that was submitted, and a copy of the invoice received, for a waiver to be considered.

(ii) UDOH and UPHL have 30 days to review information after receipt of an appeal request to make an official decision and notify the submitter.

(iii) UDOH Bureau of Epidemiology staff are available to discuss questions about testing fees and the appeal process at [phone].

([3]4) Measures for Standardized Rabies Control Practices.

(a) Humans requiring either pre- or post-exposure rabies prophylaxis shall be treated in accordance with the recommendations of the U.S. Public Health Service Immunization Practices Advisory Committee, as adopted and incorporated by reference in R386-702-12(2). A copy of the recommendations shall be made available to licensed medical personnel, upon request to the Bureau of Epidemiology, Utah Department of Health.

(b) A physician or other health care provider that administers rabies vaccine shall immediately report all serious systemic neuroparalytic or anaphylactic reactions to rabies vaccine to the Bureau of Epidemiology, Utah Department of Health, using the process described in R386-702-4.

(c) The Compendium of Animal Rabies Prevention and Control, as adopted and incorporated by reference in R386-702-12(3), is the reference document for animal vaccine use.

(d) A county, city, town, or other political subdivision that requires licensure of animals shall also require rabies vaccination as a prerequisite to obtaining a license.

(e) Animal rabies vaccinations are valid only if performed by or under the direction of a licensed veterinarian in accordance with the Compendium of Animal Rabies Prevention and Control.

(f) All agencies and veterinarians administering vaccine shall document each vaccination on the National Association of State Public Health Veterinarians (NASPHV) form number 51, Rabies Vaccination Certificate, which can be obtained from vaccine manufacturers. The agency or veterinarian shall provide a copy of the report to the animal's owner. Computer-generated forms containing the same information are also acceptable.

(g) Animal rabies vaccines may be sold or otherwise provided only to licensed veterinarians or veterinary biologic supply firms. Animal rabies vaccine may be purchased by the Utah Department of Health and the Utah Department of Agriculture.

([4]5) Measures to Prevent or Control Rabies Outbreaks.

(a) The most important single factor in preventing human rabies is the maintenance of high levels of immunity in the pet dog, cat, and ferret populations through vaccination.

(i) All dogs, cats, and ferrets in Utah should be immunized against rabies by a licensed veterinarian; and

(ii) Local governments should establish effective programs to ensure vaccination of all dogs, cats, and ferrets and to remove strays and unwanted animals.

(b) If the Utah Department of Health determines that a rabies outbreak is present in an area of the state, the Utah Department of Health may require that:

(i) all dogs, cats, and ferrets in that area and adjacent areas be vaccinated or revaccinated against rabies as appropriate for each animal's age;

(ii) any such animal be kept under the control of its owner at all times until the Utah Department of Health declares the outbreak to be resolved;

(iii) an owner who does not have an animal vaccinated or revaccinated surrender the animal for confinement and possible destruction; and

(iv) such animals found at-large be confined and possibly destroyed.

 

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: Standard precautions are required during hospitalization. Use contact precautions for diapered or incontinent patients 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 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, child care, and from providing patient care during the period of supervision by the local health department.

(3) Contacts: Administration of typhoid vaccine is recommended for all household members of known typhoid carriers. Household and close contacts of a carrier shall be restricted from food handling, child care, and patient care until two consecutive negative stool specimens, taken at least 24 hours apart, are submitted, or when approval is granted by the local health officer according to local jurisdiction.

(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 Bureau 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, child care, 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 Bureau 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 Bureau 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;

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

(d) the local health officer or his representative determines the carrier no longer presents a risk to public health according to the evaluation of other factors.

 

R386-702-8. Special Measures for the Control of Ophthalmia Neonatorum.

Every physician or midwife practicing obstetrics or midwifery shall, within three hours of the birth of a child, instill or cause to be instilled in each eye of such newborn one percent silver nitrate solution contained in wax ampules, or tetracycline ophthalmic preparations or erythromycin ophthalmic preparations, as these are the only antibiotics of currently proven efficacy in preventing development of ophthalmia neonatorum. The value of irrigation of the eyes with normal saline or distilled water is unknown and not recommended.

 

R386-702-9. Special Measures for the Control of HIV/AIDS.

