TEXAS - COMMUNICABLE, OCCUPATIONAL, AND ENVIRONMENTAL DISEASES AND INJURIES

January 1, 2008

State laws and regulations that affect your medical practice

1. Who is responsible for reporting communicable diseases in Texas?

( a ) A physician, dentist, veterinarian, chiropractor, advanced practice nurse, physician assistant, or person permitted by law to attend a pregnant woman during gestation or at the delivery of an infant shall report each patient (person or animal) he or she shall examine and who has or is suspected of having any notifiable condition.

( b ) The chief administrative officer of a hospital shall appoint one reporting officer who shall be responsible for reporting each patient who is medically attended at the facility and who has or is suspected of having any notifiable condition.

( d ) School authorities, including a superintendent, principal, teacher, school health official, or counselor of a public or private school and the administrator or health official of a public or private institution of higher learning should report those students attending school who are suspected of having a notifiable disease.

( e ) Any person having knowledge that a person or animal is suspected of having a notifiable condition should notify the local health authority or the department and provide all information known to them concerning the illness and physical condition of such person.

25 TX ADC § 97.2

2. What diseases are reportable in Texas?

( a ) Confirmed and suspected cases of acquired immune deficiency syndrome (AIDS); amebiasis; anthrax; botulism-adult and infant; brucellosis; campylobacteriosis; chancroid; chickenpox (varicella); Chlamydia trachomatis infection; Creutzfeldt-Jakob disease (CJD); cryptosporidiosis; cyclosporiasis; dengue; diphtheria; ehrlichiosis; encephalitis (specify etiology); Escherichia coli, enterohemorrhagic infection; gonorrhea; Hansen's disease (leprosy); Haemophilus influenzae type b infection, invasive; hantavirus infection; hemolytic uremic syndrome (HUS); hepatitis A, B, D, E, and unspecified (acute); hepatitis C (newly diagnosed infection effective 1/1/00); hepatitis B (chronic) identified prenatally or at delivery; human immunodeficiency virus (HIV) infection; legionellosis; listeriosis; Lyme disease; malaria; measles (rubeola); meningitis (specify type); meningococcal infection, invasive; mumps; pertussis; plague; poliomyelitis; acute paralytic; Q fever; rabies; relapsing fever; rubella (including congenital); salmonellosis, including typhoid fever; shigellosis; smallpox; spotted fever group rickettsioses (such as Rocky Mountain spotted fever); streptococcal disease: invasive group A, invasive group B or invasive Streptococcus pneumoniae; syphilis; tetanus; trichinosis; tuberculosis; tularemia; typhus; Vibrio infection, including cholera (specify species); viral hemorrhagic fevers; yellow fever; yersiniosis; and Severe Acute Respiratory Syndrome (SARS) as defined by the U.S. Centers for Disease Control and Prevention.

( b ) In addition to individual case reports, any outbreak, exotic disease, or unusual group expression of disease which may be of public health concern should be reported by the most expeditious means.

( c ) The following organisms should be reported: Enterococcus species; vancomycin resistant Enterococcus species; vancomycin resistant Staphylococcus aureus; vancomycin resistant coagulase negative Staphylococcus species; Streptococcus pneumoniae; and penicillin-resistant Streptococcus pneumoniae.

25 TX ADC § 97.3

3. What are the minimum requirements for reporting diseases in Texas?

( a ) Tuberculosis: Complete name, date of birth, physical address and county of residence, information on which diagnosis was based or suspected. In addition, if known, radiographic or diagnostic imaging results and date(s); all information necessary to complete the most recent versions of forms TB 400 A & B, TB 340 and TB 341; laboratory results used to guide prescribing, monitoring or modifying antibiotic treatment regimens for tuberculosis to include, but not limited to, liver function studies, renal function studies, and serum drug levels; pathology reports related to diagnostic evaluations of tuberculosis; reports of imaging or radiographic studies; records of hospital or outpatient care to include, but not limited to, histories and physical examinations, discharge summaries and progress notes; records of medication administration to include, but not limited to, directly observed therapy (DOT) records, and drug toxicity and monitoring records; a listing of other patient medications to evaluate the potential for drug-drug interactions; and copies of court documents related to court ordered management of tuberculosis.

( b ) Tuberculosis: for contacts to a known case of tuberculosis – complete name; date of birth; physical address; county of residence; and all information necessary to complete the most recent versions of forms TB 400 A & B, TB 340 and TB 341.

( c ) Tuberculosis: for other persons identified with latent TB infection – complete name, date of birth; physical address and county of residence; and all information necessary to complete the most recent versions of forms TB 400 A & B (Report of Case and Patient Services).

