No. 27024 (Amendment): R386-702. Communicable Disease Rule

DAR File No.: 27024
Filed: 04/01/2004, 08:41
Received by: NL

 

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rulemaking updates the list of diseases to incorporate new additions to the nationally notifiable disease list, addresses recently emerging or re-emerging diseases (to clarify timing of reporting), updates guidelines on control of rabies, and implements the Detection of Public Health Emergencies Act, Utah Code, Title 26, Chapter 23b.

 

Summary of the rule or change:

This rulemaking adds new diseases to list of reportable diseases (e.g., smallpox, monkeypox, West Nile virus); specifies a time (less than 24 hours) for immediate reporting, changes the required time of reporting from 7 to 3 days for other diseases, changes chickenpox reporting from summary numbers to individual case reports, clarifies rabies control measures, and implements the Detection of Public Health Emergencies Act, Utah Code, Title 26, Chapter 23b.

 

State statutory or constitutional authorization for this rule:

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

 

This rule or change incorporates by reference the following material:

American Public Health Association, "Control of Communicable Diseases Manual", 17th ed., 2000; The National Association of State Public Health Veterinarians, Inc., "Compendium of Animal Rabies Prevention and Control, 2004, Part II"; and American Academy of Pediatrics, "Red Book: 2003 Report of the Committee on Infectious Diseases" 26th edition, 2003

 

Anticipated cost or savings to:

the state budget:

The reporting of additional diseases under these amendments can be handled under existing communicable disease programs in the Department of Health. No additional costs are anticipated.

 

local governments:

The reporting of additional diseases under these amendments can be handled under existing communicable disease programs in the local health departments. No additional costs are anticipated for local health departments. Local governments that operate hospitals and clinics may experience intermittent increases in reporting, depending on where disease outbreaks occur. These costs will be transient and minimal but are not easily quantified.

 

other persons:

Hospitals, clinics, and other entities required to report under the rule may experience intermittent increases in reporting, depending on where disease outbreaks occur. These costs will be transient and minimal but are not easily quantified.

 

Compliance costs for affected persons:

Compliance costs for an entity required to report under the rule will be intermittent, depending on where disease outbreaks occur. These costs will be transient and minimal but are not easily quantified.

 

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

There may be some cost for reporting entities when reporting possible disease outbreaks. However, the costs will be intermittent and isolated to specific geographic areas. This reporting is essential to protect the public health and is particularly important to identify and respond to possible bioterrorism events. Scott D. Williams, 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
Epidemiology and Laboratory Services, Epidemiology
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY UT 84116-3231

 

Direct questions regarding this rule to:

Robert Rolfs at the above address, by phone at 801-538-6386, by FAX at 801-538-6694, 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:

05/17/2004

 

This rule may become effective on:

05/18/2004

 

Authorized by:

Scott D. Williams, Executive Director

 

 

RULE TEXT

R386. Health, Community Health Services, 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, [and ]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 [prevalence]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) [Communicable disease epidemiology serves as an ideal model for preventive medicine. E]The successes of medicine and public health dramatically reduced the risk of epidemics [are rare ]and early loss of life due to infectious agents [has been dramatically reduced]during the twentieth century. However, the recent emergence of new diseases, such as Human Immunodeficiency Virus, Hantavirus, and Severe Acute Respiratory Syndrome, and the rapid spread of diseases 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[ will] 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:

(a) "Outbreak" means an epidemic limited to a localized increase in incidence of disease.

(b) "Case" means a person identified as having a disease, health disorder, or condition that is 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.

 

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

(1) The Utah Department of Health declares the following [diseases]conditions to be of concern to the public health and reportable as required or authorized by Section 26-6-6 and Title 26, Chapter 23b of the Utah Health Code.[ Each confirmed or suspected case shall be reported to the Bureau of Epidemiology, Utah Department of Health or to the local health department. Upon receipt of a report, the local health department shall forward a written or electronic copy of the report to the Bureau of Epidemiology, Utah Department of Health.]

