Header:
NORTH DAKOTA ADMINISTRATIVE CODE
TITLE 33. STATE DEPARTMENT OF HEALTH
ARTICLE 6. REPORTABLE CONDITIONS
CHAPTER 4. CONTROL OF SPECIFIC DISEASES
Date:
08/31/2009
Document:
33-06-04-09. Typhoid fever, paratyphoid fever.
1. Isolation required. All cases of typhoid fever and paratyphoid fever shall be isolated in a flyproof room, preferably under hospital conditions of such cases as cannot command adequate sanitary environment and nursing care in their homes.
2. Period of isolation. No patient shall be released from isolation until reports of three negative laboratory examinations of both the urine and feces, collected not less than twenty-four hours apart, shall have been returned from the state public health laboratory.
3. Source of infection. When a case of typhoid fever or paratyphoid fever is discovered, the state department of health shall immediately proceed to search for the source of infection, missed case, carrier, or convalescent. When the source of infection is discovered, immediate abatement must be instituted.
4. Laboratory confirmation. Every physician or health officer having knowledge of a case or suspected case of typhoid fever, paratyphoid fever, or any continued fever not otherwise diagnosed must obtain laboratory confirmation by the usual approved methods, if possible. Report, however, shall be made immediately on a clinical diagnosis.
5. Control of typhoid carriers.
a. For the purpose of this section, a typhoid carrier is a person who harbors typhoid bacteria and emits them, regularly or intermittently. This condition may or may not follow a recognized attack of typhoid fever. A person continuing to discharge typhoid bacteria following an attack of typhoid fever shall be regarded as a case rather than a carrier, for a period of at least twelve weeks following subsidence of clinical symptoms. After that period the physician may, in the physician's discretion, declare such person to be a carrier.
b. The physician, upon the discovery of a typhoid carrier, shall immediately report the fact to the state department of health, giving the full name, age, occupation, and address of such carrier (together with any other information relative to possible or probable infection of others), and shall also communicate the fact to the carrier personally, or the carrier's guardian, imparting to the carrier detailed information regarding the precautions to be observed in the disposing of the carrier's discharges, in preventing contamination of the carrier's hands, and thus protecting others from infection. This information to the carrier personally shall be confirmed by a written notice to such carrier, giving special and specific instructions as may be required in special circumstances.
Instructions given by the physician shall include directions to wash the hands thoroughly with soap and water immediately after using the toilet.
c. Bowel or bladder discharges of a carrier living in a location without an approved sewage treatment plant should be deposited in a cesspool, or privy, properly located, of an approved sanitary construction. One of the essentials of a sanitary privy is the flyproof and rodent-proof vault. The interior of the privy should be kept clean and scrubbed with warm water and soap whenever necessary.
d. No typhoid carrier may engage in any occupation involving the handling of ready-to-eat food and milk, or to work as a food, drink, or milk handler, or to work in or around any place where food or drink is manufactured, packed, stored, deposited, collected, prepared, produced, or sold. It is extremely important that typhoid carriers do not prepare food or drink for anyone except themselves or their immediate families; and especially that they do not supply any food, drink, milk, or milk products to visitors at their homes, or at community or social gatherings of any type. It is recommended, that immediate members of the household should all be immunized against typhoid fever every three years during the time they are continually exposed to a carrier.
e. No typhoid carrier shall leave the community in which the carrier resides without notification to the state department of health who are to be informed of the carrier's destination, including the carrier's new address.
f. The state department of health shall visit each typhoid carrier once a year and complete a form prescribed for the purpose.
g. The release of chronic typhoid carriers may be granted only on the approval of the state health officer after submission of the following evidence:
(1) That the gall bladder has been removed.
(2) That, subsequent to the removal of the gall bladder, each of the three specimens of the duodenal contents, taken at intervals of not less than twenty-four hours, has been examined by the laboratory of the state department of health and found to contain no typhoid bacilli.
h. The physician may, at the physician's discretion, release chronic typhoid carriers upon other evidence which the physician may consider satisfactory.
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