( d ) Hepatitis B (chronic and acute identified prenatally or at delivery): mother's name, address, telephone number, age, date of birth, sex, race and ethnicity, preferred language, hepatitis B laboratory test results; estimated delivery date or date and time of birth; name and phone number of delivery hospital or planned delivery hospital; name of infant; name, phone number, and address of medical provider for infant; date, time, formulation, dose, manufacturer, and lot number of hepatitis B vaccine and hepatitis B immune globulin administered to infant;

( e ) Chickenpox: name, date of birth, sex, race and ethnicity, address, date of onset, and varicella vaccination history;

( f ) All other notifiable diseases: name, address, telephone number, age, date of birth, sex, race and ethnicity, disease, type of diagnosis, date of onset, and physician name, address and telephone number;

( g ) Isolates of Enterococcus species and isolates of Streptococcus pneumoniae regardless of resistance patterns – numeric totals at least quarterly;

( h ) Vancomycin resistant Enterococcus species; penicillin resistant Streptococcus pneumoniae; vancomycin resistant Staphylococcus aureus; vancomycin resistant coagulase negative Staphylococcus species – name, city of submitter, date of birth or age, sex, anatomic site of culture, and date of culture; and

( i ) Hansen's disease: name; date of birth; sex; race and ethnicity; social security number; disease type; place of birth; address; telephone number; date entered Texas; date entered U.S.; education/employment; insurance status; location and inclusive dates of residence outside U.S.; date of onset and history prior to diagnosis; date of initial biopsy and result; date initial drugs prescribed and name of drugs; name, date of birth and relationship of household contacts; and name, address and telephone number of physician.

25 TX ADC § 97.3

4. Which diseases require submission of cultures?

For all Neisseria meningitides from normally sterile sites, all vancomycin resistant Staphylococcus aureus, and vancomycin resistant coagulase negative Staphylococcus species – pure cultures shall be submitted accompanied by a Specimen Submission Form G-1.

25 TX ADC § 97.3

5. What information must be included in laboratory reports?

Name, patient identification number, address, telephone number, age, date of birth, sex, race and ethnicity, specimen submitter name, address, and phone number, specimen type, date specimen collected, disease test and test result, normal test values, date of test report, and physician name and telephone number.

25 TX ADC § 97.3

6. What are the reporting requirements for diseases carried by animals?

Clinically diagnosed or laboratory-confirmed animal cases of the following diseases are reportable: anthrax, arboviral encephalitis, Mycobacterium tuberculosis infection in animals other than those housed in research facilities, plague and psittacosis, Also, all non-negative rabies tests performed on animals from Texas at laboratories located outside of Texas shall be reported; all non-negative rabies tests performed in Texas will be reported by the laboratory conducting the testing. In addition to individual case reports, any outbreak, exotic disease, or unusual group expression of disease which may be of public health concern should be reported by the most expeditious means.

25 TX ADC § 97.3

7. What information must be included on reports of diseases carried by animals?

Species and number of animals affected, disease or condition, name and phone number of the veterinarian or other person in attendance, and the animal's owner's name, address and phone number.

25 TX ADC § 97.3

8. Which notifiable diseases are considered public health emergencies?

These cases shall be reported immediately by phone to the local health authority or the regional director of the Texas Department of Health: anthrax; botulism, foodborne; diphtheria; Haemophilus influenzae type b infection, invasive; measles (rubeloa); meningococcal infection, invasive; pertussis; poliomyelitis, acute paralytic; plague; rabies; smallpox; viral hemorrhagic fevers; yellow fever. Vancomycin resistant Staphylococcus aureus and vancomycin resistant coagulase negative Staphylococcus species shall be reported immediately by phone to the Infectious Disease Epidemiology and Surveillance Division, Texas Department of Health, Austin at (800) 252-8239.

25 TX ADC § 97.4

9. How much time is required to report diseases not considered public health emergencies?

( a ) One working day: brucellosis, hepatitis A (acute), Q fever, rubella (including congenital), tularemia, tuberculosis, and Vibrio infection (including cholera).

( b ) One week: Tuberculosis antibiotic susceptibility results should be reported by laboratories no later than one week after a case or suspected case is identified.

( c ) Enterococcus species; vancomycin resistant Enterococcus species; Streptococcus pneumoniae; and penicillin-resistant Streptococcus pneumoniae – reports shall be made no later than the last working day of March, June, September and December.

