Current through Register Vol. 39, No. 6, September 16, 2024
(a) The following
are the control measures for hepatitis B infection. The infected persons shall:
(1) refrain from sexual intercourse unless
condoms are used except when the partner is known to be infected with or immune
to hepatitis B;
(2) not share
needles or syringes;
(3) not donate
or sell blood, plasma, platelets, other blood products, semen, ova, tissues,
organs, or breast milk;
(4) if the
time of initial infection is known, identify to the local health director all
sexual intercourse and needle partners since the date of infection; and, if the
date of initial infection is unknown, identify persons who have been sexual
intercourse or needle partners during the previous six months;
(5) for the duration of the infection, notify
future sexual intercourse partners of the infection and refer them to their
attending physician or the local health director for control measures; and for
the duration of the infection, notify the local health director of all new
sexual intercourse partners;
(6)
identify to the local health director all current household contacts;
(7) be tested six months after diagnosis to
determine if they are chronic carriers, and when necessary to determine
appropriate control measures for persons exposed pursuant to Paragraph (b) of
this Rule;
(8) comply with all
control measures for hepatitis B infection specified in Paragraph (a) of
10A NCAC
41A .0201, in those instances where such
control measures do not conflict with other requirements of this
Rule.
(b) The following
are the control measures for persons reasonably suspected of being exposed:
(1) when a person has had a sexual
intercourse exposure to hepatitis B infection, the person shall be
tested;
(2) after testing, when a
susceptible person has had sexual intercourse exposure to hepatitis B
infection, the person shall be given a dose appropriate for body weight of
hepatitis B immune globulin and hepatitis B vaccination as soon as possible;
hepatitis B immune globulin shall be given no later than two weeks after the
last exposure;
(3) when a person is
a household contact, sexual intercourse or needle sharing contact of a person
who has remained infected with hepatitis B for six months or longer, the
partner or household contact, if susceptible and at risk of continued exposure,
shall be vaccinated against hepatitis B;
(4) when a health care worker or other person
has a needlestick, non-intact skin, or mucous membrane exposure to blood or
body fluids that, if the source were infected with the hepatitis B virus, would
pose a significant risk of hepatitis B transmission, the following shall apply:
(A) when the source is known, the source
person shall be tested for hepatitis B infection, unless already known to be
infected;
(B) when the source is
infected with hepatitis B and the exposed person is:
(i) vaccinated, the exposed person shall be
tested for anti-HBs and, if anti-HBs is unknown or less than 10
milli-International Units per ml, receive hepatitis B vaccination and hepatitis
B immune globulin as soon as possible; hepatitis B immune globulin shall be
given no later than seven days after exposure;
(ii) not vaccinated, the exposed person shall
be given a dose appropriate for body weight of hepatitis B immune globulin
immediately and begin vaccination with hepatitis B vaccine within seven
days;
(C) when the
source is unknown, the determination of whether hepatitis B immunization is
required shall be made in accordance with current published Control of
Communicable Diseases Manual and Centers for Disease Control and Prevention
guidelines. Copies of the Control of Communicable Diseases Manual may be
purchased from the American Public Health Association, Publication Sales
Department, Post Office Box 753, Waldora, MD 20604 for a cost of twenty-two
dollars ($22.00) each plus five dollars ($5.00) shipping and handling. Copies
of Center for Disease Control and Prevention guidelines contained in the
Morbidity and Mortality Weekly Report may be purchased from the Superintendent
of Documents, U.S. Government Printing Office, Washington, DC 20402 for a cost
of three dollars fifty cents ($3.50) each. Copies of both publications are
available for inspection in the General Communicable Disease Control Branch,
Cooper Memorial Health Building, 225 N. McDowell Street, Raleigh, North
Carolina 27603-1382.
