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Oregon Bulletin

October 1, 2011

 

Oregon Health Authority,
Public Health Division
Chapter 333

Rule Caption: New Definitions and New Disease Reporting Requirements

Adm. Order No.: PH 7-2011

Filed with Sec. of State: 8-19-2011

Certified to be Effective: 8-19-11

Notice Publication Date: 5-1-2011

Rules Adopted: 333-019-0003

Rules Amended: 333-017-0000, 333-017-0005, 333-018-0000, 333-018-0005, 333-018-0010, 333-018-0013, 333-018-0015, 333-018-0018, 333-018-0020, 333-018-0035, 333-019-0000, 333-019-0002, 333-019-0005, 333-019-0010, 333-019-0014, 333-019-0024, 333-019-0031, 333-019-0039, 333-019-0041, 333-019-0046

Rules Repealed: 333-018-0030

Subject: The Oregon Health Authority, Public Health Division, Acute and Communicable Disease Prevention program is permanently amending rules in chapter 333, divisions 17, 18 and 19 concerning reportable diseases in order to add new definitions and new disease requirements.

Rules Coordinator: Brittany Sande—(971) 673-1291

333-017-0000

Definitions

For purposes of OAR chapter 333, divisions 17, 18, and 19, the following definitions shall apply.

(1) “AIDS”: AIDS is an acronym for acquired immunodeficiency syndrome. An individual is considered to have AIDS when their illness meets criteria published in Morbidity and Mortality Weekly Report, Volume 41, Number RR-17, pages 1–4, December 18, 1992.

(2) “Animal Suspected of Having Rabies”: An animal is suspected of having rabies when:

(a) It is a dog, cat, or ferret not known to be satisfactorily vaccinated against rabies (as defined in OAR 333-019-0017), or it is any other mammal; and

(b) It exhibits one or more of the following aberrant behaviors or clinical signs: unprovoked biting of persons or other animals, paralysis or partial paralysis of limbs, marked excitation, muscle spasms, difficulty swallowing, apprehensiveness, delirium, or convulsions; and it has no other diagnosed illness that could explain the neurological signs.

(3) “Approved Fecal Specimen”: a specimen of feces from a person who has not taken any antibiotic orally or parenterally for at least 48 hours prior to the collection of the specimen. Improper storage or transportation of a specimen, or inadequate growth of the culture suggestive of recent antibiotic usage can, at the discretion of public health microbiologists, result in specimen rejection.

(4) “Authority” means the Oregon Health Authority.

(5) “Bite, Biting, Bitten”: The words bite, biting, and bitten refer to breaking of the skin by the teeth of an animal, or mouthing a fresh abrasion of the skin by an animal.

(6) “Case”: A case is a person who has been diagnosed by a health care provider as having a particular disease, infection, or condition, or whose illness meets defining criteria published in the Authority’s Investigative Guidelines.

(7) “Child Care Facility”: A child care facility is any facility as defined in ORS 657A.250(5) where care is provided to three or more children.

(8) “Control” has the meaning given that term in ORS 433.001.

(9) “Disease outbreak” has the meaning given that term in ORS 431.260.

(10) “Enterobacteriaceae family” means bacteria of the following genera:

(a) Budvicia

(b) Buttiauxella

(c) Cedecea

(d) Citrobacter

(e) Edwardsiella

(f) Enteric Group 58

(g) Enteric Group 59

(h) Enteric Group 60

(i) Enteric Group 63

(j) Enteric Group 64

(k) Enteric Group 68

(l) Enteric Group 69

(m) Enteric Group 137

(n) Enterobacter

(o) Escherichia

(p) Ewingella

(q) Hafnia

(r) Klebsiella

(s) Kluyvera

(t) Leclercia

(u) Leminorella

(v) Moellerella

(w) Morganella

(x) Obesumbacterium

(y) Pantoea

(z) Photorhabdus

(aa) Plesiomonas

(bb) Pragia

(cc) Proteus

(dd) Providencia

(ee) Rahnella

(ff) Salmonella

(gg) Serratia

(hh) Shigella

(ii) Tatumella

(jj) Trabulsiella

(kk) Xenorhabdus

(ll) Yersinia

(mm) Yokenella

(11) “Food Handler” means any business owner or employee who handles food utensils or who prepares, processes, handles or serves food for people other than members of their immediate household, for example restaurant, delicatessen, and cafeteria workers, caterers, and concession stand operators.

(12) “Food Service Facility” means an establishment that processes or serves food for sale.

(13) “Health Care Facility” has the meaning given that term in ORS 442.015(16).

(14) “Health Care Provider” has the meaning given that term in ORS 433.443.

(15) “HIV” means the human immunodeficiency virus, the causative agent of AIDS.

(16) “HIV Test” means a Food and Drug Administration (FDA)-approved test for the presence of HIV (including RNA testing), or for antibodies or antigens that result from HIV infection, or for any other substance specifically associated with HIV infection and not with other diseases or conditions.

(17) “HIV Positive Test” means a positive result on the most definitive HIV test procedure used to test a particular individual. In the absence of the recommended confirmation tests, this means the results of the initial test done.

(18) “Lead Poisoning” means a blood lead level of least 10 micrograms per deciliter.

(19) “Licensed Laboratory” means a medical diagnostic laboratory that is inspected and licensed by the Authority or otherwise licensed according to the provisions of the federal Clinical Laboratory Improvement Amendments of 1988 (42 U.S.C. ¦ 263a). Any laboratory operated by the U.S. Centers for Disease Control and Prevention shall also be considered a Licensed Laboratory.

(20) “Licensed Physician” means any physician who is licensed by the Oregon Medical Board or the Board of Naturopathic Medicine.

(21) “Licensed Veterinarian” means a veterinarian licensed by the Oregon Veterinary Medical Examining Board.

(22) “Local Public Health Administrator” has the meaning given that term in ORS 431.260.

(23) “Local Public Health Authority” has the meaning given that term in ORS 431.260.