(1) Authority for this section is established by Title 26, Chapter 6, Sections 3 and 3.5 of the Utah Communicable Disease Control Act. This section establishes requirements for:

(a) General reporting of screening, diagnostic, and treatment test results related to Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS).

(b) Partner identification and notification.

(2) Reporting of HIV and AIDS:

(a) A health care provider who administers or causes to have administered any of the following tests shall report all positive and indeterminate results (preliminary and confirmatory) to the Department or the local health department:

(i) Presence of antibodies to HIV;

(ii) Presence of HIV antigen;

(iii) Isolation of HIV;

(iv) Demonstration of HIV pro-viral DNA;

(v) Demonstration of HIV specific nucleic acids;

(vi) HIV viral load determination;

(vii) Any other test or condition indicative of HIV infection; and

(viii) CD4+ T-Lymphocyte tests, regardless of known HIV status.

(b) A laboratory that analyzes samples for any of the tests listed in R386-702-9(2)(a) shall report all results to the Department or the local health department.

(i) Specific electronic reporting requirements are described in R386-702-4(2)([e]b).

(c) Reports shall include, as available:

(i) First and last name of the patient;

(ii) Patient date of birth;

(iii) Sex;

(iv) Race;

(v) Occupation;

(vi) Patient phone number;

(vii) Patient hospitalization status;

(viii) Name and telephone number of the reporting facility;

(ix) Name and telephone number of the testing laboratory;

(x) Patient home and work address;

(xi) Name, address, and phone number of the requesting health care provider;

(xii) Specimen source;

(xiii) Testing results;

(xiv[ii]) Laboratory's name for, or description of, the test;

(x[i]v) Test reference range; and

(xv i) Test status (e.g. preliminary, final, amended and/or corrected).

(d) Reports may be made via ELR, or in writing, by telephone, or by other electronic means acceptable to the Department as described in R386-702-4(2).

(3) Partner identification and notification: if an individual is tested and found to have an HIV infection, the Department and/or local health department shall provide partner services, linkage-to-care activities, and promote retention to HIV care.

(a) Definitions:

(i) "Partner" is defined as any individual, including a spouse, who has shared needles, syringes, or drug paraphernalia or who has had sexual contact with an HIV infected individual.

(ii) "Spouse" is defined as any individual who is the marriage partner of that person at any time within the ten-year period prior to the diagnosis of HIV infection.

(iii) "Linkage to care" is defined by a reported CD4+ T-Lymphocyte test and/or HIV viral load determination within three months of HIV positive diagnosis.

(iv) "Retention to care" is defined by a reported CD4+ T-Lymphocyte test or HIV viral load determination twice within a 12-month period and at least three months apart.

(b) Partner services include:

(i) Confidential partner notification within 30 days of receiving a positive HIV result;

(ii) Prevention counseling;

(iii) Testing for HIV;

(iv) Providing recommendations for testing for other sexually transmitted diseases;

(v) Providing recommendations for hepatitis screening and vaccination;

(iv) Treatment or linkage to medical care within three months of HIV diagnosis; and

(v) Linkage or referral to other prevention services and support.

(4) A university or hospital that conducts research studies exempt from reporting AIDS and HIV infection under Section 26-6-3.5 shall submit the following to the Department:

(a) A summary of the research protocol including funding sources and justification for requiring anonymity;

(b) Written approval of the Utah Department of Health institutional review board; and

(c) A final report indicating the number of HIV positive and HIV negative individuals enrolled in the study.

 

R386-702-10. Special Measures to Prevent Perinatal and Person-to-Person Transmission of Hepatitis B Infection.

(1) A licensed healthcare provider who provides prenatal care shall routinely test each pregnant woman for hepatitis B surface antigen (HBsAg) at an early prenatal care visit. The provisions of this section do not apply if the pregnant woman, after being informed of the possible consequences, objects to the test on the basis of religious or personal beliefs.

(2) The licensed healthcare provider who provides prenatal care should repeat the HBsAg test during late pregnancy for those women who tested negative for HBsAg during early pregnancy, but who are at high risk based on:

(a) evidence of clinical hepatitis during pregnancy;

(b) injection drug use;

(c) occurrence during pregnancy or a history of a sexually transmitted disease;

(d) occurrence of hepatitis B in a household or close family contact; or

(e) the judgment of the healthcare provider.