(a) Acquired Immunodeficiency Syndrome

(b) Adverse event resulting after smallpox vaccination

(c) Amebiasis

([c]d) Anthrax

(e) Arbovirus infection

([d]f) Botulism

([e]g) Brucellosis

([f]h) Campylobacteriosis

([g]i) Chancroid

([h]j) Chickenpox

([i]k) Chlamydia trachomatis infection

([j]l) Cholera

([k]m) Coccidioidomycosis

([l]n) Colorado tick fever

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

([n]p) Cryptosporidiosis

([o]q) Cyclospora infection

(r) Dengue fever

([p]s) Diphtheria

([q]t) Echinococcosis

([r]u) Ehrlichiosis, human granulocytic,[ and] human monocytic, or unspecified

([s]v) Encephalitis[: primary, post-infectious, arthropod-borne and unspecified]

([t]w) Enterococcal infection, vancomycin-resistant

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

([v]y) Giardiasis

([w]z) Gonorrhea: sexually transmitted and ophthalmia neonatorum

([x]aa) Haemophilus influenzae, invasive disease

([y]bb) Hansen Disease (Leprosy)

([z]cc) Hantavirus infection[s] and pulmonary syndrome

([aa]dd) Hemolytic Uremic Syndrome, postdiarrheal

([bb]ee) Hepatitis A

([cc]ff) Hepatitis B, cases and carriers

(gg) Hepatitis C, acute and chronic infection

([dd]hh) Hepatitis, other viral[: type C, and non-A non-B]

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

([ff]jj) Influenza, laboratory confirmed

([gg]kk) Kawasaki syndrome

([hh]ll) Legionellosis

([ii]mm) Listeriosis

([jj]nn) Lyme Disease

([kk]oo) Malaria

([ll]pp) Measles

([mm]qq) Meningitis, aseptic and bacterial (specify etiology)

([nn]rr) Meningococcal Disease, invasive

([oo]ss) Mumps

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

([pp]uu) Pelvic Inflammatory Disease

([qq]vv) Pertussis

([rr]ww) Plague

([ss]xx) Poliomyelitis, paralytic

([tt]yy) Psittacosis

([uu]zz) Q Fever

([vv]aaa) Rabies, human and animal

([ww]bbb) Relapsing fever, tick-borne and louse-borne

([xx]ccc) Reye syndrome

([yy]ddd) Rheumatic fever

([zz]eee) Rocky Mountain spotted fever

([aaa]fff) Rubella

([bbb]ggg) Rubella, congenital syndrome

(hhh) Saint Louis encephalitis

([ccc]iii) Salmonellosis

(jjj) Severe Acute Respiratory Syndrome (SARS)

([ddd]kkk) Shigellosis

(lll) Smallpox

([eee]mmm) Staphylococcal diseases, all outbreaks[ and]

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

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

([fff]ppp) Streptococcal [D]disease, invasive,[ Group A,] isolated from a normally sterile site[

(ggg) Streptococcal Toxic-Shock Syndrome]

([hhh]qqq) Streptococcus pneumoniae, drug-resistant[ invasive disease], isolated from a normally sterile site

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

([jjj]sss) Tetanus

([kkk]ttt) Toxic-Shock Syndrome, staphyloccal or streptococcal

([lll]uuu) Trichinosis

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

([nnn]www) Tularemia

([ooo]xxx) Typhoid, cases and carriers

(yyy) Viral hemorrhagic fever

(zzz) West Nile virus infection

([ppp]aaaa) Yellow fever[

(qqq) Severe Acute Respiratory Syndrome (SARS)]

([rrr]bbbb) Any outbreak or epidemic, including suspected or confirmed outbreaks of foodborne or waterborne disease. Any [sudden or extraordinary]unusual occurrence of infectious or communicable disease or any unusual or increased occurrence of any illness that may indicate an outbreak, epidemic, Bioterrorism event, or public health hazard, including any newly recognized, emergent or re-emergent disease or disease producing agent, including newly identified multi-drug resistant bacteria[ is also reportable. Any disease occurrence, pattern of cases, suspect cases, or increased incidence of any illness which may indicate an outbreak, epidemic or related public health hazard, including but not limited to suspected or confirmed outbreaks of foodborne or waterborne disease, newly recognized or re-emergent diseases or disease producing agents, shall be reported immediately by telephone to the Bureau of Epidemiology, Utah Department of Health, 801-538-6191].

