 |
|
(e) Reporting of HIV infection/disease shall include classification as defined in the CDC Morbidity and Mortality Weekly Report Volume 63, No. RR-03, April 11, 2014. Supplemental reports shall be provided by the physician when an individual's classification changes. The CD4+ T-lymphocyte count and percentage or viral load count, or both, shall be included with both initial and supplemental reports.
(f) The department, under the authority of
(g) Outbreaks of any of the following shall be reported immediately upon suspicion:
(1) Any disease required to be reported under this section.
(2) Diarrhea of the newborn (in hospitals or other institutions).
(3) Foodborne or waterborne diseases in addition to those specified by name in this rule.
(4) Streptococcal illnesses.
(5) Conjunctivitis.
(6) Impetigo.
(7) Nosocomial disease within hospitals and health care facilities.
(8) Influenza-like illness.
(9) Viral meningitis.
(10) Unusual occurrence of disease.
(11) Any disease, including, but not limited to:
(A) anthrax;
(B) plague;
(C) tularemia;
(D) Brucella species;
(E) smallpox;
(F) botulism; or
(G) multiple drug-resistant tuberculosis.
(12) Chemical illness that is considered:
(A) a bioterrorism threat;
(B) an importation; or
(C) a laboratory release.
(h) Failure to report constitutes a Class A infraction as specified by
(Indiana State Department of Health;
Authority: |
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| Animal Type | Evaluation and Disposition of Animal | Postexposure Prophylaxis Recommendation |
| Dogs, cats, and ferrets | Healthy and available for 10 day observation1 | Should not begin prophylaxis unless animal develops symptoms of rabies2 |
| Rabid or suspected rabid | Immediate postexposure prophylaxis | |
| Unknown | Consult public health officials | |
| Skunks, raccoons, bats3, foxes and most other wild carnivores, including those animals kept in captivity or as pets | Regard as rabid unless geographic area is known to be free of rabies or until animal is proven negative by laboratory testing4 | Immediate postexposure prophylaxis if animal is unavailable for testing, or if animal is available for testing, as soon as a positive result is observed |
| Livestock, rodents, and lagomorphs (rabbits and hares) | Consider individually | Consult public health officials. Bites from squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, mice, other rodents, rabbits, and hares almost never require antirabies treatment. Bites from larger rodents (groundhogs, beavers, muskrats) may require antirabies treatment. |
| 1If the animal is unhealthy or has a serious injury that would make quarantine inhumane, the stray animal may be euthanized immediately and the head submitted to the rabies laboratory. | ||
| 2Postexposure prophylaxis should be started if a veterinarian identifies an animal as being symptomatic. Symptomatic animals should be euthanized and tested immediately. | ||
| 3What appears to be insignificant contact with bats may result in rabies transmission, even without clear evidence of a bite. Postexposure prophylaxis is recommended for all persons with bite, scratch, or mucous membrane exposure to a bat unless the bat is available for testing and is negative for rabies. Postexposure prophylaxis is appropriate even in the absence of bite, scratch, or mucous membrane exposure in situations in which there is a reasonable probability that such contact occurred (for example, a sleeping individual awakes to find a bat in the room, an adult witnesses a bat in the room with a previously unattended child, mentally challenged person, or intoxicated person) and rabies cannot be ruled out by testing the bat. | ||
| 4The animal should be euthanized and tested as soon as possible. Holding for observation is not allowable as time lapse from virus secretion in saliva until clinical symptoms appear have not been determined for species other than a dog, cat, or ferret. Consult with the department veterinary epidemiologist for information on presence or absence of rabies in particular species. | ||
(b) All bite wounds should be treated immediately in the following steps:
(1) Clean and flush wound as first aid.
(2) Thorough wound cleansing under medical supervision.
(3) Evaluation of need for postexposure prophylaxis.
(4) Tetanus prophylaxis and antibacterial treatment as needed.
(c) If the decision is made to provide postexposure prophylaxis to the individual, the following protocols must be followed, and a decision to provide postexposure prophylaxis must be reported to the department:
| Guidelines for Postexposure Prophylaxis | ||
| Vaccination Status | Treatment | Regimen* |
| Not previously vaccinated | Local wound cleaning | All postexposure treatment should begin with immediate thorough cleansing of all wounds with soap and water. |
| Human rabies immune globulin (HRIG) | 20 IU/kg body weight. If anatomically feasible, the full dose should be infiltrated around the wound or wounds. Any remaining volume should be administered intramuscularly at a site distant from vaccine inoculation. | |
| Vaccine | Human diploid cell vaccine (HDCV), purified chick embryo cell vaccine (PCEC), or rabies vaccine adsorbed (RVA), 1.0 ml, IM (deltoid1), one dose should be given on days 0, 3, 7, and 14. Immunocompromised individuals may require a 5th vaccine dose to be given on day 28. | |
| Previously vaccinated2 | Local wound cleaning | All postexposure treatment should begin with immediate thorough cleansing of all wounds with soap and water. |
| HRIG | Should not be administered to individuals who have been previously vaccinated. | |
| Vaccine | HDCV, PCEC, or RVA, 1.0 ml IM (deltoid1), one dose should be given on days 0 and 3. | |
| *These regimens are applicable for all age groups, including children. | ||
| 1The deltoid area is the only acceptable site of vaccination for adults and older children. For younger children, the outer aspect of the thigh may be used. The vaccine should never be administered in the gluteal area. The vaccine should never be administered in the same location with the HRIG. | ||
| 2Any person with a history of preexposure vaccination with HDCV or RVA, prior postexposure prophylaxis with HDCV or RVA, or previous vaccination with any other type of rabies vaccine and a documented history of antibody response to the prior vaccination. | ||
(d) Case definition is established by the department.
(Indiana State Department of Health;
410 IAC 1-2.5-81 Anthrax; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 81. The specific control measures for anthrax (infectious agent: Bacillus anthracis) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall be performed immediately to determine the source of exposure. History of exposure to animals and animal products (wool, hair, or raw leather) and travel to endemic anthrax areas shall be fully investigated.
(2) Standard precautions for isolation of hospitalized patients shall be followed.
(3) Discharges from lesions and articles contaminated with discharges require disinfection. An infectious agent is a spore former that will survive in environment for long periods. Disinfection requires sporicidal agent.
(4) Quarantine is not necessary.
(5) If exposure occurred in an occupational/industrial setting, a review of industrial hygiene practices shall be made to reduce the risk of other cases.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-82 Arboviral disease (non-neuroinvasive and neuroinvasive); specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 82. The specific control measures for arboviral encephalitis (West Nile virus, La Crosse/California serogroup virus, eastern equine encephalitis, western equine encephalitis, Powassan encephalitis, St. Louis encephalitis, dengue, chikungunya virus, and Japanese encephalitis) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall be performed immediately for the purpose of identifying location and presence of vector mosquitoes. If applicable, the local health officer shall:
(A) obtain travel history prior to illness; and
(B) identify traveling companions who may have been exposed.
Active surveillance shall be instituted. The local health officer shall identify areas in the community where there is a need for vector control. Identification of cases in horses, birds, or humans provides evidence of virus presence and amplification in the community environment.
(2) Use contact precautions until enterovirus meningoencephalitis is eliminated from the list of possible diagnoses.
(3) Concurrent disinfection is not required.
(4) Quarantine is not required.
(5) Immunization is not available. Protection of contacts is not applicable. Fogging or spraying insecticides:
(A) has been effectively used to abort urban epidemics; and
(B) may be recommended by the department.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-83 Babesiosis; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 83. The specific control measures for babesiosis (infectious agent: Babesia species) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall:
(A) be performed within seventy-two (72) hours; and
(B) focus on source of exposure to:
(i) infected ticks; or
(ii) recent blood transfusions.
Travel history for the previous six (6) months to include the most recent summer months is essential.
(2) Isolation is required regarding blood and body fluids.
(3) Concurrent disinfection is not required.
(4) Quarantine is not required.
(5) Immunization is not available. Household contacts or traveling companions with similar exposures should also be evaluated for infection. If the patient donated blood while incubating the disease, the blood collecting agency should be notified immediately.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-84 Botulism; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 84. The specific control measures for botulism - foodborne, infant, wound, or other (infectious agent: Clostridium botulinum), are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall meet the following conditions:
(A) Be performed immediately (within three (3) hours after clinical suspicion).
(B) Include the following prior to symptom onset:
(i) Five (5) day food and drink history.
(ii) Fourteen (14) day wound history.
(C) Recover all suspected food for appropriate testing and disposal.
(D) If suspicion is high that the source is a commercial food product or a product served in a restaurant, the local health officer shall perform active surveillance to identify additional cases. The purpose of the investigation shall be case ascertainment, assurance of availability of the appropriate antitoxin through the department, and identification of the infection source.
(2) Isolation is not required.
(3) Implicated food that is not collected for laboratory analysis shall be double-bagged and discarded. The department shall direct bulk disposal. Contaminated environmental surfaces shall be sterilized by boiling or by chlorine disinfection to inactivate any remaining toxin. Feces from infant cases may be disposed of in a sanitary sewer. Terminal cleaning shall be followed.
(4) Quarantine is not applicable.
(5) Prophylaxis with antitoxin is not recommended for asymptomatic people who have ingested a food known to contain botulinum toxin. Physicians treating a patient who has been exposed to toxin or is suspected of having any type of botulism should contact the department immediately. People exposed to toxin who are asymptomatic should have close medical observation in nonsolitary settings.
(6) The investigational botulinum toxoid pentavalent vaccine (types A, B, C, D, and E) has been discontinued for immunization among laboratory workers at high risk of exposure and is no longer available.
(7) Requests for botulinum antitoxin for treatment of suspected wound or foodborne botulism shall be made through the department. Botulism immune globulin for treatment of infants with botulism may be requested through the department. Antitoxin for noninfant forms of botulism: Antitoxin should be procured immediately through the department. If contact cannot be made with the department, the CDC Emergency Operations Center should be contacted for botulism case consultation and antitoxin. Equine-derived investigational heptavalent botulinum antitoxin (HBAT) is the only botulinum antitoxin available for treatment. Antitoxin for infant botulism: Botulism immune globulin (BabyBIG) caused by C. botulinum type A or type B is made and distributed by the California Department of Public Health. HBAT is available and is not recommended routinely for infant botulism, but has been used to treat patients with type F infant botulism on a case-by-case basis.
(8) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-85 Brucellosis; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 85. The specific control measures for brucellosis (infectious agent: Brucella species) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall be performed immediately to trace infection to the common or individual source, usually:
(A) infected dogs, domestic goats, swine, or cattle;
(B) unpasteurized milk or dairy products (cheese) from cows and goats; or
(C) foreign travel.
Occupational exposures from slaughterhouses or others working with infected animal tissues or products should be considered. Animals suspected of being infected shall be managed according to requirements of the Indiana state board of animal health.
(2) Standard precautions for hospitalized patients shall be taken.
(3) Concurrent disinfection of purulent discharges shall be followed.
(4) Quarantine is not required.
(5) Immunization is not available. Protection of contacts is not applicable.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-86 Campylobacteriosis; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 86. The specific control measures for Campylobacter enteritis (infectious agent: Campylobacter species) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall meet the following conditions:
(A) Be performed within seventy-two (72) hours.
(B) Include a five (5) day history of the following prior to symptom onset:
(i) Food and drink consumption.
(ii) Domestic and international travel.
(iii) Water exposures.
(iv) Animal exposures.
(C) Determine if the case is part of an outbreak.
(D) Determine if the case is a:
(i) food employee;
(ii) daycare worker;
(iii) health care worker; or
(iv) daycare attendee, a school attendee, or anyone who lives at a residential institution.
(E) Determine if meal companions are additional cases.
(2) In addition to standard precautions, contact precautions shall be followed for diapered or incontinent individuals or children less than six (6) years of age. For others, the following guidelines apply:
(A) Cases employed as food employees, daycare workers, health care workers, or in similar positions shall be excluded from employment involving food handling and direct care of children or hospitalized or institutionalized patients until all of the following have occurred:
(i) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours.
(ii) The case has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iii) The local health officer has discussed the following topics with the employer:
(AA) The employer's duty to comply with local and state rules pertaining to prevention of infectious diseases.
(BB) The availability of required proper hand washing facilities for employees.
(CC) The correction of any observed lapses in hygienic measures by employees.
(B) Cases shall be excluded from attending schools, preschools, and daycare facilities until all of the following have occurred:
(i) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours.
(ii) The case or case's guardian has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iii) The local health officer has discussed with the appropriate school, preschool, or daycare facility staff the need:
(AA) for proper hand washing procedures and other infection control practices; and
(BB) to comply with all local and state rules pertaining to prevention of infectious diseases.
(C) If an outbreak of the infection occurs in a daycare facility or preschool, the following shall occur:
(i) All attendees and staff may be required to submit stool specimens for examination.
(ii) Instead of exclusion, attendees and staff may be isolated from other attendees and staff in the same facility based on symptoms, laboratory testing, and treatment. This alternative shall only be considered if the physical structure and staff organization of the facility can accommodate isolation of various attendee and staff groups from one another. If this alternative is selected, increased emphasis on hand washing procedures and environmental cleaning is required.
(iii) Admission of all new attendees may be suspended while the outbreak continues.
(3) Concurrent disinfection of feces and soiled articles is required. Feces may be discarded in a sanitary sewer without prior disinfection.
(4) Quarantine is not required.
(5) Immunization is not available. Protection of contacts is not applicable.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-87 Carbapenemase producing – carbapenem resistant Enterobacteriaceae (CP-CRE); specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 87. The specific control measures for carbapenemase producing – carbapenem resistant Enterobacteriaceae (CP-CRE) (infectious agent: organisms that are nonsusceptible to at least one (1) carbapenem antibiotic with MIC >=2 μg/ml or zone diameter <=22 mm, and are positive for carbapenemase production by a phenotypic test (e.g., Modified Hodge or Carba NP)) are as follows:
(Indiana State Department of Health;
(1) An investigation shall be performed by the local health officer within seventy-two (72) hours and include individuals who have shared a residence with the patient in an acute care or long term care facility.
(2) The facility shall initiate contact precautions for CP-CRE; additional precautions should be added if any other transmissible condition is present.
(3) Supplemental measures for a health care facility with CP-CRE transmission include the following:
(A) Refer to the most recent CRE Toolkit from the Centers for Disease Control and Prevention for patient and environmental management of CRE patients.
(B) Consider screening of patients to determine if epidemiologically linked.
(C) Consider chlorhexidine gluconate bathing.
(4) Case definition is established by the department.
410 IAC 1-2.5-88 Chancroid; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 88. The specific control measures for chancroid (infectious agent: Haemophilus ducreyi) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall be:
(A) performed within seventy-two (72) hours; and
(B) focused on identifying sexual partners who were at risk for transmitting to, or contracting the infection from, the case.
Case and contacts shall be fully evaluated and treated as recommended in the Sexually Transmitted Diseases Treatment Guidelines, 2010, Morbidity and Mortality Weekly Report, December 17, 2010, Volume 59, No. RR-12.
(2) Standard precautions are required. Avoid sexual contact until all lesions are healed.
(3) Concurrent disinfection is not required.
(4) Quarantine is not required.
(5) Immunization is not available. Sexual contacts shall receive prophylactic treatment.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-89 Chlamydial infections, genital; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 89. The specific control measures for chlamydial infections, genital (infectious agent: Chlamydia trachomatis) (see psittacosis for infections caused by Chlamydia psittaci) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall be:
(A) performed within seventy-two (72) hours; and
(B) focused on identifying sexual partners who were at risk for transmitting to, or contracting the infection from, the case.
Case and contacts shall be fully evaluated and treated as recommended in the Sexually Transmitted Diseases Treatment Guidelines, 2010, Morbidity and Mortality Weekly Report, December 17, 2010, Volume 59, No. RR-12. Expedited partner therapy is allowed for the treatment of sex partners for chlamydia (http://www.in.gov/isdh/files/EPT_Guidance_Document.pdf).
(2) For hospital patients, standard precautions shall be followed. Appropriate antibiotic therapy renders discharges noninfectious. Patients shall refrain from sexual intercourse until treatment is completed.
(3) Careful disposal of articles contaminated with urethral and vaginal discharges is required.
(4) Quarantine is not required.
(5) Immunization is not available.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-90 Cholera; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 90. The specific control measures for cholera (infectious agent: Vibrio cholerae 01 or 0139) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall meet the following conditions:
(A) Be performed immediately.
(B) Include a five (5) day history of the following prior to symptom onset:
(i) Food and drink consumption.
(ii) Water exposure.
(iii) Domestic and international travel.
(C) Determine if the case is part of an outbreak.
(D) Determine if the case is a:
(i) food employee;
(ii) daycare worker;
(iii) health care worker; or
(iv) daycare attendee, a school attendee, or anyone who lives at a residential institution.
(E) Interview individuals who consumed food and water with the patient to identify additional cases and determine the contaminated food or water source. If suspicion centers on water, a commercial food product, or a restaurant as a potential source, active surveillance shall be carried out to identify additional cases.
(2) In addition to standard precautions, contact precautions shall be followed for diapered or incontinent people for the duration of illness. For others, the following guidelines apply:
(A) Cases employed as food employees shall be excluded from employment involving food handling until all of the following have occurred:
(i) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours.
(ii) One (1) negative stool culture has been confirmed.
(iii) The case has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iv) The local health officer has discussed the following topics with the employer:
(AA) The employer's duty to comply with local and state rules pertaining to prevention of infectious diseases.
(BB) The availability of required proper hand washing facilities for all employees.
(CC) The correction of any observed lapses in hygienic measures by employees.
(B) Cases employed as daycare workers, health care workers, or in similar positions shall be excluded from employment involving direct care of children or hospitalized or institutionalized patients until all of the following have occurred:
(i) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours.
(ii) The case has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iii) The local health officer has discussed the following topics with the employer:
(AA) The employer's duty to comply with local and state rules pertaining to prevention of infectious diseases.
(BB) The availability of required proper hand washing facilities for employees.
(CC) The correction of any observed lapses in hygienic measures by employees.
(C) Cases shall be excluded from attending schools, preschools, and daycare facilities until all of the following have occurred:
(i) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours.
