4.20 COMMUNICABLE DISEASE REPORTING AND INVESTIGATION

• 4.21 Communicable Disease Reporting
• 4.22 Communicable Disease Investigation

4.21 Communicable Disease Reporting

A. Reportable Diseases.

1. Notifiable conditions. State regulations specify notifiable communicable diseases and the time period in which the report must be made. See WAC 246-101-101, -201, -301.

   1. Definition. "Notifiable condition" means a disease or condition of public health importance, a case of which, and for certain diseases, a suspected case of which, must be brought to the attention of the local health officer or state health officer. WAC 246-101-010(30).

2. Disease of suspected bioterrorism origin. A “disease of suspected bioterrorism origin” is a notifiable condition to be reported immediately to the local health department. WAC 246-101-101, -201, -301.

   1. Definition. "Disease of suspected bioterrorism origin" means a disease caused by viruses, bacteria, fungi, or toxins from living organisms that are used to produce death or disease in humans, animals, or plants. Many of these diseases may have nonspecific presenting symptoms. The following situations could represent a possible bioterrorism event and should be reported immediately to the local health department:

      i. A single diagnosed or strongly suspected case of disease caused by an uncommon agent or a potential agent of bioterrorism occurring in a patient with no known risk factors;

      ii. A cluster of patients presenting with a similar syndrome that includes unusual disease characteristics or unusually high morbidity or mortality without obvious etiology; or

      iii. Unexplained increase in a common syndrome above seasonally expected levels. WAC 246-101-010(11).

   2. Examples: Anthrax and smallpox. WAC 246-101-101, -201, -301.

3. Other rare diseases of public health significance. “Other rare diseases of public health significance” are notifiable conditions to be reported immediately to the local health department. Id.

   1. Definition. “Other rare diseases of public health significance" means a disease or condition, of general public health concern, which is occasionally or not ordinarily seen in the state of Washington, including, but not limited to, viral hemorrhagic fevers, Rocky Mountain Spotted fever, and other tick borne diseases. This also includes a communicable disease that would be of general public concern if detected in Washington. WAC 246-101-010(31).

4. Unexplained critical illness or death. An “unexplained critical illness or death” is a notifiable condition to be reported immediately to the local health department. WAC 246-101-101, -301.

   1. Definition. "Unexplained critical illness or death" means cases of illness or death with infectious hallmarks but no known etiology, in previously healthy persons one (1) to forty-nine (49) years of age excluding those with chronic medical conditions (e.g., malignancy, diabetes, AIDS, cirrhosis). WAC 246-101-010(43).

5. Additional conditions required by local health officer. Each local health officer has the authority to require the notification of additional conditions of public health importance occurring within the jurisdiction of the local health officer. WAC 246-101-505(11)(d).

6. Outbreaks. Outbreaks or suspected outbreaks are reportable to the local health department, even if the disease is not a notifiable condition. WAC 246-101-105(1)(c), -305(1)(d).

   1. Definition. "Outbreak" means the occurrence of cases of a disease or condition in any area over a given period of time in excess of the expected number of cases. WAC 246-101-010(32).

   2. Examples. Outbreaks or suspected outbreaks include, but are not limited to, suspected or confirmed outbreaks of chickenpox, influenza, viral meningitis, nosocomial infection suspected due to contaminated food products or devices, or environmentally related disease. WAC 246-101-105(1)(c), -305(1)(d).

B. Persons and Entities Having Duty to Report.

1. Health care providers. Health care providers must notify public health authorities of the conditions listed in WAC 246-101-101.

   Procedures and other requirements. See WAC 246-101-105 to -120.

2. Laboratories. Laboratories must notify public health authorities of the conditions in WAC 246-101-201.

   Procedures and other requirements. See WAC 246-101-205 to -230.

3. Health care facilities. Health care facilities must notify public health authorities of the conditions in WAC 246-101-301.

   Procedures and other requirements. See WAC 246-101-305 to -320.

C. Confidential Treatment of Reported Information.

1. Confidentiality of records and specimens. Records and specimens containing or accompanied by patient-identifying information are confidential. WAC 246-101-120, -230, -320.

   1. Local health officers to maintain confidentiality. Local health officers shall establish a system at the local health department to maintain confidentiality of notifiable conditions case reports. WAC 246-101-505(2).

   2. State Department of Health to maintain confidentiality. The state health officer or designee shall establish a system to maintain confidentiality of reports of cases and suspected cases. WAC 246-101-610.

2. Permissible disclosures. See infra § 4.32.

D. Other Persons and Entities with Responsibilities Related to Reporting.

1. Veterinarians. See WAC 246-101-405.

   NOTE: Veterinarians also are required to report certain animal diseases to the Washington State Department of Agriculture. See infra § 5.41.B.

   This requirement is separate from the requirement contained in WAC 246-101-405 to report to health departments and involves a separate list of reportable conditions affecting animals.

2. Food service establishments. See WAC 246-101-410.

3. Child day care facilities. See WAC 246-101-415.

4. Schools. See WAC 246-101-420.

E. Select Agents and Toxins. Federal regulations identify select agents and toxins that have the potential to pose a severe threat to public health and safety. 42 C.F.R. pt. 73. Clinical and diagnostic laboratories and other entities that are not registered to possess, use, or transfer select agents and toxins are required to report the identification or verification of a select agent or toxin to the Centers for Disease Control, 42 C.F.R. §§ 73.5(a), 73.6(a), or to the U.S. Department of Agriculture. 7 C.F.R. § 331.5(a), 9 C.F.R. § 121.6(a).

4.22 Communicable Disease Investigation

A. Communicable Disease Investigation.

1. Duties of the local health officer. Local health officers or the local health department shall:

   1. Review and determine appropriate action for:

      i. Each reported case or suspected case of a notifiable condition;

      ii. Any disease or condition considered a threat to public health; and

      iii. Each reported outbreak or suspected outbreak of disease, requesting assistance from the state Department of Health when necessary. WAC 246-101-505(1).

   2. Conduct investigations and institute control measures in accordance with chapter 246-100 WAC. WAC 246-101-505(9).

   3. Notify the state Department of Health of any condition notifiable to the local health department (except animal bites) upon completion of the case investigation. WAC 246-101-505(4).

2. Authorities of the local health officer. Each local health officer has the authority to:

   1. Carry out additional steps determined to be necessary to verify a diagnosis reported by a health care provider. WAC 246-101-505(11)(a).

   2. Require any person suspected of having a reportable disease or condition to submit to examinations required to determine the presence of the disease or condition. WAC 246-101-505(11)(b).

   3. Investigate any case or suspected case of a reportable disease or condition or other illness, communicable or otherwise, if deemed necessary. WAC 246-101-505(11)(c).

   4. Require the notification of additional conditions of public health importance occurring within the jurisdiction of the local health officer. WAC 246-101-505(11)(d).

3. Duties of the state Department of Health related to investigation. The Department of Health shall:

   1. Provide consultation and technical assistance to local health departments upon request. WAC 246-101-605(1).

   2. Conduct investigations and institute control measures consistent with those indicated in the seventeenth edition, 2000 of Control of Communicable Diseases Manual, published by the American Public Health Association, except when superseded by more up-to-date measures, or when other measures are more specifically related to Washington State. WAC 246-101-605(6).