6 CCR 1009-1
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT EPIDEMIC AND COMMUNICABLE DISEASE CONTROL 6 CCR 1009-1 [Editor’s Notes follow the text of the rules at the end of this CCR Document.] Adopted by the Board of Health on January 21, 2026 Authority for establishing rules and regulations related to epidemic and communicable disease control The following regulations are promulgated pursuant to § 25-1-122, C.R.S., which states the State Board of Health (Board) has the authority to require reporting of occurrences of diseases and conditions to public health, and § 25-1.5-102 C.R.S., which states the Board shall determine, by rule and regulation, those epidemic and communicable diseases and conditions that are dangerous to the public health. Other pertinent statutes are referenced in this rule throughout the text. Purpose ● 6 CCR 1009-1 names the communicable diseases and conditions reportable to the Colorado Department of Public Health and Environment (the Department) or the county, district, or municipal public health agency; the manner of reporting; and parameters around information sharing and data confidentiality; and outlines public health’s authority to conduct investigations and implement disease control measures.
● 6 CCR 1009-1 is revised as needed to reflect current disease control and epidemiological priorities through the standard rulemaking process. Definitions For the purposes of these regulations:
A. Bioterrorism: intentionally releasing viruses, bacteria, toxins, fungi, or other biological agents to harm people.
B. Bioterrorism agents: bacteria, viruses, or toxins that cause illness and could be used for bioterrorism, including but not limited to, anthrax, plague, smallpox, tularemia, botulism, viral hemorrhagic fever, and brucellosis.
C. Board: Colorado State Board of Health.
D. Clinical material: (1) a culture isolate containing the infectious organism for which submission of material is required, or (2) if an isolate is not available, material containing the infectious organism for which submission of material is required, in the following order of preference: (a) a patient specimen; (b) nucleic acid; or (c) other laboratory material.
E. Electronic case reporting (eCR): the automated exchange of case report information between electronic health records and the Department using standards set forth by the Department.
F. Electronic laboratory reporting (ELR): the automated transmission of digital laboratory reports from laboratories and other disease reporters to the Department using standards set forth by the Department.
G. Electronic methods: any automated system designed to facilitate reporting with minimal human intervention as well as any web-based interface specified by the Department as acceptable for reporting, such as the Colorado Disease Reporting Portal or condition-specific Research Electronic Data Capture (REDCap) forms.
H. Gender identity: an individual’s sense of being male, female, nonbinary, or something else, and which may or may not correspond with their sex assigned at birth.
I. Healthcare-associated infection (HAI): a localized or systemic condition that results from an adverse reaction to the presence of an infectious agent or its toxins that was not present or incubating at the time of admission to the healthcare facility. Examples include: antimicrobial resistant infections; bloodstream infections; bone and joint infections; cardiovascular system infections; central nervous system infections; eye, ear, nose, throat, or mouth infections; gastrointestinal system infections; pneumonia; reproductive tract infections; skin and soft tissue infections; surgical site infections; systemic infections; and urinary tract infections.
J. Healthcare facility: a center where patient care is delivered, including, but not limited to, any hospital, freestanding emergency department, skilled nursing facility, rehabilitation facility, home healthcare agency, urgent care clinic, community health clinic, outpatient clinic, dental clinic, ambulatory surgical center, birth center, dialysis center, hospice, or specialty hospital.
K. Healthcare provider: a person who has direct or supervisory responsibility for the delivery of healthcare or medical services, including but not limited to licensed physicians, nurse practitioners, physician assistants, nurses, dentists, coroners, medical examiners, and any other person providing testing and/or counseling to a person with a sexually transmitted infection or other reportable condition.
L. Laboratory: an entity performing testing on patient samples or specimens that identifies a reportable finding as defined in this rule, including, but not limited to, in-clinic testing, hospital laboratory testing, primary clinical laboratory testing, reference laboratory testing, testing at blood banks and plasma donation centers, and testing for the purpose of research. For the purposes of this rule, laboratories include out-of-state laboratories that maintain an office or collection facility in Colorado or arrange for collection of specimens in Colorado, as well as in-state laboratories that send specimens to out-of-state referral laboratories.
