Section 690.30 General Procedures for the Control of Notifiable Diseases and Conditions, Including Outbreaks

Section 690.30  General

Procedures for the Control of Notifiable Diseases and Conditions, Including

Outbreaks

This Section establishes routine

measures for the control of notifiable diseases, conditions and outbreaks by

the Department or local health authorities and health care providers, and

establishes progressive initiatives to ensure that appropriate measures are

implemented to control the spread and occurrence of notifiable diseases, conditions

and outbreaks.  This Section does not apply to infectious or non-infectious

diseases and conditions for which reporting requirements are specified

elsewhere in the Illinois Administrative Code, such as sexually transmissible

infections, which are regulated under the Control of Sexually Transmissible

Infections Code, the HIV/AIDS Confidentiality and Testing Code, and the

Perinatal HIV Prevention Code.

a)         Investigation

1)

The

Department of Public Health shall investigate the causes of

contagious, or

dangerously

contagious, or

infectious diseases, especially when existing

in epidemic form, and take means to restrict and suppress the same, and

whenever such disease becomes, or threatens to become, epidemic in any locality

and the local board of health or local authorities neglect or refuse to enforce

efficient measures for its restriction or suppression or to act with sufficient

promptness or efficiency, or whenever the local board of health or local

authorities neglect or refuse to promptly enforce efficient measures for the restriction

or suppression of dangerously contagious or infectious diseases, the Department

of Public Health may enforce such measures as it deems necessary to protect the

public health, and all necessary expenses so incurred shall be paid by the

locality for which services are rendered

local board of health or local

authorities neglect or refuse to promptly enforce efficient measures for the restriction

or suppression of dangerously contagious or infectious diseases, the Department

of Public Health may enforce such measures as it deems necessary to protect the

public health, and all necessary expenses so incurred shall be paid by the

locality for which services are rendered.

(Section 2(a) of the Act)

2)         The

Department shall

make investigations and inquiries with respect to the

causes of disease

, health conditions,

and death; investigate the effect

of environment, including conditions of employment and other conditions that

may affect health; and to make other investigations that it may deem necessary

for the preservation and improvement of health.

(Section 510 of the Public

Health Powers and Duties Law)

3)         Each case or cluster of a notifiable disease or condition shall

be investigated to determine the source, where feasible. Findings of the

investigation shall be reported as specified under the Section of this Part

applicable to each specific disease.

4)         The

Department or local health authority may investigate the occurrence of cases, suspect

cases, or carriers of diseases or conditions or unusual disease or condition occurrences

in a public or private place for the purposes of verifying the existence of a disease

or condition; ascertaining the source of the disease or condition-causing

agent; identifying unreported cases; locating and evaluating contacts of cases

and suspect cases; identifying those at risk of disease or the condition;

determining necessary control measures, including isolation and quarantine; and

informing the public if necessary

r the purposes of verifying the existence of a disease

or condition; ascertaining the source of the disease or condition-causing

agent; identifying unreported cases; locating and evaluating contacts of cases

and suspect cases; identifying those at risk of disease or the condition;

determining necessary control measures, including isolation and quarantine; and

informing the public if necessary.

5)         When

the Director determines that a certain disease or condition warrants investigation,

the Director may declare the disease or condition to be the subject of a

medical investigation and require hospitals, physicians, health care facilities,

etc., to submit information, data and reports, and allow review and examination

of medical records as necessary for the purpose of the investigation.  No

practitioner or person shall be liable in any action at law for permitting

examination and review. The data obtained shall be held confidential in

accordance with the Communicable Disease Report Act.

6)         When two

or more cases of a suspected or notifiable disease or condition, including, but

not limited to confirmed health care associated infection or colonization, or

single case with public health significance occur in any business,

organization, institution, health care facility, school, child care center or provider,

residential facility, or private home, the business owner, the person in charge

of the establishment or the event, or the homeowner shall cooperate with public

health authorities in the investigation of cases, suspect cases, outbreaks and

suspect outbreaks

public health significance occur in any business,

organization, institution, health care facility, school, child care center or provider,

residential facility, or private home, the business owner, the person in charge

of the establishment or the event, or the homeowner shall cooperate with public

health authorities in the investigation of cases, suspect cases, outbreaks and

suspect outbreaks.  This includes, but is not limited to, release of utilization

information about a product used to mitigate spread, including therapeutics;

shopper card records; credit card receipts; food preparation methods; menus; environmental

specimens; food specimens; clinical specimens, invoices, employee work

schedules and work logs, including logs of employee illness or absences; lists

of customers, attendees, residents or patients; travel/transportation logs; utilization

information about a product used to mitigate spread, including therapeutics,

vaccinations or prophylactics; and the name and other pertinent information

about employees, guests, members or residents diagnosed with a communicable

disease or condition, including infection or colonization as the information

relates to the investigation. When outbreaks of infectious disease occur in any

business, organization, institution, health care facility or private home,

employees of the location under investigation may be considered to be contacts

to cases and be required to submit release specimens by the local health

authority.

7)         When two or more cases of a notifiable communicable disease or

condition occur in association with a common source, the investigation should

include a search for additional cases.

