DAR File No. 37345
This rule was published in the March 1, 2013, issue (Vol. 2013, No. 5) of the Utah State Bulletin.
Health, Disease Control and Prevention, Epidemiology
Communicable Disease Rule
Notice of Proposed Rule
DAR File No.: 37345
Filed: 02/15/2013 11:38:57 AM
Purpose of the rule or reason for the change:
The purpose of this amendment is to add three rare, but important, multi-drug resistant organisms (MDROs) to the list of reportable conditions in order to facilitate surveillance and detection within the healthcare setting. Detection and response in the healthcare setting provides an important opportunity to minimize spread into the community setting. Addition of these organisms has been requested by key representatives within the Infection Control community, and has been agreed on in discussions with the Utah Healthcare Infection Prevention (UHIP) Steering Committee and Healthcare Associated Infections Workgroup (HAIWG). In addition, three references are updated to include the most recent editions.
Summary of the rule or change:
The following three MDROs are proposed to be added to the list of reportable conditions: 1) Acinetobacter species with resistance or intermediate resistance to carbapenem (meropenem and imipenem) from any site; 2) Escherichia coli with resistance or intermediate resistance to carbapenem (meropenem, ertapenem, and imipenem) from any site; and 3) Klebsiella species with resistance or intermediate resistance to carbapenem (meropenem, ertapenem, and imipenem) from any site. In addition, three references are updated to include the most recent editions.
State statutory or constitutional authorization for this rule:
- Section 26-1-30
- Section 26-6-3
- Title 26, Chapter 23b
Anticipated cost or savings to:
the state budget:
There is anticipated to be a one-time cost for the state associated with personnel working with local health departments (LHDs), laboratories, and healthcare facilities to establish and implement surveillance and investigation procedures for these organisms. There is currently a federal grant in place that supports personnel who will work on this effort, so the state budget should not be impacted. It is anticipated that it will take approximately 0.25 FTE six months to achieve this initial implementation. In terms of volume of reports for ongoing costs, based on current de-identified surveillance data, it is expected that approximately two cases per week will be reported statewide, demonstrating these will be rare. It is estimated that it will take approximately 30 minutes per case in Utah Department of Health (UDOH) personnel time to investigate each case in collaboration with facilities and LHDs (approximately $2,000/year in personnel for UDOH).
There are anticipated to be some costs associated with establishing and implementing surveillance and investigation procedures collaboratively with UDOH, laboratories, and healthcare facility staff; the majority of work in developing procedures is expected to be completed by UDOH with input from LHDs, especially the Salt Lake Valley Health Department (SLVHD), since it is anticipated they will find the majority of cases within their jurisdiction. Costs for implementation should be minimal for LHDs (less than one hour/week for six months). For ongoing costs, it is estimated that approximately 60% of cases will occur in Salt Lake County hospitals; the remaining 40% will be dispersed throughout the rest of the state. Costs for SLVHD are estimated to be approximately 30 minutes per case to investigate and manage a case with UDOH and involved facilities. Assuming approximately 60 cases per year, for an investigator pay rate of $25/hour plus benefits, this would cost SLVHD approximately $1,160 per year to support investigation of these additional organisms. Because these cases are expected to be rare, impact to other LHDs in detecting and investigating cases are anticipated to be minimal. UDOH staff will be available to support these case investigations as needed.
While it is expected that these cases will be rare, if a case is identified in a small healthcare facility, it may incur a cost at the facility to assist with the investigation and response. UDOH staff will be available to support this work and any case investigations as needed. It is estimated that each case will require approximately 45 minutes for a facility to investigate; at a pay rate of $35/hour plus benefits, this equates to about $41 per case. Small facilities are not expected to have more than one case per year, therefore costs should be minimal for small facilities.