M. Normally sterile site: A part of the body where bacteria are typically not present. For these regulations, a normally sterile site is blood, cerebrospinal fluid (CSF), pleural fluid (includes chest fluid, thoracentesis fluid), peritoneal fluid (includes abdominal fluid, ascites), pericardial fluid, bone (includes bone marrow), joint or synovial fluid, needle aspirate or culture of any specific joint, and internal body sites (sterilely obtained from biopsy/tissue/abscess/ aspirate/fluid/swab from lymph node, brain, heart, liver, spleen, vitreous fluid, kidney, pancreas, vascular tissue, or ovary). Skin and skin abscesses are not considered sterile sites.
N. Outbreak: more instances of illness in a given timeframe, setting, or group of people than what is usually expected. For the purpose of this regulation, an outbreak and an epidemic are the same and are equally reportable. While not limited to the following categories, reportable outbreaks may fall into any category below:
O. Point of care test: a clinical test on patient samples or specimens performed at or near the site of patient care. These are generally rapid tests often performed in outpatient or mobile settings distant from clinical laboratories. Regulation 1. Reportable diseases, conditions, and related events In accordance with these regulations, reportable diseases, conditions, and related events (hereafter referred to as “reportable conditions”) ● Are declared to be potentially dangerous to public health and must be reported to the Department whether they are suspected or confirmed, and ● Pertain to those diagnosed or detected in humans, with the exception of those outlined in Regulation 8. Reporting of diseases among animals and waiver process for rabies inoculation.
A full list of reportable conditions appears in Appendix A: Reportable diseases, conditions, and related events table.
The Board also requires the reporting of any unusual illness, outbreak, or epidemic which may be a risk to the public whether known to be, or suspected of being, communicable. These must be reported immediately by telephone to the Department or county, district, or municipal public health agency by any disease reporters designated in this rule.
Disease reporters must report required data elements, as listed in Appendix B: Required data elements, to the Department in the manner and time frame delineated in Regulations 2 and 3 and Appendix A.
The Department shall develop or specify systems and forms for reporting for healthcare facilities, healthcare providers, laboratories, and other reporters. When reports are made electronically using systems and protocols as approved by the Department or Federal agencies that ensure protection of confidentiality, such reporting is acceptable and is considered good faith reporting.
Regulation 2. Reporting by healthcare providers, healthcare facilities, and additional disease reporters Reporting by healthcare providers:
Healthcare providers must report ● A suspected or confirmed case of any reportable condition in Appendix A where Reporter includes “P.” Healthcare providers must not defer this reporting responsibility to laboratories. Reports must be made in the time frame specified in Appendix A.
○ Conditions that are reportable by both a laboratory and a healthcare provider (marked “L&P” in Appendix A) are conditions for which information reported by the laboratory alone is not sufficient for public health response.
● A suspected or confirmed outbreak, epidemic, or unusual illness as described in Regulation 1 to the Department or county, district, or municipal public health agency about which the healthcare provider has knowledge. These outbreaks and events must be reported by phone within 4 hours of identification. ● Any reportable point of care test result. Reports must be made in the time frame specified in Appendix A. Point of care test reporting may include ensuring the result is properly transmitted to the Department by electronic laboratory reporting
All cases and events are to be reported with the data elements listed in Appendix B under “healthcare provider.” Reporting via electronic methods, such as a web-based interface specified by the Department or electronic case reporting (eCR), is preferred with the exception of reportable conditions marked “Immediate” and suspected or confirmed outbreaks.
The healthcare provider retains responsibility for ensuring the Department receives reports in accordance with these regulations. However, a designee at a facility or system that the provider is affiliated with may report on the provider’s behalf. Reporting animal bites Any healthcare provider (“P”) or veterinarian (“V” in Appendix A) with knowledge of a reportable animal bite to a human must report the bite to the Department. For bites by owned dogs and cats, the report must include the name, phone number and location information of the animal’s owner, if known. For bites by bats, skunks, foxes, raccoons, coyotes, and other wild carnivores, as well as non-bite bat exposures, the report must include the location information of the exposure event and the current location and status of the animal in addition to the information required for the bite victim. Reporting by healthcare facilities:
Healthcare facilities must report ● Suspected or confirmed cases of any reportable condition listed in Appendix A where the Reporter column contains “F.” This includes cases of hospitalized influenza, respiratory syncytial virus (RSV), and COVID-19 that must be reported by the facility where the person is hospitalized, and tuberculin skin test results (TST - defined as equal to or greater than 5 mm induration) or positive interferon- gamma release assay (IGRA) results in healthcare, correctional facility, or detention facility workers if the worker has had prolonged or frequent face-to-face contact with an infectious tuberculosis case. All cases are to be reported with the data elements listed in Appendix B under “facility.” Reporting via electronic methods, such as a web-based interface specified by the Department or eCR, is preferred.