(24) “Non-Susceptible to any Carbapenem Antibiotic” means the finding of any of the following:

(a) Gene sequence specific for carbapenemase;

(b) Phenotypic test (e.g., Modified Hodge) positive for production of carbapenemase; or

(c) Resistance to any third-generation cephalosporin antibiotic, along with any of the following elevated minimum inhibitory concentrations (MIC) for a carbapenem antibiotic:

(A) MIC for ertapenem greater than or equal to 1 µg/ml;

(B) MIC for imipenem greater than or equal to 4 µg/ml; or

(C) MIC for meropenem greater than or equal to 4 µg/ml.

(25) “Novel Influenza” means influenza A virus that cannot be subtyped by commercially distributed assays.

(26) “Onset”: Unless otherwise qualified, onset refers to the earliest time of appearance of signs or symptoms of an illness.

(27) “Pesticide Poisoning” means illness in a human that is caused by acute or chronic exposure to:

(a) Any substance or mixture of substances intended for preventing, destroying, repelling, or mitigating any pest; or

(b) Any substance or mixture of substances intended for use as a plant regulator, defoliant, or desiccant as defined in ORS 634.006(8).

(28) “Public Health Division (Division)” means the Public Health Division within the Oregon Health Authority.

(29) “Suspected Case” means a person whose illness is thought by a health care provider to have a significant likelihood of being due to a reportable disease, infection, or condition, based on facts such as but not limited to the patient’s signs and symptoms, possible exposure to a reportable disease, laboratory findings, or the presence or absence of an alternate explanation for the illness.

(30) “Uncommon Illness of Potential Public Health Significance”: These illnesses include:

(a) Any infectious disease with potentially life-threatening consequences that is exotic to or uncommon in Oregon, for example, variola (smallpox) or viral hemorrhagic disease;

(b) Any illness related to a contaminated medical device or product; or

(c) Any acute illness suspected to be related to environmental exposure to any infectious or toxic agent or to any household product.

(31) “Veterinary Laboratory” means a laboratory whose primary function is handling and testing diagnostic specimens of animal origin.

[Publications: Publications referenced are available from the Agency.]

Stat. Auth.: ORS 409.050, 433.004, 437.010, 616.745 & 624.080

Stats. Implemented: ORS 433.004, 433.360, 437.030, 616.745 & 624.380

Hist.: HD 15-1981, f. 8-13-81, ef. 8-15-81; HD 12-1983, f. & ef. 8-1-83; HD 4-1987, f. 6-12-87, ef. 6-19-87; HD 13-1990(Temp), f. 3-25-90, cert. ef. 8-1-90; HD 5-1991, f. 5-29-91, cert. ef. 4-1-91; HD 10-1991, f. & cert. ef. 7-23-91; HD 9-1992, f. & cert. ef. 8-14-92; HD 29-1994, f. & cert. ef. 12-2-94; OHD 2-2002, f. & cert. ef. 3-4-02; PH 11-2005, f. 6-30-05, cert. ef. 7-5-05; PH 5-2010, f. & cert. ef. 3-11-10; PH 7-2011, f. & cert. ef. 8-19-11

333-017-0005

Reference Documents

The following publication, which is available for inspection at the Public Health Division, is incorporated by reference in whole or in part in OAR chapter 333, divisions 12, 17, 18, and 19: “Investigative Guidelines”: Investigative Guidelines for Reportable Diseases, published on an ongoing basis by the Division’s Office of Disease Prevention and Epidemiology.

[Publications: Publications referenced are available from the agency.]

Stat. Auth.: ORS 409.050, 433.004, 437.010, 616.745 & 624.080

Stats. Implemented: ORS 409.050, 433.004, 437.010, 616.745 & 624.080

Hist.: HD 15-1981, f. 8-13-81, ef. 8-15-81; HD 4-1987, f. 6-12-87, ef. 6-19-87; HD 9-1992, f. & cert. ef. 8-14-92; HD 29-1994, f. & cert. ef. 12-2-94; OHD 2-2002, f. & cert. ef. 3-4-02; PH 5-2010, f. & cert. ef. 3-11-10; PH 7-2011, f. & cert. ef. 8-19-11

333-018-0000

Who Is Responsible for Reporting

(1) Each health care provider knowing of or attending a human case or suspected human case of any of the diseases, infections, or conditions listed in OAR 333-018-0015 shall report such cases as specified. Where no health care provider is in attendance, any individual knowing of such a case shall report in a similar manner. An individual required to report reportable diseases who is unsure whether a case meets the definition of a suspect case as that is defined in OAR 333-017-0000 should err on the side of reporting if the suspected disease, infection, or condition is one that:

(a) Is required to be reported immediately or within 24 hours under OAR 333-018-0015;

(b) Is highly transmissible; or

(c) Results in serious or severe health consequences.

(2) Each health care facility, where more than one health care provider may know or attend a human case or suspected human case, may establish administrative procedures to ensure that every case is reported.

(3) Each licensed laboratory shall report human test results as specified in OAR 333-018-0015(5). When more than one licensed laboratory is involved in testing a specimen, the laboratory that is responsible for reporting the test result directly to the health care provider that ordered the test shall be responsible for reporting.

(4) Each veterinary laboratory or licensed laboratory shall report animal test results as specified in OAR 333-018-0017. When more than one laboratory is involved in testing a specimen, the laboratory that is responsible for reporting the test result directly to the licensed veterinarian or client of record caring for the animal shall be responsible for reporting.

Stat. Auth.: ORS 409.050, 433.004 & 437.010

Stats. Implemented: ORS 433.004 & 437.030

Hist.: HD 15-1981, f. 8-13-81, ef. 8-15-81; HD 4-1987, f. 6-12-87, ef. 6-19-87; HD 29-1994, f. & cert. ef. 12-2-94; OHD 3-2002, f. & cert. ef. 3-4-02; PH 5-2010, f. & cert. ef. 3-11-10; PH 7-2011, f. & cert. ef. 8-19-11

333-018-0005

To Whom Reports Shall Be Made

(1) In general, if the patient is an Oregon resident, reports shall be made to the local public health administrator for the patient’s place of residence.