(ii) The case or case's guardian has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iii) The local health officer has discussed with the appropriate school, preschool, or daycare facility staff the need:
(AA) for proper hand washing procedures and other infection control practices; and
(BB) to comply with all local and state rules pertaining to prevention of infectious diseases.
(D) If an outbreak of the infection occurs in a daycare facility or preschool the following may occur:
(i) All attendees and staff may be required to submit stool specimens for examination.
(ii) Instead of exclusion, attendees and staff may be isolated from other attendees and staff in the same facility based on symptoms, laboratory testing, and treatment. This alternative shall only be considered if the physical structure and staff organization of the facility can accommodate isolation of various attendee and staff groups from one another. If this alternative is selected, increased emphasis on hand washing procedures and environmental cleaning is necessary.
(iii) Admission of all new attendees may be suspended while the outbreak continues.
(3) Feces, vomitus, and articles soiled by feces or vomitus, or both, shall receive concurrent disinfection. Feces and vomitus may be discarded in a sanitary sewer without prior disinfection.
(4) Quarantine is not required.
(5) No cholera vaccines are available in the United States. Cholera immunization is not required for travelers entering the United States from cholera-affected areas, and it is not recommended for travel to or from areas with cholera infection. Observe individuals who consume food and drink from the same sources as the patient for five (5) days from the last exposure. The administration of doxycycline, tetracycline, ciprofloxacin, ofloxacin, or trimethoprim-sulfamethoxazole within twenty-four (24) hours of identification of the index case may prevent coprimary cases of cholera among household contacts. However, because secondary transmission of cholera is rare, prophylaxis of contacts is not recommended, except in special circumstances in which the probability of fecal exposure is high and medication can be delivered rapidly.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-91 Coccidioidomycosis; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 91. The specific control measures for coccidioidomycosis (infectious agent: Coccidioides immitus and posadasi or Coccidioides species) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall be performed within seventy-two (72) hours.
(2) Standard precautions are required for hospitalized patients.
(3) Concurrent disinfection is required.
(4) Quarantine is not required.
(5) Immunization is not available. Protection of contacts is not applicable.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-92 Cryptosporidiosis; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 92. The specific control measures for cryptosporidiosis (infectious agent: Cryptosporidium species) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall meet the following conditions:
(A) Be performed within seventy-two (72) hours.
(B) Include a seven (7) day food and exposure history of the following prior to symptom onset:
(i) Food and drink consumption.
(ii) Daycare or preschool children.
(iii) Animal exposures.
(iv) Surface water.
(C) Determine if the case is part of an outbreak.
(D) Determine if the case is a:
(i) food employee;
(ii) daycare worker;
(iii) health care worker; or
(iv) daycare attendee, a school attendee, or anyone who lives at a residential institution.
(E) If suspicion centers on a commercial food product, restaurant, recreational water setting, or public water supply, active surveillance shall be instituted to identify additional cases.
(2) In addition to standard precautions, contact precautions shall be followed for diapered or incontinent people for the duration of illness or to control institutional outbreaks. For others, the following instructions apply:
(A) Cases employed as food employees, daycare workers, health care workers, or in similar positions shall be excluded from employment involving food handling and the direct care of children or hospitalized or institutionalized patients until all of the following have occurred:
(i) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours.
(ii) The case has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iii) The local health officer has discussed the following topics with the employer:
(AA) The employer's duty to comply with local and state rules pertaining to prevention of infectious diseases.
(BB) The availability of required proper hand washing facilities for employees.
(CC) The correction of any observed lapses in hygienic measures by employees.
(B) Cases shall be excluded from attending schools, preschools, and daycare facilities until all of the following have occurred:
(i) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours.
(ii) The case has completed effective treatment, if indicated.
(iii) The case or case's guardian has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iv) The local health officer has discussed with appropriate school, preschool, or daycare facility staff the need:
(AA) for proper hand washing procedures and other infection control practices; and
(BB) to comply with all local and state rules pertaining to prevention of infectious diseases.
(C) If an outbreak of the infection occurs in a daycare facility or preschool the following may occur:
(i) All attendees and staff may be required to submit stool specimens for examination.
(ii) Instead of exclusion, attendees and staff may be isolated from other attendees and staff in the same facility based on symptoms, laboratory testing, and treatment. This alternative shall only be considered if the physical structure and staff organization of the facility can accommodate isolation of various attendee and staff groups from one another. If this alternative is selected, increased emphasis on hand washing procedures and environmental cleaning is necessary.
(iii) Admission of all new attendees may be suspended while the outbreak continues.
(3) Concurrent disinfection of feces and feces soiled articles is required. Feces may be discarded in a sanitary sewer system.
(4) Quarantine is not required.
(5) Immunization is not available. Protection of contacts is not applicable.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-93 Cyclosporiasis; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 93. The specific control measures for cyclosporiasis (infectious agent: Cyclospora cayetanensis) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall meet the following conditions:
(A) Be performed within seventy-two (72) hours.
(B) Include a seven (7) day history of the following prior to symptom onset:
(i) Food and drink consumption.
(ii) Domestic and international travel.
(iii) Water exposures.
(C) Determine if the case is part of an outbreak.
(D) Determine if the case is a:
(i) food employee;
(ii) daycare worker;
(iii) health care worker; or
(iv) daycare attendee, a school attendee, or anyone who lives at a residential institution.
(E) If a commercial food source is suspected, active surveillance shall be undertaken. Direct person-to-person transmission is unlikely, so focus should be on a water or food source.
(2) In addition to standard precautions, contact precautions shall be followed for diapered or incontinent people for the duration of illness. For others, the following instructions apply:
(A) Cases employed as food employees, daycare workers, health care workers, or in similar positions shall be excluded from employment involving food handling and the direct care of children or hospitalized or institutionalized patients until all of the following have occurred:
(i) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours.
(ii) The case has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iii) The local health officer has discussed the following topics with the employer:
(AA) The employer's duty to comply with local and state rules pertaining to prevention of infectious diseases.
(BB) The availability of required proper hand washing facilities for employees.
(CC) The correction of any observed lapses in hygienic measures by employees.
(B) Cases shall be excluded from attending schools, preschools, and daycare facilities until all of the following have occurred:
(i) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours.
(ii) The case has completed effective treatment, if indicated.
(iii) The case or case's guardian has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iv) The local health officer has discussed with the appropriate school, preschool, or daycare facility staff the need:
(AA) for proper hand washing and other infection control practices; and
(BB) to comply with all local and state rules pertaining to prevention of infectious diseases.
(C) If an outbreak of the infection occurs in a daycare facility or preschool, the following may occur:
(i) All attendees and staff may be required to submit stool specimens for examination.
(ii) Instead of exclusion, attendees and staff may be isolated from other attendees and staff in the same facility based on symptoms, laboratory testing, and treatment. This alternative shall only be considered if the physical structure and staff organization of the facility can accommodate isolation of various attendee and staff groups from one another. If this alternative is selected, increased emphasis on hand washing procedures and environmental cleaning is necessary.
(iii) Admission of all new attendees may be suspended while the outbreak continues.
(3) Concurrent disinfection of feces and feces soiled articles is required. Feces may be discarded in a sanitary sewer.
(4) Quarantine is not required.
(5) Immunization is not applicable. Protection of contacts is not applicable.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-94 Cysticercosis; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 94. The specific control measures for cysticercosis (infectious agent: Taenia solium) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall:
(A) be performed within seventy-two (72) hours; and
(B) focus on source of exposure to:
(i) travel history (lifetime); and
(ii) identify and interview family members and household contacts to identify additional cases of cysticercosis or taeniasis (infection with Taenia solium).
(2) Standard precautions are required.
(3) Concurrent disinfection is not required.
(4) Quarantine is not required.
(5) Immunization is not available. Protection of contacts is not applicable.
(6) Case definition is established by the department.
410 IAC 1-2.5-95 Diphtheria; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 95. The specific control measures for diphtheria (infectious agent: Corynebacterium diphtheriae) are as follows:
(Indiana State Department of Health;
(1) An investigation by a department field representative, in cooperation with the local health officer, shall:
(A) be performed immediately; and
(B) include case management of diphtheria.
The investigation shall include, at a minimum, determination of immunization status of the index case or suspect case. Culture shall be obtained for organism identification. A complete list of contacts shall be generated. Contacts are defined as all individuals in the household, all individuals with a history of habitual, close contact, and all individuals directly exposed to throat and nasal secretions of the patient.
(2) For hospitalized patients, institute droplet precautions for pharyngeal diphtheria and contact precautions for cutaneous diphtheria. Continue precautions until:
(A) the patient is off antibiotics; and
(B) two (2) cultures taken twenty-four (24) hours apart are negative.
(3) Concurrent disinfection is required for the following:
(A) Articles in contact with the patient.
(B) All articles soiled by the patient's discharges.
Terminal cleaning is required.
(4) Contacts who are:
(A) food employees;
(B) employees of schools, preschools, or daycare facilities; or
(C) health care workers;
shall be excluded from work until bacteriologic examination proves them not to be carriers.
(5) All contacts, regardless of immunization status, shall be:
(A) kept under surveillance for seven (7) days for signs and symptoms of disease;
(B) cultured for C. diphtheriae; and
(C) treated prophylactically with:
(i) a single intramuscular (IM) dose of benzathine penicillin G (six hundred thousand (600,000) units (U) for those children weighing less than thirty (30) kg and one million two hundred thousand (1,200,000) U for those children weighing thirty (30) kg or more and adults); or
(ii) a ten (10) day course of oral erythromycin (forty (40) milligrams per kilogram per day (mg/kg/day maximum of two (2) grams per day).
For individuals who are culture positive, repeat cultures after completion of therapy.
Previously immunized contacts should receive a booster dose of diphtheria toxoid if more than five (5) years have lapsed since the last immunization. Individuals incompletely immunized or with unknown immunization status should start an active immunization series with a diphtheria toxoid preparation appropriate for age and medical history.
(6) Treatment of individuals suspected of having diphtheria should not be delayed while awaiting culture results. Diphtheria antitoxin should be given based on clinical diagnosis. Antitoxin dosage is dependent on length and severity of the disease. Antimicrobial therapy is essential to eliminate the organism and to prevent the spread of the disease. One (1) of the following antimicrobial therapies should be given:
(A) Procaine penicillin G (IM) (twenty-five thousand (25,000) to fifty thousand (50,000) U/kg/day for children and one million two hundred thousand (1,200,000) U/kg/day for adults in two (2) divided doses) for a recommended treatment period of fourteen (14) days.
(B) Parenteral erythromycin (forty (40) to fifty (50) mg/kg/day, maximum two (2) grams per day (gm/d)) has been recommended until the patient can swallow comfortably, at which point oral erythromycin in four (4) divided doses or oral penicillin V (one hundred twenty-five (125) to two hundred fifty (250) mg four (4) times daily) may be substituted for a recommended total treatment period of fourteen (14) days.
(7) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-96 Ehrlichiosis; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 96. The specific control measures for ehrlichiosis (infectious agent: Ehrlichiaor Anaplasma species) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall:
(A) be performed within seventy-two (72) hours; and
(B) include an interview with the patient to determine:
(i) exposure to ticks; and
(ii) the location of exposure for the previous four (4) weeks.
Information gathered is useful in identifying foci of infected environments and public education campaigns on prevention.
(2) Standard precautions are required.
(3) Concurrent disinfection is required. All ticks shall be removed from the patient.
(4) Quarantine is not required.
(5) Immunization is not available. Protection of contacts is not applicable.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-97 Escherichia coli infection (Shiga toxin-producing): E. coli 0157, E. coli 0157:H7, non-0157 E. coli, and Shiga toxin detected and hemolytic uremic syndrome (HUS), postdiarrheal; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 97. The specific control measures for Escherichia coli (E. coli) infection (Shiga toxin-producing (STEC)), including, but not limited to, E. coli 0157, E. coli 0157:H7, non-0157 E. coli, and Shiga toxin detected and hemolytic uremic syndrome (HUS) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall meet the following conditions:
(A) Be performed immediately.
(B) Include a seven (7) day history of the following prior to symptom onset:
(i) Food and drink consumption.
(ii) Water exposures.
(iii) Animal exposures.
(C) Determine if the case is part of an outbreak.
(D) Determine if the case is a:
(i) food employee;
(ii) daycare worker;
(iii) health care worker; or
(iv) daycare attendee, a school attendee, or anyone who lives at a residential institution.
(E) Determine if the case is a contact of a food employee serving a highly susceptible population.
(F) Determine if meal companions are additional cases.
(G) If a commercial food product or restaurant is suspected, conduct active surveillance for additional cases. Medical evaluation, including adequate laboratory examination of feces of contacts, should be limited to food employees, daycare workers, health care workers, or other situations where outbreaks may occur.
(2) In addition to standard precautions, contact precautions shall be followed for patients with all types of E. coli diarrhea for the duration of illness. Patients with HUS, postdiarrheal should be presumed to have STEC infection. For others, the following guidelines apply:
(A) Cases who are food employees shall abide by the following:
(i) If the case works in a food establishment serving a highly susceptible population, exclude from employment involving food handling until asymptomatic and all of the following have occurred:
(AA) The case has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(BB) The local health officer has discussed the following topics with the employer:
(aa) The employer's duty to comply with local and state rules pertaining to prevention of infectious diseases.
(bb) The availability of required proper hand washing facilities for employees.
(cc) The correction of any observed lapses in hygienic measures by employees.
(CC) The person in charge obtains approval from the regulatory authority.
(DD) One (1) of the following has been met:
(aa) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours, and the food employee is free of an infection from STEC based on test results that show two (2) consecutive negative stool cultures for STEC and nonculture assay for Shiga toxin tested simultaneously have been collected:
(1) at least twenty-four (24) hours apart; and
(2) if the case was treated with antimicrobials prior to E. coli confirmation or diagnosis, at least forty-eight (48) hours after the cessation of antimicrobial therapy.
(bb) The local health officer has determined that the symptoms of vomiting and diarrhea have resolved and more than seven (7) calendar days have passed since the food employee became asymptomatic.
(cc) The local health officer has determined the case did not develop symptoms, and more than seven (7) days have passed since the food employee was diagnosed.
(ii) If the case works in a food establishment not serving a highly susceptible population, exclude from employment involving food handling until asymptomatic from vomiting and diarrhea for at least twenty-four (24) hours, then restrict until all of the following have occurred:
(AA) The case has been counseled about preventive measures, such as hand washing procedures, that shall be followed to prevent transmission of disease.
(BB) The local health officer has discussed the following topics with the employer:
(aa) The employer's duty to comply with local and state rules pertaining to prevention of infectious diseases.
(bb) The availability of required proper hand washing facilities for employees.
(cc) The correction of any observed lapses in hygienic measures by employees.
(CC) The person in charge obtains approval from the regulatory authority.
(DD) One (1) of the following has been met:
(aa) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours, and the food employee is free of an infection from STEC based on test results that show two (2) consecutive negative stool cultures for STEC and nonculture assay for Shiga toxin tested simultaneously have been collected:
(1) at least twenty-four (24) hours apart; and
(2) if the case was treated with antimicrobials prior to E. coli confirmation or diagnosis, at least forty-eight (48) hours after the cessation of antimicrobial therapy.
(bb) The local health officer has determined that the symptoms of vomiting and diarrhea have resolved, and more than seven (7) calendar days have passed since the food employee became asymptomatic.
(cc) The local health officer has determined the case did not develop symptoms, and more than seven (7) days have passed since the food employee was diagnosed.
(B) Cases employed as daycare workers, health care workers, or in similar positions shall be excluded from employment involving direct care of children or hospitalized or institutionalized patients until all of the following have occurred:
(i) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours.
(ii) The case has been counseled about preventive measures, such as hand washing, that must be followed to prevent transmission of disease.
(iii) The local health officer has discussed the following topics with the employer:
(AA) The employer's duty to comply with local and state rules pertaining to prevention of infectious diseases.
(BB) The availability of required proper hand washing facilities for employees.
(CC) The correction of any observed lapses in hygienic measures by employees.
(C) Cases shall be excluded from attending preschools and daycare facilities until all of the following have occurred:
(i) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours.
(ii) Two (2) successive negative stool cultures for STEC and nonculture assay for Shiga toxin tested simultaneously have been collected:
(AA) at least twenty-four (24) hours apart; and
(BB) if the case was treated with antimicrobials prior to E. coli confirmation or diagnosis, at least forty-eight (48) hours after the cessation of antimicrobial therapy.
(iii) The case or case's guardian has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iv) The local health officer has discussed with the appropriate preschool or daycare facility staff the need:
(AA) for proper hand washing procedures and other infection control practices; and
(BB) to comply with all local and state rules pertaining to prevention of infectious diseases.
(D) Cases shall be excluded from attending schools until all of the following have occurred:
(i) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours.
(ii) The case or case's guardian has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iii) The local health officer has discussed with the appropriate school staff the need:
(AA) for proper hand washing procedures and other infection control practices; and
(BB) to comply with all local and state rules pertaining to prevention of infectious diseases.
(E) If an outbreak occurs in a daycare facility or preschool, the following shall occur:
(i) All attendees and staff may be required to submit stool specimens for examination.
(ii) Instead of exclusion until stool-negative, attendees and staff may be isolated from other attendees and staff in the same facility based on symptoms, laboratory testing, and treatment. This alternative shall only be considered if the physical structure and staff organization of the facility can accommodate isolation of various groups from one another. If this alternative is selected, increased emphasis on hand washing procedures and environmental cleaning is necessary.
(iii) Admission of all new attendees may be suspended while the outbreak continues.
(F) A case contact who is a food employee in a food establishment serving a highly susceptible population must abide by the following criteria:
(i) Restrict the contact if the contact meets one (1) of the following criteria:
(AA) Attended or worked in a setting of a confirmed disease outbreak of STEC within the past three (3) days of last exposure.
(BB) Lives in the same household as, and has knowledge about, an individual who works in or attends a setting where there is a confirmed disease outbreak of STEC within the past three (3) days of last exposure.
(CC) Lives in the same household as, and has knowledge about, an individual diagnosed with an illness caused by STEC within the past three (3) days of last exposure.
(DD) Consumed food prepared by a person infected with STEC within the past three (3) days of last exposure.
