WSR 04-16-099

EMERGENCY RULES

DEPARTMENT OF HEALTH


[ Filed August 3, 2004, 2:12 p.m. , effective August 3, 2004 ]


Purpose: These emergency rules add human "Arboviral Disease" to the notifiable conditions rules, replacing "Encephalitis, Viral." The rule change will allow the state's notifiable conditions rules to reflect new case definitions proposed by the Centers for Disease Control and Prevention for infections caused by viruses carried by mosquitos, ticks and other insects (ARthropod-BOrne (ARBO)). The new case definitions are designed to accurately identify all clinical manifestations of arboviral diseases, not just encephalitis. The current rules capture only cases of encephalitis (inflammation of the brain), while these infections may cause fever, influenza-like illness, meningitis (inflammation of the lining of the brain), acute flaccid paralysis (polio-like syndrome) and other serious brain and nerve disorders.

Citation of Existing Rules Affected by this Order: Amending WAC 246-101-101 (Table HC-1), 246-101-201 (Table Lab-1), and 246-101-301 (Table HF-1).

Statutory Authority for Adoption: RCW 43.20.050.

Other Authority: WAC 246-101-015(5).

Under RCW 34.05.350 the agency for good cause finds that immediate adoption, amendment, or repeal of a rule is necessary for the preservation of the public health, safety, or general welfare, and that observing the time requirements of notice and opportunity to comment upon adoption of a permanent rule would be contrary to the public interest.

Reasons for this Finding: West Nile Virus (WNV) activity has expanded rapidly across the United States since its introduction in 1999. Washington is one of two continental states that have not reported continuous, season WNV activity in insects, animals, birds, or humans. Because neighboring western states experienced a significant increase in WNV activity from 2002 to 2003, it is expected that Oregon and Washington will experience a similar course during the 2004 or 2005 mosquito season. Adding arboviral disease to the notifiable conditions rules will help DOH and local health jurisdictions target disease prevention messages to impacted communities to ensure the public has the best information to stem the spread of WNV. Adopting this change by emergency rule makes it effective for the 2004 mosquito season. Using only the permanent rule process would delay implementation of this rule until the 2005 mosquito season.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 3, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 3, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 3, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 3, Repealed 0.

Date Adopted: August 3, 2004.

M. C. Selecky

Secretary

OTS-7424.1


AMENDATORY SECTION(Amending WSR 00-23-120, filed 11/22/00, effective 12/23/00)

WAC 246-101-101   Notifiable conditions and the health care provider.   This section describes the conditions that Washington's health care providers must notify public health authorities of on a statewide basis. The board finds that the conditions in the table below (Table HC-1) are notifiable for the prevention and control of communicable and noninfectious diseases and conditions in Washington. Principal health care providers shall notify public health authorities of these conditions as individual case reports using procedures described throughout this chapter. Other health care providers in attendance shall notify public health authorities of the following notifiable conditions, unless the condition notification has already been made. Local health officers may require additional conditions to be notifiable within the local health officer's jurisdiction.

WAC 246-101-105, 246-101-110, 246-101-115, and 246-101-120 also include requirements for how notifications shall be made, when they shall be made, the content of these notifications, and how information regarding notifiable conditions cases must be handled and may be disclosed.


Table HC-1 (Conditions Notifiable by Health Care Providers)


Notifiable Condition Time frame for Notification Notifiable to Local Health Department Notifiable to State Department of Health
Acquired Immunodeficiency Syndrome (AIDS) Within 3 work days
Animal Bites Immediately
Arboviral Disease Within 3 work days
Asthma, occupational Monthly
Birth Defects Autism (Provisional through August, 2004) Monthly
Birth Defects Cerebral Palsy (Provisional through August, 2004) Monthly
Birth Defects Fetal Alcohol Syndrome/Fetal Alcohol Effects (Provisional through August, 2004) Monthly
Botulism (foodborne, infant, and wound) Immediately
Brucellosis (Brucella species) Immediately
Campylobacteriosis Within 3 work days
Chancroid Within 3 work days
Chlamydia trachomatis infection Within 3 work days
Cholera Immediately
Cryptosporidiosis Within 3 work days
Cyclosporiasis Within 3 work days
Diphtheria Immediately
Disease of suspected bioterrorism origin (including):