(2) In lieu of reporting to the local public health administrator, with the consent of the local public health administrator and the Authority, reports may be made directly to the Authority (e.g., via electronic reporting).

(3) In urgent situations when local public health staff are unavailable, case reports shall be made directly to the Authority.

(4) Where the case is not an Oregon resident, reports shall be made either to the patient’s local public health authority (if the patient resides in the United States) or directly to the Authority.

(5) In lieu of reporting to the local public health administrator, with the consent of the local public health administrator, licensed laboratories shall report directly to the Authority’s HIV Program:

(a) All tests indicative of and specific for HIV infection as required by OAR 333-018-0015;

(b) All CD4+ T-lymphocyte counts; and

(c) All HIV viral load tests.

Stat. Auth.: ORS 431.110, 433.001, 433.004, 433.006

Stats. Implemented: ORS 431.110, 433.001, 433.004, 433.006, 433.106

Hist.: HD 15-1981, f. 8-13-81, ef. 8-15-81; HD 20-1985(Temp), f. & ef. 9-30-85; HD 4-1987, f. 6-12-87, ef. 6-19-87; HD 15-1988, f. 7-11-88, cert. ef. 9-1-88; HD 13-1990(Temp), f. 5-25-90, cert. ef. 8-1-90; HD 5-1991, f. 3-29-91, cert. ef. 4-1-91; HD 10-1991, f. & cert. ef. 7-23-91; HD 29-1994, f. & cert. ef. 12-2-94; OHD 22-2001, f. & cert. ef. 10-19-01; OHD 3-2002, f. & cert. ef. 3-4-02; PH 11-2005, f. 6-30-05, cert. ef. 7-5-05; PH 1-2007, f. & cert. ef. 1-16-07; PH 7-2011, f. & cert. ef. 8-19-11

333-018-0010

Form of the Report

(1) A health care provider required to report reportable diseases under ORS 433.004 and these rules shall submit to the local public health administrator a report that includes but is not limited to:

(a) The identity, address, and telephone number of the person reporting;

(b) The identity, address, and telephone number of the attending health care provider, or other treating health care provider if any;

(c) The name of the person affected or ill, that person’s current address, telephone number, and date of birth;

(d) The diagnosed or suspected disease, infection, or condition; and

(e) The date of illness onset.

(2) A licensed laboratory required to report reportable diseases under ORS 433.004 and these rules shall submit to the local public health administrator a report that includes but is not limited to:

(a) The name and telephone number of the reporting laboratory;

(b) The name, gender, age or date of birth, the address and county of residence of the person from whom the laboratory specimen was obtained, if known;

(c) The date the specimen was obtained;

(d) The name, address and telephone number of the health care provider of the person from whom the laboratory specimen was obtained;

(e) The name or description of the test;

(f) The test result; and

(g) Information required by the Authority’s Manual for Mandatory Electronic Laboratory Reporting, if electronic reporting is required under OAR 333-018-0013.

(3) Reportable disease reports shall be made in the following manner:

(a) Reports for diseases or suspected diseases that are immediately reportable under OAR 333-018-0015 shall be submitted orally, by telephone, with a follow-up written report via facsimile.

(b) Reports for diseases or suspected diseases that are required to be reported within one to seven days under OAR 333-018-0013 shall be submitted in writing via facsimile or by other means approved by the local public health administrator, consistent with the need for timely reporting as provided in OAR 333-018-0015.

(c) Electronically, if required by OAR 333-018-0013.

(4) If requested by a local public health administrator or the Oregon Public Health Division, health care providers and licensed laboratories shall provide additional information of relevance to the investigation or control of reportable diseases or conditions (e.g., reported signs and symptoms, laboratory test results (including negative results), potential exposures, contacts, and clinical outcomes).

Stat. Auth.: ORS 409.050 & 433.004

Stats. Implemented: ORS 433.004

Hist.: HD 15-1981, f. 8-13-81, ef. 8-15-81; HD 4-1987, f. 6-12-87, ef. 6-19-87; HD 13-1990(Temp), f. 5-25-90, cert. ef. 8-1-90; HD 5-1991, f. 3-29-91, cert. ef. 4-1-91; HD 10-1991, f. & cert. ef. 7-23-91; HD 29-1994, f. & cert. ef. 12-2-94; OHD 3-2002, f. & cert. ef. 3-4-02; PH 11-2005, f. 6-30-05, cert. ef. 7-5-05; PH 5-2010, f. & cert. ef. 3-11-10; PH 7-2011, f. & cert. ef. 8-19-11

333-018-0013

Electronic Laboratory Reporting

(1) A licensed laboratory that, pursuant to ORS 433.004 and OAR chapter 333, division 18, sends an average of greater than 30 records per month to the local public health administrator shall electronically send all reportable disease data to the Authority in accordance with the standards set forth in the Authority’s Manual for Mandatory Electronic Laboratory Reporting, dated February 2009, and incorporated by reference.

(2) Prior to reporting data electronically, a licensed laboratory shall seek and obtain approval from the Authority for its electronic reporting, in accordance with the Authority’s Manual for Mandatory Electronic Laboratory Reporting.

(3) A licensed laboratory that fails to seek approval from the Authority for electronic reporting or fails to obtain approval within one year from seeking approval from the Authority may be subject to civil penalties in accordance OAR 333-026-0030.

(4) A licensed laboratory that is required to report data electronically shall have a state-approved continuity of operations plan for reporting continuity in the event of emergency situations disrupting electronic communications. At least two alternative methodologies should be incorporated, such as facsimile, mail, or courier service.

(5) A licensed laboratory required to report data electronically shall participate fully in Oregon’s Data Quality Control program, as specified in the Authority’s Manual for Mandatory Electronic Laboratory Reporting.

(6) Electronic reports shall meet the reporting timelines in OAR chapter 333, division 18.

Stat. Auth.: ORS 409.050 & 433.004

Stats. Implemented: ORS 433.004

Hist.: PH 5-2010, f. & cert. ef. 3-11-10; PH 7-2011, f. & cert. ef. 8-19-11

333-018-0015

What Is to Be Reported and When

(1) Health care providers shall report all human cases or suspected human cases of the diseases, infections, microorganisms, and conditions specified below. The timing of health care provider reports is specified to reflect the severity of the illness or condition and the potential value of rapid intervention by public health agencies.