(EE) Consumed or prepared food implicated in a confirmed disease outbreak of STEC within the past three (3) days of last exposure.
(ii) Reinstate the food employee who was restricted when one (1) of the following has occurred:
(AA) More than three (3) calendar days have passed since the last day the food employee was potentially exposed.
(BB) More than three (3) calendar days have passed since the food employee's household contact became asymptomatic.
(3) Concurrent disinfection of feces and fecal soiled articles is required. Feces may be discarded in a sanitary sewer without prior disinfection.
(4) Quarantine is not required.
(5) HUS is a serious sequel of STEC enteric infection. E. coli 0157:H7 is the STEC serotype most commonly associated with HUS, defined by the triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal dysfunction. The illness is serious and typically develops seven (7) days (up to three (3) weeks) after onset of diarrhea. STEC should be sought in stool specimens from all patients diagnosed with HUS, postdiarrheal. However, the absence of STEC does not preclude the diagnosis of probable STEC-associated HUS, because HUS typically is diagnosed a week or more after onset of diarrhea, when the organism may not be detectable by conventional methods. Negative stool specimens from HUS, postdiarrheal cases may be sent to the department for analysis.
(6) Orally administered electrolyte-containing solutions usually are adequate to prevent or treat dehydration and electrolyte abnormalities. Antimotility agents should not be administered to children with inflammatory or bloody diarrhea. Careful monitoring of patients with hemorrhagic colitis (including complete blood cell count with smear, blood urea nitrogen, and creatinine concentrations) is recommended to detect changes suggestive of HUS.
(7) Immunization is not available. Protection of contacts is not applicable.
(8) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-98 Giardiasis; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 98. The specific control measures for giardiasis (infectious agent: Giardia species) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall meet the following conditions:
(A) Be performed within seventy-two (72) hours.
(B) Include a seven (7) day history of the following prior to symptom onset:
(i) Food and drink consumption.
(ii) Contact with daycare or preschool children.
(iii) Animal exposures.
(iv) Surface water.
(v) Recreational water setting.
(C) Determine if the case is part of an outbreak.
(D) Determine if the case is a:
(i) food employee;
(ii) daycare worker;
(iii) health care worker; or
(iv) daycare attendee, a school attendee, or anyone who lives at a residential institution.
(E) If suspicion centers on a commercial food product, restaurant, or public water supply, active surveillance shall be instituted to identify additional cases.
(2) In addition to standard precautions, contact precautions shall be followed for diapered or incontinent people for the duration of illness. For others, the following instructions apply:
(A) Cases employed as food employees, daycare workers, health care workers, or in similar positions shall be excluded from employment involving food handling and direct care of children or hospitalized or institutionalized patients until all of the following have occurred:
(i) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours.
(ii) The case has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iii) The local health officer has discussed the following topics with the employer:
(AA) The employer's duty to comply with local and state rules pertaining to prevention of infectious diseases.
(BB) The availability of required proper hand washing facilities for employees.
(CC) The correction of any observed lapses in hygienic measures by employees.
(B) Cases shall be excluded from attending schools, preschools, and daycare facilities until all of the following have occurred:
(i) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours.
(ii) The case has completed effective treatment, if indicated.
(iii) The case or case's guardian has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iv) The local health officer has discussed with the appropriate school, preschool, or daycare facility staff the need:
(AA) for proper hand washing procedures and other infection control practices; and
(BB) to comply with all local and state rules pertaining to prevention of infectious diseases.
(C) If an outbreak of the infection occurs in a daycare facility or preschool, the following shall occur:
(i) All attendees and staff may be required to submit stool specimens for examination.
(ii) Instead of exclusion, attendees and staff may be isolated from other attendees and staff in the same facility based on symptoms, laboratory testing, and treatment. This alternative shall only be considered if the physical structure and staff organization of the facility can accommodate isolation of various attendee and staff groups from one another. If this alternative is selected, increased emphasis on hand washing procedures and environmental cleaning is necessary.
(iii) Admission of all new attendees may be suspended while the outbreak continues.
(iv) Identify and treat, if indicated, all symptomatic children, daycare workers, and household contacts. People with diarrhea shall be excluded from the daycare facility until they become asymptomatic for at least twenty-four (24) hours. Treatment or exclusion of asymptomatic carriers is not effective for outbreak control and is not recommended.
(3) Concurrent disinfection of feces and feces soiled articles is required. Feces may be discarded in a sanitary sewer system.
(4) Quarantine is not required.
(5) Immunization is not available. Protection of contacts is not applicable.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-99 Gonorrhea; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 99. The specific control measures for gonorrhea (infectious agent: Neisseria gonorrhoeae) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall be:
(A) performed within seventy-two (72) hours; and
(B) focused on identifying sexual partners who were at risk for transmitting to, or contracting the infection from, the case.
Case and contacts shall be fully evaluated and treated as recommended in the Update to CDC's Sexually Transmitted Diseases Treatment Guidelines, 2010: Oral Cephalosporins No Longer a Recommended Treatment for Gonococcal Infections, 2012, Morbidity and Mortality Weekly Report; August 10, 2012; Vol. 61; No. 31. Expedited partner therapy is allowed for the treatment of sex partners for gonorrhea (http://www.in.gov/isdh/files/EPT_Guidance_Document.pdf).
(2) Standard precautions shall be instituted for hospitalized individuals. Infected persons shall not engage in sexual activities involving the exchange of body fluids until:
(A) therapy is completed; and
(B) they no longer have symptoms.
Treated persons shall also refrain from sexual activities involving the exchange of body fluids with untreated previous sexual partners to avoid reinfection. Cases should be examined serologically for syphilis.
(3) Concurrent disinfection is required for articles contaminated with discharges.
(4) Quarantine is not required.
(5) Immunization is not available.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-100 Granuloma inguinale; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 100. The specific control measures for granuloma inguinale (infectious agent: Calymmatobacterium granulomatis) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall be:
(A) performed within seventy-two (72) hours; and
(B) focused on identifying sexual partners who were at risk for transmitting to, or contracting the infection from, the case.
Case and contacts shall be fully evaluated and treated as recommended in the Sexually Transmitted Diseases Treatment Guidelines, 2010, Morbidity and Mortality Weekly Report, December 17, 2010, Volume 59, No. RR-12.
(2) Standard precautions for hospitalized patients are required. Patients shall refrain from sexual activities:
(A) until treatment is complete and lesions are healed; and
(B) with untreated previous sexual partners.
(3) Concurrent disinfection is required for the following:
(A) Discharges from lesions.
(B) Articles soiled by those discharges.
(4) Quarantine is not required.
(5) Immunization is not available. Prompt treatment of contacts upon recognition or suspicion of disease is required.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-101 Haemophilus influenzae invasive disease; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 101. The specific control measures for Haemophilus influenzae type B (Hib) invasive disease (infectious agent: Haemophilus influenzae) are as follows:
(Indiana State Department of Health;
(1) An investigation by a department field representative, in cooperation with the local health officer, shall:
(A) be performed within twenty-four (24) hours; and
(B) include:
(i) case management;
(ii) an immunization history of the index case; and
(iii) identification of all contacts less than four (4) years of age.
Contacts are defined as household contacts or individuals who spent four (4) or more hours with the index case for at least five (5) of the seven (7) days preceding the day of hospital admission of the case.
(2) Droplet precautions shall be followed for twenty-four (24) hours after the initiation of parenteral antibiotic therapy.
(3) Concurrent disinfection is not required.
(4) Quarantine is not required.
(5) Prophylaxis for contacts of a case or cases of Hib disease (except for pregnant females) should be administered to the following:
(A) All members of a household where there is one (1) or more infants who have not received the primary Hib series.
(B) All members of a household with at least one (1) contact less than four (4) years of age who is unimmunized or incompletely immunized.
(C) All members of a household where a contact is an immunocompromised child, regardless of child's Hib immunization status.
(D) All daycare facility or preschool contacts where:
(i) unvaccinated or incompletely vaccinated children are in attendance; and
(ii) two (2) or more cases of Haemophilus influenzae invasive disease have occurred within sixty (60) days of each other.
(6) Prophylaxis is not recommended for the following:
(A) All members of a household where there are no children younger than four (4) years of age other than the index patient.
(B) All members of a household with a child or children less than four (4) years of age that have completed their Hib immunization series.
(C) Nursery school and child care contacts of one (1) index case, especially people older than two (2) years of age.
(D) Pregnant women.
(7) Prophylaxis is not recommended for contacts of people with nontype B Haemophilus influenzae.
(8) The case, if younger than two (2) years of age, should receive rifampin prophylaxis prior to discharge if treated with a different antibiotic for the invasive infection.
(9) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-102 Hansen's disease; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 102. The specific control measures for Hansen's disease (infectious agent: Mycobacterium leprae) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall meet the following conditions:
(A) Be performed within seventy-two (72) hours.
(B) Ensure household contacts who have resided with the patient up to three (3) years prior to lesion onset are examined initially, and provide education on the necessity of obtaining physical exams annually for the next five (5) years following the last contact with an infectious patient.
(C) Routine prophylaxis of contacts is not recommended.
(D) Direct observation therapy of multidrug therapy shall be used to ensure compliance with the medical regime for active cases.
(2) Standard precautions for hospitalized patients are indicated. Hospitalization should be limited to the following:
(A) Severe reactions.
(B) Cases of surgical correction.
(C) Treatment of ulcers.
(3) Concurrent disinfection:
(A) is required for:
(i) nasal secretions; and
(ii) articles soiled with nasal discharges; and
(B) should be considered infectious until treatment is established.
(4) Quarantine is not applicable.
(5) Immunization is not available. Protection of contacts is not applicable.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-103 Hantavirus; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 103. The specific control measures for hantavirus (infectious agent: hantavirus including Sin Nombre virus) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall:
(A) be performed immediately;
(B) include:
(i) case ascertainment; and
(ii) identification of the source of infection; and
(C) identify the source of exposure to rodent feces and urine.
Exterminate rodents at suspected site of infection and disinfect environmental surfaces.
(2) Standard precautions are required.
(3) Concurrent disinfection is not required.
(4) Quarantine is not required.
(5) Immunization is not available. Protection of contacts is not applicable.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-104 Hepatitis, viral, type A; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 104. The specific control measures for hepatitis, viral, type A (infectious agent: hepatitis A virus) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall meet the following conditions:
(A) Be performed immediately.
(B) Include a history of the following prior to symptom onset:
(i) Food and drink consumption.
(ii) Exposure to undercooked food items.
(iii) Domestic and international travel.
(iv) Sexual exposure during the fifteen (15) to fifty (50) day period prior to the onset of illness.
(C) Determine if the case is part of an outbreak.
(D) Determine if the case is a:
(i) food employee;
(ii) daycare worker;
(iii) health care worker; or
(iv) daycare attendee, a school attendee, or anyone who lives at a residential institution.
(E) Determine if the case is a contact of a food employee serving a highly susceptible population.
(F) If a commercial food product or restaurant is suspected, the local health officer shall initiate active surveillance immediately to identify additional cases.
(G) Determine the infectious period, which is defined as from seven (7) days before to fourteen (14) days after the onset of symptoms if no jaundice occurred; otherwise, the infectious period is defined as from fourteen (14) days prior to seven (7) days after the onset of jaundice.
(H) Prepare a list of all contacts during the infectious period and work schedules or school attendance records, or both, during the infectious period.
(2) In general, hospitalization is not required for patients with uncomplicated acute hepatitis A. When hospitalization is necessary, contact precautions are recommended in addition to standard precautions for diapered and incontinent patients for at least one (1) week after onset of symptoms. For others, the following guidelines apply:
(A) Cases who are food employees shall abide by the following criteria:
(i) Exclude from employment involving food handling if the case meets at least one (1) of the following criteria:
(AA) Is jaundiced and the onset of jaundice occurred within the last seven (7) calendar days, unless the food employee provides to the person in charge written medical documentation from a health practitioner specifying that the jaundice is not caused by hepatitis A virus or other fecal-orally transmitted infection.
(BB) Diagnosed with an infection from hepatitis A virus within fourteen (14) calendar days from the onset of any illness symptoms, or within seven (7) calendar days of the onset of jaundice.
(CC) Diagnosed with an infection from hepatitis A virus without developing symptoms.
(ii) Retain the exclusion until all of the following criteria are met:
(AA) The conclusion of the infectious period determined by the local health officer.
(BB) The case has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(CC) The local health officer has discussed the following topics with the employer:
(aa) The employer's duty to comply with local and state rules pertaining to prevention of infectious diseases.
(bb) The availability of required proper hand washing facilities for employees.
(cc) The correction of any observed lapses in hygienic measures by employees.
(DD) The local health officer has determined at least one (1) of the following occurs:
(aa) The employee has been asymptomatic for at least twenty-four (24) hours.
(bb) The food employee has been jaundiced for more than seven (7) calendar days.
(cc) The anicteric food employee has been symptomatic with symptoms other than jaundice for more than fourteen (14) calendar days.
(dd) The food employee provides to the person in charge written medical documentation from a health practitioner stating that the food employee is free of hepatitis A virus infection.
(B) Cases employed as daycare workers, health care workers, or in similar positions shall be excluded from employment involving food handling and direct care of children or hospitalized or institutionalized patients until all of the following have occurred:
(i) The conclusion of the infectious period determined by the local health officer.
(ii) The local health officer has determined the employee has been asymptomatic for at least twenty-four (24) hours.
(iii) The case has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iv) The local health officer has discussed the following topics with the employer:
(AA) The employer's duty to comply with local and state rules pertaining to prevention of infectious diseases.
(BB) The availability of required proper hand washing facilities for employees.
(CC) The correction of any observed lapses in hygienic measures by employees.
(C) Cases shall be excluded from attending schools, preschools, and daycare facilities until all of the following have occurred:
(i) The conclusion of the infectious period determined by the local health officer.
(ii) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours.
(iii) The case or case's guardian has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iv) The local health officer has discussed with the appropriate school, preschool, or daycare facility staff the need:
(AA) for proper hand washing procedures and other infection control practices; and
(BB) to comply with all local and state rules pertaining to prevention of infectious diseases.
(D) A case contact who is a food employee in a food establishment serving a highly susceptible population must abide by the following criteria:
(i) Restrict the contact if the contact meets one (1) of the following criteria:
(AA) Attended or worked in a setting of a confirmed disease outbreak of hepatitis A virus within the past thirty (30) days of last exposure.
(BB) Lives in the same household as, and has knowledge about, an individual who works in or attends a setting where there is a confirmed disease outbreak of hepatitis A virus within the past thirty (30) days of last exposure.
(CC) Lives in the same household as, and has knowledge about, an individual diagnosed with an illness caused by hepatitis A virus within the past thirty (30) days of last exposure.
(DD) Consumed food prepared by a person infected with hepatitis A virus within the past thirty (30) days of last exposure.
(EE) Consumed or prepared food implicated in a confirmed disease outbreak of hepatitis A virus within the past thirty (30) days of last exposure.
(ii) Reinstate the food employee who was restricted as specified in item (i) when all of the following have occurred:
(AA) The food employee receives additional training about the following:
(aa) Hepatitis A symptoms and preventing the transmission of infection.
(bb) Proper hand washing procedures.
(cc) Protecting ready-to-eat food from contamination introduced by bare hand contact.
(BB) At least one (1) of the following has occurred:
(aa) The food employee is immune to hepatitis A virus infection because of a prior illness from hepatitis A.
(bb) The food employee is immune to hepatitis A virus infection because of vaccination against hepatitis A.
(cc) The food employee is immune to hepatitis A virus infection because of immune globulin (IG) administration.
(dd) More than thirty (30) calendar days have passed since the last day the food employee was potentially exposed.
(ee) More than thirty (30) calendar days have passed since the food employee's household contact became jaundiced.
(ff) The food employee does not use an alternative procedure that allows bare hand contact with ready-to-eat food until at least thirty (30) days after the potential exposure.
(3) Sanitary disposal of feces, vomitus, and blood is required. Disposal through the sanitary system is acceptable.
(4) Quarantine is not required.
(5) People who have been exposed to HAV and previously have not received HAV vaccine should receive a single dose of single-antigen HAV vaccine or IG as soon as possible, but, to be effective, within two (2) weeks after the last exposure. Previously unvaccinated individuals who should receive postexposure prophylaxis include the following:
(A) Individuals with close personal contacts, such as household and sexual contacts (serologic testing of contacts is not recommended).
(B) Newborn infants of HAV-infected mothers if the mother's symptoms began between two (2) weeks before and one (1) week after delivery.
(C) Daycare or preschool workers, daycare or preschool attendees, and their household contacts or any sexual contacts.
(D) Schoolroom exposure generally does not pose an appreciable risk of infection, and postexposure prophylaxis is not indicated when a single case occurs; however, postexposure prophylaxis for unimmunized people who have close contact with the index patient if transmission within the school setting is documented.
(E) Health care-associated HAV in an identified outbreak for people in close contact with infected patients.
(F) If a food employee is diagnosed with hepatitis A, HAV vaccine or IG should be provided to other food employees at the same establishment unless the food employee is immune due to vaccination or past infection. Any susceptible food employee who refuses prophylaxis is to be restricted from working with:
(i) exposed food;
(ii) clean equipment, utensils, and linens; and
(iii) unwrapped single-service and single-use articles;
for fifty (50) days.
(G) Food establishment patrons who ate in the establishment where hepatitis A occurred in a food employee within two (2) weeks of exposure, but only if the following events occurred:
(i) The food employee directly handled ready-to-eat food products during the time when infectious.
(ii) Poor hygiene practices were demonstrated or worked while ill with diarrhea.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-105 Hepatitis, viral, type B and type D; specific control measures
Authority:
Sec. 105. The specific control measures for hepatitis, viral, type B (infectious agent: hepatitis B virus) and type D (infectious agent: delta hepatitis, occurs only in individuals with acute or chronic hepatitis B virus infection) are as follows:
(Indiana State Department of Health;
(1) An investigation and case management duties are assigned as follows:
(A) An investigation and case management of infants born to HBsAg (+) pregnant women shall:
(i) begin immediately (when infection is identified at or close to the time of birth); and
(ii) be performed by a department representative in cooperation with the local health officer;
for the purpose of ensuring that infants receive hepatitis B immune globulin and the complete HBV vaccine series.
