Header:
CALIFORNIA CODE OF REGULATIONS
TITLE 17. PUBLIC HEALTH
DIVISION 1. STATE DEPARTMENT OF HEALTH SERVICES
CHAPTER 4. PREVENTIVE MEDICAL SERVICE
SUBCHAPTER 1. REPORTABLE DISEASES AND CONDITIONS
ARTICLE 1. REPORTING
Date:
08/31/2009
Document:
ยง 2500. Reporting to the Local Health Authority
(a) The following definitions shall govern the interpretation of this Subchapter.
(1) 'CDC' means the Centers for Disease Control and Prevention, United States Department of Health and Human Services.
(2) 'CSTE' means the Council of State and Territorial Epidemiologists.
(3) 'MMWR' means the Morbidity and Mortality Weekly Report.
(4) 'Case' means (A) a person who has been diagnosed by a health care provider, who is lawfully authorized to diagnose, using clinical judgment or laboratory evidence, to have a particular disease or condition listed in subsection (j); or (B) a person who meets the definition of a case in Section 2564 - Diarrhea of the Newborn, Section 2574 - Food Poisoning, Section 2612 Salmonella Infections (Other than Typhoid Fever), Section 2628 - Typhoid Fever, or Section 2636 - Venereal Disease; or (C) a person who is considered a case of a disease or condition that satisfies the most recent communicable disease surveillance case definitions established by the CDC and published in the Morbidity and Mortality Weekly Report (MMWR) or its supplements; or (D) an animal that has been determined, by a person authorized to do so, to have rabies or plague.
(5) 'Clinical signs' means the objective evidence of disease.
(6) 'Clinical symptoms' means the subjective sensation of disease felt by the patient.
(7) 'Communicable disease' means an illness due to a specific microbiological or parasitic agent or its toxic products which arises through transmission of that agent or its products from an infected person, animal, or inanimate reservoir to a susceptible host, either directly or indirectly through an intermediate plant or animal host, vector, or the inanimate environment.
(8) 'Director' means State Director of Public Health.
(9) 'Drug susceptibility testing' means the process where at least one isolate from a culture of a patient's specimen is subjected to antimicrobial testing to determine if growth is inhibited by drugs commonly used to treat such infections.
(10) 'Epidemiological risk factors' means those attributes, behaviors, exposures, or other factors that alter the probability of disease.
(11) 'Epidemiologically linked case' means a case in which the patient has/has had contact with one or more persons who have/had the disease, and transmission of the agent by the usual modes of transmission is plausible.
(12) 'Foodborne disease' means illness suspected by a health care provider to have resulted from consuming a contaminated food.
(13) 'Foodborne disease outbreak' means an incident in which two or more persons experience a similar illness after ingestion of a common food, and epidemiologic analysis implicates the food as the source of the illness. There are two exceptions: even one case of botulism or chemical poisoning constitutes an outbreak if laboratory studies identify the causative agent in the food.
(14) 'Health care provider' means a physician and surgeon, a veterinarian, a podiatrist, a nurse practitioner, a physician assistant, a registered nurse, a nurse midwife, a school nurse, an infection control practitioner, a medical examiner, a coroner, or a dentist.
(15) 'Health officer' and 'local health officer' as used in this subchapter includes county, city, and district health officers.
(16) 'In attendance' means the existence of the relationship whereby a health care provider renders those services which are authorized by the health care provider's licensure or certification.
(17) 'Infection control practitioner' means any person designated by a hospital, nursing home, clinic, or other health care facility as having responsibilities which include the detection, reporting, control and prevention of infections within the institution.
(18) 'Laboratory findings' means (A) the results of a laboratory examination of any specimen derived from the human body which yields microscopical, cultural, immunological, serological, or other evidence suggestive of a disease or condition made reportable by these regulations; or (B) the results of a laboratory examination of any specimen derived from an animal which yields evidence of rabies or plague.
(19) 'Multidrug-resistant Mycobacterium tuberculosis' means a laboratory culture or subculture of Mycobacterium tuberculosis which is determined by antimicrobial susceptibility testing to be resistant to at least isoniazid and rifampin.
(20) 'Outbreak' means the occurrence of cases of a disease (illness) above the expected or baseline level, usually over a given period of time, in a geographic area or facility, or in a specific population group. The number of cases indicating the presence of an outbreak will vary according to the disease agent, size and type of population exposed, previous exposure to the agent, and the time and place of occurrence. Thus, the designation of an outbreak is relative to the usual frequency of the disease in the same facility or community, among the specified population, over a comparable period of time. A single case of a communicable disease long absent from a population or the first invasion by a disease not previously recognized requires immediate reporting and epidemiologic investigation.
(21) 'Personal information' means any information that identifies or describes a person, including, but not limited to, his or her name, social security number, date of birth, physical description, home address, home telephone number, and medical or employment history.
