FLORIDA - COMMUNICABLE, OCCUPATIONAL, AND ENVIRONMENTAL DISEASES AND INJURIES

January 1, 2008

Florida state laws and regulations that affect your medical practice

1. Which diseases or conditions must be reported in Florida?

The following notifiable diseases or conditions are declared as dangerous to the public's health or of public health significance and should be reported as set forth below:

Acquired Immune Deficiency Syndrome (AIDS); Animal Bite (includes a bite or other significant exposure to a human by an animal that is (1) infected with or suspected of being infected with rabies, or (2) capable of transmitting herpes B viruses (includes exposures from nonhuman primates); Anthrax (T); Botulism (T); Brucellosis (T); Campylobacteriosis; Cancer (except non-melanoma skin cancer); Chancroid; Chlamydia trachomatis; Ciguatera; Congenital Anomalies; Cretzfeldt-Jakob Disease (CJD); Cryptosporidiosis; Cyclosporiasis; Dengue; Diphtheria (T); Eastern equine encephalitis (EEE); Ehrlichiosis; Encephalitis, non-arboviral (T); Encephalitis, other arboviral; Enteric disease due to Escherichia coli O157:H7 (T); Enteric disease due to other pathogenic Escherichia coli (including enterotoxigenic,enteroinvasive, enteropathogenic, enterohemorrhagic, and enteroaggregative strains); Epsilon toxin of Clostridium perfringens; Giardiasis (acute); Glanders; Gonorrhea; Granuloma Inguinale; Haemophilus influenzae, invasive disease (T); Hansen's Disease (Leprosy); Hantavirus Infection (T); Hemolytic Uremic Syndrome; Hepatitis, viral A (T), B, C, non-A, non-B, and other including unspecified; Hepatitis, viral, Hepatitis B Surface Antigen (HbsAg)-positive in a pregnant woman or a child < or = 24 months of age; Herpes simplex virus (HSV) in neonates and infants to six (6) months of age; Human Immunodeficiency Virus (HIV); Human papillomavirus (HPV) in neonates and children through twelve (12) years of age; Lead Poisoning; Legionellosis; Leptospirosis; Listeriosis (T); Lyme Disease; Lymphogranuloma Venereum; Malaria; Measles (T); Melioidiosis; Meningitis, bacterial and mycotic; Meningococcal Disease (includes meningitis and meningococcemia) (T); Mercury Poisoning; Mumps; Neurotoxic Shellfish Poisoning (T); Pertussis (T); Pesticide-Related Illness and Injury; Plague (T); Poliomyelitis (T); Psittacosis; Q Fever (T); Rabies (T); Ricin Toxin; Rocky Mountain Spotted Fever, R. rickettsii; Rubella, including congenital; St. Louis Encephalitis (SLE); Salmonellosis; Saxitoxin poisoning (paralytic shellfish poisoning); Shigellosis; Smallpox (T); Staphylococcus aureus, glycopeptide (vancomycin) intermediate (GISA/VISA, MIC = or > 8 micrograms per milliliter and = or < 32 micrograms per milliliter) (T); Staphylococcus aureus, glycopeptide (vancomycin) resistant (GRSA/VRSA, MIC > 32 micrograms per milliliter) (T); Staphylococcus enterotoxin B; Streptococcal Disease, invasive, Group A; Streptococcus pneumoniae, invasive disease; Syphilis; Tetanus; Toxoplasmosis, acute; Trichinosis; Tuberculosis; Tularemia (T); Typhoid Fever (T); Typhus Fever; Vaccinia disease; Venezuelan equine encephalitis (VEE); Vibrio cholerae (T); Vibrio Infections, other; Viral hemorrhagic fever (includes Ebola, Marburg, Lassa and Machupo) (T); West Nile virus disease (includes WNV encephalitis and WNV fever); Western equine encephalitis (WEE); Yellow Fever (T); any disease outbreak in a community, a hospital, or other institution, or a foodborne or waterborne outbreak (T); any grouping or clustering of patients having similar diseases, symptoms or syndromes that may indicate the presence of a disease outbreak including those of biological agents associated with terrorism (T).

2. To whom should these diseases be reported?

The occurrence of the listed diseases or the suspected occurrence with the exception of cancer, congenital anomalies, and HIV infection, including persons who at the time of death were so affected, shall be reported by licensed practitioners to the local health department director or administrator or designee in county of patient's residence.