(3) In addition to other reporting required by this rule, each positive HBsAg result detected in a pregnant woman shall be reported to the local health department or the Utah Department of Health, as specified in Section 26-6-6. That report shall indicate that the woman was pregnant at time of testing if that information is available to the reporting entity.

(4) A licensed healthcare provider who provides prenatal care shall document a woman's HBsAg test results, or the basis of the objection to the test, in the medical record for that patient.

(5) Every hospital and birthing facility shall develop a policy to assure that:

(a) when a pregnant woman is admitted for delivery, or for monitoring of pregnancy status, the result from a test for HBsAg performed on that woman during that pregnancy is available for review and documented in the hospital record;

(b) when a pregnant woman is admitted for delivery, if the woman's test result is not available to the hospital or birthing facility, the mother is tested for HBsAg as soon as possible, but before discharge from the hospital or birthing facility;

(c) if a pregnant woman who has not had prenatal care during that pregnancy is admitted for monitoring of pregnancy status only, and if the woman's test result is not available to the hospital or birthing facility, the mother is tested for HBsAg status before discharge from the hospital or birthing facility;

(d) positive HBsAg results identified by testing performed or documented during the hospital stay are reported as specified in this rule;

(e) infants born to HBsAg positive mothers receive hepatitis B immune globulin (HBIG) and hepatitis B vaccine, administered at separate injection sites, within 12 hours of birth;

(f) infants born to mothers whose HBsAg status is unknown receive hepatitis B vaccine within 12 hours of birth, and if the infant is born preterm with birth weight less than 2,000 grams, that infant also receives HBIG within 12 hours; and

(g) if at the time of birth the mother's HBsAg status is unknown and the HBsAg test result is later determined to be positive, that infant receives HBIG as soon as possible but within 7 days of birth.

(h) hepatitis B immune globulin (HBIG) administration and birth dose hepatitis B vaccine status of infants born to mothers who are HBsAg-positive, or whose status is unknown, are reported within 24 hours of delivery to the local health department and Utah Department of Health Immunization Program at [phone].

(6) Local health departments shall perform the following activities or assure that they are performed:

(a) All females between the ages of 12 and 50 years at the time an HBsAg positive test result is reported will be screened for pregnancy status within one week of receipt of that lab result.

(b) Infants born to HBsAg positive mothers complete the hepatitis B vaccine series as specified in in the most current version of "The Red Book" as cited in R386-702-13 (4).

(c) Children born to HBsAg positive mothers are tested for HBsAg and antibody against hepatitis B surface antigen (anti-HBs) at 9 to 18 months of age (testing is done at least one month after the final dose of hepatitis B vaccine series is administered, and no earlier than 9 months of age) to monitor the success of therapy and identify cases of perinatal hepatitis B infection.

(i) Children who test negative for HBsAg and do not demonstrate serological evidence of immunity against hepatitis B when tested as described in (c) receive additional vaccine doses and are retested as specified in the most current version of "The Red Book" as cited in R386-702-13 (4).

(d) HBsAg positive mothers are advised regarding how to reduce their risk of transmitting hepatitis B to others.

(e) Household members and sex partners of HBsAg positive mothers are evaluated to determine susceptibility to hepatitis B infection and if determined to be susceptible, are offered or advised to obtain vaccination against hepatitis B.

(f) All identified acute hepatitis B cases shall be investigated by the local health department, and identified household and sexual contacts shall be advised to obtain vaccination against hepatitis B.

(7) The provisions of subsections (5) and (6) do not apply if the pregnant woman or the child's guardian, after being informed of the possible consequences, objects to any of the required procedures on the basis of religious or moral beliefs. The hospital or birthing facility shall document the basis of the objection.

(8) Prevention of transmission by individuals with chronic hepatitis B infection.

(i) HBsAg positive, and total antibody against hepatitis B core antigen (anti-HBc) positive (if done) and IgM anti-HBc negative; or

(a) An individual with chronic hepatitis B infection should be advised regarding how to reduce the risk that the individual will transmit hepatitis B to others.

(b) Household members and sex partners of individuals with chronic hepatitis B infection should be evaluated to determine susceptibility to hepatitis B infection, and if determined to be susceptible, should be offered or advised to obtain vaccination against Hepatitis B.

 

R386-702-11. Public Health Emergency.

