DAR File No. 41038
This rule was published in the December 15, 2016, issue (Vol. 2016, No. 24) of the Utah State Bulletin.
Health, Disease Control and Prevention, Epidemiology
Communicable Disease Rule
Notice of Proposed Rule
DAR File No.: 41038
Filed: 12/01/2016 08:19:21 AM
Purpose of the rule or reason for the change:
This amendment will provide for updates related to 2016 Council of State and Territorial Epidemiologists (CSTE) approved position statements. In addition, significant updates have been made to format in order to improve readability of the rule. Expansion of definitions, along with general edits and updates to improve format and accuracy of language, are proposed. 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:
Primary changes proposed in this rule amendment include: 1) making the definitions section more robust and comprehensive; 2) reformatting sections, and separating out some sections to clarify requirements for different types of reporters; 3) adding chikungunya and Zika virus as explicitly reportable conditions under "arboviral disease"; 4) adding non-seasonal influenza as an explicitly notifiable condition under "influenza infections", and adding it explicitly to the list of immediately notifiable conditions; 5) adding scientific names to all conditions and ensuring formatting throughout the list of reportable conditions is consistent; 6) adding a section regarding reporting of pregnancy for certain reportable conditions; 7) adding C. difficile and Zika virus to the list of conditions for which all results are reportable by ELR; 8) adding norovirus and liver function tests (LFTs) (for hepatitis) to the electronic laboratory reporting (ELR) section; 9) removing gonorrhea from the mandatory laboratory sample submission section; 10) adding Zika virus to the mandatory laboratory sample submission section; and 11) correcting formatting and wording errors in order to ensure clarity within sections of the rule. In addition, rabies information is updated according to the 2016 Rabies Compendium, and Compendium information is updated in the �References� section of the rule.
Statutory or constitutional authorization for this rule:
- Title 26, Chapter 23b
- Section 26-1-30
- Section 26-6-3
This rule or change incorporates by reference the following material:
- Updates Compendium of Animal Rabies Prevention and Control, 2016, published by Journal of American Veterinary Medicine, authored by National Association of State Public Health Veterinarians (NASPHV) Compendium of Animal Rabies Prevention and Control Committee, 03/01/2016
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. The two conditions being added to the list of reportable conditions (chikungunya and Zika virus) have already been implicitly reportable as unusual and emerging infections. Therefore, no additional costs or savings are anticipated through adding these conditions. Zika virus positive samples are already being sent to UPHL and CDC for confirmation; therefore, adding this to the mandatory laboratory sample submission list should be cost-neutral since it is formalizing a process already in place. Gonorrhea samples are not reliably sent to UPHL for testing; therefore, removing gonorrhea from the mandatory laboratory sample submission list should be cost-neutral for the state. 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.
The main cost that may be incurred by Local Health Departments (LHDs) is personnel time required to manage detected norovirus outbreaks, if identified through ELR. LHD personnel already investigate these outbreaks, however, when detected through alternate means, so this should not represent a large increase in cost. Chikungunya and Zika virus cases are already being reported and investigated; updating the rule to include them as explicitly reportable is formalizing what is already occurring and is anticipated to be cost-neutral.
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. While significant savings are anticipated over time, it is not possible to accurately estimate actual costs or savings. This is because costs and savings will vary depending on elements within an entity, for example, the size and workload related to reportable conditions that is already present. Variables also include if, and what, work has already been done to implement and manage electronic laboratory reporting and if a decision is made to implement it.
persons other than small businesses, businesses, or local governmental entities:
As noted above, the main cost that may be incurred by LHDs is personnel time required to manage detected norovirus outbreaks, if identified through ELR. LHD personnel already investigate these outbreaks, however, when detected through alternate means, so this should not represent a large increase in cost. Chikungunya and Zika virus cases are already being reported and investigated; updating the rule to include them as explicitly reportable is formalizing what is already occurring and is anticipated to be cost-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 changes 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. While significant savings are anticipated over time, it is not possible to accurately estimate actual costs or savings. This is because costs and savings will vary depending on elements within an entity, for example, the size and workload related to reportable conditions that is already present. Variables also include if, and what, work has already been done to implement and manage electronic laboratory reporting, and if a decision is made to implement it.