persons other than small businesses, businesses, or local governmental entities:
It is expected that there will be costs associated with identification and reporting of these cases by laboratories, and with investigation and management of these cases by healthcare facilities. Because it is anticipated only about two cases per week will be identified statewide, costs should be minimal. Laboratories already conduct testing for these organisms as ordered by physicians, so there will not be costs associated with implementation of testing for them. Reporting of results with patient information to public health will be a new activity, and estimates for costs will vary depending on the laboratory (e.g., some laboratories use computer programming to automate reporting, while others may require manual review/reporting). A general estimate for laboratory reporting taking these factors into account is 15 minutes per case. Assuming two cases per week, this equates to approximately two man-hours per month, or approximately $100 per month (at a pay rate of $30/hour plus benefits), or $1,200 per year in total for laboratories. It is estimated that each case will require approximately 45 minutes for a facility to investigate; at a pay rate of $35/hour plus benefits, this equates to about $41 per case. It is estimated that large facilities will account for about 90% of cases, or approximately 94 cases per year assuming two cases occur each week statewide; large facilities in total may expect to incur approximately $3,850 in personnel costs to investigate cases of these organisms. It is anticipated that there will be significant savings to individuals, the community at large, and healthcare facilities if these organisms are detected and managed quickly and effectively in the healthcare setting. Prevention of spread from the healthcare to the community setting represents an opportunity to save individuals from morbidity and mortality associated with these organisms (they are associated with high mortality rates - up to 40% in some studies). Prevention of spread also represents an opportunity to save healthcare facility resources, since these organisms are extremely resistant to antibiotics, presenting significant challenges for treatment in a clinical setting. If incidence is minimized in the healthcare setting, this translates into significant savings to individuals, the community, and healthcare facilities over time. Though it is not possible to accurately predict a number for these savings, studies suggest that treating patients with an MDRO costs approximately $20,000 - $30,000 more than treating patients without an MDRO in the hospital setting; therefore, preventing infections from occurring is an important cost-saving approach for these organisms.
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:
The impact on business should be minimal. Reporting should aid in control of these diseases in the facilities should result in improved health outcomes.
David Patton, PhD, 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 firstname.lastname@example.org
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:
This rule may become effective on:
David Patton, Executive Director
R386. Health, Disease Control and Prevention, Epidemiology.
R386-702. Communicable Disease Rule.
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 the public health and reportable as required or authorized by Section 26-6-6 and Title 26, Chapter 23b of the Utah Health Code.
a]) Acquired Immunodeficiency Syndrome
b]) Adverse event resulting after smallpox vaccination
e]) Arbovirus infection, including Saint Louis encephalitis
and West Nile virus infection
l]) Chlamydia trachomatis infection
o]) Colorado tick fever
p]) Creutzfeldt-Jakob disease and other transmissible human
r]) Cyclospora infection
s]) Dengue fever
v]) Ehrlichiosis, human granulocytic, human monocytic, or
Shiga toxin-producing Escherichia coli (STEC) infection
z]) Gonorrhea: sexually transmitted and ophthalmia
aa]) Haemophilus influenzae, invasive disease
bb]) Hansen Disease (Leprosy)
cc]) Hantavirus pulmonary syndrome
dd]) Hemolytic Uremic Syndrome, postdiarrheal
ee]) Hepatitis A
ff]) Hepatitis B, cases and carriers
gg]) Hepatitis C, acute and chronic infection
hh]) Hepatitis, other viral
ii])(1) Human Immunodeficiency Virus Infection. Reporting
requirements are listed in R388-803.
ii])(2) Pregnancy in a HIV case
jj]) Influenza-associated hospitalization
kk]) Influenza-associated death, in a person less than 18
years of age
nn]) Lyme Disease
rr]) Meningococcal Disease
tt]) Norovirus, formerly called Norwalk-like virus,
ww]) Poliomyelitis, paralytic
xx]) Poliovirus infection, nonparalytic
zz]) Q Fever
aaa]) Rabies, human and animal
bbb]) Relapsing fever, tick-borne and louse-borne
ddd]) Rubella, congenital syndrome
fff]) Severe Acute Respiratory Syndrome (SARS)
iii]) Spotted fever rickettsioses (including Rocky Mountain
jjj]) Staphylococcus aureus with resistance or intermediate
resistance to vancomycin isolated from any site
kkk]) Streptococcal disease, invasive, including
Streptococcus pneumoniae and Groups A, B, C, and G streptococci
isolated from a normally sterile site
lll]) Syphilis, all stages and congenital
nnn]) Toxic-Shock Syndrome, staphyloccal or streptococcal
ppp]) Tuberculosis. Special Measures for the Control of
Tuberculosis are listed in R388-804.
rrr]) Typhoid, cases and carriers
ttt]) Viral hemorrhagic fever
uuu]) Yellow fever
vvv]) Any unusual occurrence of infectious or communicable
disease or any unusual or increased occurrence of any illness that
may indicate a 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.
www]) 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, 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 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;
(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.