(1) Declaration of Emergency: With the Governor's and Executive Director's or in the absence of the Executive Director, his designee's, concurrence, the Department or a local health department may declare a public health emergency by issuing an order mandating reporting emergency illnesses or health conditions specified in sections R386-702-3 for a reasonable time.

(2) For purposes of an order issued under this section and for the duration of the public health emergency, the following definitions apply.

(a) "emergency center" means:

(i) a health care facility licensed under the provisions of Title 26, Chapter 21, Utah Code, that operates an emergency department; or

(ii) a clinic that provides emergency or urgent health care to an average of 20 or more persons daily.

(b) "encounter" means an instance of an individual presenting at the emergency center who satisfies the criteria in section R386-702-3(2); and

(c) "diagnostic information" means an emergency center's records of individuals who present for emergency or urgent treatment, including the reason for the visit, chief complaint, results of diagnostic tests, presenting diagnosis, and final diagnosis, including diagnostic codes.

(3) Reporting Encounters: The Department shall designate the fewest number of emergency centers as is practicable to obtain the necessary data to respond to the emergency.

(a) Designated emergency centers shall report using the process described in R386-702-4.

(b) An emergency center designated by the Department shall report the encounters to the Department by:

(i) allowing Department representatives or agents, including local health department representatives, to review its diagnostic information to identify encounters during the previous day; or

(ii) reviewing its diagnostic information on encounters during the previous day and reporting all encounters by 9:00 a.m. the following day, or

(iii) identifying encounters and submitting that information electronically to the Department, using a computerized analysis method, and reporting mechanism and schedule approved by the Department; or

(iv) by other arrangement approved by the Department.

(4) For purposes of epidemiological and statistical analysis, the emergency center shall report on encounters during the public health emergency that do not meet the definition for a reportable emergency illness or health condition. The report shall be made using the process described in R386-702-4[(6)] and shall include the following information for each such encounter:

(a) facility name;

(b) date of visit;

(c) time of visit;

(d) patient's age;

(e) patient's sex;

(f) patient's zip code for patient's residence.

(5) If either the Department or a local health department collects identifying health information on an individual who is the subject of a report made mandatory under this section, it shall destroy that identifying information upon the earlier of its determination that the information is no longer necessary to carry out an investigation under this section or 180 days after the information was collected. However, the Department and local health departments shall retain identifiable information gathered under other sections of this rule or other legal authority.

(6) Reporting on encounters during the public health emergency does not relieve a reporting entity of its responsibility to report under other sections of this rule or other legal authority.

 

R386-702-12. Penalties.

Any person who violates any provision of R386-702 may be assessed a penalty as provided in Section 26-23-6.

 

R386-702-13. Official References.

All treatment and management of individuals and animals who have or are suspected of having a communicable or infectious disease that must be reported pursuant to this rule shall comply with the following documents, which are adopted and incorporated by reference:

(1) American Public Health Association. "Control of Communicable Diseases Manual". [19]20th ed., Heymann, David L., editor, 20[08]15.

(2) Centers for Disease Control and Prevention. "Human Rabies Prevention---United States, 2008: Recommendations of the Advisory Committee on Immunization Practices." Morbidity and Mortality Weekly Report. 57 (RR03) (2008):1-26, 28.

(3) National Association of State Public Health Veterinarians Committee. "Compendium of Animal Rabies Prevention and Control, 2011." Nasphv.org. National Association of State Public Health Veterinarians, 31 May 2011. Web. http://nasphv.org/Documents/RabiesCompendium.pdf

(4) American Academy of Pediatrics. "Red Book: 2012 Report of the Committee on Infectious Diseases" [29]30th Edition. Elk Grove Village, IL, American Academy of Pediatrics; 201[2]5.

(5) National Association of State Public Health Veterinarians Animal Contact Compendium Committee 2013. "Compendium of Measures to Prevent Disease Associated with Animals in Public Settings, 2013." Journal of the American Veterinary Medicine Association 243 (2013): 1270-288.

 

KEY: communicable diseases, quarantines , rabies, rules and procedures

Date of Enactment or Last Substantive Amendment: [December 15, 2014]2016

Notice of Continuation: October 12, 2011

Authorizing, and Implemented or Interpreted Law: 26-1-30; 26-6-3; 26-23b

 

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