(2) When local public health administrators cannot be reached within the specified time limits, reports shall be made directly to the Authority, which shall maintain an around-the-clock public health consultation service.

(3) Licensed laboratories shall report all test results indicative of and specific for the diseases, infections, microorganisms, and conditions specified below for humans. Such tests include but are not limited to: microbiological culture, isolation, or identification; assays for specific antibodies; and identification of specific antigens, toxins, or nucleic acid sequences.

(4) Human reportable diseases, infections, microorganisms, and conditions, and the time frames within which they must be reported are as follows:

(a) Immediately, day or night: Bacillus anthracis (anthrax); Clostridium botulinum (botulism); Corynebacterium diphtheriae (diphtheria); novel influenza; Yersinia pestis (plague); poliomyelitis; rabies (human); measles (rubeola); Severe Acute Respiratory Syndrome (SARS) and infection by SARS coronavirus; rubella; variola major (smallpox); Francisella tularensis (tularemia); Vibrio cholerae O1, O139, or toxigenic; hemorrhagic fever caused by viruses of the filovirus (e.g., Ebola, Marburg) or arenavirus (e.g., Lassa, Machupo) families; yellow fever; intoxication caused by marine microorganisms or their byproducts (for example, paralytic shellfish poisoning, domoic acid intoxication, ciguatera, scombroid); any known or suspected common-source outbreaks; any uncommon illness of potential public health significance.

(b) Within 24 hours (including weekends and holidays): Haemophilus influenzae (any invasive disease; for laboratories, any isolation or identification from a normally sterile site); Neisseria meningitidis (any invasive disease; for laboratories, any isolation or identification from a normally sterile site); pesticide poisoning.

(c) Within one local public health authority working day: Bordetella pertussis (pertussis); Borrelia (relapsing fever, Lyme disease); Brucella (brucellosis); Campylobacter (campylobacteriosis); Chlamydophila (Chlamydia) psittaci (psittacosis); Chlamydia trachomatis (chlamydiosis; lymphogranuloma venereum); Clostridium tetani (tetanus); Coxiella burnetii (Q fever); Creutzfeldt-Jakob disease and other transmissible spongiform encephalopathies; Cryptococcus (cryptococcosis), Cryptosporidium (cryptosporidiosis); Cyclospora cayetanensis (cyclosporosis); bacteria of the Enterobacteriaceae family found to be non-susceptible to any carbapenem antibiotic; Escherichia coli (Shiga-toxigenic, including E. coli O157 and other serogroups); Giardia (giardiasis); Haemophilus ducreyi (chancroid); hantavirus; hepatitis A; hepatitis B (acute or chronic infection); hepatitis C; hepatitis D (delta); hepatitis E; HIV infection (does not apply to anonymous testing) and AIDS; death of a person <18 years of age with laboratory-confirmed influenza; lead poisoning; Legionella (legionellosis); Leptospira (leptospirosis); Listeria monocytogenes (listeriosis); mumps; Mycobacterium tuberculosis and M. bovis (tuberculosis); Neisseria gonorrhoeae (gonococcal infections); pelvic inflammatory disease (acute, non-gonococcal); Plasmodium (malaria); Rickettsia (all species: Rocky Mountain spotted fever, typhus, others); Salmonella (salmonellosis, including typhoid); Shigella (shigellosis); Taenia solium (including cysticercosis and undifferentiated Taenia infections); Treponema pallidum (syphilis); Trichinella (trichinosis); Yersinia (other than pestis); any infection that is typically arthropod vector-borne (for example: babesiosis, California encephalitis, Colorado tick fever, dengue, Eastern equine encephalitis, ehrlichiosis, Kyasanur Forest disease, St. Louis encephalitis, West Nile fever, Western equine encephalitis, etc.); a human bitten by any other mammal; and hemolytic uremic syndrome.

(d) Within seven days: Any blood lead level tests including the result.

(5) Licensed laboratories shall report, within seven days, the results of all tests of CD4+ T-lymphocyte absolute counts and the percent of total lymphocytes that are CD4 positive, and HIV nucleic acid (viral load) tests.

Stat. Auth.: ORS 409.050, 433.004 & 433.006

Stats. Implemented: ORS 433.004 & 437.010

Hist.: HD 15-1981, f. 8-13-81, ef. 8-15-81; HD 20-1985(Temp), f. & ef. 9-30-85; HD 4-1987, f. 6-12-87, ef. 6-19-87; HD 15-1988, f. 7-11-88, cert. ef. 9-1-88; HD 13-1990(Temp), f. 5-25-90, cert. ef. 8-1-90; HD 5-1991, f. 3-29-91, cert. ef. 4-1-91; HD 10-1991, f. & cert. ef. 7-23-91; HD 9-1992, f. & cert. ef. 8-14-92; HD 29-1994, f. & cert. ef. 12-2-94; OHD 22-2001, f. & cert. ef. 10-19-01; OHD 3-2002, f. & cert. ef. 3-4-02; PH 11-2005, f. 6-30-05, cert. ef. 7-5-05; PH 7-2006, f. & cert. ef. 4-17-06; PH 13-2006(Temp), f. 6-27-06, cert. ef. 7-1-06 thru 12-27-06; PH 19-2006, f. & cert. ef. 9-13-06; PH 11-2007(Temp), f. & cert. ef. 8-22-07 thru 2-18-08; PH 13-2007, f. & cert. ef. 11-7-07; PH 8-2009(Temp), f. & cert. ef. 9-1-09 thru 2-26-10; PH 5-2010, f. & cert. ef. 3-11-10; PH 7-2011, f. & cert. ef. 8-19-11

333-018-0018

Submission of Isolates to the Public Health Laboratory

Licensed laboratories are required to forward aliquots or subcultures of the following to the Oregon State Public Health Laboratory:

(1) Suspected Neisseria meningitidis and Haemophilus influenzae from normally sterile sites.