(B) The local health officer shall perform investigation and case management of all others within seventy-two (72) hours, including household and sexual contacts of HBsAg (+) pregnant women. Investigators shall identify a complete list of contacts. Contacts are defined as sexual partners, household members, individuals with whom needles have been shared, and others who have been exposed to infectious body fluids. In addition, the investigation shall focus on a history of the following:
(i) Surgery.
(ii) Transfusion or other blood product exposures.
(iii) Hemodialysis.
(iv) Employment as a health care worker.
(v) Other contacts with blood or other potentially infectious materials during the incubation period.
When two (2) or more cases occur in association with some common exposure, a search for additional cases shall be conducted. If transfused blood or blood products is implicated in transmission, the lot shall be withdrawn from use and reasonable steps taken to ensure that no further donations from the infected donor are utilized.
(C) Hepatitis B immunization history shall be obtained on all cases of hepatitis B.
(2) Standard precautions for hospitalized patients and universal precautions for others where exposure to blood or other potentially infectious materials, or both, is a possibility. Infected persons shall not engage in sexual activities involving the exchange of body fluids without first informing their partner of their disease status. Restrictions on sexual activities shall be removed when the previously infected person is serologically confirmed to be noninfectious. The infected persons shall not:
(A) share needles or syringes with other persons without first notifying those persons of their disease status;
(B) donate blood, plasma, or organs for transplantation; or
(C) donate semen for artificial insemination.
(3) Equipment contaminated with blood or other potentially infectious body fluids, or both, shall be appropriately disinfected or, when required, sterilized prior to reuse.
(4) Quarantine is not required.
(5) Protection/immunization of contacts shall be accomplished as follows:
(A) Infants of HBsAg (+) pregnant women shall be given the appropriate intramuscular injection (IM) of HBIG and of hepatitis B vaccine within twelve (12) hours of birth unless medically contraindicated. Additional doses of vaccine should be given at one (1) month and six (6) months of age. Infants should be tested for anti-HBs and HBsAg one (1) to three (3) months after completing the vaccine series.
(B) Potentially susceptible sexual partners should be tested for HBsAG, anti-HBs, and anti-HBc. If negative, they should be given the appropriate dosage of HBIG IM and the first dose of hepatitis B vaccine IM within fourteen (14) days of the last sexual contact. Sexual contacts should complete the hepatitis B immunization series.
(C) If the index case is the mother or primary care provider of a susceptible infant, the infant should receive the appropriate dosage of HBIG and hepatitis B vaccine according to vaccine manufacturer's directions.
(D) Other susceptible household contacts of the index case should:
(i) receive the appropriate dosage of HBIG IM; and
(ii) initiate and complete the hepatitis B vaccine;
if they have had identifiable blood exposures to the index case, such as sharing toothbrushes or razors.
(E) If the index case becomes a hepatitis B carrier, all household contacts should complete the hepatitis B vaccine series.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition for hepatitis B. The case definition for hepatitis D is established by the department.
410 IAC 1-2.5-106 Hepatitis C infection; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 106. The specific control measures for hepatitis C (acute) (infectious agent: hepatitis C virus) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall be performed within five (5) business days for the purpose of determining risk factors for infection and obtaining contacts. Contacts are defined as sexual partners, household members, individuals with whom needles have been shared, and others who have been exposed to infectious body fluids. In addition, the investigation shall focus on a history of the following:
(A) Surgery.
(B) Transfusion or other blood products exposures.
(C) Hemodialysis.
(D) Employment as a health care worker.
(E) Other contacts with blood or other potentially infectious materials during the incubation period.
When two (2) or more cases occur in association with some common exposure, a search for additional cases shall be conducted. If transfused blood or blood products is implicated in the transmission, the lot shall be withdrawn from use and reasonable steps taken to ensure that no further donations from the infected donor are utilized.
(2) Standard precautions for hospitalized patients and universal precautions for others where exposure to blood or other potentially infectious materials, or both, is a possibility. Infected persons shall not engage in sexual activities involving the exchange of body fluids without first informing their partner of their disease status. Infected persons shall not:
(A) share needles or syringes with other persons without first notifying those persons of their disease status;
(B) donate blood, plasma, or organs for transplantation; or
(C) donate semen for artificial insemination.
(3) Equipment contaminated with blood or other infectious body materials, or both, shall be appropriately disinfected or sterilized prior to reuse.
(4) Quarantine is not required.
(5) Protection/immunization with hepatitis A and B vaccine series when appropriate. Education shall be provided. Children eighteen (18) months of age or older born to infected mothers should be screened for anti-HCV. Health care workers with percutaneous or permucosal exposure to HCV shall have baseline and six (6) month follow-up serologic testing for anti-HCV and alanine aminotransferase activity.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-107 Hepatitis E infection; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 107. The specific control measures for hepatitis, viral, type E (infectious agent: hepatitis E virus) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall meet the following conditions:
(A) Be performed immediately.
(B) Include a history of the following fifteen (15) to sixty-four (64) days prior to symptom onset:
(i) Food and drink consumption.
(ii) Exposure to undercooked food items.
(iii) Domestic and international travel.
(iv) Surface water.
(v) Animal exposures.
(vi) Sexual exposure.
(C) Determine if the case is part of an outbreak.
(D) Determine if the case is a:
(i) food employee;
(ii) daycare worker;
(iii) health care worker; or
(iv) daycare attendee, a school attendee, or anyone who lives at a residential institution.
(E) If a commercial food product or restaurant is suspected, conduct active surveillance immediately to identify additional cases.
(F) Determine the infectious period, which is defined as from seven (7) days before to fourteen (14) days after the onset of jaundice or from the onset of symptoms if no jaundice occurred.
(G) Prepare a list of contacts and work schedules or school attendance records, or both, during the infectious period.
(2) In addition to standard precautions, contact precautions are recommended for diapered and incontinent patients for the duration of illness. For others, the following guidelines apply:
(A) Cases employed as food employees, daycare workers, health care workers, or in similar positions shall be excluded from employment involving food handling and direct care of children or hospitalized or institutionalized patients until all of the following have occurred:
(i) The conclusion of the infectious period determined by the local health officer.
(ii) The local health officer has determined the employee has been asymptomatic for at least twenty-four (24) hours.
(iii) The case has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iv) The local health officer has discussed the following topics with the employer:
(AA) The employer's duty to comply with local and state rules pertaining to prevention of infectious diseases.
(BB) The availability of required proper hand washing facilities for employees.
(CC) The correction of any observed lapses in hygienic measures by employees.
(B) Cases shall be excluded from attending schools, preschools, and daycare facilities until all of the following have occurred:
(i) The conclusion of the infectious period determined by the local health officer.
(ii) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours.
(iii) The case or case's guardian has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iv) The local health officer has discussed with the appropriate school, preschool, or daycare facility staff the need:
(AA) for proper hand washing procedures and other infection control practices; and
(BB) to comply with all local and state rules pertaining to prevention of infectious diseases.
(3) Sanitary disposal of feces, vomitus, and blood is required. Disposal through the sanitary system is acceptable.
(4) Quarantine is not required.
(5) Immunization is not available. Protection of contacts is not applicable.
(6) Case definition is established by the department.
410 IAC 1-2.5-108 Histoplasma capsulatum; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 108. The specific control measures for Histoplasma capsulatum (infectious agent: Histoplasma capsulatum) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall:
(A) be performed within seventy-two (72) hours;
(B) determine potential sources of exposure; and
(C) evaluate the potential for occupational exposure and, in the event of two (2) or more cases, for evidence of infection from a common environmental source.
(2) Standard precautions for hospitalized patients shall be instituted. Isolation is not required for others.
(3) Concurrent disinfection is required for the following:
(A) Sputum.
(B) Equipment and articles soiled with sputum.
Terminal cleaning is also required.
(4) Quarantine is not required.
(5) Immunization is not available. Protection of contacts is not applicable.
(6) Case definition is established by the department.
410 IAC 1-2.5-109 Human immunodeficiency virus infection/disease; specific control measures
Authority: Affected: IC 16-41
Sec. 109. The specific control measures for HIV are as follows:
(Indiana State Department of Health;
(1) An investigation by a disease intervention specialist shall:
(A) be performed within seventy-two (72) hours; and
(B) include partner services.
Persons who are tested anonymously at counseling and testing sites cannot be reported using personal identifiers. Rather, they are to be reported using a numeric identifier code. Age, race, sex, risk factors, and county of residence shall also be reported. HIV infected persons are required to warn contacts of their disease status and the need to seek health care, such as counseling and testing. All identified contacts should receive counseling and be offered serologic testing. Until their status with regard to infection has been determined, contacts shall refrain from sexual activities involving the exchange of body fluids. All contacts shall not share needles and syringes with other persons without first notifying the other persons of their disease status.
(2) Standard precautions shall be used in hospitalized patients. Universal precautions shall be used for all other medical settings. Infected persons shall not:
(A) engage in sexual activities involving exchange of body fluids without first informing their partner of their disease status;
(B) share needles or syringes with other persons without first notifying the other persons of their disease status; or
(C) donate blood, plasma, organs for transplantation, or semen for artificial insemination.
(3) Concurrent disinfection is required for equipment and articles contaminated by blood or other potentially infectious material.
(4) Quarantine is not required.
(5) An investigation of:
(A) newly diagnosed cases;
(B) HIV positive women; and
(C) perinatally exposed infants;
will be performed by HIV surveillance and disease intervention specialist staff members, who will obtain information epidemiologically necessary to protect the life of named parties.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-110 Influenza-associated death; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 110. The specific measures for influenza-associated deaths are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall:
(A) be performed within seventy-two (72) hours; and
(B) include:
(i) influenza testing;
(ii) an influenza vaccination history;
(iii) a history of disease and resultant complications; and
(iv) an epidemiologic investigation.
(2) A report is not necessary if the diagnosis of influenza is not confirmed by laboratory testing or if it is not listed on the death certificate as primary, secondary, or contributory cause of death on the death certificate as described in section 44 of this rule.
(3) During a declared influenza pandemic, influenza-associated deaths shall be reported if pandemic activity is occurring in the United States and the deceased has clinically compatible symptoms. Influenza pandemics may be declared by any of the following:
(A) The World Health Organization (WHO).
(B) The Centers for Disease Control and Prevention (CDC).
(C) The commissioner.
A laboratory test result is not necessary to report the death during an influenza pandemic.
(4) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition for influenza-associated pediatric deaths. The case definition for nonpediatric influenza-associated deaths is established by the department.
410 IAC 1-2.5-111 Latent tuberculosis infection; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 111. The specific control measures for latent tuberculosis infection (LTBI) (infectious agent: Mycobacterium tuberculosis) are as follows:
(Indiana State Department of Health;
(1) All newly diagnosed cases of LTBI shall be reported to the local health officer or the department within five (5) business days.
(2) The clinician providing medical oversight to diagnosed cases of LTBI with a multiple drug-resistant source case are required to consult with the local health officer or the department for treatment options and length of treatment.
(3) The local health officer shall perform an investigation on all newly diagnosed cases of LTBI requesting the following:
(A) Tuberculosis screening test results of either a tuberculosis skin test (TST) using a purified protein derivate (PPD) or an interferon gamma release assay (IGRA) of blood.
(B) Radiological studies.
(C) Other studies or laboratory tests needed to ascertain the absence of tuberculosis disease.
(D) Risk factors for progression to active tuberculosis disease.
(E) HIV status.
(F) Country of birth.
(G) Treatment regimen.
(H) Start of treatment date.
This information shall be reported to the department by the health officer in a timely manner.
(4) When using the twelve (12) week isoniazid-rifapentine regimen, the clinicians shall comply with the Centers for Disease Control and Prevention guidelines, Recommendations for Use of an Isoniazid-Rifapentine Regimen with Direct Observation to Treat Latent Mycobacterium tuberculosis Infection. Morbidity and Mortality Weekly Review 2011; Volume 60, Pages 1650-1653.
(5) Upon disposition of the LTBI case, the clinicians shall report to the local health officer or department in a timely manner the following:
(A) The date treatment stopped.
(B) Reason treatment stopped or never started.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-112 Legionellosis; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 112. The specific control measures for legionellosis (infectious agent: Legionella species) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall be performed within seventy-two (72) hours in the event that:
(A) a single nosocomial case is identified; or
(B) two (2) or more cases that are not nosocomial cases are identified.
A definite nosocomial case is a laboratory confirmed case who has spent ten (10) days or more continuously and admitted to a health care facility. A possible nosocomial case is a laboratory case that occurs two (2) to nine (9) days after discharge from a health care facility. The investigation shall focus on environmental sources for the exposure in the health care facility for nosocomial cases or places of common exposure for those infections not associated with a health care facility. Environmental laboratory results shall be provided to the health department immediately once a single nosocomial case or two (2) or more non-nosocomial cases are detected. Active surveillance for additional cases shall be undertaken.
(2) Standard precautions for hospitalized patients is required.
(3) Equipment contaminated with blood or infectious body fluids, or both, shall be appropriately disinfected or sterilized prior to reuse.
(4) Quarantine is not required.
(5) Immunization is not available. Protection of contacts is not applicable.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-113 Leptospirosis; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 113. The specific control measures for leptospirosis (infectious agent: Leptospira species) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall be performed within seventy-two (72) hours:
(A) for case ascertainment; and
(B) to identify potential sources of the infection, such as contaminated water or occupational exposure, including handling of infected animals.
(2) Standard precautions are required.
(3) Concurrent disinfection is required for articles soiled with urine.
(4) Quarantine is not required.
(5) Immunization is not available. Protection of contacts is not applicable.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-114 Listeriosis; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 114. The specific control measures for listeriosis (infectious agent: Listeria monocytogenes) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall meet the following conditions:
(A) Be performed within seventy-two (72) hours.
(B) Include a twenty-one (21) day history of the following prior to onset:
(i) Food and drink consumption.
(ii) Exposure to soil.
(iii) Animal exposures.
The food history should include a history of consuming raw milk, soft cheese, raw vegetables, and ready-to-eat meats. Surveillance data should be analyzed for clusters and clusters for common source exposures.
(2) Standard precautions for hospitalized patients are recommended.
(3) Concurrent disinfection is not required.
(4) Quarantine is not required.
(5) Immunization is not available. Protection of contacts is not applicable.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-115 Lyme disease; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 115. The specific control measures for Lyme disease (infectious agent: Borrelia burgdorferi) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall be performed within seventy-two (72) hours to:
(A) determine the location of exposure to ticks; and
(B) identify tick-infested areas.
(2) Standard precautions for hospitalized patients are required.
(3) Concurrent disinfection is required. All ticks shall be removed from the patient.
(4) Quarantine is not required.
(5) Immunization is not available. Protection of contacts is not applicable.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-116 Lymphogranuloma venereum; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 116. The specific control measures for lymphogranuloma venereum (infectious agent: Chlamydia trachomatis) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall be performed within seventy-two (72) hours. Partner services shall be provided by a disease intervention specialist.
(2) Standard precautions for hospitalized patients are required. Cases shall refrain from sexual contact until lesions are healed.
(3) Careful disposal of articles:
(A) contaminated with discharges from lesions; or
(B) soiled by discharges;
is required.
(4) Quarantine is not required.
(5) Immunization is not available. Sexual contacts of patients with C. trachomatis infections should be evaluated and treated for C. trachomatis if the last sexual contact was within:
(A) thirty (30) days of a symptomatic index patient's onset of symptoms; or
(B) sixty (60) days of an asymptomatic index patient's diagnosis.
Cases should also be examined serologically for syphilis initially.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-117 Malaria; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 117. The specific control measures for malaria (infectious agents: Plasmodium species) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall be performed within seventy-two (72) hours to determine the history of previous infection or possible exposure. The travel history shall be evaluated to determine if the case is from foreign travel or local exposure. Exposure may occur:
(A) from exposure to infected mosquitoes;
(B) from transfusions with infected blood; or
(C) through needle sharing.
(2) Standard precautions for hospitalized patients are required. Both hospitalized and nonhospitalized patients shall remain in mosquito-proof areas from dusk to dawn.
(3) Concurrent disinfection is not required.
(4) Quarantine is not required.
(5) Immunization is not available. Protection of contacts is not applicable.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-118 Measles (rubeola); specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 118. The specific control measures for measles (rubeola) (infectious agent: measles virus) are as follows:
(Indiana State Department of Health;
(1) An investigation by a department field representative, in cooperation with the local health officer, shall be performed immediately, include case management, and consist of the following:
(A) Ascertainment of immunization history.
(B) Case ascertainment.
(C) Identification and listing of contacts. Contacts are defined as any individual who was in the same room while the case was present or for two (2) hours afterwards at any time during the infectious period. The infectious period is defined as four (4) days before rash onset until four (4) days after the appearance of the rash. All children and adults (including staff members) attending the same school, daycare, or preschool as the case are defined as contacts.
(D) For outbreak control in public or private schools, daycare facilities, preschools, or postsecondary facilities, on the same day that a report of a suspected case of measles is received, school personnel shall do the following:
(i) Conduct an inquiry into absenteeism to determine the existence of any other cases of the illness.
(ii) Immediately report the suspect case or cases to the local health department or the department.
(iii) Send a notice home with each student, attendee, or employee born in or after 1957 who has not presented proof of immunity explaining that the student, attendee, or employee shall be excluded from the date of the letter, until acceptable proof of immunity is received by the school, daycare facility, preschool, or postsecondary facility, or in the case of medical or religious exemptions, until twenty-one (21) days after the onset of the last reported measles case. Persons receiving second doses of measles-containing vaccine, as well as previously unvaccinated persons receiving their first dose as part of the outbreak control program, may be immediately readmitted to school provided all persons without documentation of immunity have been excluded and that vaccination occurred within seventy-two (72) hours of exposure. Acceptable proof of immunity shall consist of a:
(AA) written record from the student's or employee's physician, parent, or guardian that indicates the dates of vaccination (on or after the first birthday) and the type of vaccine administered;
(BB) laboratory report showing confirmation of previous measles infection; or
(CC) laboratory report showing a protective measles antibody titer.