Compliance costs for affected persons:
There are no direct compliance costs associated with this amendment because potential costs are based on optional reporting methods.
Comments by the department head on the fiscal impact the rule may have on businesses:
The proposed amendment adds language related to the 2016 Council of State and Territorial Epidemiologists (CSTE) approved position statements. It also makes extensive changes to improve rule organization, formatting, and readability levels, and also makes general technical edits. There is some fiscal impact on business to individuals or entities under this rule because there may be minor programming changes for electronic reporting data feeds and LHDs may incur cost in its personnel time required to manage detected norovirus outbreaks, if identified through ELR.
Joseph Miner, MD, Executive Director
The full text of this rule may be inspected, during regular business hours, at the Office 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:
Joseph Miner, Executive Director
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 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, 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.
(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
Diseases, Emergency Illnesses, and Health Conditions
(1) The [
Utah ]Department[ of Health] declares the following [ conditions] to be of concern to public health and report[ able] [ a]s 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 (b) Acquired Immunodeficiency Syndrome (c) Acute Flaccid Myelitis (AFM) (d) Adverse event resulting from smallpox
vaccination (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) Coccidioidomycosis (r) Colorado tick fever (s) Creutzfeldt-Jakob disease and other transmissible
human spongiform encephalopathies (t) Cryptosporidiosis (u) Cyclospora infection (v) Cytomegalovirus (CMV), congenital, via ELR (see Utah
Administrative Rule R398-4-5 and R386-702-4 (2)(b) (w) Dengue fever (x) Diphtheria (y) Ehrlichiosis, human granulocytic, human monocytic, or
unspecified (z) Encephalitis (aa)(1) Escherichia coli, from any clinical specimen,
that is resistant to at least one carbapenem-class antibiotic, or
that has demonstrated carbapenemase production (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) Giardiasis (dd) Gonorrhea: sexually transmitted and ophthalmia
neonatorum (ee) Haemophilus influenzae, invasive disease (ff) Hansen Disease (Leprosy) (gg) Hantavirus pulmonary syndrome (Sin Nombre
virus) (hh) Hemolytic Uremic Syndrome, postdiarrheal (ii) Hepatitis A (jj) Hepatitis B, acute, chronic, and perinatal (kk) Hepatitis C (ll) Hepatitis, other viral (mm)(1) Human Immunodeficiency Virus Infection. Special
measures for the control of HIV/AIDS are included in
R386-702-9. (nn)(2) Pregnancy in a HIV case (oo) Influenza-associated hospitalization (pp) Influenza-associated death, in a person less than 18
years of age (qq) Klebsiella species, from any clinical specimen, that
is resistant to at least one carbapenem-class antibiotic, or that
has demonstrated carbapenemase production (rr) Legionellosis (ss) Leptospirosis (tt) Listeriosis (uu) Lyme Disease (vv) Malaria (ww) Measles (xx) Meningitis (aseptic, bacterial, fungal, parasitic,
protozoan, and viral) (yy) Meningococcal Disease (zz) Mumps (aaa) Mycobacteria other than tuberculosis (bbb) Norovirus, outbreaks only (ccc) Pertussis (ddd) Plague (eee) Poliomyelitis, paralytic and nonparalytic (fff) Psittacosis (ggg) Q Fever (Coxiella infection) (hhh) Rabies, human and animal (iii) Relapsing fever, tick-borne and
louse-borne (jjj) Rubella, including congenital syndrome (kkk) Salmonellosis (lll) Severe Acute Respiratory Syndrome (SARS) (mmm) Shigellosis (nnn) Smallpox (ooo) Spotted fever rickettsioses (including Rocky
Mountain Spotted Fever) (ppp) Staphylococcus aureus from any clinical specimen
with resistance or intermediate resistance to vancomycin isolated
from any site (qqq)(1) Streptococcal disease, invasive, due to
Streptococcus pneumoniae and Groups A and B 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) Syphilis, all stages and congenital (sss) Tetanus (ttt) Toxic-Shock Syndrome, staphylococcal or
streptococcal (uuu) Trichinellosis (vvv) Tuberculosis. Special Measures for the Control of
Tuberculosis are listed in R388-804. (www) Tularemia (xxx) Typhoid, cases and carriers (yyy) Vibriosis (zzz) Viral hemorrhagic fever (aaaa) Yellow fever (bbbb) 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. (cccc) 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
(1) Who must report: Each reporting entity shall report
each confirmed case, and any 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)(bbbb) or (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). (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 (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). (b) Electronic reporting: (i) Hospitals and 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. 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. (ii) When more than one licensed laboratory or hospital
is involved in testing a specimen, all 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). (iv) The following requirements apply to laboratories
that are reporting information electronically: (1) Laboratories reporting electronically shall send the
following information with all reports: (A) First and last name of the patient; (B) Patient date of birth; (C) Patient hospitalization status; (D) Name of the reporting facility; (E) Name of the testing laboratory; (F) Patient address (including street address,
unit/apartment number, city, state, and zip code); (G) Name and phone number of the requesting health care
