BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the amendment of ARM 37.114.101, 37.114.105, 37.114.201, 37.114.203, 37.114.204, 37.114.205, 37.114.301, 37.114.312, 37.114.313, 37.114.314, 37.114.315, 37.114.501, 37.114.503, 37.114.512, 37.114.515, 37.114.530, 37.114.531, 37.114.540, 37.114.542, 37.114.546, 37.114.552, 37.114.561, 37.114.563, 37.114.571, and 37.114.583, and the repeal of ARM 37.114.504, 37.114.506, 37.114.507, 37.114.509, 37.114.510, 37.114.514, 37.114.516, 37.114.518, 37.114.519, 37.114.521, 37.114.522, 37.114.524, 37.114.525, 37.114.528, 37.114.533, 37.114.534, 37.114.536, 37.114.537, 37.114.539, 37.114.544, 37.114.548, 37.114.549, 37.114.551, 37.114.554, 37.114.555, 37.114.557, 37.114.558, 37.114.560, 37.114.565, 37.114.566, 37.114.568, 37.114.570, 37.114.573, 37.114.574, 37.114.575, 37.114.577, 37.114.578, 37.114.579, 37.114.581, 37.114.582, 37.114.585, 37.114.588, 37.114.589, 37.114.591, 37.114.592, and 37.114.595, pertaining to communicable disease control

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT AND REPEAL

 

TO:  All Concerned Persons

 

            1.  On February 6, 2013, at 10:00 a.m., the Department of Public Health and Human Services will hold a public hearing in the Auditorium of the Department of Public Health and Human Services Building, 111 North Sanders, Helena, Montana, to consider the proposed amendment and repeal of the above-stated rules.

 

2.  The Department of Public Health and Human Services will make reasonable accommodations for persons with disabilities who wish to participate in this rulemaking process or need an alternative accessible format of this notice.  If you require an accommodation, contact Department of Public Health and Human Services no later than 5:00 p.m. on January 31, 2013, to advise us of the nature of the accommodation that you need.  Please contact Kenneth Mordan, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; telephone (406) 444-4094; fax (406) 444-9744; or e-mail dphhslegal@mt.gov.

 

3.  The rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:

 

            37.114.101  DEFINITIONS  Unless otherwise indicated, the following definitions apply throughout this chapter:

            (1)  "Case" means a person who is confirmed or suspected to have a reportable disease or condition as listed in ARM 37.114.203.

            (2)  "Clean" means to remove infectious agents and/or organic matter from surfaces on which and in which infectious agents and/or organic matter may be able to live and remain virulent, by scrubbing and washing as with hot water and soap or detergent.

            (3)  "Communicable disease" means an illness due or suspected to be due to a specific infectious agent or its toxic products, which results from transmission of that agent or its products to a susceptible host, directly or indirectly.

            (4)  "Concurrent disinfection" means the use of a method which will destroy any harmful infectious agents present immediately after the discharge of infectious material from the body of an infected person, or after the soiling of articles with such infectious discharges before there is opportunity for any other contact with them.

            (5)  "Contact" means a person or animal that may have had an opportunity to acquire an infection due to the contact's association with a suspected or confirmed infected person or animal or a contaminated environment.

            (6)  "Contamination" means the presence of a disease-causing agent upon a living body surface or within or upon any inanimate article or substance.

            (7)  "Control of Communicable Diseases Manual" means the "Control of Communicable Diseases Manual, An Official Report of the American Public Health Association", (18th edition, 2004) (19th edition, 2008).  A copy of the "Control of Communicable Diseases Manual" may be obtained from the American Public Health Association, 800 I Street NW, Washington, DC  20001.

            (8)  "Department" means the Department of Public Health and Human Services.

            (9)  "2007 Guideline for Isolation Precautions in Hospitals:  Preventing Transmission of Infectious Agents in Healthcare Settings" means the guideline published by the federal Government Printing Office Centers for Disease control and Prevention in association with the Healthcare Infection Control Practices Advisory Committee.  A copy of the guideline may be obtained from the National Technical Information Service, U.S. Department of Commerce, 5285 Port Royal Road, Springfield, Virginia  22161, phone: (703)487-4650.  Any orders should refer to the publication number PB96138102 for the "Guideline for Isolation Precautions in Hospitals" (1996).

            (10)  "Health care" means health care as defined in 50-16-504, MCA.

            (11)  "Health care facility" is a facility as defined in 50-5-101, MCA.

            (12)  "Health care provider" means a health care provider as defined in 50-16-504, MCA.

            (13)  "HIV infection" means infection with the human immunodeficiency virus.

            (14)  "Household contact" is a person or animal living within the household of an infected person.

            (15)  "Infected person" means a person who harbors an infectious agent whether or not illness is currently discernible.

            (16)  "Infection" means the entry and development or multiplication of an infectious agent in the body of man or animals.

            (17)  "Infection control precautions" means those measures necessary to prevent the transmission of disease from an infected person to another person, taking into consideration the specific suspected or confirmed communicable disease and the specific circumstances of the case.  The infection control precautions required for a case admitted to a hospital or other health care facility are those measures identified as isolation precautions applicable to the specific disease in the "2007 Guideline for Isolation Precautions in Hospitals:  Preventing Transmission of Infectious Agents in Healthcare Settings" (1996) adopted in ARM 37.114.105.  The infection control precautions required for a case not admitted to a hospital or other health care facility are those measures identified as methods of control applicable to the specific disease in the "Control of Communicable Diseases Manual, An Official Report of the American Public Health Association", (18th edition, 2004) (19th edition, 2008), adopted in ARM 37.114.105.  Infection control precautions are required, as stated in this rule, whether or not the person is subject to isolation.

            (18)  "Infectious agent" means an organism, chiefly a microorganism, but including helminths, (including but not limited to virus, rickettsia, bacteria, fungus, protozoan, prion, or helminth) that is capable of producing an infection or infectious disease.

            (19)  "Infectious disease" means a clinically manifest disease of man or animals resulting from an infection.

            (20)  "Infectious person" means a person from whom another person may acquire an infectious agent by touch or proximity.

            (21)  "Isolation" means separation during the period of communicability of an infected or probably infected person from other persons, in places and under conditions approved by the department or local health officer and with observance of all applicable infection control precautions.

            (22)  "Laboratory" means any facility or other area used by microbiological, serological, chemical, hematological, immunohematological, molecular, biophysical, cytological, pathological or other examinations of human body fluids, secretions, excretions, or excised or exfoliated tissues, for the purpose of providing information for the diagnosis, prevention or treatment of any human disease or impairment, for the assessment of human health.

            (22) (23)  "Laboratorian" "Laboratory Professional" means any person who supervises or works in a laboratory.

            (23) (24)  "Local health officer" means a county, city, city-county, or district health officer appointed by a local board of health.  As used in these rules, the term will include the authorized representative of a local health officer.

            (24) (25)  "Outbreak" means an incidence of a disease or infection significantly exceeding the incidence normally observed in a population of people over a period of time specific to the disease or infection in question.

            (25) (26)  "Physician" means a person licensed to practice medicine in any jurisdiction in the United States or Canada.

            (26) (27)  "Potential outbreak" means the presence or suspected presence of a communicable disease in a population where the number of susceptible persons and the mode of transmission of the disease may cause further spread transmission of that disease.

            (27) (28)  "Quarantine" means those measures required by a local health officer or the department to prevent transmission of disease to or by those individuals who have been or are otherwise likely to be in contact with an individual with a communicable disease.

            (28) (29)  "Reportable disease" means any disease, the occurrence or suspected occurrence of which is required to be reported by ARM 37.114.203.

            (29) (30)  "Sensitive occupation" means an occupation described in ARM 37.114.301.

            (30) (31)  "Sexually transmitted disease" means human immunodeficiency virus (HIV) infection, syphilis, gonorrhea, chancroid, lymphogranuloma venereum, granuloma inguinale, or all chlamydia trachomatis infections including chlamydial genital infections.

(31) (32)  "Sexually Transmitted Diseases Treatment Guidelines 2002, 2010" means the guidelines published by the U.S. Centers for Disease Control and Prevention.  A copy of the 2002 guidelines is available from the Department of Public Health and Human Services, Public Health and Safety Division, HIV/STD Section, 1400 Broadway, P.O. Box 202951, Helena, MT  59620-2951, phone: (406)444-3565.

            (32) (33)  "Surveillance" means scrutiny of all aspects of occurrence and spread transmission of a disease that are pertinent to effective control.