(5)
infants born to HBsAg-positive mothers shall be given hepatitis B vaccination
and hepatitis B immune globulin within 12 hours of birth or as soon as possible
after the infant is stabilized. Additional doses of hepatitis B vaccine shall
be given in accordance with current published Control of Communicable Diseases
Manual and Centers for Disease Control and Prevention Guidelines. The infant
shall be tested for the presence of HBsAg and anti-HBs within three to nine
months after the last dose of the regular series of vaccine; if required
because of failure to develop immunity after the regular series, additional
doses shall be given in accordance with current published Control of
Communicable Diseases Manual and Centers for Disease Control and Prevention
guidelines. Copies of the Control of Communicable Diseases Manual may be
purchased from the American Public Health Association, Publication Sales
Department, Post Office Box 753, Waldora, MD 20604 for a cost of twenty-two
dollars ($22.00) each plus five dollars ($5.00) shipping and handling. Copies
of Center for Disease Control and Prevention guidelines contained in the
Morbidity and Mortality Weekly Report may be purchased from the Superintendent
of Documents, U.S. Government Printing Office, Washington, DC 20402 for a cost
of three dollars fifty cents ($3.50) each. Copies of both publications are
available for inspection in the General Communicable Disease Control Branch,
Cooper Memorial Health Building, 225 N. McDowell Street, Raleigh, North
Carolina 27603-1382;
(6) infants
born to mothers whose HBsAg status is unknown shall be given hepatitis B
vaccine within 12 hours of birth and the mother tested. If the tested mother is
found to be HBsAg-positive, the infant shall be given hepatitis B immune
globulin as soon as possible and no later than seven days after
birth;
(7) when an acutely infected
person is a primary caregiver of a susceptible infant less than 12 months of
age, the infant shall receive an appropriate dose of hepatitis B immune
globulin and hepatitis vaccinations in accordance with current published
Control of Communicable Diseases Manual and Centers for Disease Control and
Prevention Guidelines. Copies of the Control of Communicable Diseases Manual
may be purchased from the American Public Health Association, Publication Sales
Department, Post Office Box 753, Waldora, MD 20604 for a cost of twenty-two
dollars ($22.00) each plus five dollars ($5.00) shipping and handling. Copies
of Center for Disease Control and Prevention guidelines contained in the
Morbidity and Mortality Weekly Report may be purchased from the Superintendent
of Documents, U.S. Government Printing Office, Washington, DC 20402 for a cost
of three dollars fifty cents ($3.50) each. Copies of both publications are
available for inspection in the General Communicable Disease Control Branch,
Cooper Memorial Health Building, 225 N. McDowell Street, Raleigh, North
Carolina 27603-1382.
(c)
The attending physician shall advise all patients known to be at high risk,
including injection drug users, men who have sex with men, hemodialysis
patients, and patients who receive multiple transfusions of blood products,
that they should be vaccinated against hepatitis B if susceptible. The
attending physician shall also recommend that hepatitis B chronic carriers
receive hepatitis A vaccine (if susceptible).
(d) The following persons shall be tested for
and reported in accordance with
10A NCAC
41A .0101 if positive for hepatitis B
infection:
(1) pregnant women unless known to
be infected; and
(2) donors of
blood, plasma, platelets, other blood products, semen, ova, tissues, or
organs.
(e) The
attending physician of a child who is infected with hepatitis B virus and who
may pose a significant risk of transmission in the school or day care setting
because of open, oozing wounds or because of behavioral abnormalities such as
biting shall notify the local health director. The local health director shall
consult with the attending physician and investigate the
circumstances.
(f) If the child
referred to in Paragraph (e) of this Rule is in school or scheduled for
admission and the local health director determines that there may be a
significant risk of transmission, the local health director shall consult with
an interdisciplinary committee, which shall include school personnel, a medical
expert, and the child's parent or guardian to assist in the investigation and
determination of risk. The local health director shall notify the
superintendent or private school director of the need to appoint such an
interdisciplinary committee. If the superintendent or private school director
establishes such a committee within three days of notification, the local
health director shall consult with this committee. If the superintendent or
private school director does not establish such a committee within three days
of notification, the local health director shall establish such a
committee.
(g) If the child
referred to in Paragraph (e) of this Rule is in school or scheduled for
admission and the local health director determines, after consultation with the
committee, that a significant risk of transmission exists, the local health
director shall:
(1) notify the
parents;
(2) notify the
committee;
(3) assist the committee
in determining whether an adjustment can be made to the student's school
program to eliminate significant risks of transmission;
(4) determine if an alternative educational
setting is necessary to protect the public health;
(5) instruct the superintendent or private
school director concerning protective measures to be implemented in the
alternative educational setting developed by school personnel; and
(6) consult with the superintendent or
private school director to determine which school personnel directly involved
with the child need to be notified of the hepatitis B virus infection in order
to prevent transmission and ensure that these persons are instructed regarding
the necessity for protecting confidentiality.
(h) If the child referred to in Paragraph (e)
of this Rule is in day care and the local health director determines that there
is a significant risk of transmission, the local health director shall notify
the parents that the child must be placed in an alternate child care setting
that eliminates the significant risk of transmission.
Authority
G.S.
130A-135;
130A-144;
Eff.
February 1, 1990;
Amended Eff. October 1, 1990;
Recodified from
15A NCAC
19A .0201(i) Eff. June 11,
1991;
Amended Eff. August 1, 1998; October 1, 1994;
Temporary Amendment Eff. February 18, 2002;
Amended Eff. April 1,
2003;
Pursuant to
G.S.
150B-21.3A, rule is necessary without
substantive public interest Eff. January 9,
2018.