(2) Suspected Shiga-toxigenic Escherichia coli (STEC), including E. coli O157, Salmonella spp., Shigella spp., Vibrio spp., Listeria spp., Yersinia spp., and Mycobacterium tuberculosis.

(3) Serum that tests positive for IgM antibody to hepatitis A virus.

(4) Serum that tests positive for IgM core antibody to hepatitis B virus.

(5) All cryptococcal isolates

(6) All carbapenem-resistant isolates of species in the Enterobacteriaceae family

(7) For laboratory confirmed influenza, respiratory specimens or viral isolates, Staphylococcus aureus isolates, and after consulting with the Oregon Public Health Division, autopsy specimens for persons under the age of 18 that died with laboratory-confirmed influenza infection.

Stat. Auth.: ORS 409.050, 433.004 & 438.450

Stats. Implemented: ORS 433.004 & 438.310

Hist.: HB 248, f. 6-30-70, ef. 7-25-70; HD 28-1988, f. & cert. ef. 12-7-88; HD 20-1994, f. & cert. ef. 7-20-94; HD 6-1995, f. & cert. ef. 9-13-95; OHD 11-2001, f. & cert. ef. 5-16-01, Renumbered from 333-024-0050(5); OHD 3-2002, f. & cert. ef. 3-4-02; PH 11-2005, f. 6-30-05, cert. ef. 7-5-05; PH 28-2006, f. 11-30-06, cert. ef 12-18-06; PH 5-2010, f. & cert. ef. 3-11-10; PH 7-2011, f. & cert. ef. 8-19-11

333-018-0020

Reports from Local Public Health Administrators

(1) The local public health administrator shall notify the Authority immediately of any reported cases of the following diseases and conditions: anthrax, botulism (foodborne), cholera, diphtheria, marine intoxications, measles, pesticide poisoning, plague, poliomyelitis, rabies; any uncommon illness of potential public health significance; any outbreak of disease.

(2) For other diseases, the local public health administrator shall notify the Authority no later than the end of each business week of all cases reported during that week except animal bites that have been investigated by the local public health administrator need not be reported to the Authority. Reports shall be sent by fax or other means approved by the Authority, in a format approved by the Authority.

Stat. Auth.: ORS 431.110, 431.120, 433.004, 437.010, 616.010 & 624.005

Stats. Implemented: ORS 433.004 & 437.010

Hist.: HD 15-1981, f. 8-13-81, ef. 8-15-81; HD 12-1983, f. & ef. 8-1-83; HD 4-1987, f. 6-12-87, ef. 6-19-87; HD 29-1994, f. & cert. ef. 12-2-94; OHD 3-2002, f. & cert. ef. 3-4-02; PH 7-2011, f. & cert. ef. 8-19-11

333-018-0035

Procedures Involving Emergency Response Employees

(1) Each person or local government employing persons to render emergency care shall designate a contact person or “designated officer” to receive reports from the local public health administrator made under ORS 433.006. The employer shall assure that the designated officer has sufficient training to carry out the duties as described below, which shall include appropriate procedures for follow-up after occupational exposures to specific diseases as specified below in section (2) and section (6).

(2) Sections (3) through (5) apply only to the following subset of reportable diseases: meningococcal disease, infectious pulmonary or laryngeal tuberculosis, diphtheria, plague (Yersinia pestis), rabies, hemorrhagic fevers (e.g., Lassa, Marburg, and Ebola).

(3) Health care providers and health care facilities shall, when reporting this subset of diseases, determine and include as part of their report whether or not an emergency care provider was involved in pre-hospital care for this disease.

(4) Health care providers and facilities shall report to the local public health administrator and may relay the diagnosis of these diseases directly to the emergency care providers or the designated officer specified below in section (5), but shall not disclose the identity or addresses of the person having the disease or otherwise refer specifically to the person.

(5) Upon receiving a report of a reportable disease as defined in section (2) above, the designated officer shall notify all out-of-hospital caregivers, including but not limited to: first responders, emergency medical technicians, paramedics, firefighters, law enforcement officers, corrections officers, probation officers, or other current or former personnel of the employer who may have been exposed to the reportable disease. The designated officer shall inform the personnel only of the reportable disease and the fact of possible exposure and the appropriate follow-up procedures. The designated officer shall not inform the personnel of the identity or addresses of the individual having the reportable disease or otherwise refer specifically to the individual having the reportable disease.

(6) In the event of an occupational exposure to a bloodborne pathogen as defined by ORS 433.060(8), the designated officer shall also assist the exposed worker as defined in ORS 433.060(11) in implementing the provisions of ORS 433.065 through ORS 433.080 and associated Authority rules (333-012-0260 through 333-012-0270). These rules include provisions for determining HIV, hepatitis B and C status of the source patient and soliciting HIV testing after an occupational exposure.

Stat. Auth.: ORS 433.045 - 433.080 & 431.110(1)(e)

Stats. Implemented: ORS 433.006 & 433.065

Hist.: HD 15-1981, f. 8-13-81, ef. 8-15-81; HD 12-1983, f. & ef. 8-1-83; HD 4-1987, f. 6-12-87, ef. 6-19-87; HD 29-1994, f. & cert. ef. 12-2-94; HD 8-1997, f. & cert. ef. 6-26-97; OHD 15-2001, f. & cert. ef. 7-12-01, Renumbered from 333-018-0023; OHD 3-2002, f. & cert. ef. 3-4-02; PH 7-2011, f. & cert. ef. 8-19-11

333-019-0000

Responsibility of Public Health Authorities to Investigate Reportable Diseases

(1) The local public health administrator shall use all reasonable means to investigate in a timely manner all reports of reportable diseases, infections, or conditions. To identify possible sources of infection and to carry out appropriate control measures, the local public health administrator shall investigate each report following procedures outlined in the Authority’s Investigative Guidelines or other procedures approved by the Authority. The Authority may provide assistance in these investigations.

(2) Investigations of outbreaks involving residents of multiple states or counties or exposures in multiple states of counties may be supervised by the Authority.