            (33) (34)  "Susceptible" means having insufficient resistance against a disease and likely to contract the disease if exposed.

 

AUTH:  50-1-202, 50-2-116, 50-17-103, MCA

IMP:     50-1-202, 50-17-103, 50-18-101, MCA

 

37.114.105  INCORPORATION BY REFERENCE  (1)  The department adopts and incorporates by reference the following publications:

            (a)  The "Control of Communicable Diseases Manual, An Official Report of the American Public Health Association", (18th edition, 2004) (19th edition, 2008), which lists and specifies control measures for communicable diseases.  A copy of the "Control of Communicable Diseases Manual" this document may be obtained from the American Public Health Association, 800 I Street NW, Washington, DC 20001.

            (b)  The "2007 Guideline for Isolation Precautions in Hospitals:  Preventing Transmission of Infectious Agents in Healthcare Settings" (1996), published by the U.S. Centers for Disease Control and Prevention, which specifies precautions that should be taken to prevent transmission of communicable diseases for cases admitted to a hospital or other health care facility.  A copy of the guideline may be obtained from the National Technical Information Service, U.S. Department of Commerce, 5285 Port Royal Road, Springfield, Virginia 22161, phone: (703) 487-4650.  Any orders should refer to the publication number PB96138102 for the "Guideline for Isolation Precautions in Hospitals" (1996).  A copy of this document is available from the Department of Public Health and Human Services, Public Health and Safety Division, Communicable Disease Epidemiology Section, 1400 Broadway, P.O. Box 202951, Helena, Montana  59620-2951, phone:  (406) 444-0272.

            (c)  The "Sexually Transmitted Diseases Guidelines for Treatment Guidelines, 2010 2002" are published by the U.S. Centers for Disease Control and Prevention in the May 10, 2002 December 17, 2010, Morbidity and Mortality Weekly Report, volume 51, which and specify the most currently accepted effective treatments for sexually transmitted diseases.  A copy of the 2002 guidelines this document is available from the Department of Public Health and Human Services, Public Health and Safety Division, HIV/STD Section, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951, phone: (406) 444-3565.

 

AUTH:   50-1-202, MCA

IMP:    50-1-202, MCA

 

            37.114.201  REPORTERS  (1)  With the exception noted in (3) and (4) below, any person, including but not limited to a physician, dentist, nurse, medical examiner, other health care practitioner, administrator of a health care facility or laboratory, public or private school administrator, or laboratorian laboratory professional who knows or has reason to believe that a case exists of a reportable disease or condition defined in ARM 37.114.203 shall must immediately report to the local health officer the information specified in ARM 37.114.205(1) through and (2).

            (2)  A local health officer must submit to the department, on the schedule noted in ARM 37.114.204, the information specified in ARM 37.114.205 concerning each confirmed or suspected case of which the officer is informed.

            (3)  A state-funded anonymous testing site for HIV infection is not subject to the reporting requirement in (1) with regard to HIV testing. 

            (4)  With the exception of a licensed healthcare provider, reporters under (1) may report directly to the department at the department's request with approval of the local health authority. 

 

AUTH:  50-1-202, 50-17-103, 50-18-105, MCA

IMP:     50-1-202, 50-2-118, 50-17-103, 50-18-102, 50-18-106, MCA

 

            37.114.203  REPORTABLE DISEASES AND CONDITIONS  (1)  The following communicable diseases and conditions are reportable:

            (a)  AIDS, as defined by the centers for disease control Centers for Disease Control and Prevention, or and HIV infection, as determined by a positive result from a test approved by the Federal Food and Drug Administration for the detection of HIV, including but not limited to antibody, antigen, or all HIV nucleic acid tests irrespective of result, and CD4 and other tests used to monitor HIV disease;

            (b)  Amebiasis Anaplasmosis;

            (c)  Anthrax;

            (d)  Arboviral Disease (California serogroup, Eastern equine encephalitis, Powassan, Saint Louis encephalitis, West Nile Virus, Western equine encephalitis);

            (e)  Babesiosis;

            (d) (f)  Botulism (including infant botulism);

            (e) (g)  Brucellosis;

            (f) (h)  Campylobacter enteritis;

            (g) (i)  Chancroid;

            (h)  Chickenpox;

            (i) (j)  Chlamydial trachomatis genital infection;

            (j) (k)  Cholera;

            (k) (m)  Colorado tick fever;

            (l) (n)  Cryptosporidiosis;

            (m) (l)  Cytomegaloviral illness Coccidioidomycosis;

            (n)  Diarrheal disease outbreak;

            (o)  Cyclosporiasis;

            (p)  Denque virus infections;

            (o) (q)  Diphtheria;

            (p)  Encephalitis;

            (r)  Erlichiosis;

            (q) (s)  Escherichia coli 0157:H7 enteritis Escherichia coli, shiga toxin-producing (STEC);

            (r) (t)  Gastroenteritis outbreak;

            (s) (u)  Giardiasis;

            (t) (v)  Gonorrhea Gonorrheal infection;

            (u)  Gonococcal ophthalmia neonatorum;

            (v) (w)  Granuloma inguinale;

            (w) (x)  Haemophilus influenzae B invasive disease (meningitis, epiglottitis, pneumonia, and septicemia);

            (x) (y)  Hansen's disease (leprosy);

            (y) (z)  Hantavirus pulmonary syndrome or infection;

            (z) (aa)  Hemolytic uremic syndrome, post diarrheal;

            (aa)  Hepatitis A, B (acute or chronic), or C (acute or chronic);

            (ab)  Kawasaki disease Hepatitis A, acute;

            (ac)  Hepatitis B, acute, chronic, perinatal;

            (ad)  Hepatitis C, acute, infection, past or present;

            (ac) (ae)  Influenza;

            (ad) (af)  Lead poisoning (levels ≥ 10 micrograms per deciliter) (blood levels ≥ than 5 micrograms per deciliter for children 13 years of age or younger);

            (ae) (ag)  Legionellosis;

            (af) (ah)  Listeriosis;

            (ag) (ai)  Lyme disease;

            (ah) (aj)  Lymphogranuloma venereum;

            (ai) (ak)  Malaria;

            (aj) (al)  Measles (rubeola);

            (ak) (am)  Meningitis, bacterial or viral Meningococcal disease (Neisseria meningitidis);

            (al) (an)  Mumps;

            (am)  Ornithosis (psittacosis);

            (an) (ao)  Pertussis (whooping cough);

            (ao) (ap)  Plague;

            (ap) (aq)  Poliomyelitis, paralytic or non-paralytic;

            (ar)  Psittacosis;

            (aq) (as)  Q-fever;

            (ar) (at)  Rabies or rabies exposure (human) Rabies in a human or animal; exposure to a human by a species susceptible to rabies infection;

            (as)  Reye's syndrome;

            (at) (au)  Rocky Mountain spotted fever Rickettsiosis (spotted fever);

            (au) (av)  Rubella (including congenital);

            (av) (aw)  Salmonellosis;

            (aw) (ax)  Severe acute respiratory syndrome (SARS) Severe Acute Respiratory Syndrome-associated Coronavirus (SARS-CoV) disease;

            (ax) (ay)  Shigellosis;

            (ay) (az)  Smallpox;

            (az) (ba)  Streptococcus pneumoniae invasive disease, drug resistant;

            (bb)  Streptococcal toxic shock syndrome;

            (ba) (bc)  Syphilis;

            (bb) (bd)  Tetanus;

            (bc) (be)  Tickborne relapsing fever;

            (bf)  Toxic shock syndrome (nonstreptococcal);

            (bd) (bg)  Transmissible spongiform encephalopathies;

            (be) (bh)  Trichinosis Trichinellosis (Trichinosis);

            (bf) (bi)  Tuberculosis;

            (bg) (bj)  Tularemia;

            (bh) (bk)  Typhoid fever;

            (bl)  Varicella;

            (bm)  Vibriosis;

            (bn)  Viral hemorrhagic fevers;

            (bi) (bo)  Yellow fever; and

            (bj)  Yersiniosis;

            (bk)  Illness occurring in a traveler from a foreign country;

            (bl)  An occurrence in a community or region of a case or cases of any communicable disease in the "Control of Communicable Diseases Manual, An Official Report of the American Public Health Association", (18th edition, 2004), 2000, with a frequency in excess of normal expectancy; and

            (bm) (bp)  Any unusual incident of unexplained illness or death in a human or animal with potential human health implications. 

