PART 1. DEPARTMENT OF STATE HEALTH SERVICES
CHAPTER 97. COMMUNICABLE DISEASES
SUBCHAPTER A. CONTROL OF COMMUNICABLE DISEASES
25 TAC §§97.1, 97.3, 97.4, 97.7
The Executive Commissioner of the Health and Human Services Commission, on behalf of the Department of State Health Services (department), proposes amendments to §§97.1, 97.3, 97.4, and 97.7, concerning the control of communicable diseases.
BACKGROUND AND PURPOSE
The amendments comply with Health and Safety Code, Chapter 81. The amendments will enable the reporting sources to more clearly identify the conditions and diseases that must be reported, define the minimal reportable information on these conditions and diseases, and describe the procedures for reporting. The amendments adjust the list of reportable diseases to include diseases and conditions of concern to public health. The conditions being added are newly emerging infectious conditions that have received international attention. Texas is complying with guidance from the Centers for Disease Control and Prevention regarding surveillance for these conditions. These amendments will allow the department to conduct more relevant and efficient disease surveillance.
The amendments to §§97.1, 97.3, and 97.4 add the reporting of Carbapenem resistant Enterobacteriaceae (CRE) and the reporting of Multi-drug Resistant (MDR) Acinetobacter as defined in the Centers for Disease Control and Prevention, National Healthcare Safety Network (NHSN) Manual, Patient Safety Component, Protocol for Multidrug-Resistant Organism and Clostridium difficile Infection (MDRO/CDI) Module, or its successor.
The amendments to §97.3 and §97.4 remove references to severe acute repository syndrome (SARS) and replace with the reporting of novel coronavirus causing severe acute respiratory disease because it is a broader category/definition that includes SARS. The disease novel influenza is placed in correct alphabetical order in §97.3.
In §97.1 and §97.7, the references to the legacy agency are updated.
The amendment to §97.7 updates exclusion criteria from a school for a student who has or is suspected of having a communicable condition, so that meningitis, bacterial and Meningococcal Infections (meningitis and bacteremia) are handled in a similar fashion.
Ms. Janna Zumbrun, Assistant Commissioner, Disease Control and Prevention Services, has determined that for each year of the first five years that the sections are in effect, there will be no fiscal implications to state or local governments as a result of enforcing and administering the sections as proposed.
SMALL AND MICRO-BUSINESS IMPACT ANALYSIS
Ms. Zumbrun has also determined that there will be no adverse economic costs to small businesses or micro-businesses required to comply with the sections as proposed. This was determined by interpretation of the rules that small businesses and micro-businesses will not be required to alter their business practices in order to comply with the sections.
ECONOMIC COSTS TO PERSONS AND IMPACT ON LOCAL EMPLOYMENT
There are no anticipated costs to persons who are required to comply with the sections as proposed. There is no anticipated negative impact on local employment.
In addition, Ms. Zumbrun also has determined that for each year of the first five years the sections are in effect, the public will benefit from their adoption. These rules impact the people of Texas whose risk of illness is decreased by the early detection and control or prevention of infectious diseases in the community.
The department has determined that this proposal is not a "major environmental rule" as defined by Government Code, §2001.0225. "Major environmental rule" is defined to mean a rule the specific intent of which is to protect the environment or reduce risk to human health from environmental exposure and that may adversely affect, in a material way, the economy, a sector of the economy, productivity, competition, jobs, the environment or the public health and safety of a state or a sector of the state. This proposal is not specifically intended to protect the environment or reduce risks to human health from environmental exposure.
TAKINGS IMPACT ASSESSMENT
The department has determined that the proposed rules do not restrict or limit an owner's right to his or her property that would otherwise exist in the absence of government action and, therefore, do not constitute a taking under Government Code, §2007.043.
Comments on the proposal may be submitted to David Rhinehart, Emerging and Acute Infectious Disease Branch, Infectious Disease Control Unit, Infectious Disease Prevention Section, Division for Disease Control and Prevention Services, Department of State Health Services, Mail Code 1960, P.O. Box 149347, Austin, Texas 78714-9347 or by email to email@example.com. Comments will be accepted for 30 days following publication of the proposal in the TexasRegister.