(3) Investigations by the Authority or public health administrator shall be conducted in accordance with ORS 433.004.

[Publications: Publications referenced are available from the agency.]

Stat. Auth.: ORS 409.050, 431.110, 433.004, 437.010, 616.010 & 624.005

Stats. Implemented: ORS 433.004 & 437.030

Hist.: HD 15-1981, f. 8-13-81, ef. 8-15-81; HD 4-1987, f. 6-12-87, ef. 6-19-87; HD 29-1994, f. & cert. ef. 12-2-94; OHD 4-2002, f. & cert. ef. 3-4-02; PH 7-2011, f. & cert. ef. 8-19-11

333-019-0002

Cooperation with Public Health Authorities

(1) Health care providers, health care facilities, and licensed laboratories shall cooperate with local public health administrators and the Authority in the investigation and control of reportable diseases and conditions.

(2) Every health care provider attending a person with a reportable disease, infection, or condition shall instruct the person in measures appropriate to controlling the spread of the disease.

Stat. Auth.: ORS 409.050, 431.110, 433.004, 437.010, 616.010 & 624.005

Stats. Implemented: ORS 433.004, 433.106 & 433.130

Hist.: OHD 4-2002, f. & cert. ef. 3-4-02; PH 11-2005, f. 6-30-05, cert. ef. 7-5-05; PH 7-2011, f. & cert. ef. 8-19-11

333-019-0003

Providing Information to the Oregon Health Authority or Local Public Health Administrator

(1) The Authority or local public health administrator (LPHA) may, as necessary to investigate a case of a reportable disease, disease outbreak or epidemic, require a health care provider, public or private entity, or an individual to permit the inspection or provide copies of information necessary to the investigation.

(2) Information that may be inspected or provided to the Authority or LPHA includes but is not limited to:

(a) Individually identifiable health information and contact information related to:

(A) The case;

(B) An individual who may be the potential source of exposure or infection;

(C) An individual who has been or may have been exposed to or affected by the disease; or

(D) A control.

(b) Policies, practices, systems or structures that may have affected the likelihood of disease transmission.

(c) Factors that may influence an individual’s susceptibility to the disease or likelihood of being diagnosed with the disease.

(3) In addition to requesting information the Authority or LPHA may inspect, sample or test real or personal property. The Authority or LPHA will request permission to inspect, sample or test real or personal property prior to taking any action. If an individual or entity refuses to allow access to real or personal property for this purpose, the Authority or LPHA may seek an administrative warrant in order to obtain access.

(4) The Authority or LPHA shall request the information required to be submitted orally or in writing and shall inform the individual or entity from whom the information is sought when the information is required to be submitted. In lieu of requesting that information be provided to the Authority or LPHA, the Authority or LPHA may request access to the information at the location where the information is located.

(5) A person who provides information in accordance with these rules is immune from civil or criminal liability that might otherwise be incurred or imposed with respect to providing information under this section.

(6) Pursuant to ORS 433.008, all information obtained by the Authority or LPHA in the course of an investigation is confidential, may only be released in accordance with ORS 433.008(2) through (6), and except as required for the administration of public health laws or rules, a state or local public health official or employee may not be examined in any administrative or judicial proceeding about the existence or contents of a reportable disease report or other information received by the Authority or LPHA in the course of an investigation of a reportable disease or disease outbreak.

Stat. Auth.: ORS 433.004

Stat. Implemented: ORS 433.004

Hist.: PH 7-2011, f. & cert. ef. 8-19-11

333-019-0005

Conduct of Special Studies by the Oregon Health Authority

The Authority may conduct special studies concerning the causes and prevention of diseases and other significant health conditions. Special studies include any collection of information about the health status or potential health risk factors of individuals or groups of individuals, other than the routine collection of birth, death, and marriage information, and are not restricted to reportable diseases, infections, or conditions. The Authority may collaborate with local public health authorities, other institutions, or other individuals in the conduct of these studies.

Stat. Auth.: ORS 409.050, 431.110, 433.004, 437.010, 616.010 & 624.005

Stats. Implemented: ORS 433.006 & 433.065

Hist.: HD 15-1981, f. 8-13-81, ef. 8-15-81; HD 4-1987, f. 6-12-87, ef. 6-19-87; HD 9-1997, f. & cert. ef. 6-26-97; OHD 4-2002, f. & cert. ef. 3-4-02; PH 11-2005, f. 6-30-05, cert. ef. 7-5-05; PH 7-2011, f. & cert. ef. 8-19-11

333-019-0010

Imposition of Restrictions

(1) To protect the public health, persons who attend or work at schools or child care facilities or who work at health care facilities or food service facilities shall not attend or work at these facilities whilst in a communicable stage of any restrictable diseases unless authorized to do so as hereunder specified.

(2) At all such facilities, restrictable diseases include: diphtheria, measles, Salmonella Typhi infection, shigellosis, Shiga-toxigenic Escherichia coli (STEC) infection, hepatitis A, tuberculosis, open or draining skin lesions infected with Staphylococcus aureus or Streptococcus pyogenes, and any illness accompanied by diarrhea or vomiting.

(3) At schools, child care, and health care facilities, such restrictable diseases shall also include: chickenpox, pertussis, rubella, and scabies. Children in the communicable stages of hepatitis B infection may be excluded from attending school or child care if, in the opinion of the local health officer, the child poses an unusually high risk to other children (e.g., exhibits uncontrollable biting or spitting).

(4) At the discretion of local school authorities or the local public health authority, pediculosis may be considered a school-restrictable condition.

(5) Nothing in these rules prohibits the adoption of more stringent rules regarding exclusion from schools or child care facilities. Such additional restrictions shall require formal certification that the disease or condition in question presents a significant public health risk in that setting. For schools, this action may be taken by the local public health authority or the local school governing body. For child care facilities, this action may be taken by the local public health authority.

(6) The infection control committee at all health care facilities shall adopt policies to restrict the work of employees with restrictable diseases in accordance with recognized principles of infection control. Nothing in these rules prohibits health care facilities or the local public health authority from adopting additional or more stringent rules for exclusion from these facilities.