 

AUTH:    50-1-202, 50-17-103, 50-18-105, 50-18-106, MCA

IMP:      50-1-202, 50-2-118, 50-17-103, 50-18-102, 50-18-106, MCA

 

            37.114.204  REPORTS AND REPORT DEADLINES  (1)  A local health officer must immediately report (within four hours) to the department by telephone the information cited in ARM 37.114.205(1) through (2) whenever a case of one of the following diseases is suspected or confirmed:

            (a)  Anthrax;

            (b)  Botulism (including infant botulism);

            (c)  Diphtheria;

            (d)  Measles (rubeola);

            (e) (c)  Plague;

            (d)  Poliomyelitis, paralytic or nonparalytic;

            (f)  Rabies or rabies exposure (human);

            (g) (e)  Severe acute respiratory syndrome (SARS) Severe Acute Respiratory Syndrome-associated Coronavirus (SARS-CoV) disease;

            (h) (f)  Smallpox;

            (i) (g)  Tularemia;

            (j)  Typhoid fever; or

            (h)  Viral hemorrhagic fevers.

            (k)  Any unusual incident of unexplained illness or death in a human or animal.

            (2)  A local health officer must mail or transmit by telephone or a secure electronic means to the department the information required by ARM 37.114.205(1) through and (2) for each suspected or confirmed case of one of the following diseases, within the time limit noted for each:

            (a)  Information about a case of one of the following diseases should be submitted on the same day it is received within 24 hours by telephone by the local health officer:

            (i)  Chancroid Brucellosis;

            (ii)  Cholera Diphtheria;

            (iii)  Diarrheal disease outbreak Gastroenteritis outbreak;

            (iv)  Escherichia coli 0157:H7 enteritis Influenza-associated mortality, pediatric;

            (v)  Gastroenteritis outbreak Novel influenza A virus infection;

            (vi)  Gonorrhea Measles;

            (vii)  Gonococcal ophthalmia neonatorum Rabies in a human;

            (viii)  Granuloma inguinale Rabies in an animal;

            (ix)  Haemophilus influenzae B invasive disease (meningitis, epiglottitis, pneumonia, and septicemia);

            (x)  Hantavirus pulmonary syndrome;

            (xi)  Hemolytic uremic syndrome;

            (xii)  Listeriosis;

            (xiii)  Lymphogranuloma venereum;

            (xiv)  Meningitis, bacterial or viral;

            (xv)  Pertussis (whooping cough);

            (xvi)  Poliomyelitis, paralytic or non-paralytic;

            (xvii) (ix)  Rubella (including congenital);

            (xviii) (x)  Syphilis; and

            (xix)  Tetanus;

            (xx) (xi)  Yellow fever;.

            (xxi)  Illness occurring in a traveler from a foreign country; and

            (xxii)  An occurrence in a community or region of a case or cases of any communicable disease in the "Control of Communicable Diseases Manual, An Official Report of the American Public Health Association", (18th edition, 2004), with a frequency in excess of normal expectancy.

            (b)  Information about a case of one of the following diseases should be submitted within seven calendar days after it is received by the local health officer:

            (i)  Amebiasis AIDS or HIV infection;

            (ii)  Brucellosis Anaplasmosis;

            (iii)  Arboviral Disease (neuroinvasive and non-neuroinvasive);

            (iv)  Babesiosis;

            (iii) (v)  Campylobacter enteritis;

            (vi)  Chancroid;

            (iv)  Chickenpox (varicella);

            (v) (vii) Chlamydial trachomatis genital infection;

            (viii)  Coccidioidomycosis;

            (ix)  Colorado Tick Fever;

            (vi) (x)  Cryptosporidiosis;

            (xi)  Cyclosporioasis;

            (vii)  Cytomegaloviral illness;

            (xii)  Denque virus infections;

            (viii)  Encephalitis;

            (vix) (xiii) Giardiasis;

            (xiv)  Gonorrhea;

            (xv)  Haemophilus influenzae, invasive disease;

            (x) (xvi)  Hansen's disease (leprosy);

            (xvii)  Hantavirus pulmonary syndrome or infection;

            (xviii)  Hemolytic uremic syndrome, post diarrheal;

            (xi)  Hepatitis, A, B (acute or chronic), or C (acute or chronic);

            (xix)  Hepatitis A, acute;

            (xx)  Hepatitis B, acute, chronic, perinatal;

            (xxi)  Hepatitis C, acute, infection past or present;

            (xii)  Kawasaki disease;

            (xiii) (xxii)  Lead poisoning (levels ≥ 10 micrograms per deciliter) (blood levels ≥ 5 micrograms per deciliter for children 13 years of age or younger);

            (xiv) (xxiii)  Legionellosis;

            (xxiv)  Listeriosis;

            (xv) (xxv)  Lyme disease;

            (xvi) (xxvi)  Malaria;

            (xxvii)  Meningococcal disease (Neisseria meningitidis);

            (xvii) (xxviii)  Mumps;

            (xxix)  Pertussis;

            (xxx)  Psittacosis;

            (xviii)  Ornithosis (Psittacosis);

            (xix) (xxxi)  Q-fever;

            (xx)  Reye's syndrome;

            (xxi) (xxxii)  Rocky Mountain spotted fever Rickettsiosis (Spotted Fever);

            (xxii) (xxxiii)  Salmonellosis;

            (xxiii) (xxxiv)  Shigellosis;

            (xxiv) (xxxv)  Streptococcus pneumonia, invasive disease, drug resistant;

            (xxxvi)  Streptococcal toxic shock syndrome;

            (xxxvii)  Tetanus;

            (xxv) (xxxviii)  Tickborne relapsing fever;

            (xxxix)  Toxic shock syndrome (non-streptococcal);

            (xxvi) (xl)  Transmissible spongiform encephalopathies;

            (xxvii) (xli)  Trichinosis Trichinellosis (Trichinosis);

            (xxviii) (xlii)  Tuberculosis; or

            (xxix)  Yersiniosis.

            (xliii)  Typhoid Fever;

            (xliv)  Varicella;

            (xlv)  Vibrio cholera infection (Cholera); and

            (xlvi)  Vibriosis.

            (3)  Each week during which a suspected or confirmed case of influenza is reported to the local health officer, the officer must mail or transmit by secure electronic means to the department on Friday of that week the total number of the cases of influenza reported.

            (4)  For any animal bite to a human by a species susceptible to rabies infection, the local health officer must report by secure electronic means to the department documentation of a rabies post-exposure prophylaxis recommendation and/or administration on a form provided by the department within seven calendar days of the recommendation or administration.

            (4) (5)  A laboratory that performs a blood lead analysis must submit to the department, by the 15th day following the month in which the test was performed, a copy of all blood lead analyses performed that month, including analyses in which lead was undetectable.

            (5)  A laboratory that performs tuberculosis, hepatitis B surface antigen, or sexually transmitted disease testing must submit to the department by the 15th day following each month, a report on a form supplied by the department indicating the number of tests with negative or positive results which were done that month for each of those diseases.

            (6)  In the event of a chickenpox outbreak, the local health officer may elect to report a weekly summary count of suspected and confirmed cases in lieu of individual case reports.  Individual case reports will resume when the health officer determines the outbreak has ended. 

 

AUTH:  50-1-202, 50-17-103, 50-18-105, MCA

IMP:    50-1-202, 50-17-103, 50-18-102, 50-18-106, MCA

 

            37.114.205  REPORT CONTENTS  (1)  A report of a case of reportable disease or a condition which is required by ARM 37.114.204(1) or (2) must include, if available:

            (a)  name and age of the case first and last name and middle initial, physical address including city, state and zip code, date of birth, gender, race, and ethnicity of the case;

            (b)  dates of onset of the disease or condition and the date the disease or condition was reported to the health officer;

            (c)  whether or not the case is suspected or confirmed;

            (d)  name and address of the case's physician; and

            (e)  name of the reporter or other person the department can contact for further information regarding the case.

            (2)  The information required by (1) must be supplemented by any other information in the possession of the reporter which the department or local health officer requests and which is related to case management and/or investigation of the case.

            (3)  The laboratory reports required by ARM 37.114.204(5) and the numerical report required by ARM 37.114.204(3) need contain only the information specified in those sections.

            (4) (3)  The name or other identifying information of any case with a reportable disease or condition and the name and address of the reporter of any such case are confidential and not open to public inspection. 