The Department of State Health Services General Counsel, Lisa Hernandez, certifies that the proposed rules have been reviewed by legal counsel and found to be within the state agencies' authority to adopt.
The amendments are authorized by Health and Safety Code, §81.004, which authorizes rules necessary for the effective administration of the Communicable Disease Prevention and Control Act; §81.042, which requires a rule on the exclusion of children from schools; §81.050 which requires a rule to prescribe criteria that constitute exposure to reportable diseases; and Government Code, §531.0055, and Health and Safety Code, §1001.075, which authorize the Executive Commissioner of the Health and Human Services Commission to adopt rules and policies necessary for the operation and provision of health and human services by the department and for the administration of Health and Safety Code, Chapter 1001.
The amendments affect Government Code, Chapter 531, and Health and Safety Code, Chapters 81 and 1001.
The following words and terms, when used in this chapter, shall have the following meanings unless the context clearly indicates otherwise.
(1) - (2) (No change.)
(3) Carbapenem resistant Enterobacteriaceae (CRE)--CRE-Ecoli or CRE-Klebsiella as defined in the Centers for Disease Control and Prevention, National Healthcare Safety Network (NHSN) Manual, Patient Safety Component, Protocol for Multidrug-Resistant Organism and Clostridium difficile Infection (MDRO/CDI) Module, or its successor.
(3)] Carrier--An infected
person or animal that harbors a specific infectious agent in the absence
of discernible clinical disease and serves as a potential source or
reservoir of infection.
(4)] Case--As distinct from
a carrier, the term "case" is used to mean a person or animal in whose
tissues the etiological agent of a communicable disease is lodged
and which usually produces signs or symptoms of disease. Evidence
of the presence of a communicable disease may also be revealed by
of the Department of State Health Services [ Health].
(6)] Common carrier--Any
vehicle or device available to the public for transportation of persons,
goods, or messages.
(7)] Communicable disease--An
illness due to an infectious agent or its toxic products which is
transmitted directly to a well person from an infected person or animal,
or indirectly through an intermediate plant or animal host, vector,
or the inanimate environment.
(8)] Contact--A person or
animal that has been in such association with an infected person or
animal or a contaminated environment so as to have had opportunity
to acquire the infection.
(9)] Diarrhea--A watery
or loose stool that takes the shape of the container that holds it.
of State Health Services.
of chemical or physical agents to destroy infectious agents outside
(12)] Epidemic--The occurrence
in a community or region of a group of illnesses of similar nature,
clearly in excess of normal expectancy, and derived from a common
or a propagated source.
(13)] Exposure--A situation
or circumstance in which there is significant risk of becoming infected
with the etiologic agent for the disease involved.
(14)] Fever--A temperature
of 100 degrees Fahrenheit (37.8 degrees Celsius) or higher.
(15)] Health authority--A
physician designated to administer state and local laws relating to
public health under the Local Public Health Reorganization Act, Health
and Safety Code, Chapter 121. The health authority, for purposes of
this subchapter, may be:
(A) a local health authority appointed by the local government jurisdiction; or
(B) a regional director of the Department of State Health Services if no physician has been appointed by the local government.
(16)] Hospital laboratory--Any
laboratory that performs laboratory test procedures for a patient
of a hospital either as a part of the hospital or through contract
with the hospital.
(18) Multi-drug resistant (MDR) Acinetobacter--MDR-Acinetobacter as defined by the Centers for Disease Control and Prevention, National Healthcare Safety Network (NHSN) Manual, Patient Safety Component, Protocol for Multidrug-Resistant Organism and Clostridium difficile-Infection (MDRO/CDI) Module, or its successor.
(17)] Notifiable condition--Any
disease or condition that is required to be reported under the Act
or by this chapter. See §97.3 of this title (relating to What
Condition to Report and What Isolates to Report or Submit). Any outbreak,
exotic disease, or unusual group expression of illness which may be
of public health concern, whether or not the disease involved is listed
in §97.3 of this title, shall be considered a "notifiable condition."
The term "notifiable condition" is the same as the term "reportable
disease" as used in the Health and Safety Code.
(18)] Outbreak--See definition
of epidemic in this section.
(19)] Pandemic--A global
disease epidemic or an epidemic that crosses international borders
and affects an extremely large number of people.