● A suspected or confirmed outbreak, epidemic, or unusual illness as described in Regulation 1 to the Department or county, district, or municipal public health agency about which the healthcare facility has knowledge. These outbreaks and events must be reported by phone within 4 hours of identification. ● Healthcare-associated infections (HAIs)
○ Methicillin-resistant Staphylococcus aureus (MRSA) LabID events must be reported by acute care hospitals via NHSN and by conferring rights to the Department to view the data. This condition is not covered by § 25-3-601, C.R.S., and is therefore listed in Appendix A.
○ Facilities choosing to voluntarily participate in applied public health projects related to HAIs will make medical records available for review by the Department upon request within a reasonable time frame. Facilities may report healthcare provider-reportable conditions on behalf of individual providers. When a facility reports on behalf of a provider, the healthcare facility must include all data elements listed in Appendix B under “provider.” The Department has the authority to receive and utilize pertinent data for any reportable condition from the electronic health record (EHR) via eCR for any facilities that have onboarded to eCR.
Reporting by educational settings, assisted and senior living settings, correctional settings, other congregate living settings, and additional disease reporters:
Persons in charge of schools, licensed child care facilities, institutions of higher education, assisted living, independent senior living, correctional settings, any other congregate living settings such as shelters and group homes, or their designee, or others with knowledge of the reportable conditions specified below must report ● A suspected or confirmed outbreak as described in Regulation 1 to the Department or county, district, or municipal public health agency. These outbreaks must be reported by phone within 4 hours of identification. ● A suspected or confirmed case of a reportable condition that is identified in Appendix A where Reporter = “A.” This includes animal bites and bat exposures. Reports must be made in the time frame specified in Appendix A. With the exception of suspected or confirmed outbreaks, which must be reported by phone within 4 hours of identification, reporting via electronic methods such as via a web-based interface specified by the Department is preferred. Healthcare providers (as defined in these regulations) who provide patient care within the settings above are required to report conditions as specified under the section above for healthcare providers.
Regulation 3. Laboratory Reporting Reporting:
Laboratories must report ● Results that are diagnostic of or highly correlated with a reportable condition, as listed in Appendix A where Reporter includes “L.”
● The results of any reportable test that is specifically listed in Appendix A where Reporter includes “L.” For some conditions, this includes negative test results, antibody test results, or genotype or sequencing information. ● A suspected or confirmed outbreak, epidemic, or unusual illness as described in Regulation 1 to the Department or county, district, or municipal public health agency. These outbreaks and events must be reported by phone within 4 hours of identification.
Laboratories must report to CDPHE in the time frame specified in Appendix A. Reports must contain the data elements listed in Appendix B.
Laboratories must report all test results and patient information using ELR or a web- based interface specified by the Department if using ELR is not possible. Conditions marked as “immediate” must be reported by phone within 4 hours of positive results. Specimen submission to the State Public Health Laboratory, as described in the next section, does not constitute disease reporting.
Specimen submission to the State Public Health Laboratory: For organisms in Appendix A where the column “send clinical material” is “required” or “upon request,” testing laboratories must submit bacterial culture isolates or patient clinical material that yields positive findings to the State Public Health Laboratory no later than one working day after the detection of positive findings in the manner specified by the Department. Clinical material may be requested regardless of whether testing was performed for the purpose of detecting colonization or infection. All specimens must be accompanied by a test order with the following information: ● Patient's name, date of birth, sex assigned at birth, race, ethnicity, phone number, physical address (including city and county), email address, and preferred language ● Pregnancy status must be included with testing for syphilis, HIV, hepatitis B and hepatitis C ● Name, address and phone number of responsible physician or other healthcare provider ● Name of disease or condition ● Laboratory information–test name, collection date, specimen accession number, and specimen type.
● Name, address, and phone number of the laboratory submitting the specimen Regulation 4. Treatment and control of tuberculosis The emergence of multi-drug-resistant tuberculosis in this country and state dictates a coherent and consistent strategy to protect public health. The underlying principles of disease control expressed in the following rules are as follows: use of the most rapid and modern diagnostic methods by laboratories, rapid reporting, full patient compliance with medical treatment, and prevention of spread of tuberculosis in healthcare settings. The tuberculosis statute (§ 25-4-501, et seq., C.R.S.) covers subject matters not included in these regulations.