(22) 'Sexually Transmitted Diseases' means Chancroid, Lymphogranuloma Venereum, Granuloma Inguinale, Syphilis, Gonorrhea, Chlamydia, Pelvic Inflammatory Disease, and Nongonococcal Urethritis.
(23) 'Suspected case' means (A) a person whom a health care provider believes, after weighing signs, symptoms, and/or laboratory evidence, to probably have a particular disease or condition listed in subsection (j); or (B) a person who is considered a probable case, or an epidemiologically-linked case, or who has supportive laboratory findings under the most recent communicable disease surveillance case definition established by CDC and published in the Morbidity and Mortality Weekly Report (MMWR) or its supplements; or (C) an animal which has been determined by a veterinarian to exhibit clinical signs or which has laboratory findings suggestive of rabies or plague.
(24) 'Unusual disease' means a rare disease or a newly apparent or emerging disease or syndrome of uncertain etiology which a health care provider has reason to believe could possibly be caused by a transmissible infectious agent or microbial toxin.
(25) 'Water-associated disease' means an illness in which there is evidence to suggest that the illness could possibly have resulted from physical contact with or swallowing water from a microbiologically or chemically contaminated source. Examples of such potentially contaminated water sources are lakes, rivers, streams, irrigation water, wells, public and private drinking water, bottled water, reclaimed water, ocean and bay waters, hot springs, hot tubs, whirlpool spas, and swimming pools. Epidemiologic investigation by public health authorities is required to demonstrate that a suspected water-associated illness was likely to have been waterborne and related to the suspected source.
(26) 'Waterborne disease outbreak' means an incident in which two or more persons experienced a similar illness after consumption or use of the same water intended for drinking or after water contact such as by immersion, and epidemiologic investigation by public health authorities implicates the same water as the source of the waterborne illness. There is one exception: a single case of waterborne chemical poisoning constitutes an outbreak if laboratory studies indicate that the source water is contaminated by the chemical.
(b) It shall be the duty of every health care provider, knowing of or in attendance on a case or suspected case of any of the diseases or conditions listed in subsection (j) of this section, to report to the local health officer for the jurisdiction where the patient resides as required in subsection (h) of this section. Where no health care provider is in attendance, any individual having knowledge of a person who is suspected to be suffering from one of the diseases or conditions listed in subsection (j) of this section may make such a report to the local health officer for the jurisdiction where the patient resides.
(c) The administrator of each health facility, clinic or other setting where more than one health care provider may know of a case, a suspected case or an outbreak of disease within the facility shall establish and be responsible for administrative procedures to assure that reports are made to the local health officer.
(d) Each report made pursuant to subsection (b) shall include all of the following information if known:
(1) name of the disease or condition being reported; the date of onset; the date of diagnosis; the name, address, telephone number, occupation, race/ethnic group, Social Security number, sex, age, and date of birth for the case or suspected case; the date of death if death has occurred; and the name, address and telephone number of the person making the report.
(2) If the disease reported pursuant to subsection (b) is hepatitis, a sexually transmitted disease or tuberculosis, then the report shall include the following applicable information, if known: (A) hepatitis information as to the type of hepatitis, type-specific laboratory findings, and sources of exposure, (B) sexually transmitted disease information as to the specific causative agent, syphilis-specific laboratory findings, and any complications of gonorrhea or chlamydia infections, or (C) tuberculosis information on the diagnostic status of the case or suspected case, bacteriologic, radiologic and tuberculin skin test findings, information regarding the risk of transmission of the disease to other persons, and a list of the anti-tuberculosis medications administered to the patient.
(e) Confidential Morbidity Report forms, PM 110 (1/90), are available from the local health department for reporting as required by this section.
(f) Information reported pursuant to this section is acquired in confidence and shall not be disclosed by the local health officer except as authorized by these regulations, as required by state or federal law, or with the written consent of the individual to whom the information pertains or the legal representative of the individual.
(g) Upon the State Department of Public Health's request, a local health department shall provide to the Department the information reported pursuant to this section. Absent the individual's written consent, no information that would directly or indirectly identify the case or suspected case as an individual who has applied for or been given services for alcohol or other drug abuse by a federally assisted drug or alcohol abuse treatment program (as defined in federal law at 42 C.F.R. Section 2.11) shall be included.
(h) The urgency of reporting is identified by symbols in the list of diseases and conditions in subsection (j) of this section. Those diseases with a diamond ([diamond]) are considered emergencies and shall be reported immediately by telephone. Those diseases and conditions with a cross (+) shall be reported by mailing, telephoning or electronically transmitting a report within one (1) working day of identification of the case or suspected case. Those diseases and conditions not otherwise identified by a diamond or a cross shall be reported by mailing a written report, telephoning, or electronically transmitting a report within seven (7) calendar days of the time of identification.