(20)] Perinatal hepatitis
B infection--HBsAg positivity in any infant aged >1-24 months.
(21)] Physician--A person
licensed by the Texas Medical Board to practice medicine in Texas.
(22)] Physician assistant--A
person licensed as a physician assistant by the Texas Physician Assistant Board.
(23)] Regional director--The
physician who is the chief administrative officer of a region as designated
by the department under the Local Public Health Reorganization Act,
Health and Safety Code, Chapter 121.
that is required to be provided to the department.
(25)] Report of a disease--The
notification to the appropriate authority of the occurrence of a specific
communicable disease in man or animals, including all information
required by the procedures established by the department.
(26)] Research facility--A
facility that is licensed by the United States Department of Agriculture
to use vertebrate animals for research purposes and is in compliance
with the federal Animal Welfare Act (7 U.S.C., Chapter 54).
(27)] School Administrator--The
city or county superintendent of schools or the principal of any school
not under the jurisdiction of a city or county board of education.
(28)] Significant risk--A
determination relating to a human exposure to an etiologic agent for
a particular disease, based on reasonable medical judgments given
the state of medical knowledge, relating to the following:
(A) nature of the risk (how the disease is transmitted);
(B) duration of the risk (how long an infected person may be infectious);
(C) severity of the risk (what is the potential harm to others); and
(D) probability the disease will be transmitted and will cause varying degrees of harm.
(29)] Specimen Submission
Form--A current Department of State Health Services laboratory specimen
submission form available from the Department of State Health Services,
Laboratory Services Section, 1100 West 49th Street, Austin, Texas, 78756-3199.
resistant Staphylococcus aureus (VISA)--Staphylococcus aureus with a vancomycin
minimum inhibitory concentration (MIC) of 4 µg/mL through 8 µg/mL.
(31)] Vancomycin-resistant Staphylococcus aureus (VRSA)--Staphylococcus aureus with a vancomycin
MIC of 16 µg/mL or greater.
(32)] Veterinarian--A person
licensed by the Texas State Board of Veterinary Medical Examiners
to practice veterinary medicine in Texas.
§97.3.What Condition to Report and What Isolates to Report or Submit.
(1) Identification of notifiable conditions.
(A) A summary list of notifiable conditions and reporting time frames is published on the Department of State Health Services web site at http://www.dshs.state.tx.us/idcu/. Copies are filed in the Emerging and Acute Infectious Disease Branch, Department of State Health Services, 1100 West 49th Street, Austin, Texas 78756.
(B) Repetitive test results from the same patient do not need to be reported except those for mycobacterial infections.
(2) Notifiable conditions or isolates.
(A) Confirmed and suspected human cases of the following
diseases/infections are reportable: acquired immune deficiency syndrome
(AIDS); amebiasis; amebic meningitis and encephalitis; anaplasmosis;
anthrax; arboviral infections caused by California serogroup virus,
Eastern equine encephalitis (EEE) virus, Powassan virus, St. Louis
encephalitis (SLE) virus, Western equine encephalitis (WEE) virus,
and West Nile (WN) virus; babesiosis; botulism-adult and infant; brucellosis;
campylobacteriosis; carbapenem resistant Enterobacteriaceae
(CRE); Chagas' disease; chancroid; chickenpox (varicella); Chlamydia trachomatis infection; Creutzfeldt-Jakob
disease (CJD); cryptosporidiosis; cyclosporiasis; dengue; diphtheria;
ehrlichiosis; shiga-toxin producing Escherichia
coli infection; gonorrhea; Hansen's disease (leprosy); Haemophilus influenzae type b infection,
invasive; hantavirus infection; hemolytic uremic syndrome (HUS); hepatitis
A, B, C, and E, (acute); hepatitis B, (acute and chronic) identified
prenatally or at delivery; perinatal hepatitis B infection; human
immunodeficiency virus (HIV) infection; influenza-associated pediatric
mortality; legionellosis; leishmaniasis; listeriosis; Lyme disease;
malaria; measles (rubeola); meningococcal infection, invasive; multi-drug
resistant (MDR) Acinetobacter-MDR [
novel influenza]; mumps; novel coronavirus causing severe
acute respiratory disease; novel influenza; pertussis; plague;
poliomyelitis, acute paralytic; poliovirus infection, non-paralytic;
Q fever; rabies; relapsing fever; rubella (including congenital);
salmonellosis, including typhoid fever; [ severe acute respiratory
syndrome (SARS) as defined by the United States Centers for Disease
Control and Prevention;] shigellosis; smallpox; spotted fever
group rickettsioses (such as Rocky Mountain spotted fever); streptococcal
disease: invasive group A, invasive group B, or invasive Streptococcus pneumoniae; syphilis; Taenia solium and undifferentiated Taenia infections, including cysticercosis;
tetanus; trichinosis; tuberculosis; tularemia; typhus; Vibrio infection, including cholera (specify
species); viral hemorrhagic fevers; yellow fever; yersiniosis; and
vancomycin-intermediate resistant Staphylococcus
aureus (VISA), and vancomycin-resistant Staphylococcus aureus (VRSA).