 

AUTH:   50-1-202, 50-17-103, 50-18-105, MCA

IMP:    50-1-202, 50-17-103, 50-18-102, 50-18-106, MCA

 

            37.114.301  SENSITIVE OCCUPATIONS  (1)  A local health officer or the department may restrict a person employed or engaged in direct care of children, the elderly, or individuals who are otherwise at a high risk for disease from practicing an occupation or activity while infected by a reportable disease if, given the means of transmission of the disease in question, the nature of the person's work would tend to spread transmit the disease.

            (2)  No infectious person may engage in any occupation or activity involving the preparation, serving, or handling of food, including milk, to be consumed by others than his/her immediate family, until a local health officer determines him/her to be free of the infectious agent or unlikely to transmit the infectious agent due to the nature of his/her particular work.

 

AUTH:   50-1-202, MCA

IMP:    50-1-202, MCA

 

            37.114.312  IMPORTATION OF DISEASE  (1)  No person who has a reportable disease for which subchapter 5 of this chapter prescribes isolation may be brought within the boundaries of the state without prior notice to the department and approval of measures to be taken within Montana to prevent disease transmission.

            (2)  Whenever a person knows or has reason to believe that an infected person, whether or not infectious, has been brought within the boundaries of the state, he shall report the name and location of the infected person to the department, with the exception of those individuals who are HIV-positive; in the latter case, only the information described in ARM 37.114.205 must be provided to the department.

 

AUTH:    50-1-202, MCA

IMP:      50-1-202, MCA

 

            37.114.313  CONFIRMATION OF DISEASE  (1)  Subject to the limitation in (2), if a local health officer receives information about a case of any of the following diseases, the officer must ensure that a specimen from the case is submitted to the department, when possible, which will be analyzed to confirm the existence or absence of the disease in question, or for use in surveillance:

            (a)  Anthrax;

            (b)  Botulism (foodborne);

            (c)  Brucellosis;

            (d)  Campylobacteriosis;

            (d) (e)  Cholera;

            (e)  Diarrheal disease outbreak;

            (f)  Diphtheria;

            (g)  Escherichia coli, shiga toxin-producing (STEC);

            (h)  Gastroenteritis outbreak;

            (i)  Gonorrhea;

            (j)  Haemophilus influenzae invasive disease;

            (g) (k)  Hantavirus pulmonary syndrome or infection;

            (h) (l)  Human immunodeficiency virus (HIV);

            (i) (m)  Influenza;

            (n)  Listeriosis;

            (j) (o)  Measles (rubeola);

            (p)  Meningococcal disease (Neisseria meningitidis);

            (k) (q)  Pertussis (whooping cough);

            (l) (r)  Plague;

            (m) (s)  Poliomyelitis, paralytic or non-paralytic;

            (n) (t)  Rabies (human);

            (o) (u)  Rubella (including congenital);

            (v)  Salmonellosis;

            (p) (w)  Severe acute respiratory syndrome (SARS) Severe Acute Respiratory Syndrome-associated Coronavirus (SARS-CoV) disease;

            (x)  Shigellosis;

            (q) (y)  Smallpox;

            (r) (z)  Syphilis;

            (s) (aa)  Trichinosis Trichinellosis (Trichinosis);

            (t) (ab)  Tuberculosis; and

            (u) (ac)  Typhoid fever.;

            (ad)  Vancomycin-intermediate Staphylococcus aureus (VISA);

            (ae)  Vancomycin-resistant Staphylococcus aureus (VRSA); and

            (af)  Vibriosis.

            (2)  In the event of an outbreak of diarrheal disease gastroenteritis, influenza, or measles, or pertussis, analysis of specimens from each case is unnecessary after the disease organism is determined by the department.

            (3)  A laboratorian laboratory professional or any other person in possession of a specimen from a case of a disease listed in (1)(a) through (u) (af) must submit the specimen to the local health officer department upon request.

            (4)  If no specimen from the case is otherwise available and the case refuses to allow a specimen to be taken for purposes of (1), the case will be assumed to be infected and must comply with whatever control measures are imposed by the department, or the local health officer.

 

AUTH:   50-1-202, 50-1-204, MCA

IMP:     50-1-202, 50-1-204, MCA

 

            37.114.314  INVESTIGATION OF A CASE  (1)  Immediately after being notified of a case or an outbreak of a reportable disease, a local health officer must investigate and take whatever steps are necessary to prevent spread transmission of the disease.

            (2)  If the local health officer finds that the nature of the disease and the circumstances of the case or outbreak warrant such action, the local health officer must:

            (a)  examine or ensure that a health care provider examines any infected person in order to verify the diagnosis;

            (b)  make an epidemiologic investigation to determine the source and possible spread transmission of infection;

            (c)  take appropriate steps, as outlined in the "Control of Communicable Diseases Manual, An Official Report of the American Public Health Association", (18th edition, 2004) (19th edition, 2008), to prevent or control the spread transmission of disease; and

            (d)  notify contacts as defined in ARM 37.114.101 of the case and give them the information needed to prevent contracting the disease.

            (3)  Whenever the identified source of a reportable disease or a person infected or exposed to a reportable disease who should be quarantined, interviewed, or placed under surveillance is located outside of the jurisdiction of the local health officer, the local health officer must:

            (a)  notify the department or the local health officer of the jurisdiction in which the source or person is located if within Montana; or

            (b)  notify the department who will then notify the health officer of the relevant jurisdiction if the source or person is located outside of Montana.

 

AUTH:   50-1-202, 50-2-118, 50-17-103, 50-18-105, MCA

IMP:      50-1-202, 50-2-118, 50-17-103, 50-17-105, 50-18-102, 50-18-107, 50-18-108, MCA

 

            37.114.315  POTENTIAL OUTBREAKS  (1)  Whenever a disease listed in ARM 37.114.204(1) is confirmed reported or whenever any other communicable disease listed in the "Control of Communicable Diseases Manual, An Official Report of the American Public Health Association", (18th edition, 2004) (19th edition, 2008), or other communicable disease which constitutes a threat to the health of the public becomes so prevalent as to endanger an area outside of the jurisdiction where it first occurred, the local health officer of the jurisdictional area in which the disease occurs must notify the and cooperate with the department and cooperate with the department's epidemiologist or the epidemiologist's representative to control the spread transmission of the disease in question.

 

AUTH:   50-1-202, MCA

IMP:     50-1-202, 50-2-118, MCA

 

            37.114.501  MINIMAL CONTROL MEASURES  (1)  The department, except as otherwise provided in this subchapter, adopts and incorporates by reference the control measures in the ″Control of Communicable Diseases Manual, An Official Report of the American Public Health Association″ (19th edition, 2008).  This subchapter contains minimal control measures to prevent the spread of disease. The Unless a particular control measure specifies who is responsible, the local health officer or the authorized representative of a local health officer officer's designee must: either employ the minimal control measures or ensure that a representative of the department when assisting a local health officer with a case, a health care provider treating a person with a reportable disease, or any other person caring for a person with a reportable disease does so, with the exception that if a particular control measure specifies who is responsible for carrying it out, only that person is responsible.

            (a)  employ the minimum control measures; or

            (b)  ensure that minimal control measures are employed by a health care provider or other person caring for a person with a reportable disease.

            (2)  If a reportable disease is not listed in this subchapter, no minimum control measures for the disease are required.

 

AUTH:   50-1-202, 50-2-116, 50-2-118, MCA

IMP:     50-1-202, 50-2-116, 50-2-118, MCA

 

            37.114.503  ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS) AND HIV INFECTION  (1)  Whenever human immunodeficiency virus (HIV) infection occurs, infection control fluid precautions must be used for the duration of the infection.

            (2)  If a test confirms HIV infection, the department will contact the health care provider submitting the test or another health care provider designated by the subject of the test in order to determine whether acquired immune deficiency syndrome is present.  If AIDS exists, the provider must submit a report pursuant to ARM 37.114.205.

            (3) (2)  The department or local health officer must ensure that the following actions are taken:  Either a health care provider treating an individual with HIV infection for that infection or a representative of the department or local health department must:

            (a)  instruct the case how to prevent spreading transmitting the HIV infection to others;

            (b)  provide the case with information about any available services relevant to the case's health status and refer the case to appropriate services;

            (c)  interview the infected person to determine the person's contacts; and

            (d)  locate each contact, counsel each contact, advise the contact to receive testing to determine the contact's HIV status, and refer the contact for appropriate services.

            (4) (3)  The health care provider may perform the required actions under (2) must either conduct the interview with the case and assist the case with contact notification at the discretion of or request the department or local health officer to assist in conducting the interview and/or notifying contacts.