Anthrax

Smallpox

Immediately
Disease of suspected foodborne origin (communicable disease clusters only) Immediately
Disease of suspected waterborne origin (communicable disease clusters only) Immediately
((Encephalitis, viral Within 3 work days ))
Enterohemorrhagic E. coli (shiga-like toxin producing infections only) such as E. coli O157:H7 Infection Immediately
Giardiasis Within 3 work days
Gonorrhea Within 3 work days
Granuloma inguinale Within 3 work days
Haemophilus influenzae (invasive disease, children under age 5) Immediately
Hantavirus pulmonary syndrome Within 3 work days
Hemolytic uremic syndrome Immediately
Hepatitis A (acute infection) Immediately
Hepatitis B (acute infection) Within 3 work days
Hepatitis B surface antigen + pregnant women Within 3 work days
Hepatitis B (chronic) Initial diagnosis, and previously unreported prevalent cases (Provisional through August, 2004) Monthly
Hepatitis C Acute and chronic (Provisional through August, 2004) Monthly
Hepatitis (infectious), unspecified Within 3 work days
Herpes simplex, neonatal and genital (initial infection only) (Provisional through August, 2004) Within 3 work days
Human immunodeficiency virus (HIV) infection Within 3 work days
Legionellosis Within 3 work days
Leptospirosis Within 3 work days
Listeriosis Immediately
Lyme Disease Within 3 work days
Lymphogranuloma venereum Within 3 work days
Malaria Within 3 work days
Measles (rubeola) Immediately
Meningococcal disease Immediately
Mumps Within 3 work days
Paralytic shellfish poisoning Immediately
Pertussis Immediately
Pesticide poisoning (hospitalized, fatal, or cluster) Immediately
Pesticide poisoning (all other) Within 3 work days
Plague Immediately
Poliomyelitis Immediately
Psittacosis Within 3 work days
Q Fever Within 3 work days
Rabies (Confirmed Human or Animal) Immediately
Rabies (Including use of post-exposure prophylaxis) Within 3 work days
Relapsing fever (borreliosis) Immediately
Rubella (including congenital rubella syndrome) Immediately
Salmonellosis Immediately
Serious adverse reactions to immunizations Within 3 work days
Shigellosis Immediately
Streptococcus, Group A, Invasive (Indicated by blood, spinal fluid or other normally sterile site) (Provisional through August, 2004) Within 3 work days
Syphilis Within 3 work days
Tetanus Within 3 work days
Trichinosis Within 3 work days
Tuberculosis Immediately
Tularemia Within 3 work days
Typhus Immediately
Vibriosis Within 3 work days
Yellow fever Immediately
Yersiniosis Within 3 work days
Other rare diseases of public health significance Immediately
Unexplained critical illness or death Immediately

[Statutory Authority: RCW 43.20.050, 70.24.125 and 70.28.010. 00-23-120, 246-101-101, filed 11/22/00, effective 12/23/00.]


AMENDATORY SECTION(Amending WSR 00-23-120, filed 11/22/00, effective 12/23/00)

WAC 246-101-201   Notifiable conditions and laboratories.   This section describes the conditions about which Washington's laboratories must notify public health authorities of on a statewide basis. The board finds that the conditions in the table below (Table Lab-1) are notifiable for the prevention and control of communicable and noninfectious diseases and conditions in Washington. The board also finds that submission of specimens for many of these conditions will further prevent the spread of disease. Laboratory directors shall notify public health authorities of positive cultures and preliminary test results as individual case reports and provide specimen submissions using procedures described throughout this chapter. Local health officers may require additional conditions to be notifiable within the local health officer's jurisdiction.

WAC 246-101-205, 246-101-210, 246-101-215, 246-101-220, 246-101-225, and 246-101-230 also include requirements for how notifications and specimen submissions are made, when they are made, the content of these notifications and specimen submissions, and how information regarding notifiable conditions cases must be handled and may be disclosed.