(iv) Make available to officials of the local health department or the department, or both, involved in investigating and controlling the outbreak, immunization records of all students and employees born in or after 1957 in the school or attendees, students, and employees born in or after 1957 in the daycare or preschool.
(E) For outbreak control in health care facilities, all health care workers and employees, regardless of age, without evidence of immunity who have been exposed to measles should be excluded from the facility from the fifth day to the twenty-first day after exposure, even if postexposure vaccination or immune globulin (IG) was administered.
(2) In addition to standard precautions, airborne precautions shall be followed for hospitalized patients through the fourth day of the rash to reduce the exposure of other persons at high risk. Other infected persons shall be excluded from:
(A) school and daycare facilities or preschools;
(B) public gatherings; and
(C) contact with susceptible persons outside the household;
for at least four (4) days after appearance of the rash.
(3) Concurrent disinfection is not required.
(4) Quarantine may be required. Children in institutions, wards, or dormitories for children may be quarantined. If measles occurs in an institution where infants reside, these infants shall be segregated from infected persons and susceptible contacts. Susceptible individuals exposed to measles should avoid contact with other susceptible persons outside the household.
(5) Protection/immunization of contacts shall be as follows:
(A) Live measles vaccine given to inadequately vaccinated persons within seventy-two (72) hours of exposure may provide protection against disease.
(B) IG may be given within six (6) days to the susceptible household or other contacts, especially those for whom:
(i) risk of complications is very high, such as contacts less than twelve (12) months of age; or
(ii) the measles vaccine is contraindicated.
(C) Live measles vaccine should be given five (5) months later to IG recipients for whom vaccine is not contraindicated.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-119 Meningococcal invasive disease; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 119. The specific control measures for meningococcal invasive disease (infectious agent: Neisseria meningitidis) are as follows:
(Indiana State Department of Health;
(1) An investigation shall be performed immediately upon suspicion of a case by the local health officer or designee for the purpose of identifying and treating close contacts as follows:
(A) Close contacts are defined as the following:
(i) Daycare or preschool contact at any time during seven (7) days before onset of symptoms.
(ii) Individuals who have shared residence with the patient.
(iii) Direct exposure to patient's saliva during seven (7) days prior to onset of symptoms.
(iv) Passengers seated directly next to the patient during airline flights lasting more than eight (8) hours.
(B) Treatment of close contacts should be as follows:
| Medication | Dosage |
| Rifampin | |
| Less than 1 month of age | 5 mg/kg every 12 hours for 2 days |
| 1 month of age and over | 10 mg/kg (maximum 600 mg) every 12 hours for 2 days |
| Ceftriaxone | |
| Less than 15 years of age | 125 mg IM single dose |
| 15 years of age and over | 250 mg IM single dose |
| Ciprofloxacin | |
| 18 years of age and over | 500 mg oral single dose |
Prophylaxis ideally should be initiated within twenty-four (24) hours after the index patient is identified; prophylaxis given more than two (2) weeks after exposure has little value. For individuals who cannot safely receive any of the medications listed above, a single dose of azithromycin, 10 mg/kg up to 500 mg may be given to prevent disease. Rifampin and ciprofloxacin should not be administered during pregnancy.
(2) Droplet precautions are required for hospitalized patients until twenty-four (24) hours of effective antimicrobial therapy has been completed.
(3) Concurrent disinfection is required for the following:
(A) Discharges from the nose and throat.
(B) All articles soiled by discharges from the nose and throat.
Terminal cleaning is required.
(4) Quarantine is not required.
(5) Outbreak control measures are as follows:
(A) An outbreak of meningococcal disease is defined as the occurrence of three (3) or more cases of meningococcal disease with the same serogroup in less than three (3) months among persons with a common affiliation or residing in the same area but do not have close contact with each other, resulting in attack rate of greater than ten (10) cases/one hundred thousand (100,000) population. In certain populations, the attack rate threshold may be reached with as few as two (2) cases. Mass vaccination should be considered when the attack threshold is reached, particularly in populations at high risk for disease.
(B) Mass prophylaxis or closure of public and private facilities is not recommended.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-120 Mumps; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 120. The specific control measures for mumps (infectious agent: mumps virus) are as follows:
(Indiana State Department of Health;
(1) An investigation by a department field representative in cooperation with the local health officer shall meet the following conditions:
(A) Be performed within twenty-four (24) hours.
(B) Include:
(i) obtaining clinical specimens in suspect cases; and
(ii) identifying susceptible contacts who should be immunized. Contacts are defined as any individual who had unprotected face-to-face (less than three (3) feet) contact with the suspect case for at least five (5) minutes during the infectious period. The infectious period is defined as two (2) days before swelling onset until five (5) days after swelling onset.
(C) Acceptable proof of immunity shall consist of a:
(i) written record from the student's or employee's physician, parent, or guardian that indicates the dates of vaccination (on or after the first birthday) and the type of vaccine administered;
(ii) laboratory report showing confirmation of previous mumps infection; or
(iii) laboratory report showing a protective mumps antibody titer.
(D) For outbreak control, exclude exposed contacts born in or after 1957 without proof of immunity from school or the workplace from the ninth day to the twenty-fifth day after exposure. Excluded workers and students can immediately return to work or school after they are vaccinated.
(E) For outbreak control in health care facilities, all health care workers and employees, regardless of age, without evidence of immunity who have been exposed to mumps should be excluded from the facility from the ninth day to the twenty-fifth day after exposure, even if postexposure vaccination was administered.
(2) For hospitalized patients, droplet precautions are indicated for five (5) days from the onset of swelling.
(3) Concurrent disinfection shall be followed to disinfect articles contaminated with nose and throat secretions.
(4) Infected persons shall be excluded from:
(A) schools, preschools, daycare facilities, and postsecondary facilities;
(B) public gatherings; and
(C) contact with susceptible persons outside the household;
for five (5) days after the onset of swelling.
(5) Vaccination of susceptible persons after exposure to mumps may not prevent disease; however, vaccination may be given to protect against subsequent exposures.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-121 Novel influenza A; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 121. The specific control measures for novel influenza A (infectious agent: novel influenza A virus) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall be performed within twenty-four (24) hours.
(2) Standard precautions are required for hospitalized patients. Respiratory protection that is at least as protective as a fit-tested N95 respirator for health care personnel who are in close contact with patients with suspect or confirmed novel influenza A is recommended. This recommendation may change after there has been adequate time to assess the recommendation, and the Centers for Disease Control and Prevention will continue to revisit its guidance as new information and sufficient supplies become available.
(3) Concurrent disinfection is required.
(4) Quarantine is not required.
(5) Immunization is not available. Protection of contacts is not applicable.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-122 Pertussis; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 122. The specific control measures for pertussis (infectious agent: Bordetella pertussis) are as follows:
(Indiana State Department of Health;
(1) An investigation by a department field representative, in cooperation with the local health officer, shall be performed within twenty-four (24) hours for the purpose of case ascertainment and identification of close contacts. Close contacts are defined as household and daycare or preschool contacts and persons who have had direct contact with respiratory secretions of the case, including, but not limited to, the following:
(A) Explosive cough or sneeze in the face.
(B) Sharing food or utensils.
(C) Kissing.
(D) Mouth to mouth resuscitation.
(E) Performing a full medical exam, including examination of the nose and throat.
A search for unrecognized or unreported, early, and atypical cases is indicated where a nonimmune infant or child is, or might be, at risk.
(2) Droplet precautions shall be utilized for hospitalized patients for five (5) days after the start of effective treatment (see Table 1 of this section).
| Table 1 | ||||
| Agents for Treatment and Postexposure Prophylaxis of Pertussis | Alternate agent* | |||
| Age group | Azithromycin | Erythromycin | Clarithromycin | TMP-SMZ |
| <1 month | 10 mg/kg per day as a single dose for 5 days1 | 40 mg/kg per day in 4 divided doses for 14 days | Not recommended | Contraindicated at <2 months |
| 1-5 months | See above | See above | 15 mg/kg per day in 2 divided doses for 7 days | >2 months of age: TMP, 8 mg/kg per day; SMX, 40 mg/kg per day in 2 doses for 14 days |
| >6 months and children | 10 mg/kg as a single dose on day 1 (maximum 500 mg), then 5 mg/kg per day as a single dose on days 2-5 (maximum 250 mg) | See above (maximum 2 g/day) | See above (maximum 1 g/day) | See above |
| Adolescents and adults | 500 mg in a single dose on day 1, then 250 as a single dose on days 2-5 | 2 g per day in 4 divided doses for 14 days | 1 g per day in 2 divided doses for 7 days | TMP, 320 mg per day; SMX, 1,600 mg/day in 2 divided doses for 14 days |
| *TMP indicates trimethoprim; SMX, sulfamethoxazole. This drug can be an alternate in patients >2 months who are allergic to macrolides, who cannot tolerate macrolides, or who are infected with a rare macrolide resistant strain to Bordetella pertussis. | ||||
| 1 Preferred macrolide for this age because of risk of idiopathic hypertrophic pyloric stenosis associated with erythromycin. | ||||
Infected persons shall be excluded from:
(A) schools, preschools, daycare facilities, and postsecondary facilities;
(B) public gatherings; and
(C) contact with susceptible persons outside the household;
until they have received at least five (5) days of effective treatment (see Table 1 of this section). Infected persons shall not have contact with unimmunized infants. Infected persons not receiving the prophylaxis as established in this subdivision shall be excluded from schools, preschools, daycare facilities, postsecondary facilities, and public gatherings for twenty-one (21) days.
(3) Concurrent disinfection is not required.
(4) Quarantine is not applicable.
(5) Close contacts less than seven (7) years of age who have not received:
(A) four (4) diphtheria, tetanus, or pertussis (DTP or DTaP) doses; or
(B) a DTaP dose within three (3) years;
should be given a DTaP dose as soon after exposure as possible. Prophylaxis (see Table 1 of this section) for all household and other close contacts regardless of age and vaccination status should be given. Immunization after discovery of a case or an outbreak does not provide protection to newly immunized persons during that outbreak. Therefore, contacts must be protected immediately by other measures.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-123 Plague; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 123. The specific control measures for plague (infectious agent: Yersinia pestis) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall be performed immediately to identify all contacts. Contacts are defined as those individuals who have been in household or face-to-face contact with patients with pneumonic plague. Establish if the case had traveled to endemic areas in the past seven (7) days. Determine if patients:
(A) were exposed to rodents, cats, or dogs; or
(B) visited areas of rodent habitat during travel.
(2) Standard precautions are required for hospitalized patients with bubonic plague. Droplet precautions for hospitalized patients with pneumonic plague are required until seventy-two (72) hours after the start of effective therapy.
(3) Concurrent disinfection is required for the following:
(A) Sputum and purulent discharges.
(B) Articles soiled with sputum and purulent discharges.
(4) Those who have had face-to-face contact or are in a household with patients shall be:
(A) placed on prophylaxis; and
(B) observed for seven (7) days.
Those who refuse prophylaxis must be isolated for seven (7) days.
(5) Immunization is not available. Close contacts (including medical personnel) shall be evaluated for prophylaxis. Contacts of pneumonic plague shall be provided prophylaxis as recommended by the Centers for Disease Control and Prevention.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-124 Poliomyelitis; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 124. The specific control measures for poliomyelitis (infectious agent: poliovirus) are as follows:
(Indiana State Department of Health;
(1) An investigation by a department field representative, in cooperation with the local health officer, shall be performed immediately and include the following:
(A) Laboratory confirmation.
(B) The immunization status of the case.
(C) The time since the last vaccination.
(D) The type of vaccine given.
(E) A history of underlying immunosuppressive condition.
(F) A history of contact with high risk individuals, such as the following:
(i) Persons who object to vaccination.
(ii) Recent immigrants.
(iii) Travelers.
(iv) Persons who are a probable or confirmed case of polio.
A travel history of the case shall be determined. If wild poliovirus is implicated, an immunization program designed to contain the spread shall be initiated using trivalent polio vaccine. A thorough search shall be conducted for sick persons, especially children, to ensure early detection, facilitate control, and permit appropriate treatment of unrecognized and unreported cases.
(2) For hospitalized patients, both contact and standard precautions are required. Other infected persons shall be excluded from:
(A) schools;
(B) preschools;
(C) daycare facilities;
(D) public gatherings; and
(E) contact with susceptible persons outside the home;
for a period of not less than twenty-one (21) days after the onset of illness.
(3) Concurrent disinfection shall be followed for the following:
(A) Throat discharges.
(B) Feces.
(C) Articles soiled by throat discharges or feces.
Feces may be disposed of directly into sanitary sewage system. Terminal cleaning shall also be followed.
(4) Quarantine is not indicated.
(5) Familial and other close contacts may be vaccinated, but this measure, when implemented after recognition of the case, is of unknown value.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-125 Psittacosis; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 125. The specific control measures for psittacosis (infectious agent: Chlamydophila psittaci) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall meet the following conditions:
(A) Be performed within seventy-two (72) hours.
(B) Include:
(i) identifying the source of infection; and
(ii) implementation of control measures.
(C) Identify exposure to:
(i) psittacine birds (owned by individuals or pet shops);
(ii) occupational exposure to poultry flocks; or
(iii) processing plants;
for the previous four (4) weeks.
Identified locations for potential exposure shall be forwarded to the Indiana state board of animal health for investigation.
(2) Standard precautions are required. Coughing patients shall cough into tissue to prevent aerosolization of infectious agent.
(3) Concurrent disinfection is required for all discharges.
(4) Quarantine is not required.
(5) Immunization is not available. Protection of contacts is not applicable.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-126 Q fever; specific control measures
Authority: Affected: IC 16-41-2-1
Sec. 126. The specific control measures for Q fever (infectious agent: Coxiella burnetii) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall be performed immediately for case ascertainment and identification of an infection source. Investigation of the infection source shall be directed at:
(A) exposure to sheep, cattle, and goats;
(B) consumption of unpasteurized milk; and
(C) laboratories that handle the disease agents.
(2) Standard precautions for hospitalized patients shall be taken.
(3) Concurrent disinfection is required for sputum and blood and articles freshly soiled by these substances, using five-hundredths percent (0.05%) hypochlorite, five percent (5%) peroxide, or a 1:100 solution of triphenyl-based disinfectant. Use precautions at postmortem examination of suspected cases in humans and animals.
(4) Quarantine is not required.
(5) Immunization is not available. Protection of contacts is not applicable.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-127 Rabies, human and animal; specific control measures
Authority:
Sec. 127. The specific control measures for rabies (see also animal bites in section 80 of this rule) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer in collaboration with the state public health veterinarian shall:
(A) be performed immediately; and
(B) identify:
(i) the route of the exposure;
(ii) the animal responsible for the exposure; and
(iii) other individuals who may have been exposed to:
(AA) that animal; or
(BB) the salivary secretions of the patient.
Individuals who have been exposed to salivary secretions of the patient shall be evaluated for postexposure prophylaxis. Postexposure prophylaxis guidance is provided in section 80 of this rule.
(2) Standard precautions shall be followed for hospitalized patients. Health care workers shall prevent mucous membrane and open wound contact with patient's saliva.
(3) Concurrent disinfection is required. Saliva and articles contaminated with saliva shall be disinfected.
(4) Quarantine for animals may be required depending on circumstances (see section 80 of this rule).
(5) Contacts who have experienced saliva exposure to:
(A) open wounds; or
(B) mucous membranes;
should receive postexposure prophylaxis.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-128 Rocky Mountain spotted fever; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 128. The specific control measures for Rocky Mountain spotted fever (infectious agent: Rickettsia rickettsii) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall be performed within seventy-two (72) hours to determine the location of exposure to infected ticks. Recent travel and exposure to tick-infested areas shall be identified.
(2) Standard precautions are required for hospitalized patients.
(3) Concurrent disinfection is required. All ticks shall be removed from the patient.
(4) Quarantine is not required.
(5) Immunization is not available. Protection of contacts is not applicable.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-129 Rubella (German measles); specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 129. The specific control measures for rubella (German measles) (infectious agent: rubella virus) are as follows:
(Indiana State Department of Health;
(1) An investigation by a department field representative in cooperation with the local health officer shall be performed immediately and include case management, case ascertainment, previous immunization history, and identification of exposed pregnant female and other susceptible contacts. For outbreak control in public or private schools, daycare facilities, preschools, or postsecondary facilities, on the same day that a report of a suspected case of rubella is received, school personnel shall do the following:
(A) Conduct an inquiry into absenteeism to determine the existence of any other cases of the illness.
(B) Immediately report the suspect case or cases to the local health department or the department.
(C) Send a notice home with each student, attendee, or employee born in or after 1957 who has not presented proof of immunity, explaining that the student or employee shall be excluded from a given day until acceptable proof of immunity is received by the school or, in the case of medical or religious exemptions, until twenty-three (23) days after the onset of the last reported rubella case. Acceptable proof shall consist of one (1) or more of the following:
(i) A written record from the student's physician or parent or guardian that indicates the:
(AA) date of vaccination (on or after the first birthday); and
(BB) type of vaccine administered.
(ii) A laboratory report showing a protective rubella antibody titer.
(iii) A laboratory report showing confirmation of previous rubella infection.
(D) Make available to officials of the local health department or the department, or both, involved in investigating and controlling the outbreak, immunization records of all students and employees born in or after 1957 in the school or postsecondary facility or attendees and employees born in or after 1957 in daycare or preschool.
(2) Droplet precautions shall be followed for seven (7) days after the onset of a rash. Contact precautions shall be followed for suspected or known congenital rubella until one (1) year of age unless urine and nasopharyngeal cultures are negative for the virus after three (3) months. In hospitals and institutions, patients suspected of having rubella shall be managed in a private room. Infected persons shall be excluded from:
(A) schools, daycare facilities, preschools, and postsecondary facilities;
(B) places of work;
(C) public gatherings; and
(D) contact with susceptible persons outside the household;
for seven (7) days after the onset of a rash.
(3) Concurrent disinfection is not applicable.
(4) Quarantine is not applicable.