A. All confirmed or suspected cases of active tuberculosis disease, regardless of whether confirmed by laboratory tests, must be reported to the Department or county, district, or municipal public health agency within one working day by all healthcare providers, laboratories, and healthcare facilities as defined in these regulations or any other person providing treatment to the confirmed or suspected case. All cases and events are to be reported with the data elements listed in Appendix B. If reported by a healthcare provider, the healthcare provider shall also give the evidence upon which the diagnosis of tuberculosis was made or why tuberculosis is being considered, the suspected or confirmed affected body part, and whether it is confirmed or suspected tuberculosis disease. For the purposes of this reporting requirement, “suspected” is defined as anyone being considered for tuberculosis disease as part of the differential diagnosis, leading to the ordering and performing of any tuberculosis testing.
B. Healthcare providers and healthcare facilities must report within four calendar days a positive TST (defined as equal to or greater than 5 mm induration) or positive IGRA test (based on manufacturer’s interpretation criteria) in a healthcare, correctional facility, or detention facility worker if the worker has had prolonged or frequent face-to-face contact with an infectious tuberculosis case.
C. Laboratories must report within one working day any result diagnostic of or highly correlated with active tuberculosis disease, including culture and nucleic acid amplification tests (NAAT) positive for Mycobacterium tuberculosis or similar confirmatory testing, and sputum smears positive for acid-fast bacilli. Laboratories must report the results of tests for antimicrobial susceptibility performed on positive cultures for tuberculosis.
D. When a laboratory performs a culture that is positive for Mycobacterium tuberculosis, the laboratory must submit a sample of the isolate to the State Public Health Laboratory no later than one working day after the detection of positive findings.
E. The Department or county, district, or municipal public health agency is authorized to perform evaluations of the timeliness of laboratory diagnostic processes. The data collected in an evaluation may include the mean, median, and range for the following indices: the length of time from specimen collection to isolation; the length of time from isolation of an organism to identification of the organism as Mycobacterium tuberculosis; and the length of time from isolation until antimicrobial susceptibility test results are finalized. The Department or county, district, or municipal public health agency shall provide the laboratory and hospital the results of its evaluation, including comparison of the laboratory indices to norms for other similar laboratories.
F. The Board determines that to prevent the emergence of multi-drug-resistant tuberculosis, it is necessary, appropriate, and standard medical practice for persons with active tuberculosis disease to receive directly observed therapy
G. All healthcare providers within all correctional and healthcare facilities providing inpatient testing or treatment to persons with suspected and confirmed active tuberculosis disease must notify and include the Department or county, district, or municipal public health agency when they begin their discharge planning process and involve the Department or county, district, or municipal public health agency in the transition planning process prior to discharging the patient from the facility to ensure a safe and appropriate discharge plan is in place for the safety of the patient and the community. Public health will be involved in the discharge planning to ensure continuity of care, safe discharge for the patient and community, appropriate medication regimen, arrangement of home visits, and directly observed therapy.
H. All licensed hospitals and nursing home facilities must maintain a registry of the TST and/or IGRA test results of healthcare workers in their facility, including healthcare providers who are not employees of the facility but provide care to or have face-to-face contact with patients in the facility. The facility must maintain such TST and IGRA test results as confidential medical information. Pursuant to § 25-4-508, C.R.S., authorized personnel of the Department may inspect and have access to such a register in the course of an investigation intended to identify sources and contacts of a case of active tuberculosis disease and to control tuberculosis.
I. Tuberculosis screening and control requirements:
Regulation 5. Investigations to confirm the diagnosis, treatment, and causes of epidemic and communicable diseases and to determine appropriate methods of epidemic and communicable disease control Investigations may be conducted to confirm the diagnosis, treatment, and causes of identified or potential reportable conditions and are considered official duties of the Department or county, district, or municipal public health agencies. Investigations may be conducted to evaluate exposures to known causes of reportable conditions for purposes of case identification and prevention. Reasonable efforts shall be made by the Department or county, district, or municipal public health agencies to consult with the responsible physician, other healthcare providers, or the medical facility caring for the patient prior to any further follow-up by Department or county, district, or municipal public health agencies. Such investigations may include, but are not limited to:
A. Review of pertinent, relevant medical records by authorized personnel, if necessary to confirm the diagnosis; to investigate causes; to identify other cases related to the outbreak or the reported communicable disease in a region, community, or workplace; to determine if a patient with a reportable disease has received adequate treatment to render the person non-infectious or a person exposed to a case has received prophylaxis, if appropriate. Such review of records may occur without patient consent and shall be conducted at reasonable times and with such notice as is reasonable under the circumstances. Such review of records may include negative or inconclusive laboratory results. Where feasible, facilities are encouraged to provide remote electronic access to authorized health department staff for this purpose.