Table Lab-1 (Conditions Notifiable by Laboratory Directors)


Notifiable Condition Time frame for Notification Notifiable to Local Health Department Notifiable to Department of Health Specimen Submission to Department of Health (Type & Timing)
Arboviral Disease (Isolation; Detection of Viral Nucleic Acid or Antibody) 2 days
Blood Lead Level Elevated Levels 2 Days

Nonelevated Levels Monthly

Botulism (Foodborne) Immediately Serum and Stool - If available, submit suspect foods (2 days)
Botulism (Infant) Immediately Stool (2 days)
Botulism (Wound) Immediately Culture, Serum, Debrided tissue, or Swab sample (2 days)
Brucellosis (Brucella species) 2 days Subcultures (2 days)
CD4+ (T4) lymphocyte counts less than 200 and/or CD4+ (T4) percents less than fourteen percent of total lymphocytes (patients aged thirteen or older) Monthly Only when the local health department is designated by the Department of Health
Chlamydia trachomatis infection 2 days
Cholera Immediately Culture (2 days)
Cryptosporidiosis 2 days
Cyclosporiasis 2 days Specimen (2 days)
Diphtheria 2 days Culture (2 days)
Disease of Suspected Bioterrorism Origin (examples):

Anthrax

Smallpox

Immediately Culture (2 days)
Enterohemorrhagic E. coli (shiga-like toxin producing infections only) such as E. coli O157:H7 Infection 2 days Culture (2 days)
Gonorrhea 2 days
Hepatitis A (IgM positive) 2 days
Human immunodeficiency virus (HIV) infection (including positive Western Blot assays, P24 antigen or viral culture tests) 2 days Only when the local health department is designated by the Department of Health √ (Except King County)
Human immunodeficiency virus (HIV) infection (positive results on HIV nucleic acid tests (RNA or DNA)) Monthly Only when the local health department is designated by the Department of Health √ (Except King County)
Listeriosis 2 days
Measles (rubeola) Immediately Serum (2 days)
Meningococcal disease 2 days Culture (Blood/CSF or other sterile sites) (2 days)
Pertussis 2 days
Plague Immediately Culture or other appropriate clinical material (2 days)
Rabies (human or animal) Immediately √ (Pathology Report Only) Tissue or other appropriate clinical material (Upon request only)
Salmonellosis 2 days Culture (2 days)
Shigellosis 2 days Culture (2 days)
Syphilis Serum (2 days)
Tuberculosis 2 days Culture (2 days)
Tuberculosis (Antibiotic sensitivity for first isolates) 2 days
Tularemia Culture or other appropriate clinical material (2 days)
Other rare diseases of public health significance Immediately

Additional notifications that are requested but not mandatory include:

(1) Laboratory directors may notify either local health departments or the department or both of other laboratory results including hepatitis B and hepatitis C through cooperative agreement.

(2) Laboratory directors may submit malaria cultures to the state public health laboratories.

[Statutory Authority: RCW 43.20.050, 70.24.125 and 70.28.010. 00-23-120, 246-101-201, filed 11/22/00, effective 12/23/00.]


AMENDATORY SECTION(Amending WSR 00-23-120, filed 11/22/00, effective 12/23/00)

WAC 246-101-301   Notifiable conditions and health care facilities.   This section describes the conditions that Washington's health care facilities must notify public health authorities of on a statewide basis. The board finds that the conditions in the table below (Table HF-1) are notifiable for the prevention and control of communicable and noninfectious diseases and conditions. Local health officers may require additional conditions to be notifiable within the local health officer's jurisdiction. Health care facilities are required to notify public health authorities of cases that occur in their facilities. Health care facilities may choose to assume the notification for their health care providers for conditions designated in Table HF-1. Health care facilities may not assume the reporting requirements of laboratories that are components of the health care facility. Local health officers may require additional conditions to be notifiable within the local health officer's jurisdiction.

WAC sections 246-101-305, 246-101-310, 246-101-315, and 246-101-320 also include requirements for how notifications shall be made, when they are made, the content of these notifications, and how information regarding notifiable conditions cases must be handled and may be disclosed.