(5) Immunization, while not contraindicated (except during pregnancy), will not necessarily prevent infection or illness. Passive immunization with immune globulin may be given to a susceptible pregnant woman exposed to the disease but should only be administered after thorough consultation with her attending physician, and any such measure should be provided by her attending physician. Pregnant female contacts, especially those in the first trimester, should be referred immediately to their attending physician for:
(A) serological testing to determine susceptibility or early infection (IgM) antibody; and
(B) thorough medical consultation.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-130 Salmonellosis, nontyphoidal; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 130. The specific control measures for salmonellosis, nontyphoidal (infectious agent: Salmonella species) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall meet the following conditions:
(A) Be performed within seventy-two (72) hours.
(B) Include a three (3) day food and drink consumption history prior to symptom onset with emphasis on exposure to inadequately cooked poultry and poultry products, uncooked or lightly cooked eggs or egg products, and unpasteurized milk products.
(C) Determine if meal companions are additional cases.
(D) If a commercial food product or restaurant is suspected, active surveillance shall be conducted to identify additional cases.
(E) Determine if the case is part of an outbreak.
(F) Determine if the case is a:
(i) food employee;
(ii) daycare worker;
(iii) health care worker; or
(iv) daycare attendee, a school attendee, or anyone who lives at a residential institution.
Medical evaluation, including adequate laboratory examination of feces of contacts, should be limited to food employees, daycare workers, health care workers, or other situations where outbreaks may occur.
(2) In addition to standard precautions, contact precautions should be used for diapered and incontinent children for the duration of illness. For others, the following guidelines apply:
(A) Cases who are food employees shall be excluded from employment involving food handling until asymptomatic from vomiting and diarrhea for at least twenty-four (24) hours, then restrict until all of the following have occurred:
(i) The case has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(ii) The local health officer has discussed the following topics with the employer:
(AA) The employer's duty to comply with local and state rules pertaining to prevention of infectious diseases.
(BB) The availability of proper hand washing facilities for all employees.
(CC) The correction of any observed lapses in hygienic measures by employees.
(iii) The person in charge obtains approval from the regulatory authority.
(iv) One (1) of the following has been met:
(AA) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours and the food employee is free of a nontyphoidal Salmonella infection based on test results that show two (2) consecutive negative stool cultures have been collected:
(aa) at least twenty-four (24) hours apart; and
(bb) at least forty-eight (48) hours after cessation of antimicrobial treatment.
(BB) The local health officer has determined more than thirty (30) days have passed since the food employee became asymptomatic.
(CC) The local health officer has determined the case did not develop symptoms, and more than thirty (30) days have passed since the food employee was diagnosed.
(B) Cases employed as daycare workers, health care workers, or in similar positions shall be excluded from employment involving direct care of children or hospitalized or institutionalized patients until all of the following have occurred:
(i) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours.
(ii) The case has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iii) The local health officer has discussed the following topics with the employer:
(AA) The employer's duty to comply with local and state rules pertaining to prevention of infectious diseases.
(BB) The availability of required proper hand washing facilities for employees.
(CC) The correction of any observed lapses in hygienic measures by employees.
(C) Cases shall be excluded from attending schools, preschools, and daycare facilities until all of the following have occurred:
(i) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours.
(ii) The case or case's guardian has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iii) The local health officer has discussed with the appropriate school, preschool, or daycare facility staff the need:
(AA) for proper hand washing procedures and other infection control practices; and
(BB) to comply with all local and state rules pertaining to prevention of infectious diseases.
(D) If an outbreak of the infection occurs in a daycare facility or preschool, the following shall occur:
(i) All attendees and staff may be required to submit stool specimens for examination.
(ii) Instead of exclusion, attendees and staff may be isolated from other attendees and staff in the same facility based on symptoms, laboratory testing, and treatment. This alternative shall only be considered if the physical structure and staff organization of the facility can accommodate isolation of various attendee groups from one another. If this alternative is selected, increased emphasis on hand washing procedures and environmental cleaning is necessary.
(iii) Admission of all new attendees may be suspended while the outbreak continues.
(3) Concurrent disinfection of feces and soiled articles is required. Feces may be discarded in a sanitary sewer without prior disinfection. Terminal cleaning is required.
(4) Reporting of disease is required to follow the "When to Report (from probable diagnosis)" time frame and salmonellosis antimicrobial susceptibility testing results are to be reported as soon as they become available.
(5) Quarantine is not required.
(6) Immunization is not available. Protection of contacts is not applicable.
(7) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-131 Shigellosis; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 131. The specific control measures for shigellosis (infectious agent: Shigella species) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall meet the following conditions:
(A) Be performed immediately.
(B) Include a five (5) day food and drink consumption history.
(C) Determine if the case is part of an outbreak.
(D) Determine if the case is a:
(i) food employee;
(ii) daycare worker;
(iii) health care worker; or
(iv) daycare attendee, a school attendee, or anyone who lives at a residential institution.
(E) Determine if the case is a contact of a food employee serving a highly susceptible population.
(F) Identify household members and close contacts who are food employees, health care workers, or daycare workers. Any such identified contact shall have one (1) stool culture, whether asymptomatic or not, to identify other infected individuals.
(2) In addition to standard precautions, contact precautions are indicated for the duration of illness. For others, the following guidelines apply:
(A) Cases who are food employees shall abide by the following:
(i) If the case works in a food establishment serving a highly susceptible population, exclude from employment involving food handling until asymptomatic and all of the following have occurred:
(AA) The case has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(BB) The local health officer has discussed the following topics with the employer:
(aa) The employer's duty to comply with local and state rules pertaining to prevention of infectious diseases.
(bb) The availability of required proper hand washing facilities for employees.
(cc) The correction of any observed lapses in hygienic measures by employees.
(CC) The person in charge obtains approval from the regulatory authority.
(DD) One (1) of the following has been met:
(aa) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours, and the food employee is free of a Shigella species infection based on test results that show two (2) consecutive negative stool cultures have been collected at least forty-eight (48) hours after cessation of antimicrobial treatment.
(bb) The local health officer has determined that the symptoms of vomiting and diarrhea have resolved and more than seven (7) calendar days have passed since the food employee became asymptomatic.
(cc) The local health officer has determined the case did not develop symptoms and more than seven (7) days have passed since the food employee was diagnosed.
(ii) If the case works in a food establishment not serving a highly susceptible population, exclude from employment involving food handling until asymptomatic from vomiting and diarrhea for at least twenty-four (24) hours, then restrict until all of the following have occurred:
(AA) The case has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(BB) The local health officer has discussed the following topics with the employer:
(aa) The employer's duty to comply with local and state rules pertaining to prevention of infectious diseases.
(bb) The availability of required proper hand washing facilities for employees.
(cc) The correction of any observed lapses in hygienic measures by employees.
(CC) The person in charge obtains approval from the regulatory authority.
(DD) One (1) of the following has been met:
(aa) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours and the food employee is free of a Shigella species infection based on test results that show two (2) consecutive negative stool cultures have been collected at least forty-eight (48) hours after cessation of antimicrobial treatment.
(bb) The local health officer has determined that the symptoms of vomiting and diarrhea have resolved and more than seven (7) days have passed since the food employee became asymptomatic.
(cc) The local health officer has determined the case did not develop symptoms and more than seven (7) days have passed since the food employee was diagnosed.
(B) Cases employed as daycare workers, health care workers, or in similar positions shall be excluded from employment involving direct care of children, hospitalized patients, or institutionalized patients until all of the following have occurred:
(i) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours, or one (1) negative stool specimen has been collected at least forty-eight (48) hours after completion of any antimicrobial therapy.
(ii) The case has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iii) The local health officer has discussed the following topics with the employer:
(AA) The employer's duty to comply with local and state rules pertaining to prevention of infectious diseases.
(BB) The availability of required proper hand washing facilities for employees.
(CC) The correction of any observed lapses in hygienic measures by employees.
(C) Cases shall be excluded from attending preschools and daycare facilities until all of the following have occurred:
(i) The local health officer has determined the case has been asymptomatic for at least forty-eight (48) hours or treatment or testing has determined the case to be no longer infectious by either:
(AA) completion of effective antimicrobial therapy supported by antimicrobial susceptibility testing; or
(BB) one (1) negative stool culture has been collected at least forty-eight (48) hours after cessation of antimicrobial therapy, if case was treated with antimicrobials.
(ii) The case or case's guardian has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iii) The local health officer has discussed with the appropriate preschool or daycare facility staff the need:
(AA) for proper hand washing procedures and other infection control practices; and
(BB) to comply with all local and state rules pertaining to prevention of infectious diseases.
(D) Cases shall be excluded from attending school until all of the following have occurred:
(i) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours or treatment or testing has determined the case to be no longer infectious by either:
(AA) initiation of effective antimicrobial therapy for at least forty-eight (48) hours supported by antimicrobial susceptibility testing; or
(BB) one (1) negative stool culture has been collected at least forty-eight (48) hours after cessation of antimicrobial therapy, if case was treated with antimicrobials.
(ii) The case or case's guardian has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iii) The local health officer has discussed with the appropriate school staff the need:
(AA) for proper hand washing procedures and other infection control practices; and
(BB) to comply with all local and state rules pertaining to prevention of infectious diseases.
(E) If an outbreak occurs in a school, cases may be excluded until the following has occurred:
(i) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours.
(ii) Treatment or testing has determined the case to be no longer infectious by either:
(AA) initiation of effective antimicrobial therapy for at least forty-eight (48) hours supported by antimicrobial susceptibility testing; or
(BB) one (1) negative stool culture has been collected:
(aa) at least twenty-four (24) hours apart; and
(bb) at least forty-eight (48) hours after cessation of antimicrobial therapy, if case was treated with antimicrobials.
(F) If an outbreak occurs in a daycare facility or preschool, the following shall occur:
(i) All attendees and staff may be required to submit stool specimens for examination.
(ii) Instead of exclusion until stool negative, attendees and staff may be isolated from other attendees and staff in the same facility based on symptoms, laboratory testing, and treatment. This alternative shall only be considered if the physical structure and staff organization of the facility can accommodate isolation of various attendee groups from one another. If this alternative is selected, increased emphasis on hand washing procedures and environmental cleaning is necessary.
(iii) Admission of all new attendees may be suspended while the outbreak continues.
(G) A case contact who is a food employee in a food establishment serving a highly susceptible population must abide by the following criteria:
(i) Restrict the contact if the contact meets one (1) of the following criteria:
(AA) Attended or worked in a setting of a confirmed disease outbreak of shigellosis within the past three (3) days of last exposure.
(BB) Lives in the same household as, and has knowledge about, an individual who works in or attends a setting where there is a confirmed disease outbreak of shigellosis within the past three (3) days of last exposure.
(CC) Lives in the same household as, and has knowledge about, an individual diagnosed with an illness caused by shigellosis within the past three (3) days of last exposure.
(DD) Consumed food prepared by a person infected with shigellosis within the past three (3) days of last exposure.
(EE) Consumed or prepared food implicated in a confirmed disease outbreak of shigellosis within the past three (3) days of last exposure.
(ii) Reinstate the food employee who was restricted when one (1) of the following has occurred:
(AA) More than three (3) calendar days have passed since the last day the food employee was potentially exposed.
(BB) More than three (3) calendar days have passed since the food employee's household contact became asymptomatic.
(3) Concurrent disinfection of feces and soiled articles is required. Feces may be discarded in a sanitary sewer without prior disinfection.
(4) Reporting of disease is required to follow the "When to Report (from probable diagnosis)" time frame and Shigella species antimicrobial susceptibility testing results are to be reported as soon as they become available.
(5) Quarantine is not required.
(6) Immunization is not available. Protection of contacts is not applicable.
(7) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-132 Smallpox; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 132. The control measures for smallpox (infectious agent: Variola virus) are as follows:
(Indiana State Department of Health;
(1) An investigation by the department in conjunction with the local health officer shall be performed immediately to determine the possible sources of infection and the extent of the outbreak and include the following:
(A) A history of past and recent smallpox vaccinations.
(B) A history of varicella and shingles vaccinations.
(C) A history of varicella or herpes zoster.
(D) A medical history.
(E) A collection of appropriate laboratory specimens.
(F) A recent travel history.
A complete list of contacts shall be generated and traced. Contacts are defined as all individuals in the household, all individuals with a history of habitual close contact, and all individuals directly exposed to the patient.
(2) For hospitalized patients, the following precautions are required:
(A) Standard.
(B) Airborne.
(C) Contact.
The patient shall be placed in a private, negative airflow room for airborne infection isolation.
(3) Concurrent disinfection is required. Laundry and waste shall be discarded into biohazard bags and sterilized, and bedding and clothing shall be incinerated or laundered in hot water with laundry detergent followed by hot air drying.
(4) Quarantine is required.
(5) Postexposure immunization provides some protection against disease and significant protection against fatal outcome. Any person with a significant exposure to a patient with proven smallpox during the infectious stage of illness (from onset of symptoms (fever, head and body aches) until scabs have fallen off) requires immunization as soon after exposure as possible but within four (4) days of first exposure.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-133 Staphylococcus aureus, vancomycin resistant level > 8 μg/mL, or severe Staphylococcus aureus in a previously healthy person; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 133. The specific control measures for Staphylococcus aureus, vancomycin resistant level > 8 μg/mL, or severe Staphylococcus aureus in a previously healthy person are as follows:
(Indiana State Department of Health;
(1) An investigation by the department in collaboration with the local health officer shall be performed within seventy-two (72) hours to:
(A) verify resistant or intermediate resistant culture isolate to vancomycin; and
(B) provide antibiotic susceptibility results for severe Staphylococcus aureus infection in a previously healthy person that results in death or admission to an intensive care unit.
For purposes of this section, "previously healthy person" means a person who has not been hospitalized or had surgery, dialysis, or residency in a long term care facility in the past year and did not have an indwelling catheter or percutaneous medical device at the time of culture. The investigation includes laboratory verification of resistance. Abrupt increases in the prevalence of the disease in the community shall be investigated for a common source.
(2) For hospitalized patients, contact precautions are required.
(3) Concurrent disinfection is required for all:
(A) discharges from the skin, wound, or burn; and
(B) articles contaminated with discharges.
Fecal material may be disposed of in a sanitary sewer.
(4) Quarantine is not applicable.
(5) Immunization is not available. Protection of contacts is not applicable.
(6) Case definition is established by the department.
410 IAC 1-2.5-134 Streptococcus pneumoniae, invasive disease; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 134. The specific control measures for Streptococcus pneumoniae, invasive disease, are as follows:
(Indiana State Department of Health;
(1) An investigation of cases and the source of infection shall be as follows:
(A) An investigation by a department field representative, in collaboration with the local health officer, shall:
(i) be performed within seventy-two (72) hours for cases less than five (5) years of age; and
(ii) include:
(AA) a complete pneumococcal vaccine immunization history;
(BB) drug resistance pattern of isolate; and
(CC) a history of chronic underlying medical conditions, asplenia, or immunosuppression.
(B) An investigation by a local health officer shall:
(i) be performed within seventy-two (72) hours for all other cases; and
(ii) include:
(AA) a complete pneumococcal vaccine immunization history;
(BB) drug resistance pattern of isolate; and
(CC) a history of chronic underlying medical conditions, asplenia, or immunosuppression.
(2) For hospitalized patients, standard precautions are required.
(3) Disinfect:
(A) purulent discharges; and
(B) articles soiled by purulent discharges.
(4) Quarantine is not applicable.
(5) Immunization of contacts is not required. Protection of contacts is not applicable.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-135 Streptococcal invasive disease, group A and streptococcal toxic shock syndrome; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 135. The specific control measures for streptococcal invasive disease (see section 46 of this rule for definition of invasive disease) and toxic shock syndrome (infectious agent: Streptococcus pyogenes) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall be performed within seventy-two (72) hours to ascertain that the case meets the case definition for group A streptococcal invasive disease or streptococcal toxic shock syndrome as follows:
(A) The Centers for Disease Control and Prevention (CDC) case definition for an invasive group A streptococcal (GAS) states that the GAS must be isolated from a normally sterile site, such as blood, cerebrospinal fluid (CSF), pleural fluid, peritoneal fluid, surgical aspirate, bone, joint fluid, or internal body site (e.g., lymph node, brain, muscle, if surgically removed). An exception to the sterile site case definition would be a GAS isolated from a wound culture and accompanied by necrotizing fasciitis or streptococcal toxic shock syndrome (STSS).
(B) The CDC case definition for STSS is the isolation of GAS along with the following clinical manifestations:
(i) Hypotension defined by a systolic blood pressure less than or equal to ninety (90) mm Hg for adults or less than the fifth percentile by age for children less than sixteen (16) years of age.
(ii) Multi-organ involvement characterized by two (2) or more of the following:
(AA) Renal impairment.
(BB) Coagulopathy.
(CC) Liver involvement.
(DD) Acute respiratory distress.
(EE) Rash.
(FF) Soft-tissue necrosis.
Identify if the case had a recent case of varicella or underlying chronic disease. Be alert for outbreaks defined as two (2) or more cases occurring close together in place and time.
(2) For hospitalized children with pharyngitis, pneumonia, or scarlet fever, droplet precautions shall be followed until at least twenty-four (24) hours of antimicrobial therapy have been administered. For patients with skin, wound, or burn infections, contact precautions shall be followed for at least twenty-four (24) hours after antimicrobial therapy has been administered.
(3) Discharges and articles soiled with discharges shall be disinfected.
(4) Quarantine is not applicable.
(5) Immunization is not available. Protection of contacts is not applicable, except in an outbreak setting. During an outbreak, special close contact groups, for example:
(A) the military;
(B) daycare facilities;
(C) schools; and
(D) nursing homes;
may need antibiotic therapy to prevent further spread of disease.
(6) Case definition is established by the department.
410 IAC 1-2.5-136 Syphilis; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 136. The specific control measures for syphilis (infectious agent: Treponema pallidum) are as follows:
(Indiana State Department of Health;
(1) An investigation by a disease intervention specialist, in cooperation with the local health officer, shall be performed within seventy-two (72) hours. The investigation shall be focused on identifying sexual partners who were at risk for transmitting to, or contracting the infection from, the case. Cases and contacts shall be fully evaluated (including pregnancy status of females) and treated as recommended in the Sexually Transmitted Diseases Treatment Guidelines, 2010, Morbidity and Mortality Weekly Report, December 17, 2010, Volume 59, No. RR-12.