B. Performing follow-up interview(s) with the case or persons knowledgeable about the case to collect information pertinent and relevant to the cause(s) of or risk factors for the reportable condition.
C. Medical examination and testing of persons with the explicit consent of such persons.
D. Obtaining from public or private businesses or institutions the lists of persons with a similar or common potential exposure to a reported case; such exposure may be current or have occurred in the past.
E. Interviewing or administering questionnaire surveys confidentially to any person residing in or visiting a Colorado community or any agent, owner, operator, employer, employee of a public or private business or institution that is either epidemiologically associated with a reported case or has had a similar exposure as a reported case.
F. Collecting and analyzing samples or measurements of items that may be related to the cause of the outbreak or reportable disease.
G. Taking photographs or videos related to the purpose of the investigation. If the photographs/videos are taken in a business, the Department will give the employer the opportunity to review the photographs/videos taken or obtained for the purpose of identifying those which contain or might reveal a trade secret.
H. Entering a public or private entity, such as a business or school, for the purpose of conducting investigations of those processes, conditions, structures, machines, apparatus, devices, equipment, records (including but not limited to current and former employee/student rosters and contact information, schedules, health and medical information, job duties and descriptions, and patron or client contact information), and materials and supplies within the place of employment which are relevant, pertinent, and necessary to the investigation; such investigations must be conducted during regular working hours or at other reasonable times and with such notice as is reasonable under the circumstances.
I. Review of workers' compensation claims.
J. Review of toxic tort or product liability claims filed with state or federal courts within the state.
K. Review of previously conducted environmental or product sampling data that may be related to the cause of the outbreak or reportable disease. Regulation 6. Information sharing Whenever a county, district, or municipal public health agency learns of a case of a reportable disease or an outbreak or epidemic or communicable disease exposure potentially threatening to public health, it must notify the Department or the local jurisdiction in which the case resides in a timely manner, usually within the timeframe for reporting in Regulations 2, 3, and Appendix A. Utilizing the statewide disease reporting system developed and in use by the Department and county, district, and municipal public health agencies fulfills the notification requirement. The Department must, in turn, notify the appropriate county, district, or municipal public health agency in a timely manner, usually within the timeframe for reporting in Regulations 2, 3, and Appendix A, whenever it learns of a case of a reportable disease or of an epidemic or communicable disease exposure potentially threatening to public health in the local agency’s jurisdiction. Utilizing the statewide disease reporting system developed and in use by the Department and county, district, and municipal public health agencies fulfills the notification requirement.
These requirements will not apply if the Department and county, district, or municipal public health agencies mutually agree not to share information on reported cases. Sharing of medical information on persons with reportable diseases between authorized personnel of the Department and county, district, or municipal public health agencies must be restricted to information necessary for the treatment, control, investigation, and prevention of epidemic and communicable diseases dangerous to public health. Regulation 7. Food handling and infected persons No person, while infected with a disease in a communicable form that can be transmitted by foods or who is afflicted by a boil, or an infected wound, shall work in a food processing, milk producing, milk processing or food service setting in any capacity in which there is a likelihood of such person contaminating food or food contact surfaces with pathogenic organisms or transmitting diseases to other persons. The employer is responsible for ensuring the exclusion or restriction from work of an employee with an infectious disease for which there is evidence of transmission to persons in a food service, food processing, milk producing, or milk processing setting, as determined by the Department.
Regulation 8. Reporting of diseases among animals and waiver process for rabies inoculation A. Every veterinarian, livestock owner, veterinary diagnostic laboratory director, or other person having the care of, or knowledge of, the existence of animals having or suspected of having any disease which may endanger public health such as rabies, anthrax, plague, tularemia, encephalitis, bovine spongiform encephalopathy, novel influenza viruses, coronaviruses that cause novel or severe human disease, including SARS-CoV-2, etc., must report the facts to the Department or county, district, or municipal public health agency within the reporting timeframes outlined for providers and laboratories in Appendix A.