64 FL ADC 64D-3.002

3. How soon after discovery of the disease must it be reported?

Reports shall be made within 72 hours of recognition by telephone, or other electronic means, or in writing, except for certain specified diseases as indicated above by a (T), which shall be reported immediately by telephone. Telephone reports shall be followed within 72 hours by a subsequent written report. There are exceptions for syphilis, HIV and AIDS, as discussed below. Cancer cases shall be reported to the Florida Cancer Data System.

64 FL ADC 64D-3.002

4. What are the reporting requirements for laboratories?

( a ) Each laboratory director or designee in charge of a laboratory shall report evidence suggestive of or diagnostic of the diseases listed above from any specimen derived from a human body or from an animal in the case or rabies or plague testing, to the county health department director or the State Health Officer or to either of their designated representatives. Such reports shall be made within 72 hours of recognition by telephone, or other electronic means, or in writing, except for certain specified diseases indicated by a (T), which shall be reported immediately by telephone and followed by a written report.

( b ) All reports of cancer identified by laboratories shall be submitted to the Florida Cancer Data System within six months of diagnosis.

( c ) The State Health Officer shall periodically, but no less than annually, issue a listing of laboratory test results that are to be reported.

( d ) To allow follow-up of laboratory findings by the local county health department director/administrator or their designee, all specimens submitted for laboratory tests or examinations related to a disease or condition shall be accompanied by certain identifying information. In addition to the name and date of birth of the person from whom the specimen was obtained; the name, address and telephone number of the processing clinical laboratory; and the diagnostic tests(s) performed, specimen type and result, the following information shall be provided:

( 1 ) Address, telephone number, race, sex, and ethnicity of the person from whom the specimen was obtained or, if this is not available,

( 2 ) Name, address and telephone number of the submitting physician, health care provider or other authorized person who submitted the specimen.

( e ) The practitioner who first authorizes, orders, requests or submits a specimen shall be responsible for obtaining and providing the information required at the time the specimen is sent to or received by the laboratory.

( f ) Notification of test results shall be submitted by telephone, or other electronic means, or in writing on a form furnished by the laboratory. Reports shall be made within 72 hours of a test result. Any preliminary telephone communication must be followed up by a written report.

( g ) If the laboratory that makes the positive finding received the specimen from another laboratory, the laboratory making the positive finding shall be responsible for reporting such results.

( h ) Each laboratory that obtains a human isolate of Escherichia coli 0157:H7, or Neisseria meningitidis or Haemophilus influenzae from a sterile site or Staphylococcus aureus with a vancomycin minimum inhibitory concentration (MIC) = or > 8 micrograms per milliliter from any site shall retain a subculture of the isolate on suitable media for at least six months after receipt of the specimen in the laboratory. In lieu of retaining this subculture, the laboratory is permitted to send the subculture to the Florida Department of Health State Central Laboratory, which will maintain a record indicating the date that these subcultures were submitted to the Central Laboratory.

( i ) Each laboratory that makes a finding, or suggestive finding, of malaria or cyclospora parasites in a specimen of a patient shall retain a stained permanent slide for at least six months after receipt of the specimen in the library. In lieu of retaining the slide(s), the laboratory may send such slide(s) to the State of Florida Department of Health Central Laboratory, which will maintain a record indicating the date that these specimens were submitted to the Central Laboratory.

( j ) Each laboratory licensed to perform tests for any reportable disease or condition shall makes its records for such diseases or conditions available for on-site inspection by the department or its authorized representatives.

( k ) Persons submitting specimens for reportable laboratory tests to the Florida Department of Health are required to supply the laboratories with sufficient information.

64 FL ADC 64D-3.003

5. Who is responsible to report animal bites to humans as well as conditions that they diagnose or suspect in animals?

Animal control officers, animal disease laboratories and wildlife officers.

64 FL ADC 64D-3.0031

4. What information must be included in notifiable disease case reports?

All reports shall contain the diagnosis, name, address, age, sex social security number, race and ethnicity if known, and date of onset of each case. Information contained in such a report is confidential and will only be released as determined as necessary by the State Health Officer for the protection of the public's health due to the highly infectious nature of the disease, the potential for further outbreaks, and/or the inability to identify or locate specific persons in contact with the cases.