 

AUTH:    50-1-202, 50-2-118, 50-16-1004, MCA

IMP:      50-1-202, 50-2-118, 50-16-1004, MCA

 

            37.114.512  CHANCROID  (1)  A person infected with chancroid must be directed not to engage in sexual contact until all chancroid lesions are healed.  The  local health officer or the department must either employ or ensure that control measures as outlined in the Centers for Disease Control and Prevention ″Sexually Transmitted Diseases Treatment Guidelines, 2010″ are followed. 

 

AUTH:   50-1-202, 50-2-118, 50-18-105, MCA

IMP:    50-1-202, 50-2-118, 50-18-102, MCA

 

            37.114.515  CHLAMYDIAL GENITAL INFECTION  (1)  The local health officer or the department must either employ or ensure that control measures as outlined in the Centers for Disease Control and Prevention ″Sexually Transmitted Diseases Treatment Guidelines, 2010″ are followed.  An individual with a chlamydial genital infection must be directed to undergo appropriate antibiotic therapy and to avoid sexual contact until seven days have elapsed since the commencement of effective treatment prescribed by the Centers for Disease Control and Prevention in the "Sexually Transmitted Diseases Treatment Guidelines 2002".

            (2)  An individual who contracts the infection must be interviewed by the local health officer to determine the person's sexual contacts, and those contacts must be provided with appropriate medical treatment.

 

AUTH:   50-1-202, 50-2-118, 50-18-105, MCA

IMP:     50-1-202, 50-2-118, 50-18-102, 50-18-107, MCA

 

            37.114.530  GONORRHEA  (1)  The local health officer or the department must either employ or ensure that control measures as outlined in the Centers for Disease Control and Prevention ″Sexually Transmitted Diseases Treatment Guidelines, 2010″ are followed.  A person who contracts genital gonorrhea must be directed to undergo appropriate antibiotic therapy and to avoid sexual contact until seven days have elapsed since the commencement of effective treatment prescribed by the Centers for Disease Control and Prevention in the "Sexually Transmitted Diseases Treatment Guidelines 2002".  Individuals who have contracted genital gonorrhea must also be treated for Chlamydia.

            (2)  The local health officer must interview an individual who contracts the infection in order to determine the person's sexual contacts, and must ensure that those contacts are examined and receive the medical treatment indicated by clinical or laboratory findings.

 

AUTH:   50-1-202, 50-2-118, 50-18-105, MCA

IMP:      50-1-202, 50-2-118, 50-18-102, 50-18-107, MCA

 

            37.114.531  GRANULOMA INGUINALE  (1)  The local health officer or the department must either employ or ensure that control measures as outlined in the Centers for Disease Control and Prevention ″Sexually Transmitted Diseases Treatment Guidelines, 2010″ are followed.  Contact with lesions must be avoided until after the lesions are healed.

            (2)  The local health officer or the officer's designee must identify and treat sexual contacts.

 

AUTH:   50-1-202, 50-2-118, 50-18-105, MCA

IMP:     50-1-202, 50-2-118, 50-18-102, MCA

 

            37.114.540  HEPATITIS TYPE B (ACUTE OR CHRONIC)  (1)  For a case of type B hepatitis not involving a pregnant woman, control measures outlined in Control of Communicable Diseases Manual must be applied.:

            (a)  Infection control precautions must be imposed until it is determined that viremia no longer exists.

            (b)  The local health officer designee must identify contacts and advise them how to prevent acquisition of the disease, given the nature of their relationship to the case.

            (2)  In the event a hepatitis B surface antigen (HbsAg) is positive in a pregnant woman, the local health officer must:

            (a)  ensure appropriate health care providers and the birthing facility are aware of the mother's status and the infant's need for prophylaxis;

            (b)  ensure that hepatitis B immunoglobulin (HBIG) and vaccine are readily available at the birthing facility at the expected time of delivery;

            (c)  confirm the administration of HBIG and vaccine after delivery and submit the report form provided by the department within seven days after delivery and counsel the mother and provider regarding the need for further vaccination and testing;

            (d)  at one to two months and again at six to seven months after delivery contact the health care provider or guardian of the infant to confirm the vaccine was given and provide an update to the department using a form provided by the department; and

            (e)  at nine to 15 months after delivery, confirm testing of the infant for the surface antigen and antibody to the hepatitis B virus (HBV), counsel as appropriate, and provide an update to the department using a form provided by the department.

 

AUTH:    50-1-202, 50-2-118, 50-19-101, MCA

IMP:    50-1-202, 50-2-118, 50-19-101, MCA

 

            37.114.542  HEPATITIS C (ACUTE OR CHRONIC)  (1)  The local health officer must ensure that each case:

            (a)  is counseled regarding prevention of transmission to others and provided with referrals to counseling and medical care as appropriate.; and

            (b) (2)  In cases of acute Hepatitis C, the local health officer must identify, is encouraged to notify, and refer at-risk contacts for testing.

            (3)  In cases of chronic Hepatitis C, the local health officer may notify and refer at-risk contacts for testing, or encourage the case to do so, or to request assistance of the local public health officer with contact notification.

 

AUTH:     50-1-202, 50-2-118, MCA

IMP:      50-1-202, 50-2-118, MCA

 

            37.114.546  LEAD POISONING:  ELEVATED BLOOD LEAD LEVELS IN CHILDREN     (1)  When an elevated capillary test of a child aged 13 or under shows an elevated blood lead level (EBL) greater than or equal to 10 micrograms per deciliter (ug/dl), the health care provider who ordered the capillary test must confirm the results as soon as possible by a venous draw.  An elevated blood lead level is defined as being greater than or equal to 5 micrograms per deciliter (ug/dl) in children 13 years of age or younger.  If the blood lead level was determined by capillary blood method, then the test result must be confirmed by venous method as soon as possible.  The elevated blood lead level of concern is based on 2012 guidance from the Centers for Disease Control and Prevention (CDC).  A copy of this document is available from the Department of Public Health and Human Services, Public Health and Safety Division, Communicable Disease Epidemiology Section, 1400 Broadway, P.O. Box 202951, Helena, Montana  59620-2951, telephone (406) 444-0273.

            (2)  In the case of an elevated venous level, the health care provider must retest the blood lead level at intervals recommended by the federal Centers for Disease Control and Prevention (CDC), until two consecutive tests taken at least two months apart show a level of less than 10 5 ug/dl.

            (3)  The department hereby adopts and incorporates by reference the recommendations for blood lead testing intervals for children with elevated venous levels published in the May 2012 MMWR announcement cited above, the November 1997 by the federal Centers for Disease Control and Prevention (CDC) and contained in CDC's manual "Screening Young Children for Lead Poisoning:  Guidance for State and Local Public Health Officials", and the March 2002 CDC manual ″Managing Elevated Blood Lead Levels Among Young Children:  Recommendations from the Advisory Committee on Childhood Lead Poisoning Prevention,″ which contains guidance for identifying children with dangerous blood lead levels and intervening to protect them.  A copy of the manual is available from the Centers for Disease Control, MASO Publications Distribution Facility, 5665 New Peachtree Road (PO7), Atlanta, GA  30341.  A copy of this document is available from the Department of Public Health and Human Services, Public Health and Safety Division, Communicable Disease Epidemiology Section, 1400 Broadway, P.O. Box 202951, Helena, Montana  59620-2951, telephone (406) 444-0273.

 

AUTH:    50-1-202, MCA

IMP:      50-1-202, MCA

 

            37.114.552  LYMPHOGRANULOMA VENEREUM  (1)  The local health officer or the department must either employ or ensure that control measures as outlined in the Centers for Disease Control and Prevention ″Sexually Transmitted Diseases Treatment Guidelines, 2010" are followed.  A person who contracts lymphogranuloma venereum must be instructed to avoid sexual contact until after the lesions heal.

            (2)  An individual who contracts the disease must be interviewed by the local health officer or the officer's designee to determine who that individual's contacts are, and the local health officer must ensure that those contacts are examined and receive the medical treatment indicated by clinical and laboratory findings.

 

AUTH:    50-1-202, 50-2-118, 50-18-105, MCA

IMP:     50-1-202, 50-2-118, 50-18-102, MCA

 

            37.114.561  ORNITHOSIS (PSITTACOSIS)  (1)  Infection control precautions must be imposed upon a case of ornithosis as long as the fever lasts.  For a case of Psittacosis, control measures outlined in Control of Communicable Diseases Manual must be applied.