Table HF-1 (Conditions Notifiable by Health Care Facilities)


Notifiable Condition Time frame for Notification Notifiable to Local Health Department Notifiable to State Department of Health
Acquired Immunodeficiency Syndrome (AIDS) Within 3 work days
Animal Bites Immediately
Arboviral Disease Within 3 work days
Asthma, occupational Monthly
Birth Defects Abdominal Wall Defects (inclusive of gastroschisis and omphalocele) (Provisional through August, 2004) Monthly
Birth Defects Autism (Provisional through August, 2004) Monthly
Birth Defects Cerebral Palsy (Provisional through August, 2004) Monthly
Birth Defects Down Syndrome Monthly
Birth Defects Fetal Alcohol Syndrome/Fetal Alcohol Effects (Provisional through August, 2004) Monthly
Birth Defects Hypospadias Monthly
Birth Defects Limb reductions Monthly
Birth Defects Neural Tube Defects (inclusive of anencephaly and spina bifida) Monthly
Birth Defects Oral Clefts (inclusive of cleft lip with/without cleft palate) Monthly
Botulism (foodborne, infant, and wound) Immediately
Brucellosis (Brucella species) Immediately
Cancer (See chapter 246-430 WAC) Monthly
Chancroid Within 3 work days
Chlamydia trachomatis infection Within 3 work days
Cholera Immediately
Cryptosporidiosis Within 3 work days
Cyclosporiasis Within 3 work days
Diphtheria Immediately
Disease of suspected bioterrorism origin (including):

Anthrax

Smallpox

Immediately
Disease of suspected foodborne origin (communicable disease clusters only) Immediately
Disease of suspected waterborne origin (communicable disease clusters only) Immediately
((Encephalitis, viral Within 3 work days ))
Enterohemorrhagic E. coli (shiga-like toxin producing infections only) such as E. coli O157:H7 Infection Immediately
Giardiasis Within 3 work days
Gonorrhea Within 3 work days
Granuloma inguinale Within 3 work days
Gunshot wounds (nonfatal) Monthly
Haemophilus influenzae (invasive disease, children under age 5) Immediately
Hantavirus pulmonary syndrome Within 3 work days
Hemolytic uremic syndrome Immediately
Hepatitis A (acute infection) Immediately
Hepatitis B (acute infection) Within 3 work days
Hepatitis B surface antigen+ pregnant women Within 3 work days
Hepatitis B (chronic) Initial diagnosis, and previously unreported prevalent cases (Provisional through August, 2004) Monthly
Hepatitis C Acute and chronic (Provisional through August, 2004) Monthly
Hepatitis (infectious), unspecified Within 3 work days
Human immunodeficiency virus (HIV) infection Within 3 work days
Legionellosis Within 3 work days
Leptospirosis Within 3 work days
Listeriosis Immediately
Lyme Disease Within 3 work days
Lymphogranuloma venereum Within 3 work days
Malaria Within 3 work days
Measles (rubeola) Immediately
Meningococcal disease Immediately
Mumps Within 3 work days
Paralytic shellfish poisoning Immediately
Pertussis Immediately
Pesticide poisoning (hospitalized, fatal, or cluster) Immediately
Plague Immediately
Poliomyelitis Immediately
Psittacosis Within 3 work days
Q Fever Within 3 work days
Rabies (Confirmed Human or Animal) Immediately
Rabies (Use of post-exposure prophylaxis) Within 3 work days
Relapsing fever (borreliosis) Immediately
Rubella (including congenital rubella syndrome) Immediately
Salmonellosis Immediately
Serious adverse reactions to immunizations Within 3 work days
Shigellosis Immediately
Streptococcus, Group A Invasive (Indicated by blood, spinal fluid or other normally sterile site) (Provisional through August, 2004) Within 3 work days
Syphilis Within 3 work days
Tetanus Within 3 work days
Trichinosis Within 3 work days
Tuberculosis Immediately
Tularemia Within 3 work days
Typhus Immediately
Vibriosis Within 3 work days
Yellow fever Immediately
Yersiniosis Within 3 work days
Other rare diseases of public health significance Immediately
Unexplained critical illness or death Immediately

[Statutory Authority: RCW 43.20.050, 43.70.545, 70.24.125, 70.28.010 and 70.104.030. 00-23-120, 246-101-301, filed 11/22/00, effective 12/23/00.]

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