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

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

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

(c) influenza-like constitutional symptoms and signs;

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

(e) rash illness;

(f) hemorrhagic illness;

(g) botulism-like syndrome;

(h) lymphadenitis;

(i) sepsis or unexplained shock;

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

(k) nontraumatic coma or sudden death; and

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

 

R386-702-[3]4. Reporting.

(1) [Case Report:]Each reporting entity shall report each confirmed case and any case 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-(1)(bbbb) to the local health department or to the Office of Epidemiology, Utah Department of Health. Unless otherwise specified, the report of these diseases to the local health department or to the [Bureau]Office 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 [sources]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 Office of Epidemiology, Utah Department of Health.

(2) [Immediate Reports: Any outbreak or suspected outbreak shall be reported immediately by telephone. Cases and suspect cases of anthrax, botulism, cholera, diphtheria, measles, meningococcal disease, mumps, pertussis, plague, poliomyelitis, rabies, relapsing fever, rubella, tetanus, tuberculosis, typhoid, yellow fever, and Severe Acute Respiratory Syndrome (SARS) are to be made by telephone to the Bureau of Epidemiology, Utah Department of Health, 801-538-6191, or the local health department.]Where immediate reporting is required, 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 Office of Epidemiology, Utah Department of Health at 801-538-6191 or 888-EPI-UTAH (888-374-8824). All diseases not required to be reported immediately or by number of cases shall be reported within three working days from the time of identification. Reporting entities shall send reports to the local health department or the Office of Epidemiology, 288 North 1460 West, P. O. Box 142104, Salt Lake City, Utah 84114-2104.

(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 day care centers, and citizens shall provide any relevant information.

(c) Laboratories and other testing sites shall report laboratory evidence confirming any of the reportable diseases. Laboratories and other testing sites shall also report any test results that provide presumptive evidence of infection such as positive tests for syphilis, measles, and viral hepatitis.

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

(3) Case Notification:Chickenpox, influenza, Staphylococcus aureus with resistance to methicillin and vancomycin resistant enterococcus are to be reported by number of cases only. These reports shall be made monthly.]

(4) Immediately Reportable Conditions: Cases and suspect cases of anthrax, botulism, cholera, diphtheria, Haemophilus influenzae (invasive disease), measles, meningococcal disease, pertussis, plague, poliomyelitis, rabies, rubella, Severe Acute Respiratory Syndrome (SARS), smallpox, syphilis (primary or secondary stage), tuberculosis, tularemia, typhoid, viral hemorrhagic fever, yellow fever, and any condition described in R386-702-3(1)(bbbb) are to be made immediately as provided in R386-702-4(2).

(5) Staphylococcus aureus (MRSA) and vancomycin resistant enterococcus (VRE) shall be reported monthly by number of cases. Full reporting of all relevant patient information related to MRSA and VRE cases 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.

(6) Reports of emergency illnesses or health conditions under R386-702-3(2) shall be made as soon as practicable using a process and schedule approved by the Department. The report shall include at least, if known, the name of the facility, a patient identifier, the date and time of visit, the patient's age and sex, the zip code of the patient's residence, the reportable condition suspected and whether the patient was admitted to the hospital. Full reporting of all relevant patient information is authorized.