provider; (H) Pregnancy status; (I) Specimen source; (J) The laboratory's name for, or description of, the
test; (K) Testing results; (L) Test reference range; and (M) Test status (e.g. preliminary, final, amended and/or
corrected). (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. (3) Laboratories reporting electronically shall submit
all local vocabulary codes with translations to UDOH, if
applicable. (4) Laboratories reporting electronically must report
preliminary positive results for immediately notifiable
conditions as specified in R386-702-4 (4). (c) Electronic reporting of negative results: (i) Electronic reporting shall include negative as well
as positive results for the following conditions: (1) Chlamydia (2) Cytomegalovirus (CMV), congenital (see Utah
Administrative Rule R398-4-5 and R386-702-4 (2)(b)(i)) (3) Gonorrhea (4) Hepatitis A (5) Hepatitis B (6) Hepatitis C, including viral loads (7) Human Immunodeficiency Virus (HIV), including viral
loads and confirmatory tests (8) Lyme disease (9) Syphilis (10) Tuberculosis (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): (1) To determine when a previously reported case becomes
non-infectious; (2) To identify newly acquired infections through
identification of a seroconversion window; or (3) To provide information critical for assignment of a
case definition. (iii) Information associated with a negative test result
will be retained by the Utah Department of Health for a period of
18 months. (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. (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 of any of the reportable diseases.
Laboratories and other testing sites shall also report any test
result that provides 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 Creutzfeldt-Jakob disease and other 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)(bbbb) and (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)(bbbb) or
(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 (801) 965-2400, or after hours at (801)
560-6586, 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. 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.]
5]. General Measures for the Control of Communicable
(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.
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
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
(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 (801) 538-6191.
(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: email@example.com, 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 (801) 538-6191.
(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.
(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.
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.
8]. Special Measures for the Control of Ophthalmia
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.
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)(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) Laboratory's name for, or description of, the
test; (xv) Test reference range; and (xvi) 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:
i]f 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.
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
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
v]) Providing recommendations for hepatitis screening and
iv]) Treatment or linkage to medical care within three months
of HIV diagnosis; and
v]) Linkage or referral to other prevention services and
(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.]
0]. 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 sh[
ould] 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
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
(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 (801) 538-9450.
(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 1
8] 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
(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.
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 sh[ ould] 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 sh[ ould] be evaluated to determine susceptibility to hepatitis B
infection, and if determined to be susceptible, sh[ ould] be offered or advised to obtain vaccination against
1]. 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
(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 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.
Any person who violates any provision of R386-702 may be
assessed a penalty as provided in Section 26-23-6.
3]. 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". 20th ed., Heymann, David L., editor, 2015.
(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, 201[
1]." Nasphv.org. National Association of State Public
Health Veterinarians, [ 31 May 2011]. Web. http://nasphv.org/Documents/
(4) American Academy of Pediatrics. "Red Book: 2012 Report of the Committee on Infectious Diseases" 30th Edition. Elk Grove Village, IL, American Academy of Pediatrics; 2015.
(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: [
February 11, 2016]
Notice of Continuation: April 15, 2016
Authorizing, and Implemented or Interpreted Law: 26-1-30; 26-6-3; 26-23b
More information about a Notice of Proposed Rule is available online.
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/2016/b20161215.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.
Text to be deleted is struck through and surrounded by brackets ([
example]). Text to be added is underlined (). Older browsers may not depict some or any of these attributes on the screen or when the document is printed.
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 firstname.lastname@example.org. For questions about the rulemaking process, please contact the Office of Administrative Rules.