            (2)  The local health officer must inquire whether a bird epidemiologically linked to a case of ornithosis psittacosis was obtained from an aviary, and, if so, determine the location of the aviary and report it to the Montana State Veterinarian, Department of Livestock.

 

AUTH:    50-1-202, 50-2-118, MCA

IMP:      50-1-202, 50-2-118, MCA

 

            37.114.563  PERTUSSIS (WHOOPING COUGH)  (1)  Infection control precautions must be imposed upon a case of pertussis for five days after the start of antibiotic therapy, or 21 days after the date of onset of symptoms if no antibiotic therapy is given.

            (2)  An individual identified by the local health officer as a close contact must be referred by the officer to a physician for chemoprophylaxis.

            (3)  A person identified by the local health officer as a close contact must be monitored by the local health officer for respiratory symptoms for 20 days after the person's last contact with the case.

            (4)  If a close contact shows respiratory symptoms consistent with pertussis, the health officer must order the contact to avoid contact with anyone outside of the contact's immediate family until a medical evaluation indicates that the contact is not developing pertussis.

            (5)  Surveillance for susceptible contacts must be initiated immediately by the local health officer and immediate immunizations recommended by the officer must be administered to identified susceptible contacts.

 

AUTH:   50-1-202, 50-2-118, MCA

IMP:      50-1-202, 50-2-118, MCA

 

            37.114.571  RABIES EXPOSURE  (1)  Control measures outlined in Control of Communicable Diseases Manual must be applied for confirmed or suspected exposures to a human by a species susceptible to rabies infection.  The following actions must be reported to the local health officer if they are committed by an animal other than a rabbit, hare, or rodent whose species can be infected with rabies:

            (a)  biting of a human being;

            (b)  contamination of a mucous membrane, scratch, abrasion, or open wound of a human by the saliva or other potentially infectious material from an animal that exhibits:

            (i)  paralysis or partial paralysis of the limbs;

            (ii)  marked excitation, muscle spasms, difficulty swallowing, apprehensiveness, delirium, or convulsions; or

            (iii)  unusual aggressive or unnatural behavior toward a person, animal, or inanimate object.

            (2)  The local health officer shall must investigate each report of possible rabies exposure and gather, at a minimum, information about the circumstances of the possible rabies exposure; nature of the exposure; name, age, and address of the exposed individual; vaccination status of the animal in question; treatment of the exposed person; and eventual outcome for both animal and person involved.

            (3)  As soon as possible after investigating a report of possible rabies exposure, the local health officer must inform the exposed person or the individual responsible for the exposed person if that person is a minor whether or not treatment is recommended to prevent rabies and provide a referral to a health care provider.

            (4)  Whenever the circumstances described in (1) involve a dog, cat, or ferret, the local health officer must either:

            (a)  arrange for the animal to be observed for signs of illness during a ten-day quarantine period at an animal shelter, veterinary facility, or other adequate facility, and ensure that any illness in the animal during the confinement or before release is evaluated by a veterinarian for signs suggestive of rabies; or

            (b)  if the symptoms described in (1)(b) above exist observed are consistent with rabies, order the animal killed euthanized and the head sent to the Department of Livestock's diagnostic laboratory at Bozeman for rabies analysis.  The local health officer may also order an animal killed euthanized subsequent to isolation, and the brain analyzed.

            (5)  Additional rabies reporting and control requirements are contained in ARM 32.3.1201 through 32.3.1207, rules of the Department of Livestock.

            (6)  The department hereby adopts and incorporates by reference ARM 32.3.1205, which contains the standards for proper vaccination against rabies.  A copy of ARM 32.3.1205 may be obtained from the Department of Livestock, Animal ″444-2043.

 

AUTH:  50-1-202, 50-2-118, MCA

IMP:     50-1-202, 50-2-118, MCA

 

            37.114.583  SYPHILIS  (1)  The local health officer or the department must either employ or ensure that control measures as outlined in the Centers for Disease Control and Prevention ″Sexually Transmitted Diseases Treatment Guidelines, 2010″ are followed.  A person with a case of infectious syphilis must be instructed to refrain from activities in which body fluids are shared (such as sexual intercourse) until 48 hours after effective treatment has been commenced and must either receive treatment or be isolated until treatment is received.

            (2)  A person with syphilis must be interviewed by the local health officer or the officer's designee to identify the following types of contacts, depending upon the disease stage in question:

            (a)  for primary syphilis, all sexual contacts during the three months prior to the onset of symptoms;

            (b)  for secondary syphilis, all sexual contacts during the six months preceding diagnosis;

            (c)  for early latent syphilis, those sexual contacts during the year preceding diagnosis, if the time that primary and secondary lesions appeared cannot be established;

            (d)  for late latent syphilis, marital partners and children of infected mothers;

            (e)  for congenital syphilis, all members of the immediate family of the case.

            (3)  All identified contacts of confirmed cases of early syphilis must be examined to determine if they have syphilis, directed to refrain from activities in which body fluids are shared, and, if they consent, immediately be given appropriate treatment.  Laboratory specimens must be taken during the examination.

 

AUTH:  50-1-202, 50-2-118, 50-18-105, MCA

IMP:     50-1-202, 50-2-118, 50-18-102, 50-18-107, MCA

 

4.  The department proposes to repeal the following rules:

 

37.114.504  AMEBIASIS is found on page 37-28864 of the Administrative Rules of Montana.

 

AUTH:  50-1-202, 50-2-118, MCA

IMP:     50-1-202, 50-2-118, MCA

 

            37.114.506  ANTHRAX is found on page 37-28867 of the Administrative Rules of Montana.

 

AUTH:   50-1-202, 50-2-118, MCA

IMP:      50-1-202, 50-2-118, MCA

 

            37.114.507  BOTULISM:  INFANT BOTULISM is found on page 37-28868 of the Administrative Rules of Montana.

 

AUTH:   50-1-202, 50-2-118, MCA

IMP:     50-1-202, 50-2-118, MCA

 

            37.114.509  BRUCELLOSIS is found on page 37-28871 of the Administrative Rules of Montana.

 

AUTH:   50-1-202, 50-2-118, MCA

IMP:     50-1-202, 50-2-118, MCA

 

            37.114.510  CAMPYLOBACTER ENTERITIS is found on page 37-28871 of the Administrative Rules of Montana.

 

AUTH:  50-1-202, 50-2-118, MCA

IMP:     50-1-202, 50-2-118, MCA

 

            37.114.514  CHICKENPOX (VARICELLA) is found on page 37-28875 of the Administrative Rules of Montana.

 

AUTH:  50-1-202, MCA

IMP:     50-1-202, MCA

 

            37.114.516  CHOLERA is found on page 37-28878 of the Administrative Rules of Montana.

 

AUTH:     50-1-202, 50-2-118, MCA

IMP:        50-1-202, 50-2-118, MCA

 

            37.114.518  COLORADO TICK FEVER is found on page 37-28881 of the Administrative Rules of Montana.

 

AUTH:   50-1-202, 50-2-118, MCA

IMP:      50-1-202, 50-2-118, MCA

 

            37.114.519  CRYPTOSPORIDIOSIS is found on page 37-28882 of the Administrative Rules of Montana.

 

AUTH:    50-1-201, MCA

IMP:     50-1-202, MCA

 

            37.114.521  DIARRHEAL DISEASE OUTBREAK is found on page 37-28885 of the Administrative Rules of Montana.

 

AUTH:   50-1-202, 50-2-118, MCA

IMP:      50-1-202, 50-2-118, MCA

 

            37.114.522  DIPHTHERIA is found on page 37-28886 of the Administrative Rules of Montana.

 

AUTH:  50-1-202, 50-1-204, 50-2-118, MCA

IMP:     50-1-202, 50-1-204, 50-2-118, MCA

 

            37.114.524  ENCEPHALITIS is found on page 37-28889 of the Administrative Rules of Montana.

 

AUTH:  50-1-202, 50-2-118, MCA

IMP:     50-1-202, 50-2-118, MCA

 

            37.114.525  ESCHERICHIA COLI 0157:H7 ENTERITIS is found on page 37-28889 of the Administrative Rules of Montana.

 

AUTH:  50-1-202, 50-2-118, MCA

IMP:    50-1-202, 50-2-118, MCA

 

            37.114.528  GIARDIASIS is found on page 37-28891 of the Administrative Rules of Montana.

 

AUTH:   50-1-202, 50-2-118, MCA

IMP:      50-1-202, 50-2-118, MCA

 