(7) An entity reporting emergency illnesses or health conditions 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 or health condition. 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;

(8) Mandatory Submission of Isolates: Laboratories shall submit all isolates of the following organisms to the Utah Department of Health, public health laboratory:

(a) Bacillus anthracis;

(b) Bordetella pertussis;

(c) Brucella species;

(d) Campylobacter species;

([d]e) Clostridium botulinum;

([e]f) Cornybacterium diphtheriae;

([f]g) Enterococcus, vancomycin-resistant;

([g]h) Escherichia coli, enterohemorrhagic;

([h]i) Francisella tularensis;

([i]j) Haemophilus influenzae, from normally sterile sites;

([j]k) Influenza, types A and B;

([k]l) Legionella species;

([l]m) Listeria monocytogenes;

([m]n) Mycobacterium tuberculosis complex;

([n]o) Neisseria gonorrhoeae;

([o]p) Neisseria meningitidis, from normally sterile sites;

([p]q) Salmonella species;

([q]r) Shigella species;

([r]s) Staphylococcus aureus with resistance or intermediate resistance to vancomycin isolated from any site;

([s]t) Vibrio cholera;

([t]u) Yersinia species; and

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

Submission of an isolate does not replace the requirement to report the case also to the local health department or Office of Epidemiology, Utah Department of Health.

[(5) Occurrence of Unusual Diseases: Any unusual disease of public health importance, including newly identified multi-drug resistant bacteria, and any outbreak or undue prevalence of a disease, whether or not listed as reportable, shall also be promptly reported by telephone to the local health department or the Bureau of Epidemiology, Utah Department of Health.

(6) Timing of Reports: All diseases not required to be reported by telephone or by number of cases shall be reported within seven calendar days from the time of identification. Reports are to be sent to the local health department or the Bureau of Epidemiology, 288 North 1460 West, P. O. Box 142104, Salt Lake City, Utah 84114-2104.

(7) Individuals Required to Report Communicable Diseases: Section 26-6-6 lists those individuals and facilities required to report diseases known or suspected of being communicable. Physicians, hospitals, health care facilities, home health agencies, health maintenance organizations, and other health care providers shall report details regarding each case. Schools, child day care centers, and citizens shall provide any relevant information. Laboratories and other testing sites shall report laboratory evidence confirming any of the reportable diseases. Laboratories and other testing sites shall also report any test results which provide presumptive evidence of infection such as positive tests for syphilis, measles, and viral hepatitis.

(8) ](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: 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.

 

R386-702-[4]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]Office 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 [which]that are dangerous or important or [which]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]Office of Epidemiology, Utah Department of Health or official reference listed in R386-702-[9(1)(a)]11.

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

[(a) ]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) Public Food Handlers.

[(a) ]A person known to be infected with a communicable disease that can be transmitted by food, water, or milk, or who is suspected of being infected with such a disease may not engage in the commercial handling of food, water, or other drink or be employed in a dairy or on any premises handling milk or milk products, until he is determined by the local health department to be free of communicable disease, or incapable of transmitting the infection.

(5) Communicable Diseases in Places Where Milk or Food Products are Handled or Processed.

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

(6) Request for State Assistance.

[(a) ]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]Office 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.

(7) Approved Laboratories.

[(a) ]Laboratory analyses which 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-[5]6. Special Measures for Control of Rabies.

(1) Rationale of Treatment.

[(a) ]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 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-[5]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 [other] 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 personn[a]el 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-[5]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 [and]or testing. Unusual exposures to any animal should be reported to the local health department or the [Bureau]Office 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]Office of Epidemiology, Utah Department of Health shall be notified. The provisions of subsection R386-702-[5]6(2)(e) may be waived by the [Bureau]Office 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 [veterianian]veterinarian or animal control officer shall direct that the animal be euthanized and the head shall be handled as described in subsection R386-702-[5]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-[5]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) 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-[9(b)]11(2). A copy of the recommendations shall be made available to licensed medical personnel, upon request to the [Bureau]Office of Epidemiology, Utah Department of Health.

([i]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]Office of Epidemiology, Utah Department of Health, [801-538-6191]using the process described in R386-702-4.

([b]c) The Compendium of Animal Rabies Prevention and Control, [1999, Part II,]as adopted and incorporated by reference in R386-702-11(3), is the reference document for animal vaccine use.

([c]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.

([d]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.

([e]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.