8)

All reports of an outbreak shall be

entered in the Department’s ORS by the local health jurisdiction within 24

hours of receipt of the report.  Within 30 days of the end of the outbreak

investigation, the final information shall be entered in the Department’s ORS

disease or

condition occur in association with a common source, the investigation should

include a search for additional cases.

8)

All reports of an outbreak shall be

entered in the Department’s ORS by the local health jurisdiction within 24

hours of receipt of the report.  Within 30 days of the end of the outbreak

investigation, the final information shall be entered in the Department’s ORS.

Supplemental questionnaires may be used during the outbreak investigation,

including, but not limited to use of REDCap or other online systems.

9)         Under circumstances with highly infectious diseases or other

disease or conditions causing extreme harm, including, but not limited to, high

risk or high occurrence of death or complication, and when normal attempts to

make contact have failed, the Department, local health authority, or law

enforcement may obtain and review any cell phone, computer, mobile device or

other communication device, from a case for the purpose of the investigation,

including, but not limited to, the identification of possible contacts or

possible exposures, for the purpose of preventing or controlling disease or the

condition.

10)        State and local law enforcement authority shall share

information with the Department or local health department as requested by

either the Department or the local health authority for the treatment, response

to, control of, investigation of, or prevention of a notifiable disease,

condition or outbreak.

11)        The

Department or local health authority may conduct sentinel surveillance for an infectious

disease, condition or syndrome if the Department or local health authority determines

that sentinel surveillance will provide adequate data for the purpose of

preventing or controlling disease or the condition or achieving other

significant public health purposes in a defined geographic area or the entire

State

ment or local health authority may conduct sentinel surveillance for an infectious

disease, condition or syndrome if the Department or local health authority determines

that sentinel surveillance will provide adequate data for the purpose of

preventing or controlling disease or the condition or achieving other

significant public health purposes in a defined geographic area or the entire

State.  The Department or local health authority shall select, after

consultation with the sites, sentinel surveillance sites that have

epidemiological significance for the disease, condition or syndrome under

investigation.  A disease, condition or syndrome may be removed from sentinel

surveillance if the Department or local health authority determines that the

surveillance is no longer necessary.  The Department or local health authority shall

provide a description, in writing, to sentinel surveillance sites of a

specific, planned mechanism for surveillance of the disease, condition or

syndrome and, as necessary, submission of clinical materials from cases and

suspect cases.

12)        An individual or entity, including a health information

exchange, may carry out activities such as sentinel surveillance under a grant,

contract or cooperative agreement with the Department. The authorized

individual or entity functions as a public health authority for the purposes of

the activity.

13)        Investigations

conducted by the Department or local health authority may include, but are not

limited to:

A)        Review

of pertinent, relevant medical records by authorized personnel, if necessary to

confirm the diagnosis; investigation of causes; identification of other cases

related to the outbreak or the reported disease (including colonization) or

condition in a region, community, or workplace; to conduct epidemiologic

studies; to determine whether a patient with a notifiable disease or condition has

received adequate treatment to render the patient non-infectious, whether a

person exposed to a case has recei

vestigation of causes; identification of other cases

related to the outbreak or the reported disease (including colonization) or

condition in a region, community, or workplace; to conduct epidemiologic

studies; to determine whether a patient with a notifiable disease or condition has

received adequate treatment to render the patient non-infectious, whether a

person exposed to a case has received vaccination or prophylaxis, if

appropriate, or infection or environmental control measures have been

implemented, if appropriate.  Review of records may occur without patient

consent and shall be conducted at times and with such notice as is possible

under the circumstances;

B)        Performing

interviews with the case, or persons knowledgeable about the case, and

collecting pertinent and relevant information about the causes of or risk

factors for the notifiable disease or condition;

C)        Medical

examination and testing of persons, with their explicit consent;

D)        Obtaining,

from public or private businesses or institutions, the identities of and location

and contact information about persons, travelers, passengers or transportation

crews with a similar or common potential exposure to the infectious agent as a

reported case; exposure may be current or have occurred in the past;

E)        Interviewing

or administering questionnaire surveys confidentially to any resident of any

community, or any agent, owner, operator, employer, employee, or client of a

public or private business or institution, who is epidemiologically associated

either with the outbreak or with the reported disease or condition case or has

had a similar exposure as a reported case;

F)         Collecting

environmental samples of substances or measurements of physical agents that may

be related to the cause of an outbreak or notifiable disease or condition;

G)        Taking

photographs related to the purpose of the investigation

miologically associated

either with the outbreak or with the reported disease or condition case or has

had a similar exposure as a reported case;

F)         Collecting

environmental samples of substances or measurements of physical agents that may

be related to the cause of an outbreak or notifiable disease or condition;

G)        Taking

photographs related to the purpose of the investigation. If the photographs are

taken in a business, the employer shall have the opportunity to review the

photographs taken or obtained for the purpose of identifying those that contain

or might reveal a trade secret; and

H)        Entering

a place of employment for the purpose of conducting investigations of those

processes, conditions, structures, machines, apparatus, devices, equipment,

records, and materials within the place of employment that are relevant,

pertinent, and necessary to the investigation of the outbreak or notifiable

dangerously contagious or infectious disease.  Investigations shall be

conducted during regular business hours, if possible, and with as much notice

as possible under the circumstances.