(i) For foodborne disease, the bullet (w) symbol indicates that, when two (2) or more cases or suspected cases of foodborne disease from separate households are suspected to have the same source of illness, they shall be reported immediately by telephone.
(j) Health care providers shall submit reports for the following diseases or conditions.
Acquired Immune Deficiency Syndrome (AIDS)
+ Amebiasis
Anaplasmosis/Ehrlichiosis
[diamond] Anthrax
[diamond] Avian Influenza (human)
+ Babesiosis
[diamond] Botulism (Infant, Foodborne, Wound, Other)
[diamond] Brucellosis
+ Campylobacteriosis
Chancroid
+ Chickenpox (only hospitalization and deaths)
Chlamydia trachomatis infections, including
lymphogranuloma venereum (LGV)
[diamond] Cholera
[diamond] Ciguatera Fish Poisoning
Coccidioidomycosis
+ Colorado Tick Fever
Creutzfeldt-Jakob Disease (CJD) and other Transmissible
Spongiform Encephalopathies (TSE)
+ Cryptosporidiosis
Cysticercosis or taeniasis
[diamond] Dengue
[diamond] Diphtheria
[diamond] Domoic Acid Poisoning (Amnesic Shellfish Poisoning)
+ Encephalitis, Specify Etiology: Viral, Bacterial, Fungal,
Parasitic
[diamond] Nscherichia coli: shiga toxin producing (STEC) including
E. coli O157
+ . Foodborne Disease
Giardiasis
Gonococcal Infections
+ Haemophilus influenzae, invasive disease (report an incident of
less than 15 years of age)
[diamond] Hantavirus Infections
[diamond] Hemolytic Uremic Syndrome
Hepatitis, Viral
+ Hepatitis A
Hepatitis B (specify acute case or chronic)
Hepatitis, C (specify acute case or chronic)
Hepatitis D (Delta)
Hepatitis, other, acute
Influenza deaths (report an incident of less than 18 years of age)
Kawasaki Syndrome (Mucocutaneous Lymph Node
Syndrome)
Legionellosis
Leprosy (Hansen Disease)
Leptospirosis
+ Listeriosis
Lyme Disease
+ Malaria
[diamond] Measles (Rubeola)
+ Meningitis, Specify Etiology: Viral, Bacterial, Fungal,
Parasitic
[diamond] Meningococcal Infections
Mumps
[diamond] Paralytic Shellfish Poisoning
Pelvic Inflammatory Disease (PID)
+ Pertussis (Whooping Cough)
[diamond] Plague, Human or Animal
+ Poliovirus Infection
+ Psittacosis
+ Q Fever
[diamond] Rabies, Human or Animal
+ Relapsing Fever
Rheumatic Fever, Acute
Rocky Mountain Spotted Fever
Rubella (German Measles)
Rubella Syndrome, Congenital
+ Salmonellosis (Other than Typhoid Fever)
[diamond] Scombroid Fish Polsoning
[diamond] Severe Acute Respiratory Infection (SARS)
[diamond] Shiga toxin (detected in feces)
+ Shigellosis
[diamond] Smallpox (Variola)
+ Staphylococcus aureus infection (only a case resulting in death
or admission to an intensive care unit of a person who has not
been hospitalized or had surgery, dialysis, or residency in a
long-term care facility in the past year, and did not have an
indwelling catheter or percutaneous medical device at the
time of culture.)
+ Streptococcal Infections (Outbreaks of Any Type and
Individual Cases in Food Handlers and Dairy Workers Only)
+ Syphilis
Tetanus
Toxic Shock Syndrome
+ Trichinosis
+ Tuberculosis
[diamond] Tularemia
+ Typhoid Fever, Cases and Carriers
Typhus Fever
+ Vibrio Infections
[diamond] Viral Hemorrhagic Fevers (e.g., Crimean-Congo, Ebola, Lassa
and Marburg viruses)
+ Water-Associated Disease (e.g., Swimmer's Itch and Hot Tub
Rash)
+ West Nile virus infection
[diamond] Yellow Fever
+ Yersiniosis
[diamond] OCCURRENCE of ANY UNUSUAL DISEASE
[diamond] OUTBREAKS of ANY DISEASE (Including diseases not
listed in Section 2500). Specify if institutional and/or open
community.
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([diamond]) = to be reported immediately by telephone.
(+) = to be reported by mailing a report, telephoning, or
electronically transmitting a report within one (1) working day of
identification of the case or suspected case.
(No diamond or cross symbol) = to be reported within seven (7) calendar days by mail, telephone, or electronic report from the time of identification.
(.) = when two (2) or more cases or suspected cases of foodborne disease from separate households are suspected to have the same source of illness,; they should be reported immediately by telephone.
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