Stat. Auth.: ORS 409.050, 431.110, 433.004, 437.010, 616.750, 616.715 & 624.005

Stats. Implemented: ORS 433.260, 433.407, 433.411 & 433.419

Hist.: HD 15-1981, f. 8-13-81, ef. 8-15-81; OHD 4-2002, f. & cert. ef. 3-4-02; PH 11-2005, f. 6-30-05, cert. ef. 7-5-05; PH 7-2011, f. & cert. ef. 8-19-11

333-019-0014

Removal of Restrictions

(1) Worksite, child care, and school restrictions can be removed by statement of the local public health administrator that the disease is no longer communicable to others or that adequate precautions have been taken to minimize the risk of transmission.

(2) School or child care restrictions for chickenpox, scabies, staphylococcal skin infections, streptococcal infections, diarrhea, or vomiting may also be removed by a school nurse or health care provider.

(3) Restrictions at health care facilities for chickenpox, scabies, staphylococcal skin infections, streptococcal infections, diarrhea, or vomiting may also be removed by the facility’s infection control committee when sufficient measures have been taken to prevent or minimize the transmission of disease, in accordance with written procedures approved by the committee.

(4) In general, restrictions on persons diagnosed with shigellosis or Shiga-toxigenic Escherichia coli (STEC) infection, including E. coli O157 infection shall not be lifted until no pathogens are identified by a licensed laboratory in two consecutive approved fecal specimens collected not less than 24 hours apart. Such restrictions may be waived or modified at the discretion of the local public health administrator.

Stat. Auth.: ORS 409.050, 431.110, 433.004, 437.010, 616.010 & 624.005

Stats. Implemented: ORS 433.260 & 433.273

Hist.: OHD 4-2002, f. & cert. ef. 3-4-02; PH 7-2011, f. & cert. ef. 8-19-11

333-019-0024

Management of Animal Bites

(1) The circumstances surrounding bites of humans by mammals shall be investigated by the local public health administrator in accordance with the Investigative Guidelines published by the Authority.

(2) Except as provided in section (3) of this rule, any dog, cat, or ferret that has bitten a person shall be held for observation until the 10th day following the bite. This observation shall be under the supervision of a licensed veterinarian or other person designated by the local public health administrator. Animals shall be held within an enclosure or with restraints deemed adequate by the local public health administrator to prevent contact with any person or other animals. At the discretion of the local public health administrator, properly vaccinated dogs used by public law enforcement agencies may be exempted from the observation period requirement; however, any law enforcement agency shall notify the local public health administrator immediately should any exempted dog develop abnormal behavior within 10 days of biting a person.

(3) The local public health administrator may order the euthanasia and rabies testing of animals that have bitten humans when these animals are:

(a) Inadequately vaccinated dogs, cats, or ferrets that have inflicted an unprovoked bite to the face, head, or neck of a person; or

(b) Any other mammal suspected of having rabies or that has been in contact with an animal suspected of having rabies.

(4) Because it is preferable to hold such animals for observation, no person shall either euthanize any dog, cat, or ferret that has bitten a human or destroy the head of any mammal that has bitten a person without authorization by the local public health administrator.

[Publications: Publications referenced are available from the agency.]

Stat. Auth.: ORS 409.050, 431.110, 433.004, 433.340, 433.350

Stats. Implemented: ORS 433.345, 433.350

Hist.: OHD 4-2002, f. & cert. ef. 3-4-02; PH 7-2011, f. & cert. ef. 8-19-11

333-019-0031

Acquired Immunodeficiency Syndrome/Human Immuno­deficiency Virus

Investigation of cases of HIV infection or AIDS. Investigations of HIV infection or AIDS shall be conducted to the extent that resources permit. The Authority, or the local public health administrator, will ensure that each identified case is offered prevention, care, and partner counseling and referral services.

NOTE: Specific rules regarding reporting requirements for HIV and AIDS may be found in OAR 333-018-0015. Rules regarding informed consent for HIV testing and confidentiality of HIV test results may be found in OAR 333-012-0265 and 333-012-0270.

Stat. Auth.: ORS 431.110, 433.004

Stats. Implemented: ORS 431.110, 433.004

Hist.: HD 4-1987, f. 6-12-87, ef. 6-19-87; HD 15-1988, f. 7-11-88, cert. ef. 9-1-88; HD 29-1994, f. & cert. ef. 12-2-94; OHD 13-2001, f. & cert. ef. 7-12-01, Renumbered from 333-019-0223; OHD 22-2001, f. & cert. ef. 10-19-01; OHD 4-2002, f. & cert. ef. 3-4-02; PH 7-2006, f. & cert. ef. 4-17-06; PH 7-2011, f. & cert. ef. 8-19-11

333-019-0039

Sudden Infant Death Syndrome

(1) In compliance with ORS 431.120(4), the Authority will conduct an epidemiologic investigation of each instance of sudden infant death syndrome.

(2) In order to promote support of this effort, the Authority will reimburse any county health department (or other agency providing public health services in lieu of a county health department for this purpose) to the extent of $25 to help defray the cost of one home visit by a public health nurse to any family who has lost a member of the family to SIDS.

(3) In order for the home visit to be reimbursed the following procedure will be required:

(a) On receiving the death investigation report in which the cause of death is SIDS, the administrator of the local public health authority receiving the report will, if possible, assure the arrangement of a home visit to the affected family by a public health nurse at an appropriate time;

(b) The home visit will include:

(A) A nursing assessment of family needs related to the SIDS event;

(B) Grief counseling;

(C) Education regarding the state of knowledge regarding the cause of SIDS;

(D) Discussion of other support resources available to help meet family needs;

(E) Information alerting the family to expect to receive in the mail an epidemiologic investigation questionnaire, including an explanation of its purpose, of its confidentiality, and assurance of assistance in completing the form if necessary.

(4) After the home visit has been completed, the local agency will notify the Authority in writing, including the name and birth date of the deceased infant, and the family name and address, and the date of the visit. This notice should be addressed to the Public Health Division, Office of Disease Prevention and Epidemiology, 800 NE Oregon Street, Portland, OR 97232.

