(a) Laboratory specimens for diagnosis of cases and release.

1. (1)

   1. (A) Samples of feces and whole blood submitted to the Public Health Laboratory for culture within the first week of the suspected case of typhoid fever give the greatest probability of obtaining a positive result insofar as the culture is concerned.
   2. (B) Such cultures when positive are the only proof of diagnosis of typhoid fever.

2. (2)

   1. (A) All patients testing positive for typhoid fever should undergo additional testing to determine if they are a carrier.
   2. (B) Carrier testing involves submission of successive stool samples at least one (1) month apart until three (3) negative samples are obtained.

3. (3)

   1. (A) Patients who have been determined to have typhoid fever shall be:

(i) Isolated or excluded for such period as required; and

1. (ii) Released from isolation and supervision only by the health authority.

   1. (B) If the person is continent and does not work in food handling, then they do not have to be excluded.

   2. (C) If the person is incontinent or a food handler, then they will be required to be excluded from job duties and followed by the Department of Health until they:

      1. (i) Have three (3) negative stool samples at least one (1) month apart; and
      2. (ii) Are cleared through the Department of Health.

(b) Typhoid carriers.

1. (1)

   1. (A) Any person who has recovered from typhoid fever, and in whose feces or urine typhoid bacilli are present one (1) year or longer after such recovery, shall be declared to be a chronic carrier.

   2. (B) Any person who has recently recovered from typhoid fever and from whose feces or urine typhoid organisms are cultured by the Public Health Laboratory during the first year from such recovery shall:

      1. (i) Be considered a convalescent, or temporary carrier; and
      2. (ii) Conform to all rules regarding the control of typhoid carriers.
   3. (C) Any person found in the investigation of a case or cases of typhoid fever from whose feces or urine typhoid bacilli are cultured by the Public Health Laboratory shall be declared to be a chronic carrier except that such person be one who has recently recovered from typhoid fever.

2. (2) Control of typhoid carriers.

   1. (A) The urine and feces of a typhoid carrier shall be disposed of in such a manner that they will not:

      1. (i) Endanger any public or private water supply; or
      2. (ii) Be accessible to flies.
   2. (B) No typhoid carrier shall prepare or handle any food or drink to be consumed by persons other than members of the household with whom he or she resides.

   3. (C)

      1. (i) No typhoid carrier shall:

(b) (b) Conduct a lodging house in which, prior to taking lodgers, a separate toilet and bathroom have not been installed for the use solely of the typhoid carrier.

1. (ii) Said toilet shall be located in a part of the house separate from any part that may be occupied by a lodger.

   1. (D)

      1. (i) Any person determined to be a typhoid carrier as defined in this part shall sign an agreement, to be witnessed by at least two (2) persons.
      2. (ii) Said agreement shall read as follows: TYPHOID CARRIER AGREEMENT In view of the fact that I have been proven to be a Typhoid carrier, I do solemnly swear to abide by the following rules as long as I remain a Typhoid carrier, which I understand will probably be for the remainder of my life: 1. Under no circumstances will I handle milk or milk products such as cream, ice cream, butter or cheese, nor any other foodstuffs, nor will I do any cooking of food except for my own individual consumption and for those members of my immediate family who have been immunized against typhoid fever within the past three years. 2. Following each visit to the toilet I will wash my hands thoroughly with soap and water. 3. I will inform the Arkansas Department of Health, Outbreak Response Section, 4815 West Markham Street, Little Rock, Arkansas 72205-3867, by phone at 1-501-537-8969, in advance of any change in address from that listed below. Signature of Carrier Complete Address of Carrier Signatures and addresses of two witnesses Name Address Name Address Date of Signing

2. (3) Release of chronic typhoid carriers from control restrictions.

   1. (A)

      1. (i) A chronic typhoid carrier may be released from restrictions only on approval of the Secretary of the Department of Health and only after submitting proof of a minimum of six (6) consecutive negative feces cultures (for urinary carriers, urine cultures):

(b) (b) Performed by the Public Health Laboratory.

1. (ii) At least two (2) of the specimens must be liquid stools obtained after administration of a cathartic such as magnesium sulfate.

   1. (iii) At least two (2) of the specimens must be validated by collection under close supervision as having come from the carrier.

      1. (iv) For fecal carriers, the identity of the specimen may be confirmed by:

(b) (b) Finding this material in a specimen.

1. (v) Cultures of duodenal fluid may be substituted for stool cultures, if desired.

   1. (B)

      1. (i) A released chronic carrier who wishes to work in a food handling or other occupation from which carriers are excluded must present evidence from a local health department that he or she has received instruction in methods of:

(b) (b) Personal hygiene.

1. (ii) While employed in such a restricted occupation, he or she must submit evidence of a negative stool, or urine if appropriate, culture and additional food handling instruction every year.