(2) For hospitalized patients, standard precautions are required. For others, the infected persons shall refrain from sexual activities involving exchange of body fluids until:
(A) their lesions clear; and
(B) they have been on appropriate antibiotic therapy for at least twenty-four (24) hours.
Treated persons shall also avoid sexual activities involving exchange of body fluids with untreated partners to avoid reinfection.
(3) Disinfection is not required in adequately treated cases, but care shall be taken to avoid contact with:
(A) discharges from open lesions; and
(B) articles soiled by discharges.
(4) Quarantine is not required.
(5) Immunization is not available.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-137 Taeniasis; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 137. The specific control measures for taeniasis (infectious agent: Taenia solium) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall be performed within seventy-two (72) hours. Collect food consumption history, concentrating on meats, specifically undercooked pork, for eight (8) to forty-five (45) days prior to the onset of symptoms. A travel history may provide leads to unusual foods or source of foods with increased risk. Identify and interview family members and others that the case normally shares meals with to identify additional cases of taeniasis and possibly cysticercosis.
(2) Standard precautions are required.
(3) Concurrent disinfection is not required.
(4) Quarantine is not required.
(5) Immunization is not available. Protection of contacts is not applicable.
(6) Case definition is established by the department.
410 IAC 1-2.5-138 Tetanus; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 138. The specific control measures for tetanus (infectious agent: Clostridium tetani) are as follows:
(Indiana State Department of Health;
(1) An investigation by a department field representative, in cooperation with the local health officer, shall:
(A) be performed within seventy-two (72) hours; and
(B) include:
(i) a complete tetanus toxoid immunization history;
(ii) the wound location and circumstance of injury or possible source of infection;
(iii) treatment information; and
(iv) the outcome of the case.
(2) For hospitalized patients, standard precautions are required.
(3) Concurrent disinfection is not applicable.
(4) Quarantine is not required.
(5) Immunization of contacts is not required. Protection of contacts is not applicable. Persons recovering from tetanus should begin or complete immunization with tetanus toxoid (Td) during convalescence.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-139 Toxic shock syndrome; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 139. The specific control measures for toxic shock syndrome (staphylococcal) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall be performed within seventy-two (72) hours for the following:
(A) Case ascertainment.
(B) Clinical findings.
(C) Culture results.
(D) Suspected source of infection.
(2) Standard precautions shall be followed.
(3) Sanitary disposal of blood and articles soiled with body discharges.
(4) Quarantine is not required.
(5) Immunization is not available. Protection of contacts is not applicable.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-140 Trichinosis; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 140. The specific control measures for trichinosis (infectious agent: Trichinella spiralis) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall be performed within seventy-two (72) hours. Collect food consumption history, concentrating on meats, for eight (8) to forty-five (45) days prior to the onset of symptoms. A travel history may provide leads to unusual foods or source of foods with increased risk. Identify and interview family members and others that the case normally shares meals with to identify additional cases.
(2) Standard precautions are required.
(3) Concurrent disinfection is not required.
(4) Quarantine is not required.
(5) Immunization is not available. Protection of contacts is not applicable.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-141 Tuberculosis; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 141. The specific control measures for tuberculosis disease (called tuberculosis or TB) (infectious agent: Mycobacterium tuberculosis) are as follows:
(Indiana State Department of Health;
(1) All suspect and confirmed cases of pulmonary, extrapulmonary, and miliary tuberculosis must be reported to the local health officer or the department. All suspect and confirmed cases of multiple drug-resistant tuberculosis require consultation with the department for appropriate and adequate treatment.
(2) An investigation by the local health officer shall be performed immediately and shall include case management. The local health officer shall request laboratory, radiological, and other studies as required for case ascertainment and to determine if the suspect case should be isolated as described in subdivision (3). For confirmed and suspected cases of pulmonary, laryngeal, or pleural tuberculosis, a contact investigation shall be performed, identifying both high and medium priority contacts. Prioritization of contacts is to be assigned in accordance with Guidelines for the Investigation of Contacts of Persons with Infectious Tuberculosis. Recommendations from the National Tuberculosis Controllers Association and CDC. MMWR; December 16, 2005; Vol. 54; No. RR-15. Priority is based on the likelihood of infection and the potential hazards to the individual contact infected as follows:
(A) Prioritization of contacts exposed to persons with acid-fast bacilli (AFB) sputum positive or cavitary tuberculosis cases is as follows:
(i) High-priority contacts include the following:
(AA) Household contacts.
(BB) Children less than five (5) years of age.
(CC) Persons with medical risk factors, including HIV.
(DD) Persons exposed during medical procedures.
(EE) Persons exposed in a congregate setting.
(FF) Persons that exceed duration of environment limits as determined on a case-by-case basis by the department.
(ii) Medium-priority contacts include the following:
(AA) Children five (5) to fifteen (15) years of age.
(BB) Persons that exceed duration of environment limits as determined on a case-by-case basis by the department.
(B) Prioritization of contacts exposed to persons with AFB sputum negative pulmonary, pleural, or laryngeal tuberculosis cases with abnormal chest radiographs and cultures positive for Mycobacterium tuberculosis is as follows:
(i) High-priority contacts include the following:
(AA) Children less than five (5) years of age.
(BB) Persons with medical risk factors, including HIV.
(CC) Persons exposed during medical procedures.
(ii) Medium-priority contacts include the following:
(AA) Household contacts.
(BB) Persons exposed in a congregate setting.
(CC) Persons that exceed duration of environment limits as determined on a case-by-case basis by the department.
(3) Pulmonary, laryngeal, and pleural tuberculosis cases and suspect cases who:
(A) have three (3) consecutive AFB smear negative sputa obtained at least eight (8) hours apart with one (1) being an early morning specimen or two (2) consecutive final negative sputa culture for Mycobacterium tuberculosis;
(B) are clinically improving;
(C) are known to be medically evaluated;
(D) have completed two (2) weeks of an adequate antituberculosis therapy per Centers for Disease Control and Prevention guidelines; and
(E) are known to be adherent to their ongoing antituberculosis treatment regimen;
are defined as noninfectious for public health measures. All other pulmonary, laryngeal, and pleural tuberculosis cases and suspect cases must be isolated until they meet the criteria to be noninfectious. All confirmed cases of multiple drug-resistant tuberculosis (resistant to isoniazid and rifampin) must be isolated until two (2) final negative sputa cultures for Mycobacterium tuberculosis are obtained. In health care facilities, tuberculosis cases and suspect cases must be isolated in accordance with the Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005, as published by Centers for Disease Control and Prevention in Morbidity and Mortality Weekly Report, December 30, 2005, Volume 54, No. RR-17. Prior to discharge of any case or suspect case of tuberculosis, the health care facility shall notify the local health department in the jurisdiction where the tuberculosis suspect or case resides. Prior to discharge of a tuberculosis case or suspect case, the local health department shall make plans, in writing, for continuation of medical follow-up, ensuring adherence to therapy and isolation unless the case or suspect case meets the criteria in this subdivision and is deemed to be noninfectious. Plans shall be developed in cooperation with the treating physician and the patient and must be in accordance with this rule. For patients with confirmed or suspected infectious pulmonary
tuberculosis who do not need to be hospitalized, in-home isolation is an acceptable alternative. Contact with persons outside the home shall be prohibited unless the infectious person wears a surgical mask, properly tied. Children less than four (4) years of age and immunocompromised persons shall not be in the home while the case is considered infectious.
(4) Concurrent disinfection is required and shall include hand washing and good housekeeping practices combined with dilution of particles in the air by ventilation.
(5) Because of the potential for unrecognized exposure and known exposure of medical personnel to tuberculosis, health care facilities and laboratories shall develop and follow tuberculosis prevention and control programs for their facilities. At a minimum, facilities programs shall include an annual tuberculosis risk assessment, with risks identified as low, medium, or potential ongoing transmission, based on the criteria in the Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005, as published by Centers for Disease Control and Prevention in Morbidity and Mortality Weekly Report, December 30, 2005, Volume 54, No. RR-17.
(6) For every case of pulmonary, laryngeal, or pleural tuberculosis, the local health officer must initiate a contact investigation within one (1) business day of reporting for infectious cases (smear positive) and within three (3) business days of a smear negative Mycobacterium tuberculosis culture positive report. The first step in performing the contact investigation for pulmonary cases is to estimate the degree of infectiousness and determine the infectious period. Infectiousness is generally predicted by disease in a pulmonary or respiratory site, for example, endobronchial or laryngeal site, a lung cavity seen on a chest x-ray, AFB seen in a smear of concentrated sputum, and protracted cough. Under most circumstances, tuberculosis without a pulmonary, laryngeal, or pleural site is not infectious. The infectious period is defined as the period three (3) months prior to the start of medication, symptom onset (especially cough), or first positive finding consistent with tuberculosis (i.e., abnormal chest x-ray, positive AFB smear), whichever occurred first until any of the following endpoints is attained:
(A) Contact is broken with the infectious case.
(B) Effective isolation measures are instituted for that case.
(C) The case is determined to be noninfectious by the criteria in subdivision (3).
The case shall be interviewed in detail to identify all contacts who shared air space during the infectious period. Priorities for contact investigation are determined on the basis of the characteristics of the index patient, susceptibility and vulnerability of contacts, and circumstances of the exposures. High priority shall also be assigned to exposed children less than five (5) years of age and any exposed persons who have medical conditions, for example, HIV infection, TNF therapy, cancer treatment, and organ transplants, etc. making them vulnerable to tuberculosis.
(7) All high-priority and medium-priority contacts not known to have a previously positive Mantoux tuberculin skin test (TST), positive interferon gamma release assay (IGRA), or active tuberculosis disease shall be tested with the IGRA or by five (5) tuberculin units (TU) purified protein derivative (PPD) intradermally by the Mantoux method. The PPD shall be administered and read by an individual trained with a department approved curriculum in the administration and reading of tuberculin skin tests. The skin test should be read forty-eight (48) to seventy-two (72) hours later. Date and time given, location of placement of test, date and time read, and the amount of induration in millimeters shall be recorded. If any of the following conditions are met, then the contact investigation shall be progressively expanded to include contacts with lesser degrees of exposure:
(A) The prevalence of positive TST (induration > 5 mm) or positive IGRA is higher in contacts tested than the prevalence in similar populations residing in the jurisdiction.
(B) A new positive TST or positive IGRA is found in a child less than five (5) years of age.
(C) A documented skin test conversion is found among contacts.
(D) A secondary case of active tuberculosis disease is found among contacts.
When none of the criteria in this subdivision are met, further expansion of the contact investigation is not necessary.
(8) Contacts with positive TST or positive IGRA results, those with symptoms, those with immunosuppressive conditions, or children younger than five (5) years of age should have a chest x-ray and medical evaluation performed to determine if they have tuberculosis disease. Those with tuberculosis disease symptoms or abnormal chest x-rays consistent with active tuberculosis disease should submit sputa for AFB smear, culture, and sensitivity.
(9) Contacts with suspected or confirmed active tuberculosis disease shall be evaluated and managed according to this section.
(10) All contacts identified through contact investigation who have a positive TST (induration > 5 mm) or a positive IGRA, a normal chest x-ray, and no symptoms of tuberculosis disease should be reported to the local health department and offered latent tuberculosis infection treatment, regardless of age or risk, unless otherwise medically contraindicated. Contacts should also be considered for treatment of latent infection with tuberculosis in any of the following situations:
(A) Evaluation of other contacts with a similar degree of exposure demonstrates a high prevalence of infection.
(B) The contact is a child or immunosuppressed person.
(11) Infants who are exposed to a person with infectious active tuberculosis disease should be evaluated with a TST and a chest radiograph. If the skin test result is negative and the chest radiograph is normal, the infant should be skin tested again at three (3) to four (4) months of age and at six (6) months of age. The infant should receive preventive therapy (window prophylaxis) even if the TST is negative, unless medically contraindicated. Preventive therapy (window prophylaxis) may be discontinued if the infant is skin test negative at six (6) months of age, provided at least ten (10) weeks have passed since the infant was last exposed to infectious tuberculosis.
(12) The local health officer shall ensure that:
(A) high and medium risk contacts are appropriately evaluated for tuberculosis infection;
(B) infants and children less than five (5) years of age are started in preventive therapy (window prophylaxis); and
(C) a complete course of treatment for latent tuberculosis infection is recommended for contacts with evidence of tuberculosis infection, regardless of age, unless medically contraindicated.
The local health officer is responsible for recording and reporting to the department the results of the contact investigation per department guidelines.
(13) The local health department of the jurisdiction shall actively case manage every tuberculosis case and suspect where the case or suspect resides until they have completed an adequate course of tuberculosis chemotherapy as described in Treatment of Tuberculosis published by the Centers for Disease Control and Prevention (CDC) in Morbidity and Mortality Weekly Report, June 20, 2003, Volume 52, No. RR-11 or until the patient is determined not to have tuberculosis disease or infection. The duties of the local health department shall include the following:
(A) Requesting laboratory studies, such as AFB smear and cultures as needed for the following:
(i) Case ascertainment.
(ii) Determining whether isolation is necessary.
(iii) Genotyping of organisms.
(B) Requesting drug susceptibility testing of all initial Mycobacterium tuberculosis isolates.
(C) Ensuring appropriate antituberculosis medications are initiated at the appropriate dose in accordance with this subsection.
(D) Ensuring that the pulmonary tuberculosis patient is isolated until confirmed to be noninfectious according to the criteria in subdivision (3).
(E) Assessing that medication is taken as prescribed using directly observed therapy (DOT) or a department approved alternative such as video DOT, for all doses except occasional dosages which may be self administered due to inclement weather, holidays, etc., unless a waiver is obtained from the department.
(F) Documenting and reporting conversion of sputa from AFB smear positive to negative and tuberculosis culture identification from Mycobacterium tuberculosis isolated to not isolated.
(G) Contact investigation.
(H) Completion and submission of the contact investigation report for Mycobacterium tuberculosis culture positive cases to the department.
(14) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-142 Tularemia; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 142. The specific control measures for tularemia (infectious agent: Francisella tularensis) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall be performed immediately for the following:
(A) Case ascertainment.
(B) Identification of infection source.
(2) Standard precautions for hospitalized patients are required, including drainage and secretion precautions for open lesions.
(3) Concurrent disinfection is required for all discharges from the following:
(A) Ulcers.
(B) Lymph nodes.
(C) Conjunctival sacs.
(4) Quarantine is not required.
(5) Immunization is not available. Protection of contacts is not applicable.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-143 Typhoid and paratyphoid fever; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 143. The specific control measures for typhoid and paratyphoid fever (infectious agents: Salmonella serotype Typhi, Paratyphi A, Paratyphi B (tartrate negative), or Paratyphi C) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall meet the following conditions:
(A) Be performed immediately.
(B) Include a three (3) week history of the following prior to symptom onset:
(i) Food and drink consumption.
(ii) Domestic and international travel.
(C) Identify unreported cases or carriers.
(D) Identify any potentially contaminated:
(i) food;
(ii) water;
(iii) milk; and
(iv) shellfish.
(E) If the case traveled three (3) weeks prior to onset, all members of travel groups in which a case has occurred shall be interviewed for probable source of infection and additional cases.
(F) Determine if the case is part of an outbreak.
(G) Determine if the case is a:
(i) food employee;
(ii) daycare worker;
(iii) health care worker; or
(iv) daycare attendee, a school attendee, or anyone who lives at a residential institution.
(H) Determine if the case is a contact of a food employee serving a highly susceptible population.
(2) In addition to standard precautions, contact precautions should be used for diapered and incontinent children for the duration of illness until consecutive stool cultures are negative. For others, the following guidelines shall apply:
(A) Cases who are food employees shall be excluded from employment involving food handling if the case is diagnosed with an infection from Salmonella Typhi or Paratyphi A, B (tartrate negative), or C, or reports a previous infection with Salmonella Typhi or Paratyphi A, B (tartrate negative), or C, diagnosed by a health practitioner within the past three (3) months without having received antibiotic therapy, as determined by a health practitioner, exclude until all of the following have occurred:
(i) Three (3) consecutive negative stool and urine cultures have been collected:
(AA) at least twenty-four (24) hours apart;
(BB) at least forty-eight (48) hours after cessation of any antimicrobial treatment; and
(CC) at least one (1) month after onset.
(ii) The local health officer has determined the employee has been asymptomatic for at least twenty-four (24) hours.
(iii) The case has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iv) The local health officer has discussed the following topics with the employer:
(AA) The employer's duty to comply with local and state rules pertaining to prevention of infectious diseases.
(BB) The availability of required proper hand washing facilities for all employees.
(CC) The correction of any observed lapses in hygienic measures by employees.
(B) Cases employed as daycare workers, health care workers, or in similar positions shall be excluded from employment involving direct care of children or hospitalized or institutionalized patients until all of the following have occurred:
(i) Three (3) consecutive negative stool cultures have been collected:
(AA) at least twenty-four (24) hours apart;
(BB) at least forty-eight (48) hours after cessation of any antimicrobial treatment; and
(CC) at least one (1) month after onset.
(ii) The local health officer has determined the worker has been asymptomatic for at least twenty-four (24) hours.
(iii) The case has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iv) The local health officer has discussed the following topics with the employer:
(AA) The employer's duty to comply with local and state rules pertaining to prevention of infectious diseases.
(BB) The availability of required proper hand washing facilities for all employees.
(CC) The correction of any observed lapses in hygienic measures by employees.
(v) If the case is still infected after the initial three (3) stool cultures, the case may return to work provided that the case has been fully compliant with all instructions and screening requirements under this section.
(C) Household and other close contacts of the case shall be excluded from employment involving food handling and direct care of children or hospitalized or institutionalized patients until the following have been met:
(i) Two (2) consecutive negative stool cultures have been collected:
(AA) at least twenty-four (24) hours apart; and
(BB) at least forty-eight (48) hours after cessation of any antimicrobial treatment.
(ii) The local health officer has determined the contact is asymptomatic.
(D) Cases shall be excluded from attending schools, preschools, and daycare facilities until all of the following have occurred:
(i) Three (3) consecutive negative stool cultures have been collected:
(AA) at least twenty-four (24) hours apart;
(BB) at least forty-eight (48) hours after cessation of any antimicrobial treatment; and
(CC) at least one (1) month after onset.