([f]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) 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 [finds]determines that a rabies outbreak is present in an area of the state[ and a quarantine is declared], the Utah Department of Health may require that:

(i) all dogs, cats, and ferrets in that area and adjacent areas be vaccinated [at three months of]or revaccinated against rabies as appropriate for each animal's age;[. Unvaccinated animals are subject to confinement and possible destruction.]

(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-[6]7. Special Measures for Control of Typhoid.

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

(2) Cases: Enteric precautions are required during hospitalization. Hospital care is desirable during acute illness. Release of the patient from supervision by the local health department shall be based on not less that three negative cultures of feces[,] and of urine in patients with schistosomiasis, taken [at least 24 hours apart and at least 48 hours after any antibiotic, and not earlier than one month after onset]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. The patient shall be restricted from food handling and from providing patient care during the period of supervision by the local health department.

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

(4) Carriers: If a laboratory or physician identifies a carrier of typhoid, the attending physician shall immediately report the details of the case [shall be reported by the attending physician ]by telephone to the local health department or the [Bureau]Office of Epidemiology, Utah Department of Health[, 801-538-6191,] using the process described in R386-702-4.[and e] Each infected individual shall submit to the supervision of the local health department. Carriers are prohibited from food handling and patient care until released in accordance with R386-702-[6-]7(4)(a) or R386-702-[6]7(4)(b). All reports and orders of supervision shall be kept confidential and [shall]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-[6]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 bacilliis 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]Office of Epidemiology, Utah Department of Health. If the person continues to excrete typhoid bacilli for more than 12 months, he is a chronic carrier and may be released after satisfying the criteria for chronic carriers in R386-702-[6]7(6).

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

(a) Require the necessary laboratory tests for release;

(b) Issue written instructions to the carrier;

(c) Supervise the carrier.

(6) Requirements for Release of Convalescent and Chronic Carriers: [A convalescent or chronic carrier may be released from supervision and occupational and food handling restrictions by the local health officer or his representative. ]The local health officer or his representative may [grant] 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, [T]three consecutive negative cultures [of feces , and urine in patients with schistosomiasis, are obtained from fecal specimens taken at least one month apart and at least 48 hours after antibiotic therapy has stopped. The attending physician, hospital personnel, laboratory personnel, or local health department staff shall authenticate that the fecal specimens come from the known carrier. ]obtained from fecal specimens authenticated by the attending physician, hospital personnel, laboratory personnel, or local health department staff taken at least one month apart and at least 48 hours after antibiotic therapy has stopped;

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

([b) In the judgment of]c) the local health officer or his representative[,] determine that additional treatment such as cholecystectomy or nephrectomy has terminated the carrier state.

 

R386-702-[7]8. Special Measures for the Control of Ophthalmia Neonatorum.

[(1) ]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. 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 702-9(3)(b) 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.

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-[8]10. Penalties.

[(1) ]Any person who violates any provision of R386-702 may be assessed a penalty not to exceed the sum of $5,000 or be punished for violation of a class B misdemeanor for the first violation and for any subsequent similar violation within two years for violation of a class A misdemeanor as provided in Section 26-23-6.

 

R386-702-[9]11. Official References.

[(1) ]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:

([a]1) American Public Health Association. "Control of Communicable Diseases Manual". 1[6]7th ed., [Abram S. Benenson, editor, 1995]Chin, James, editor, 2000.

([b]2) Centers for Disease Control and Prevention. Recommendation of the Immunization Practices Advisory Committee (ACIP): Human rabies Prevention - United States, 1999. "Morbidity and Mortality Weekly Report." 1999; 48: RR-1, 1-21.

([c]3) The National Association of State Public Health Veterinarians, Inc.[], "Compendium of Animal Rabies Prevention and Control, [1999]2004, Part II."

(4) American Academy of Pediatrics. "Red Book: 2003 Report of the Committee on Infectious Diseases" 26th Edition. Elk Grove Village, IL, American Academy of Pediatrics; 2003.

 

KEY: communicable diseases, rules and procedures

[August 22, 2003]2004

Notice of Continuation August 20, 2002

26-1-30

26-6-3

26-23b