( d ) All Neisseria meningitides from normally sterile sites, all vancomycin resistant Staphylococcus aureus, and all vancomycin resistant coagulase negative Staphylococcus species shall be submitted as pure cultures to the Texas Department of Health, Bureau of Laboratories, 1100 West 49th Street, Austin, Texas 78756-3199 as they become available.

25 TX ADC s 97.4

10. How much time is required for reportable conditions in animals?

Reportable conditions affecting animals shall be reported within one working day following the diagnosis to either the appropriate Texas Department of Health regional zoonosis control office or the Zoonosis Control Division office in Austin. Conditions in animals that are reportable to both the Texas Department of Health and the Texas Animal Health Commission can be reported to either one of the agencies which will forward the information to the other agency.

25 TX ADC s 97.4

11. Who is responsible for reporting sexually transmitted diseases in Texas?

( a ) A physician or dentist shall report each patient that is diagnosed or treated for AIDS, chancroid, Chlamydia trachomatis infection, gonorrhea, HIV infection, or syphilis. A physician or dentist may designate an employee of the clinic, including a school based clinic or physician/dentist's office to serve as the reporting officer. A physician or dentist who can assure that a designated or appointed person in the clinic or office is regularly reporting every occurrence of these diseases does not have to submit a duplicate report.

( b) The chief administrative officer of a hospital, medical facility, or penal institution shall report each patient who is medically attended at the facility and is diagnosed with AIDS, chancroid, Chlamydia trachomatis infection, gonorrhea, HIV infection, or syphilis. The chief administrative officer may designate an employee of the institution to serve as the reporting officer. A chief administrative officer who can assure that a designated or appointed person in the institution is regularly reporting every occurrence of these diseases does not have to submit a duplicate report. Hospital laboratories may report through the reporting officer or independently in accordance with the hospital's policies and procedures.

( c ) Any person in charge of a clinical laboratory blood bank, mobile unit, or other facility in which a laboratory examination of a blood specimen or any specimen derived from a human body that yields microscopic, cultural, serological or any other evidence of AIDS, chancroid, Chlamydia trachomatis infection, gonorrhea, HIV infection, or syphilis, including a CD4+ T lymphocyte cell count below 200 cells/microliter or a CD4+ T lymphocyte percentage of less than 14%.

( d ) The medical director or other physician responsible for the medical oversight of a counseling and testing site of a community-based organization shall report each patient that is diagnosed with AIDS, chancroid, Chlamydia trachomatis infection, gonorrhea, HIV infection, or syphilis. The medical director or clinic physician may designate an employee of the counseling and testing site or community-based organization to serve as the reporting officer. A medical director or clinic physician who can assure that the designated reporting officer is regularly reporting every occurrence of these diseases does not have to submit a duplicate report.

( e ) School administrators who are not medical directors are exempt from reporting AIDS, chancroid, Chlamydia trachomatis infection, gonorrhea, HIV infection or syphilis.

( f ) Failure to report a reportable disease is a Class B misdemeanor under the Texas Health and Safety Code.

25 TX ADC s 97.132

12. What are the procedures for reporting sexually transmitted diseases?

( a ) Reports of AIDS, HIV infection, CD4+ T Lymphocyte cell count below 200 cells/microliter, or CD4+ T lymphocyte percentage of less than 14% shall be made using all of the information collected by the reporting entity found in the most current version of forms CDC 50.42B, CDC 50.42C, or STD-28.

( b ) Reports of chancroid, chlamydia trachomatis infection, gonorrhea and syphilis shall be made using all of the information collected by the reporting entity found in the most current version of form STD-27 or STD-28.

( c ) Reports pertaining to congenital syphilis shall be made using all of the elements found in the most current version of the form adopted by the Bureau of HIV and STD Prevention.

( d ) Reports pertaining to enhanced perinatal HIV surveillance shall be made using all of the elements found in the most current version of the form adopted by the Bureau of HIV and STD Prevention.

25 TX ADC s 97.133

13. What other types of injuries or conditions are reportable?

Submersion injuries, traumatic spinal cord injuries, traumatic brain injuries and information on trauma patients. All pre-hospital calls where the pre-hospital provider is dispatched, responds, provides care and/or transports a patient should be reported.

25 TX ADC s 103.12

14. What are the reporting requirements for human exposure to rabies?

( a ) Any person having knowledge of a potential rabies exposure to a human will report the incident to the local rabies control authority as soon as possible, but not later than 24 hours from the time of the incident. This requirement does not apply to bites by low risk animals.

( b ) The owner or custodian of the potentially rabid animal will place that animal in quarantine or submit it for testing.

( c ) The local rabies control authority will investigate each potential exposure and assure appropriate resolution.

25 TX ADC s 169.25

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