(ii) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours.
(iii) The case or case's guardian has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iv) The local health officer has discussed with the appropriate school, preschool, or daycare facility staff the need:
(AA) for proper hand washing procedures and other infection control practices; and
(BB) to comply with all local and state rules pertaining to prevention of infectious diseases.
(E) If an outbreak of infection is associated with a restaurant or other food service operation, the following shall occur:
(i) All food employees shall be screened for infection.
(ii) Household members and close contacts of the case shall be excluded from employment involving food handling and direct care of children or hospitalized or institutional patients until the following have been met:
(AA) Two (2) consecutive negative stool cultures have been collected:
(aa) at least twenty-four (24) hours apart; and
(bb) at least forty-eight (48) hours after cessation of any antimicrobial treatment.
(BB) The local health officer has determined the contact is asymptomatic.
(F) If an outbreak occurs in a daycare facility or preschool, the following shall occur:
(i) All attendees and staff may be required to submit stool specimens for examination.
(ii) Instead of exclusion until stool negative, attendees and staff may be isolated from other attendees and staff in the same facility based on symptoms, laboratory testing, and treatment. This alternative shall only be considered if the physical structure and staff organization of the facility can accommodate isolation of various attendee groups from one another. If this alternative is selected, increased emphasis on hand washing procedures and environmental cleaning is necessary.
(iii) Admission of all new attendees may be suspended while the outbreak continues.
(G) A case contact who is a food employee in a food establishment serving a highly susceptible population must abide by the following criteria:
(i) Restrict the contact if the contact meets one (1) of the following criteria:
(AA) Attended or worked in a setting of a confirmed disease outbreak of Salmonella Typhi or Paratyphi A, B (tartrate negative), or C within the past fourteen (14) days of last exposure.
(BB) Lives in the same household as, and has knowledge about, an individual who works in or attends a setting where there is a confirmed disease outbreak of Salmonella Typhi or Paratyphi A, B (tartrate negative), or C within the past fourteen (14) days of last exposure.
(CC) Lives in the same household as, and has knowledge about, an individual diagnosed with an illness caused by Salmonella Typhi or Paratyphi A, B (tartrate negative), or C within the past fourteen (14) days of last exposure.
(DD) Consumed food prepared by a person infected with Salmonella Typhi or Paratyphi A, B (tartrate negative), or C within the past fourteen (14) days of last exposure.
(EE) Consumed or prepared food implicated in a confirmed disease outbreak of Salmonella Typhi or Paratyphi A, B (tartrate negative), or C within the past fourteen (14) days of last exposure.
(ii) Reinstate the food employee who was restricted when one (1) of the following has occurred:
(AA) More than fourteen (14) calendar days have passed since the last day the food employee was potentially exposed.
(BB) More than fourteen (14) calendar days have passed since the food employee's household contact became asymptomatic.
(3) Feces, urine, and articles soiled by feces or urine, or both, shall receive concurrent disinfection. Feces and urine may be discarded in a sanitary sewer without prior disinfection. Terminal cleaning is required.
(4) Reporting of disease is required to follow the "When to Report (from probable diagnosis)" time frame and Salmonella serotype Typhi or Paratyphi A, B (tartrate negative), or C antimicrobial susceptibility testing results are to be reported as soon as they become available.
(5) Quarantine is not applicable.
(6) Immunization is recommended only for the following people:
(A) Travelers to areas where risk of exposure to Salmonella serotype Typhi or Paratyphi A, B (tartrate negative), or C is recognized.
(B) People with close contact to a documented typhoid or paratyphoid fever carrier.
(C) Laboratory workers with frequent contact with Salmonella serotype Typhi or Paratyphi A, B (tartrate negative), or C.
(D) People living outside the United States in areas with endemic typhoid infection.
Protection of contacts is not applicable.
(7) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-144 Typhus, endemic (fleaborne); specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 144. The specific control measures for endemic typhus (infectious agent: Rickettsia species) are as follows:
(Indiana State Department of Health;
(1) An environmental investigation for the presence of rodents or squirrels, or both, around the premises of the home of the patient shall be done within seventy-two (72) hours. Provide guidance on:
(A) the use of insecticides to kill rodent fleas; and
(B) rodent exclusion from the premises or home.
(2) Standard precautions are required for hospitalized individuals.
(3) Concurrent disinfection is not required.
(4) Quarantine is not required.
(5) Immunization is not available. Protection of contacts is not applicable.
(6) Case definition is established by the department.
410 IAC 1-2.5-145 Varicella (chickenpox); specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 145. The specific control measures for varicella (chickenpox) (infectious agent: Varicella-zoster virus) are as follows:
(Indiana State Department of Health;
(1) Every case of primary varicella disease shall be reported to the local health officer within seventy-two (72) hours. For all cases of primary varicella disease, an investigation shall be performed to ascertain the following:
(A) An immunization history.
(B) Primary varicella disease history.
(C) A history of underlying chronic or immunosuppressive disease.
(D) Disease severity and hospitalization.
(E) Characteristics of the rash, reported as the following:
(i) Crusts.
(ii) Macules (flat spots).
(iii) Papules (solid bumps).
(iv) Vesicles (fluid-filled blisters).
(F) Location of the rash, reported as the following:
(i) Generalized.
(ii) Focal.
(iii) Unknown.
(G) Name and contact information for employer or school/daycare attended.
(H) Identification of any known case of varicella with an epidemiologic link.
(2) For hospitalized patients, institute airborne and contact precautions.
(3) Concurrent disinfection of articles soiled by nose or throat discharges.
(4) Infected persons shall avoid contact with susceptible individuals outside of the household and shall be excluded from:
(A) schools;
(B) preschools;
(C) daycare facilities; and
(D) public gatherings;
until lesions have crusted over (severe cases) or disappeared (mild or atypical cases). Individuals with shingles (herpes zoster) do not need to remain excluded as long as the rash is covered with a clean, dry bandage.
(5) Individuals with known recent exposure to a single case of chickenpox:
(A) Varicella vaccine given to healthy inadequately vaccinated persons within five (5) days (one hundred twenty (120) hours) of exposure may provide protection against disease.
(B) Individuals who must remain in a hospital setting for medical reasons shall be quarantined from the eighth day to the twenty-first day following exposure. Individuals who receive varicella-zoster immune globulin shall be quarantined for a period of up to twenty-eight (28) days.
(C) Persons without evidence of immunity who have contraindications for vaccination and who are at risk for severe disease and complications may be given varicella-zoster immune globulin within ninety-six (96) hours of exposure to prevent or modify disease. Other susceptible high-risk individuals who should be considered for varicella-zoster immune globulin include the following:
(i) Newborns of mothers who develop chickenpox within five (5) days before or forty-eight (48) hours after delivery.
(ii) Immunocompromised susceptible children and adults.
(iii) Preterm infants born at twenty-eight (28) weeks gestation or later who are exposed during the neonatal period and whose mothers do not have evidence of immunity.
(iv) Premature infants of less than twenty-eight (28) weeks gestation, or weighing one thousand (1,000) grams or less (regardless of maternal history of disease or vaccination).
(v) Susceptible pregnant women.
(D) Exposed health care workers must provide evidence of immunity (chickenpox or shingles). Evidence of immunity in health care workers includes documentation of two (2) doses of varicella vaccine given at least twenty-eight (28) days apart (after the first birthday), history of varicella or herpes zoster based on physician diagnosis, laboratory evidence of immunity, or laboratory confirmation of disease. Health care workers who cannot provide evidence of immunity should be furloughed from the eighth day to the twenty-first day following exposure.
(6) Individuals with suspected "break-through" disease, or those developing varicella within seven (7) to forty-two (42) days postvaccination should undergo appropriate laboratory testing that includes viral culture and polymerase chain reaction for viral strain typing.
(7) Individuals who are hospitalized due to the infection should have appropriate laboratory evidence to support diagnosis including viral culture or polymerase chain reaction. Serologic testing should be undertaken in cases of suspected death due to primary varicella.
(8) Outbreak control measures. An outbreak of chickenpox is defined as five (5) or more cases in persons less than thirteen (13) years of age that are related in place and epidemiologically linked. For individuals thirteen (13) years of age and older, a total of three (3) cases related in place and epidemiologically linked meets the outbreak definition. The cases may be linked by affiliation or attendance at the same school or facility. In order to reach the outbreak threshold, the cases must reside in at least two (2) different households.
(A) Varicella vaccine should be offered to all healthy, susceptible individuals within five (5) days of exposure to provide additional protection against disease. Individuals who remain susceptible shall be quarantined for twenty-one (21) days following last known exposure. This includes exclusion from school attendance, daycare settings, and employment.
(B) Vaccination or disease history, or both, for varicella shall be obtained in schools and daycare settings for each exposed individual.
(9) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-146 Vibriosis; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 146. The specific control measures for vibriosis (non-cholera) (infectious agent: Vibrio species other than toxigenic Vibrio cholerae 01 or 0139, Grimontia hollisae (Vibrio hollisae), Photobacterium damselae (Vibrio damsela)) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall meet the following conditions:
(A) Be performed within seventy-two (72) hours.
(B) Include a three (3) week history of the following prior to symptom onset:
(i) Food and drink consumption.
(ii) Wounds.
(iii) Domestic and international travel.
(C) Every case should be investigated for an actual or probable source. The investigation shall focus on identifying the following:
(i) Unreported cases.
(ii) Carriers.
(iii) Contaminated:
(AA) food;
(BB) water;
(CC) milk; and
(DD) shellfish.
(D) If the case traveled three (3) weeks prior to onset, all members of travel groups in which a case has occurred shall be interviewed for probable source of infection and additional cases.
(E) Determine if the case is part of an outbreak.
(F) Determine if the case is a:
(i) food employee;
(ii) daycare worker;
(iii) health care worker; or
(iv) daycare attendee, a school attendee, or anyone who lives at a residential institution.
(2) In addition to standard precautions, contact precautions are recommended for diapered or incontinent children. For all others, the following apply:
(A) Cases employed as food employees, daycare workers, health care workers, or in similar positions shall be excluded from employment involving food handling and direct care of children or hospitalized or institutionalized patients until all of the following have occurred:
(i) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours.
(ii) The case has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iii) The local health officer has discussed the following topics with the employer:
(AA) The employer's duty to comply with local and state rules pertaining to prevention of infectious diseases.
(BB) The availability of required proper hand washing facilities for employees.
(CC) The correction of any observed lapses in hygienic measures by employees.
(B) Cases shall be excluded from attending schools, preschools, and daycare facilities until all of the following have occurred:
(i) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours.
(ii) The case or case's guardian has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iii) The local health officer has discussed with the appropriate school, preschool, or daycare facility staff the need:
(AA) for proper hand washing procedures and other infection control practices; and
(BB) to comply with all local and state rules pertaining to prevention of infectious diseases.
(C) If an outbreak of the infection occurs in a daycare facility or preschool, the following may occur:
(i) All attendees and staff may be required to submit stool specimens for examination.
(ii) Instead of exclusion, attendees and staff may be isolated from other attendees and staff in the same facility based on symptoms, laboratory testing, and treatment. This alternative shall only be considered if the physical structure and staff organization of the facility can accommodate isolation of various attendee groups from one another. If this alternative is selected, increased emphasis on hand washing procedures and environmental cleaning is necessary.
(iii) Admission of all new attendees may be suspended while the outbreak continues.
(3) Concurrent disinfection is required for feces and fecal contaminated articles. Feces may be disposed directly into a sanitary sewage system. Terminal cleaning is required.
(4) Quarantine is not required.
(5) Immunization is not available. Protection of contacts is not applicable.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-147 Yellow fever; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 147. The specific control measures for yellow fever (infectious agent: yellow fever virus) are as follows:
(Indiana State Department of Health;
(1) An investigation by a department field representative, in cooperation with the local health officer, shall:
(A) be performed immediately; and
(B) include:
(i) laboratory confirmation;
(ii) immunization status; and
(iii) a history of foreign travel in three (3) to six (6) days prior to the onset.
Identify traveling companions who may also have been exposed.
(2) Standard precautions are required for hospitalized individuals.
(3) Concurrent disinfection is not applicable.
(4) Quarantine is not required.
(5) Immunization is available. Protection of contacts is not applicable.
(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.
410 IAC 1-2.5-148 Yersiniosis; specific control measures
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 148. The specific control measures for yersiniosis (infectious agents: Yersinia enterocolitica or Yersinia pseudotuberculosis) are as follows:
(Indiana State Department of Health;
(1) An investigation by the local health officer shall meet the following conditions:
(A) Be performed within seventy-two (72) hours.
(B) Include a seven (7) day history of the following prior to symptom onset:
(i) Food and drink consumption.
(ii) Water exposure.
(iii) Animal exposure.
(C) Determine if the affected individual is a:
(i) food employee;
(ii) daycare worker;
(iii) health care worker; or
(iv) daycare attendee, a school attendee, or anyone who lives at a residential institution.
(D) Determine if meal companions are additional cases.
(E) If a commercial food product or restaurant is suspected, conduct active surveillance for additional cases.
(2) In addition to standard precautions, contact precautions are recommended for diapered or incontinent children. For all others, the following apply:
(A) Cases employed as food employees, daycare workers, health care workers, or in similar positions and cases who attend daycare, attend school, or anyone who is living in a residential institution shall be excluded from employment involving food handling and direct care of children or hospitalized or institutionalized patients until all of the following have occurred:
(i) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours.
(ii) The case has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.
(iii) The local health officer has discussed the following topics with the employer:
(AA) The employer's duty to comply with local and state rules pertaining to prevention of infectious diseases.
(BB) The availability of required proper hand washing facilities for all employees.
(CC) The correction of any observed lapses in hygienic measures by employees.
(3) Concurrent disinfection is required for feces and fecal contaminated articles. Feces may be discarded in a sanitary sewage system without prior disinfection.
(4) Quarantine is not required.
(5) Immunization is not applicable. Protection of contacts is not applicable.
(6) Case definition is established by the department.
410 IAC 1-2.5-149 Incorporation by reference
Authority: Affected: IC 16-41-2 ; IC 16-41-9
Sec. 149. (a) The following documents are hereby incorporated by reference into this rule:
(1) Centers for Disease Control and Prevention (CDC). Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007. Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee (HICPAC); June 2007. Electronic copies of this publication are available at http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf.
(2) CDC. Case Definitions for Infectious Conditions Under Public Health Surveillance. Morbidity and Mortality Weekly Report (MMWR); May 2, 1997; Vol. 46; No. RR-10.
(3) CDC. 2012 Nationally Notifiable Diseases and Conditions and Current Case Definitions. Publication available from the CDC Office of Surveillance, Epidemiology and Laboratory Services, Division of Notifiable Diseases and Healthcare Information, 1600 Clifton Road, Atlanta, Georgia 30333. Electronic copies of this publication are available at http://stacks.cdc.gov/view/cdc/12088/.
(4) CDC. Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the HICPAC and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR; October 25, 2002; Vol. 51; No. RR-16.
(5) 45 CFR 164.512 (2013).
(6) American Public Health Association (APHA). Control of Communicable Diseases Manual, 20th Edition. Heymann, DL, ed.; 2014. Publication available from the APHA, Publication Sales, P.O. Box 933019, Atlanta, Georgia, 31193-3019. Electronic copies of this publication are available at https://www.apha.org.
(7) CDC. Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR; December 17, 2010; Vol. 59; No. RR-12.
(8) CDC. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR; December 30, 2005; Vol. 54; No. RR-17.
(9) CDC. Treatment of Tuberculosis. American Thoracic Society, CDC, and Infectious Diseases Society of America. MMWR; June 20, 2003; Vol. 52; No. RR-11.
(10) CDC. Guidelines for the Investigation of Contacts of Persons with Infectious Tuberculosis. Recommendations from the National Tuberculosis Controllers Association and CDC. MMWR; December 16, 2005; Vol. 54; No. RR-15.
(11) Centers for Disease Control and Prevention guidelines, Recommendations for Use of an Isoniazid-Rifapentine Regimen with Direct Observation to Treat Latent Mycobacterium tuberculosis Infection. MMWR 2011; Volume 60, Pages 1650-1653.
(12) American Academy of Pediatrics (AAP). Red Book: 2012 Report of the Committee on Infectious Diseases, 29th edition. Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds.; 2012. Publication available from the AAP, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007-1098.
(13) CDC. Epidemiology and Prevention of Vaccine-Preventable Diseases. 12th Edition. Atkinson,W, Wolfe S, Hamborsky J, eds. Publication available from The Public Health Foundation, Publication Sales, P.O. Box 753, Waldorf, Maryland, 20604-0753.
(14) CDC. Manual for the Surveillance of Vaccine-Preventable Diseases. 5th Edition. Roush SW, McIntyre L, Baldy LM, eds.; 2012. Electronic copies of this publication are available at http://www.cdc.gov/vaccines/pubs/surv-manual/index.html.
(15) CDC. Update to CDC's Sexually Transmitted Diseases Treatment Guidelines, 2010: Oral Cephalosporins No Longer a Recommended Treatment for Gonococcal Infections, 2012, MMWR; August 10, 2012; Vol. 61; No. 31; 590-594.
(16) World Health Organization (WHO). WHO Guidelines on Hand Hygiene in Health Care. WHO Press: Geneva, Switzerland, 2009.
(17) CDC. Revised definition for HIV Infection, as found in MMWR, Volume 63, Recommendations and Reports No. RR-03, April 11, 2014.
(b) Where the provisions of this rule or the laws of Indiana conflict with matters incorporated by reference, this rule and the laws of Indiana shall control.
(c) All incorporated material is available for public review at the department.
(d) The MMWR series of publications is published by the Office of Surveillance, Epidemiology, and Laboratory Services, CDC, U.S. Department of Health and Human Services, 1600 Clifton Road, Atlanta, Georgia 30333. Electronic copies of most MMWR publications are available at http://www.cdc.gov/MMWR.
(Indiana State Department of Health;
SECTION 2. 410 IAC 1-2.3 IS REPEALED.
Posted: 06/10/2015 by Legislative Services Agency
DIN: 20150610-IR-410150039PRA
Composed: May 05,2024 7:56:50AM EDT
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