Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This amendment changes the title and disease
categories to be in accordance with the disease categories listed in section
192.020,
RSMo and listed and updated in
19 CSR
20-20.020 and updates the department of health to
department. This amendment also sets forth additional methods to determine the
prevalence and to prevent the spread of diseases which are infectious,
contagious, communicable, or dangerous in their nature within Missouri
including notification of the public and potentially exposed individuals and
the issuance of orders.
(1)
The director shall use the legal means necessary to control, investigate, or
both, any disease or condition listed in
19 CSR
20-20.020 which is a threat to the public
health.
(2) It shall be the duty of
the local health authority, the director of the department , or the director's
designated representative on receiving a report of a disease which is
infectious, contagious, communicable, or dangerous in its nature as included in
19 CSR
20-20.020 to-
(A)
Inspect any premises that they have reasonable grounds to believe are in a
condition conducive to the spread of the disease;
(B) Confer with the physician, laboratory or
person making the report;
(C)
Collect for laboratory analysis any samples or specimens that may be necessary
to confirm the diagnosis or presence of the disease or biological, chemical, or
physical agents and to determine the source of the infection, epidemic, or
exposure. Health program representatives and other personnel employed by the
department , after training and certification to perform venipuncture, and
after specific authorization from a physician, are authorized to perform
venipuncture utilizing procedures within the scope of the training they have
been given. The content and scope of this training shall be established by the
department . Training shall be provided by a physician or his/her designee and
the certificate shall be signed by the physician. Nothing in this rule shall
limit the authority of local public health departments to establish their own
training policies, with or without certification, or to limit their voluntary
participation in the certification program developed by the department , nor
shall it apply to venipuncture for other purposes;
(D) Make a complete epidemiological,
environmental or occupational industrial hygiene investigation and record of
the findings on a communicable disease or exposure report form;
(E) Establish and maintain quarantine,
isolation or other measures as required;
(F) Provide the opportunity to be immunized
to all contacts of persons suffering from those diseases for which there is a
reliable and approved means of immunization;
(G) Establish appropriate control measures
which may include isolation, quarantine, disinfection, immunization, closure of
establishment, notification to potentially exposed individuals to make them
aware of the risk or potential risk of the disease and such information
required to avoid or appropriately respond to the exposure, notification to the
public of the risk or potential risk of the disease and such information
required to avoid or appropriately respond to the exposure, the creation and
enforcement of adequate orders to prevent the spread of the disease and other
measures considered by the department and/or local health authority as
appropriate disease control measures based upon the disease, the patient's
circumstances, the type of facility available, and any other available
information related to the patient and the disease or infection;
(H) Establish, as the local health authority,
whenever a case of unrecognized illness is reported or otherwise brought to the
attention of the local health authority or the department and investigation
presents symptoms of a communicable disease, but sufficient time has not
elapsed to render a positive diagnosis, after consultation with the director or
his/her designated representative, the control measures applicable in actual
cases of the suspected communicable disease, until a positive diagnosis can be
established. If a disease proves to be noncommunicable, the temporary control
measures shall be terminated at once;
(I) Assume direct responsibility as director
of health to make necessary investigation and immediately institute appropriate
control measures necessary for the protection of the public health in
occurrence of outbreaks or unusual clusters of illness involving more than one
(1) county or a general regional area; and
(J) Investigate, as the local health
authority, the disease within the local jurisdiction with assistance from the
director of the department or his/her designated representative when any
outbreak or unusual occurrence of a reportable disease is identified through
reports required by 19 CSR 20-20.020. If, in the
judgment of the director, the disease outbreak or unusual occurrence
constitutes a medical emergency, the director may assume direct responsibility
for the investigation.
(3) It shall be the duty of the local health
authority, upon identification of a case of a reportable disease or upon
receipt of a report of that disease, to take actions and measures as may be
necessary according to any policies which have been or may be established by
the director of the department , within the provisions of section (2) and
subsections (2)(A)-(J) of this rule.
(A) When
the local health authority is notified of a reportable disease or has reason to
suspect the existence of a reportable disease within the local jurisdiction,
the local health authority, either in person or through a designated
representative, shall make an investigation as is necessary and immediately
institute appropriate control measures as set forth in section (2) and
subsections (2)(A)-(J) of this rule.
(B) The local health authority shall use
every reasonable means to determine the presence of a communicable disease or
the source of any disease listed in
19
CSR 20-20.020 or of any epidemic disease of unknown
cause. In the performance of this duty, the local health authority shall
examine or cause to be examined any person reasonably suspected of being
infected or of being a source or contact of infection and any person who
refuses examination shall be quarantined or isolated.
(C) Control measures implemented by the local
health authority shall be at least as stringent as those established by the
director of the department and shall be subject to review and alteration by the
director. If the local health authority fails to carry out appropriate control
measures, the director or his/her designated representative shall take steps
necessary to protect the public health.
(4) It shall be the duty of the attending
physician, immediately upon diagnosing a case of a reportable communicable
disease, to give detailed instructions to the patient, members of the household
and attendants regarding proper control measures. When a person dies while
infected with a communicable disease, it shall be the duty of the attending
physician to learn immediately who is to prepare the body for burial or
cremation and then notify the funeral director, embalmer or other responsible
person regarding the communicable disease the deceased had at the time of
death. A tag shall also be affixed to the body providing the name of the
communicable disease likely to have been present at the time of
death.
(5) Every practitioner of
the healing arts and every person in charge of any medical care facility shall
permit the director of the depart-ment or the director's designated
representative to examine and review any medical records which are in the
practitioner's or person's possession or to which the practitioner or person
has access, upon request of the director or the director's designated
representative in the course of investigation of reportable diseases in
19 CSR
20-20.020.
(6) In order to determine the prevalence of
infectious diseases, contagious diseases, communicable diseases, or diseases
dangerous in their nature within Missouri, the department may inspect,
investigate, make findings, and make and enforce adequate orders to prevent the
spread of such diseases included in
19 CSR
20-20.020.
(7) In order to prevent the spread of
infectious diseases, contagious diseases, communicable diseases, or diseases
that are dangerous in their nature within Missouri, it shall be the duty of the
local health authority, the director of the department or the director's
designated representative to do the following:
(A) Notify or ensure adequate notice is given
to potentially exposed individuals when such official determines that a case or
outbreak of any such disease subjects such individuals to serious illness or
death, if acquired; and
(B) Notify
or ensure adequate notice is given to the public when such official determines
that a case or outbreak of any such disease subjects the public to serious
illness or death, if acquired, and the identity of potentially exposed
individuals is not known at such time or cannot be known.
Such notice shall provide necessary information for the
recipient to avoid or appropriately respond to the exposure.
The following material is incorporated into this rule by
reference: 1) Morbidity and Mortality Weekly Report (Atlanta: Centers for
Disease Control). In accordance with section 536.031(4), RSMo, the full text of
material incorporated by reference will be made available to any interested
person at the Office of the Secretary of State and the headquarters of the
adopting state agency.
*Original authority: 192.006.1., RSMo 1993, amended 1995
and 192.020, RSMo 1939, amended 1945,
1951.