(5) On receipt of this written notice, the Authority will reimburse the agency in the amount of $25. Reimbursement for repeat visits to the same family will not be available.

(6) An epidemiologic questionnaire will be mailed by the Authority to the parent(s) (guardian) of the deceased infant, with instructions as to its purpose and means of completing and a request that it be completed and returned.

(7) In the event that the completed questionnaire has not been returned in a reasonable length of time, the Authority will notify the county health department (or agency acting in lieu of the county health department) with a request for a follow-up contact with the family to ensure the highest possible rate of return and of accuracy.

(8) Completed questionnaires will be collected and tabulated and the information analyzed by the Authority. A report of the findings will be published biennially beginning in 1985.

Stat. Auth.: ORS 431.001 & 433.004

Stats. Implemented: ORS 431.001 & 433.004

Hist.: HD 3-1983, f. & ef. 3-3-83; HD 16-1991, f. & cert. ef. 10-10-91; HD 29-1994, f. & cert. ef. 12-2-94; OHD 15-2001, f. & cert. ef. 7-12-01, Renumbered from 333-018-0025; OHD 4-2002, f. & cert. ef. 3-4-02; PH 7-2011, f. & cert. ef. 8-19-11

333-019-0041

Tuberculosis

(1) Each health care facility shall formally assess the risk of tuberculosis transmission among staff (professional and volunteer), residents, and patients at least annually and shall follow tuberculosis screening recommendations outlined in “Guidelines for preventing the transmission of Mycobacterium tuberculosis in Health-Care Settings,” published by the Centers for Disease Control and Prevention (Morbidity and Mortality Weekly Report, Vol. 54, Number RR-17: 1-141; December 30, 2005) or otherwise approved by the Authority.

(2) Each facility specified below shall formally assess the risk of tuberculosis transmission among staff (professional and volunteer), residents, inmates, and patients at least annually and shall follow appropriate tuberculosis screening recommendations as outlined in the relevant publication or as otherwise approved by the Authority:

(a) Correctional Facilities: “Prevention and Control of Tuberculosis in Correctional and Detention Facilities: Recommendations from CDC” published by the Centers for Disease Control and Prevention (Morbidity and Mortality Weekly Report, Vol. 55, Number RR09: 1-44: July 7, 2006).

(b) Long Term Care Facilities for the Elderly: “Prevention and control of tuberculosis in facilities providing long-term care to the elderly. Recommendations of the Advisory Committee for Elimination of Tuberculosis,” published by the Centers for Disease Control and Prevention (Morbidity and Mortality Weekly Report, Vol. 39, RR-10, pp. 7-20; July 13, 1990) and “Guidelines for preventing the transmission of Mycobacterium tuberculosis in Health-Care Settings,” published by the Centers for Disease Control and Prevention (Morbidity and Mortality Weekly Report, Vol. 54, Number RR-17: 1-141; December 30, 2005).

(c) Homeless Shelters: “Prevention and control of tuberculosis among homeless persons,” published by the Centers for Disease Control and Prevention (Morbidity and Mortality Weekly Report, Vol. 41, RR-5, pp. 13-23; April 17, 1992)

[Publications: Publications referenced are available from the agency.]

Stat. Auth.: ORS 431.110, 432.060, 433.001–433.035, 433.110–433.220 & 437.030

Stats. Implemented: ORS 431.150, 431.155, 431.170, 433.001–433.035, 433.110 –433.220 & 437.030

Hist.: OHD 4-2002, f. & cert. ef. 3-4-02; PH 10-2005, f. 6-15-05, cert. ef. 6-21-05; PH 9-2009, f. & cert. ef. 9-22-09; PH 7-2011, f. & cert. ef. 8-19-11

333-019-0046

Typhoid

(1) Special procedures govern the management of persons infected with Salmonella enterica serotype Typhi, including both persons with acute disease and asymptomatic carriers (hereinafter collectively “typhoid cases”). All typhoid cases shall periodically submit approved fecal specimens for testing in a licensed laboratory until released from this requirement by the local public health administrator. Any person who excretes Salmonella enterica serotype Typhi more than one year after onset or first diagnosis or on two occasions at least one year apart is defined to be a “chronic carrier.”

(2) Unless the case is a chronic carrier, worksite, school, and other restrictions on typhoid cases (see OAR 333-019-0010) shall be lifted by the local public health administrator when Salmonella enterica serotype Typhi is not identified by a licensed laboratory in any of four successive approved fecal specimens and one urine specimen. These specimens are to be collected at least 24 hours apart and not earlier than one month after onset.

(3) If the case has been a chronic carrier, worksite, school, and other restrictions on the case shall be lifted when Salmonella enterica serotype Typhi is not identified in any of six successive approved fecal specimens and one urine specimen. These specimens are to be collected not less than 72 hours apart.

(4) All chronic carriers shall abide by the Typhoid Carrier Agreement, which must be renewed annually. The local public health administrator may cause the carrier to be isolated for failure to abide by the Carrier Agreement. The Carrier Agreement is a legally enforceable agreement by the chronic carrier that they:

(a) Will not work as a food handler or provide personal care (e.g., feeding, bathing, dressing, assisting with personal hygiene, changing diapers, changing bedding, or other services involving direct physical contact) to children in child care facilities or to residents of residential facilities;

(b) Will immediately notify the local public health administrator of illness suggestive of typhoid fever among the carrier’s family or immediate associates;

(c) Will furnish specimens for examination in the manner prescribed by the local public health administrator;

(d) Will immediately notify the local public health administrator of any change of permanent address.

Stat. Auth.: ORS 431.110, 433.004 616.010 & 624.005

Stats. Implemented: ORS 431.001 & 433.004

Hist.: HD 15-1981, f. 8-13-81, ef. 8-15-81; HD 4-1987, f. 6-12-87, ef. 6-19-87; HD 29-1994, f. & cert. ef. 12-2-94; OHD 4-2002, f. & cert. ef. 3-4-02; PH 7-2011, f. & cert. ef. 8-19-11

Notes
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