            37.114.533  HAEMOPHILUS INFLUENZA B INVASIVE DISEASE is found on page 37-28897 of the Administrative Rules of Montana.

 

AUTH:   50-1-202, 50-2-118, MCA

IMP:     50-1-202, 50-2-118, MCA

 

            37.114.534  HANSEN'S DISEASE (LEPROSY) is found on page 37-28897 of the Administrative Rules of Montana.

 

AUTH:  50-1-202, 50-1-204, 50-2-118, MCA

IMP:     50-1-202, 50-1-204, 50-2-118, MCA

 

            37.114.536  HANTAVIRUS PULMONARY SYNDROME is found on page 37-28899 of the Administrative Rules of Montana.

 

AUTH:  50-1-202, 50-2-118, MCA

IMP:    50-1-202, 50-2-118, MCA

 

            37.114.537  HEMOLYTIC UREMIC SYNDROME is found on page 37-28899 of the Administrative Rules of Montana.

 

AUTH:   50-1-202, MCA

IMP:      50-1-202, MCA

 

            37.114.539  HEPATITIS TYPE A is found on page 37-28901 of the Administrative Rules of Montana.

 

AUTH:  50-1-202, 50-2-118, MCA

IMP:     50-1-202, 50-2-118, MCA

 

            37.114.544  INFLUENZA is found on page 37-28905 of the Administrative Rules of Montana.

 

AUTH:    50-1-202, 50-2-118, MCA

IMP:      50-1-202, 50-2-118, MCA

 

            37.114.548  LEGIONELLOSIS is found on page 37-28909 of the Administrative Rules of Montana.

 

AUTH:   50-1-202, 50-2-118, MCA

IMP:      50-1-202, 50-2-118, MCA

 

            37.114.549  LISTERIOSIS OUTBREAK is found on page 37-28909 of the Administrative Rules of Montana.

 

AUTH:    50-1-202, 50-2-118, MCA

IMP:       50-1-202, 50-2-118, MCA

 

            37.114.551  LYME DISEASE is found on page 37-28911 of the Administrative Rules of Montana. 

 

AUTH:   50-1-202, 50-2-118, MCA

IMP:      50-1-202, 50-2-118, MCA

 

            37.114.554  MALARIA is found on page 37-28913 of the Administrative Rules of Montana.

 

AUTH:   50-1-202, 50-2-118, MCA

IMP:     50-1-202, 50-2-118, MCA

 

            37.114.555  MEASLES:  RUBEOLA is found on page 37-28913 of the Administrative Rules of Montana.

 

AUTH:  50-1-202, 50-1-204, 50-2-118, MCA

IMP:     50-1-202, 50-1-204, 50-2-118, MCA

 

            37.114.557  MENINGITIS:  BACTERIAL OR VIRAL is found on page 37-28915 of the Administrative Rules of Montana.

 

AUTH:  50-1-202, 50-1-204, 50-2-118, MCA

IMP:     50-1-202, 50-1-204, 50-2-118, MCA

 

            37.114.558  MUMPS is found on page 37-28915 of the Administrative Rules of Montana. 

 

AUTH:  50-1-205, 50-2-118, MCA

IMP:     50-1-202, 50-2-118, MCA

 

            37.114.560  OPHTHALMIA NEONATORUM is found on page 37-28917 of the Administrative Rules of Montana.

 

AUTH:  50-1-202, 50-2-118, MCA

IMP:  50-1-202, 50-1-118, MCA

 

            37.114.565  PLAGUE is found on page 37-28921 of the Administrative Rules of Montana. 

 

AUTH:  50-1-202, 50-1-204, 50-2-118, MCA

IMP:    50-1-202, 50-1-204, 50-2-118, MCA

 

            37.114.566  POLIOMYELITIS is found on page 37-28922 of the Administrative Rules of Montana.

 

AUTH:  50-1-202, 50-2-118, MCA

IMP:     50-1-202, 50-2-118, MCA

 

            37.114.568  Q-FEVER (QUERY FEVER) is found on page 37-28923 of the Administrative Rules of Montana.

 

AUTH:   50-1-202, 50-2-118, MCA

IMP:      50-1-202, 50-2-118, MCA

 

            37.114.570  RABIES:  HUMAN is found on page 37-28923 of the Administrative Rules of Montana.

 

AUTH:    50-1-202, 50-1-204, 50-2-118, MCA

IMP:       50-1-202, 50-1-204, 50-2-118, MCA

 

            37.114.573  ROCKY MOUNTAIN SPOTTED FEVER is found on page 37-28929 of the Administrative Rules of Montana.

 

AUTH:  50-1-202, 50-2-118, MCA

IMP:     50-1-202, 50-2-118, MCA

 

            37.114.574  RUBELLA is found on page 37-28929 of the Administrative Rules of Montana.

 

AUTH:    50-1-202, 50-2-118, MCA

IMP:       50-1-202, 50-2-118, MCA

 

            37.114.575  RUBELLA:  CONGENITAL is found on page 37-28930 of the Administrative Rules of Montana. 

 

AUTH:  50-1-202, 50-2-118, MCA

IMP:    50-1-202, 50-2-118, MCA

 

            37.114.577  SALMONELLOSIS (OTHER THAN TYPHOID FEVER) is found on page 37-28933 of the Administrative Rules of Montana.

 

AUTH:  50-1-202, 50-2-118, MCA

IMP:    50-1-202, 50-2-118, MCA

 

            37.114.578  SEVERE ACUTE RESPIRATORY SYNDROME (SARS) is found on page 37-28934 of the Administrative Rules of Montana.

 

AUTH:  50-1-202, MCA

IMP:     50-1-202, MCA

 

            37.114.579  SHIGELLOSIS is found on page 37-28935 of the Administrative Rules of Montana. 

 

AUTH:  50-1-202, 50-2-118, MCA

IMP:    50-1-202, 50-2-118, MCA

 

            37.114.581  SMALLPOX is found on page 37-28937 of the Administrative Rules of Montana.

 

AUTH:  50-1-202, MCA

IMP:     50-1-202, MCA

 

            37.114.582  STREPTOCOCCUS PNEUMONIAE INVASIVE DISEASE, DRUG RESISTANT is found on page 37-28939 of the Administrative Rules of Montana.

 

AUTH:  50-1-202, MCA

IMP:     50-1-202, MCA

 

            37.114.585  TRICHINOSIS is found on page 37-28943 of the Administrative Rules of Montana.

 

AUTH:    50-1-202, 50-2-118, MCA

IMP:       50-1-202, 50-2-118, MCA

 

            37.114.588  TULAREMIA is found on page 37-28945 of the Administrative Rules of Montana.

 

AUTH:  50-1-205, 50-2-118, MCA

IMP:      50-1-202, 50-2-118, MCA

 

            37.114.589  TYPHOID FEVER is found on page 37-28946 of the Administrative Rules of Montana.

 

AUTH:  50-1-202, 50-2-118, MCA

IMP:      50-1-202, 50-2-118, MCA

 

            37.114.591  YELLOW FEVER is found on page 37-28947 of the Administrative Rules of Montana. 

 

AUTH:  50-1-202, 50-2-118, MCA

IMP:     50-1-202, 50-2-118, MCA

 

            37.114.592  YERSINIOSIS is found on page 37-28947 of the Administrative Rules of Montana.

 

AUTH:  50-1-202, 50-2-118, MCA

IMP:     50-1-202, 50-2-118, MCA

 

            37.114.595  ILLNESS IN TRAVELER FROM FOREIGN COUNTRY is found on page 37-28951 of the Administrative Rules of Montana.

 

AUTH:  50-1-202, 50-1-204, 50-2-118, MCA

IMP:      50-1-202, 50-1-204, 50-2-118, MCA

 

            5.  STATEMENT OF REASONABLE NECESSITY

 

The Department of Public Health and Human Services (the department) is proposing amendments to the Communicable Disease Control Rules to address redundancies, update and better align the rules with Centers for Disease Control and Prevention (CDC) Council for State and Territorial Epidemiologists (CSTE) "2012 Case Definitions:  Nationally Notifiable Conditions Infectious and Non-Infectious Case. (2012)."  In addition, control measures are being edited to "control" by reference and align with the American Public Health Association "Control of Communicable Diseases Manual."  Many of the proposed amendments are simple clarifications, grammatical errors, or internal inconsistencies.  The substantive changes are specifically outlined below.

 

ARM 37.114.101 

 

The department is proposing to amend, update, and add new definitions to clearly explain terms used in these rules.