64 FL ADC 64D-3.004

5. What are the reporting requirements for sexually transmissible diseases (STDs), including HIV and AIDS?

( a ) Except for the special reporting requirements for AIDS, HIV infection, early syphilis, herpes simplex virus, human papillomavirus infections, and hepatitis A and B, all reports shall be submitted on the Florida Confidential Report of Sexually Transmitted Diseases. within three (3) working days from diagnosis.

( b ) Except for AIDS, HIV, and hepatitis A and B, all reports of sexually transmissible diseases shall be completed and submitted on the Florida Confidential Report of Sexually Transmitted Diseases, DH 720, 8-02.

( c ) All cases of AIDS which meet the Centers for Disease Control and Prevention case definition of AIDS and all positive tests to diagnose HIV infection obtained from specimens collected shall be reported. Examples of tests to diagnose HIV infection are antibody-based test systems such as repeat ELISA positives followed by a confirmatory test, and antigen tests such as p24 antigen or polymerase chain reaction (PCR) when these are used for confirmatory purposes. Indeterminate test results and unconfirmed positive antibody tests are not reportable. Reporting shall be as follows:

( 1 ) AIDS cases and HIV infection shall be reported on the Adult or Pediatric HIV/AIDS Confidential Case Report Form.

( 2 ) Reports must be submitted within two weeks of the diagnosis. Reports shall be submitted to the local county health department.

( d ) Reports shall contain the following information: patient's name, address, contact telecommunication number, date of birth, sex, race and/or ethnicity (if available), social security number (if available), diagnosis, treatment, provider's name and provider's address.

( e ) All cases of early syphilis shall be reported by telephone to the local county health department within 24 hours of diagnosis.

( f ) All cases of herpes simplex virus in neonates and infants to six months of age shall be reported to the local county health department within 24 hours of diagnosis. These reports shall be submitted using the Standard STD Morbidity Report Card which is incorporated by reference in this rule and furnished by the county health department.

( g ) All cases of human papillomavirus infection in neonates and children through twelve years of age shall be reported to the local county health department within two working days of diagnosis. These reports shall be submitted using the Standard STD Morbidity Report Card.

( h ) Any report of a sexually transmitted disease shall be submitted in a sealed envelope marked "Confidential."

64 FL ADC 64D-3.016

8. What are the reporting requirements for tuberculosis?

( a ) Each individual who makes a diagnosis of or provides medical services to a person with suspected or confirmed active tuberculosis shall report or cause to be reported such diagnosis to the department.

( b ) A person has active tuberculosis when either of the following occurs:

( 1 ) A culture specimen taken from any source has tested positive for tuberculosis and the person has not completed an appropriate prescribed course of medication for tuberculosis disease, or

( 2 ) There is current radiologic, clinical, or laboratory evidence sufficient to establish a medical diagnosis of tuberculosis for which treatment is indicated and the person has not completed an appropriate prescribed course of medication for tuberculosis.

( c ) The reporting individual shall provide to the department, to the fullest extent known at the time the report is made, the following information: patient's name; patient's address (including temporary living quarters); patient's home telephone number (including temporary living quarters); patient's date of birth; sex; and race and the name, title, address and telephone number of the diagnosing physician or the individual submitting the report.

( d ) The reporting individual shall also provide pertinent diagnostic information including, but not limited to, results of Mantoux tuberculin skin tests, laboratory examinations, the 15 digit spoligotype (octal code), radiographic examinations, and physical examinations. If the spoligotyping is not available, the isolate must be submitted to the department's laboratory in Jacksonville. The department will provide the mailing materials and pay mailing costs.

( e ) Initial reports shall be submitted confidentially by telephone, facsimile or in writing within 72 hours of diagnosis. Reports shall be submitted to the county health department office having jurisdiction for the area in which the office of the reporting individual or the patient's residence is located.

( f ) Subsequent status reports on the patient's treatment and progress shall be submitted to the county health department every 3 months until the case is closed and follow-up is completed. Within the 3-month intervals, status reports shall be provided by the reporting individual upon request by the county health department.

( g ) All initial reports and subsequent status reports on the patient's treatment and progress from the reporting individual shall be submitted to the county health department office for the area in which the office of the submitting individual or patient's residence is located.

Copyright Kern Augustine Conroy and Schoppmann, P.C. Used with permission.