(1) 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
vvv]) or ([ www]) 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) 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 Bureau 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 by phone, secured fax, secured email, or mail; or the Bureau of Epidemiology by phone (801-538-6191), secured fax (801-538-9923), 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). Laboratories may report case information electronically in a manner approved of by the Department if the laboratory has capacity to do so (please contact the Bureau of Epidemiology at 801-538-6191 for information on this option).
(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 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 HIV, syphilis, measles, and viral hepatitis.
(d) Pharmacists shall report unusual prescriptions or patterns of prescribing as specified in section 26-23b-105.
(4) Immediately Reportable Conditions:
Cases and suspect cases of anthrax, botulism (except for infant
botulism), cholera, diphtheria, Haemophilus influenzae (invasive
disease), hepatitis A, measles, meningococcal disease, plague,
poliomyelitis, rabies, rubella, 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)([
vvv]) or ([ www]) are to be made immediately as provided in
(5) 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.
(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. 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) the reportable condition suspected; and
(i) whether the patient was admitted to the hospital.
(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. 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.
(8) Mandatory Submission of Isolates: Laboratories shall submit all isolates of the following organisms to the Utah Department of Health, public health laboratory. Laboratories should alert the Unified State Laboratories: Public Health (USLPH), via telephone during business hours (801) 965-2560 or after hours (888) EPI-UTAH, on all bioterrorism (BT) agents that are being submitted. BT agents are marked below (as (BT)) with other organisms mandated for submission:
(a) Bacillus anthracis (BT);
(b) Brucella species (BT);
(c) Campylobacter species;
(d) Clostridium botulinum (BT);
(e) Corynebacterium diphtheriae;
(f) Shiga toxin-producing Escherichia coli (STEC) (including enrichment and/or MacConkey broths that tested positive by enzyme immunoassay for Shiga toxin);
(g) Francisella tularensis (BT);
(h) Haemophilus influenzae, from normally sterile sites;
(i) Influenza (hospitalized cases only), types A and B;
(j) Legionella species;
(k) Listeria monocytogenes;
(l) Mycobacterium tuberculosis complex;
(m) Neisseria gonorrhoeae;
(n) Neisseria meningitidis, from normally sterile sites;
(o) Salmonella species;
(p) Shigella species;
(q) Staphylococcus aureus with resistance or intermediate resistance to vancomycin isolated from any site;
(r) Vibrio species;
(s) Yersinia species (Yersinia pestis, BT); and
(t) any organism implicated in an outbreak when instructed by authorized local or state health department personnel.
(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.
(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.
R386-702-6. 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 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) 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 R386-702-1[
1](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
1](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) 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.
R386-702-12. 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". 19th ed., Heymann, David L., editor, 2008.
(2) Centers for Disease Control and
Recommendation of the
Advisory Committee (ACIP): Human rabies Prevention - United
States, 1999]. "Morbidity and Mortality Weekly
Report." [ 1999]; [ 48]:[
RR-1,] 1-2[ 1].
(3) The National Association of State
Public Health Veterinarians, Inc., "Compendium of Animal
Rabies Prevention and Control, 20[
(4) American Academy of Pediatrics.
Plus]: 20[ 09] Report of the Committee on Infectious Diseases" 2[ 8]th Edition. Elk Grove Village, IL, American Academy of
Pediatrics; 20[ 09].
KEY: communicable diseases, quarantine, rabies, rules and procedures
Date of Enactment or Last Substantive Amendment: [
August 8, 2012]
Notice of Continuation: October 12, 2011
Authorizing, and Implemented or Interpreted Law: 26-1-30; 26-6-3; 26-23b
The Portable Document Format (PDF) version of the Bulletin is the official version. The PDF version of this issue is available at https://rules.utah.gov/publicat/bull-pdf/2013/b20130301.pdf. The HTML edition of the Bulletin is a convenience copy. Any discrepancy between the PDF version and HTML version is resolved in favor of the PDF version.
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For questions regarding the content or application of this rule, please contact 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 email@example.com.