 

ARM 37.114.105 

 

The department is proposing to update the referenced documents to the most recent versions of those documents.

 

ARM 37.114.201

 

The department is proposing to update and clarify terminology.  The department is also proposing to add language to allow reporting entities other than licensed providers to submit electronic reports directly to the department.  This change will accommodate the department's efforts to implement a statewide electronic surveillance system that supports the needs of local and state public health agencies.  Licensed healthcare providers are excluded due to the fact that they are providing direct care to cases needing reporting and must comply with specific reporting statutes.

 

ARM 37.114.203 

 

The department is proposing to add and remove diseases and conditions to align with national recommendations outlined in CDC/CSTE "2012 Case Definitions:  Nationally Notifiable Conditions Infectious and Non-Infectious Case. (2012)." 

 

ARM 37.114.204 

 

The department is proposing to align the rule with case definitions and the reporting time frames associated with the CDC/CSTE "2012 Case Definitions:  Nationally Notifiable Conditions Infectious and Non-Infectious Case. (2012)."  The Department is also proposing to remove language for conditions that no longer serve any useful purpose. 

 

ARM 37.114.205 

 

The department is proposing to add language to include nationally required minimal data elements and to remove language for a report no longer asked for or needed under ARM 37.114.204.

 

ARM 37.114.301 

 

The department proposes minor modifications to clarify those persons, other than paid employees, who may engage in sensitive occupations and will be subject to the rule.

 

ARM 37.114.312 

 

The department proposes removing language that is redundant with other reporting requirements outlined elsewhere in this chapter. 

 

ARM 37.114.313 

 

The department proposes adding language to align language with the CDC/CSTE "2012 Case Definitions:  Nationally Notifiable Conditions Infectious and Non-Infectious Case. (2012)" and to ensure specimens and isolates of significant interest to public health are submitted for confirmation and/or analysis to the state public health laboratory.

 

ARM 37.114.314 

 

The department proposes changing language to update referenced documents and to clarify cross jurisdictional reporting in order to address miscommunication issues that have occurred as a result of the old language.

 

ARM 37.114.315 

 

The department proposes changing language to improve the timeliness of reporting for diseases requiring "immediate" reporting under ARM 37.114.204(1).  Use of the older "confirmed" language could delay the reporting of diseases that represent extreme public health threats including the potential for bioterrorism.

 

ARM 37.114.501 

 

The department proposes amending this rule by changing language to utilize the proposed reference to guide control measures under this subchapter in a way that encompasses more diseases and aligns control measures to national standardized approaches.  The department proposes to clarify the role and responsibility of local health officers relative to employing control measures.

 

ARM 37.114.503 

 

The department proposes to remove language that is no longer necessary due to evolving case definitions of this disease and the addition of language under ARM 37.114.203(a) and clarify responsibilities for actions to be taken. 

 

ARM 37.114.512

 

The department proposes amending this rule by adding the language that references the control measures in the Centers for Disease Control and Prevention "Sexually Transmitted Diseases Treatment Guidelines, 2010" and removing older language that does not fully encompass necessary control measures.   This rule addresses a sexually transmitted disease as defined under 50-18-101, MCA as distinct from other communicable diseases. 

 

ARM 37.114.515 

 

The department proposes amending this rule by adding the language which aligns with the CDC/CSTE "2012 Case Definitions:  Nationally Notifiable Conditions Infectious and Non-Infectious Case. (2012)" and that references the control measures in the Centers for Disease Control and Prevention "Sexually Transmitted Diseases Treatment Guidelines, 2010" and removing older language that does not fully encompass necessary control measures.  This rule addresses a sexually transmitted disease as defined under 50-18-101, MCA as distinct from other communicable diseases. 

 

ARM 37.114.530 and 37.114.531

 

The department proposes amending ARM 37.114.530 and 37.114.531 by adding the language that references the control measures in the Centers for Disease Control and Prevention "Sexually Transmitted Diseases Treatment Guidelines 2010" and removing older language that does not fully encompass necessary control measures.  ARM 37.114.530 and 37.114.531 address sexually transmitted diseases as defined under 50-18-101, MCA as distinct from other communicable diseases. 

 

ARM 37.114.540, 37.114.542, and 37.114.561

 

The department is proposing to add and remove language to clarify the control measures associated with these rules. 

 

ARM 37.114.546 

 

The department proposes amending this rule by adding the language that references the control measures in the Centers for Disease Control and Prevention "Response to the Advisory Committee on Childhood Lead Poisoning Prevention Report, Low Level Lead Exposure Harms Children:  A Renewed Call for Primary Prevention", May 25, 2012/61(20);383 and removing older language that does not fully encompass necessary control measures. 

 

ARM 37.114.552 

 

The department proposes amending this rule by adding the language that references the control measures in the Centers for Disease Control and Prevention "Sexually Transmitted Diseases Treatment Guidelines, 2010" and removing older language that does not fully encompass necessary control measures.  This rule addresses a sexually transmitted disease as defined under 50-18-101, MCA as distinct from other communicable diseases. 

 

ARM 37.114.563 

 

The department proposes removing language determined to be unnecessary. 

 

ARM 37.114.571 

 

The department is proposing to add and remove language to this rule to clarify the responsibilities of the local health officer and to remove language that is redundant and unnecessary due to changes in reportables under ARM 37.114.203.

 

ARM 37.114.583 

 

The department proposes amending this rule by adding the language that references the control measures in the Centers for Disease Control and Prevention "Sexually Transmitted Diseases Treatment Guidelines, 2010" and removing older language that does not fully encompass necessary control measures.  This rule addresses a sexually transmitted disease as defined under 50-18-101, MCA as distinct from other communicable diseases.

 

ARM 37.114.504, 37.114.506, 37.114.507, 37.114.509, 37.114.510, 37.114.514, 37.114.516, 37.114.518, 37.114.519, 37.114.521, 37.114.522, 37.114.524, 37.114.525, 37.114.528, 37.114.533, 37.114.534, 37.114.536, 37.114.537, 37.114.539, 37.114.544, 37.114.548, 37.114.549, 37.114.551, 37.114.554, 37.114.555, 37.114.557, 37.114.558, 37.114.560, 37.114.565, 37.114.566, 37.114.568, 37.114.570, 37.114.573, 37.114.574, 37.114.575, 37.114.577, 37.114.578, 37.114.579, 37.114.581, 37.114.582, 37.114.585, 37.114.588, 37.114.589, 37.114.591, and 37.114.592

 

The department is proposing to repeal these rules.  Since these rules were enacted there have been ongoing and dynamic changes to control measures for specific diseases.  The department proposes utilizing the "Control of Communicable Diseases Manual, An Official Report of the American Public Health Association" (19th edition, 2008) addressed in ARM 37.114.501 to guide minimal control measures for the diseases falling under these rules.   

 

ARM 37.114.595 

 

The department is proposing to repeal this rule as it is unnecessary. 

 

            6.  Concerned persons may submit their data, views, or arguments either orally or in writing at the hearing.  Written data, views, or arguments may also be submitted to: Kenneth Mordan, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; fax (406) 444-9744; or e-mail dphhslegal@mt.gov, and must be received no later than 5:00 p.m., February 14, 2013.

 

7.  The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.

 

8.  The department maintains a list of interested persons who wish to receive notices of rulemaking actions proposed by this agency.  Persons who wish to have their name added to the list shall make a written request that includes the name, e-mail, and mailing address of the person to receive notices and specifies for which program the person wishes to receive notices.  Notices will be sent by e-mail unless a mailing preference is noted in the request.  Such written request may be mailed or delivered to the contact person in 6 above or may be made by completing a request form at any rules hearing held by the department.

 

9.  An electronic copy of this proposal notice is available through the Secretary of State's web site at http://sos.mt.gov/ARM/Register.  The Secretary of State strives to make the electronic copy of the notice conform to the official version of the notice, as printed in the Montana Administrative Register, but advises all concerned persons that in the event of a discrepancy between the official printed text of the notice and the electronic version of the notice, only the official printed text will be considered.  In addition, although the Secretary of State works to keep its web site accessible at all times, concerned persons should be aware that the web site may be unavailable during some periods, due to system maintenance or technical problems.

 

10.  The bill sponsor contact requirements of 2-4-302, MCA, do not apply.

 

 

 

/s/ Shannon L. McDonald              /s/ Anna Whiting Sorrell                

Rule Reviewer                                 Anna Whiting Sorrell, Director

                                                          Public Health and Human Services

           

Certified to the Secretary of State January 7, 2013