b)         Control of Food Products

Whenever a

case, a carrier, or a suspect case or carrier of the following diseases exists

in a home or establishment where food is produced that is likely to be consumed

raw or handled after pasteurization and before final packaging, the sale,

exchange, removal or distribution of the food items from the home or establishment

may be prohibited by the Department or the local health authority as necessary

to prevent the transmission of communicable diseases or conditions. These

include, but are not limited to, the following diseases:

1)         Campylobacteriosis

2)         Cholera

3)         Cryptosporidiosis

4)         Diphtheria

5)         E. coli infections (Shiga toxin-producing E

s from the home or establishment

may be prohibited by the Department or the local health authority as necessary

to prevent the transmission of communicable diseases or conditions. These

include, but are not limited to, the following diseases:

1)         Campylobacteriosis

2)         Cholera

3)         Cryptosporidiosis

4)         Diphtheria

5)         E. coli infections (Shiga toxin-producing E. coli)

6)         Foodborne or waterborne illness

7)         Hepatitis A

8)         Norovirus

9)         Salmonellosis

10)         Shigellosis

11)         Smallpox

12)         Staphylococcal skin infections

13)         Streptococcal infections

14)         Typhoid fever

c)         Schools, Child Care Facilities, and Colleges/Universities

1)         Except in an emergency, the occurrence of a case of a

communicable disease in a school, child care facility or college/university

should not be considered a reason for closing the school, facility or

college/university.

2)         Persons suspected of being infected with a notifiable

infectious disease for which isolation is required, or persons with diarrhea or

vomiting believed to be infectious in nature, shall be refused admittance to

the school or child care facility until fever-free and diarrhea and vomiting

free for 24 hours without use of fever reducing, antidiarrheal, or antiemetic medications

and other medications.

3)         School, child care facility, and college/university

authorities shall handle contacts of infectious disease cases as prescribed in

this Part, or as recommended by the local health authority.

4)         When outbreaks of disease occur in any child care facility,

staff and attendees of the facility may be considered to be contacts to cases

and may be required by the local health authority to submit specimens for

testing

y, and college/university

authorities shall handle contacts of infectious disease cases as prescribed in

this Part, or as recommended by the local health authority.

4)         When outbreaks of disease occur in any child care facility,

staff and attendees of the facility may be considered to be contacts to cases

and may be required by the local health authority to submit specimens for

testing.

5)         Identifiable information on a student or staff, such as name

and contact information (including current address and phone), seating charts

on busses and in the classroom, and rosters for extracurricular activities,

shall be reported to the Department or local public health authority for any

notifiable disease or condition within the timeframes specified in this Part.

d)         Release of Specimens

1)         Whenever this Part requires the submission of laboratory

specimens for release from imposed restrictions, the results of the

examinations will not be accepted unless the specimens have been examined in

the Department's laboratory or an acceptable medical laboratory.  The number of

specimens needed for release, as detailed under specific diseases, is the

minimum and may be increased by the Department as necessary. Improper storage

or transportation of a specimen or inadequate growth of the culture suggestive

of recent antibiotic usage can result in disapproval of the submitted specimen

by the Department's laboratory or an acceptable medical laboratory and result

in the need for an additional specimen to be collected.

2)         The

local health authority may require testing of food handlers for specific

pathogens, including, but not limited to, E. coli, Salmonella and Norovirus, as

necessary in response to an outbreak

sage can result in disapproval of the submitted specimen

by the Department's laboratory or an acceptable medical laboratory and result

in the need for an additional specimen to be collected.

2)         The

local health authority may require testing of food handlers for specific

pathogens, including, but not limited to, E. coli, Salmonella and Norovirus, as

necessary in response to an outbreak.

3)         A

local health authority may disclose and require to a food service business

owner or the owner’s designee that an employee with a disease that can be

transmitted through food cannot return to work until the local health authority

lets the business owner know that the employee can return to work.

e)         Persons

with diarrhea or vomiting of infectious or unknown cause shall not work in

sensitive occupations, as a health care worker, or as food handlers until 48

hours after diarrhea and vomiting have resolved without use of antidiarrheal or

antiemetic medications and shall adhere to restrictions specified in this Part

specific to each etiologic agent.

f)         Persons with draining skin lesions shall not

work as food handlers unless the drainage is contained by a dressing and

lesions are not on the hands or forearms.

g)         Persons with jaundice and the onset of jaundice within seven

calendar days shall not work as health care workers, food handlers or in

sensitive occupations until seven days after the jaundice ceases, unless the

employee provides written documentation from a health care provider that the jaundice

is not caused by the hepatitis A virus or other fecal-orally transmitted

infection.  If the case is confirmed as hepatitis A and jaundice is not

present, the health care worker, food handler or person in a sensitive

occupation shall be restricted from work for two weeks from the start of the

clinical symptoms.