(B) (No change.)
(3) - (5) (No change.)
(b) (No change.)
§97.4.When to Report a Condition or Isolate.
(1) The following notifiable conditions are public
health emergencies and suspect cases shall be reported immediately
by phone to the local health authority or the regional director of
the Department of State Health Services (department): anthrax; botulism; carbapenem resistant Enterobacteriaceae (CRE);
diphtheria; measles (rubeola); meningococcal infection, invasive; multi-drug resistant (MDR) Acinetobacter-MDR;
novel coronavirus causing severe acute respiratory disease; poliomyelitis,
acute paralytic; plague; novel influenza; rabies; [
respiratory syndrome (SARS);] smallpox; tularemia; viral hemorrhagic
fevers; yellow fever; and any outbreak, exotic disease, or unusual
group expression of disease that may be of public health concern.
Vancomycin-intermediate resistant Staphylococcus
aureus (VISA) and vancomycin-resistant Staphylococcus
aureus (VRSA) shall be reported immediately by phone to the
Emerging and Acute Infectious Disease Branch, Department of State
Health Services, Austin at (800) 252-8239.
(2) - (6) (No change.)
(b) (No change.)
§97.7.Diseases Requiring Exclusion from Schools.
(a) The school administrator shall exclude from attendance any child having or suspected of having a communicable condition. Exclusion shall continue until the readmission criteria for the conditions are met. The conditions and readmission criteria are as follows:
(1) - (14) (No change.)
(15) meningitis, bacterial--exclude until 24 hours
after start of effective treatment and approval by health care provider [
exclude until written permission and/or permit is issued by a physician
or local health authority];
(16) (No change.)
(17) meningococcal infections (invasive disease)--exclude until 24 hours after start of effective treatment and approval by health care provider;
(17)] mumps--exclude until
five days after the onset of swelling;
(18)] pertussis (whooping
cough)--exclude until completion of five days of antibiotic therapy;
(19)] ringworm--none, if
infected area can be completely covered by clothing or a bandage,
otherwise exclude until treatment has begun;
(20)] rubella (German measles)--exclude
until seven days after rash onset or in the case of an outbreak, unimmunized
children should be excluded until at least three weeks after the onset
of the last rash;
until diarrhea free for 24 hours without the use of diarrhea suppressing
medications and fever free for 24 hours without the use of fever suppressing
until treatment has begun;
until diarrhea free for 24 hours without the use of diarrhea suppressing
medications and fever free for 24 hours without the use of fever suppressing
(24)] streptococcal sore
throat and scarlet fever--exclude until 24 hours from time antibiotic
treatment was begun and fever free for 24 hours without the use of
fever suppressing medications; and
(25)] tuberculosis, pulmonary--exclude
until antibiotic treatment has begun and a physician's certificate
or health permit obtained.
(b) The school administrator shall exclude from attendance
any child having or suspected of having a communicable disease designated
by the Commissioner of the Department of State Health Services [
Health] (commissioner) as cause for exclusion until one of the
criteria listed in subsection (c) of this section is fulfilled.
(c) (No change.)
The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.
Filed with the Office of the Secretary of State on November 18, 2013.
Department of State Health Services
Earliest possible date of adoption: January 5, 2014
For further information, please call: (512) 776-6990