B. Pursuant to § 25-4-607 (2), C.R.S., a veterinarian licensed in Colorado may issue a written waiver, as provided in this section, exempting an animal from a rabies vaccination order if the veterinarian, in their professional opinion, determines the rabies inoculation is contraindicated due to the animal’s medical condition. The terms “waiver” and “exemption” as used in this section are interchangeable. A veterinarian may issue a waiver if:
C. A waiver may not exceed a period of three years from the date of issuance. If the medical condition persists beyond a three year period and, in the professional opinion of a veterinarian licensed in Colorado, the exemption continues to be appropriate, a new waiver may be issued.
D. Upon receiving a complaint regarding the validity of a rabies inoculation exemption, the executive director or their designee(s) may review Exemption from Rabies Vaccination forms and examine the veterinary records pertaining to the medical condition to determine if the medical condition legitimately contraindicates rabies inoculation. If appropriate, the executive director or their designee(s) may refer the case to the Board of Veterinary Medicine. Regulation 9. Confidentiality All personal medical records and reports held or viewed by the Department or county, district, or municipal public health agency in compliance with these regulations are confidential information subject to §§ 25-1-122(4) and 25-4-406(1), C.R.S. This information is to be used by the public health agencies as source material for necessary disease control efforts and the development of prevention programs. Regulation 10. Use of Sterile Needles, and Cleaning and Disinfection of Other Instruments, Probes, and Devices Used by Practitioners of Acupuncture and Adjunctive Therapies (promulgated by the Executive Director) This regulation is promulgated pursuant to § 12-200-1115, C.R.S., which states the Department shall promulgate rules relating to the proper use of sterile needles used in the practice of acupuncture and the sanitation of acupuncture offices. All parts of the premises of an acupuncture establishment shall be kept in a clean, sanitary, neat, and orderly condition at all times. All surfaces (e.g., tables, counters, chairs, etc.) used in connection with procedures shall be cleaned and disinfected with a disinfectant registered by the U.S. Environmental Protection Agency (EPA) that is approved for use in healthcare settings. Cleaning and disinfection shall occur following each use and according to the disinfectant manufacturer label instructions. Puncturing devices shall be defined as any needle, instrument, probe, or other devices utilized by practitioners of acupuncture, or adjunctive therapies, that punctures the skin or enters tissue of any patient/client. Needles and other puncturing devices shall be sterile and disposable single-use items that are appropriately discarded immediately after use in an appropriate sharps container, and shall never be used on more than one patient/client. The Food and Drug Administration (FDA) requires that sterile needles be used and always labeled for single patient use.
Equipment shall be defined as any item utilized by practitioners of acupuncture, or adjunctive therapies, that serve as vehicles for needles or other puncturing devices. These items do not puncture the skin or enter the tissue. Equipment shall either be disposable, single-use items (preferred), or thoroughly cleaned and disinfected between each patient/client use according to the manufacturers’ instructions. If there are no manufacturers’ instructions for how to clean and disinfect the equipment, the equipment shall not be used on more than one patient and disposed of properly. Acupuncture and adjunctive therapies where sterile needles and puncturing devices are used shall only be performed by licensed practitioners. Prior to and after each treatment of acupuncture, the practitioner shall perform hand hygiene by either washing their hands with soap and water or using an alcohol-based hand sanitizer. Regulation 11. Sexually transmitted infections The Board recognizes that non-sexual transmission may occur for some infections, and in individual cases, based on clinical and epidemiologic information, the responsible physician or other healthcare provider may conclude the patient’s infection was not sexually acquired.
Information concerning testing, treatment, causes, or the prevention of sexually transmitted infections (STIs) shall be shared, to the minimum extent necessary to achieve the public health purpose, between the appropriate county, district, or municipal public health agency, contracted agency, Ryan White Comprehensive Human Immunodeficiency Virus (HIV) Resources Emergency Act-funded agency, or other health agency or person providing direct services related to STIs and the Department, as provided by § 25-4-406(1)(b), C.R.S.
With respect to Regulation 5, investigations related to STIs will be limited to the information necessary to confirm the diagnosis, treatment, source of infection, and identification of measures that may be used to prevent additional STIs. The Department shall destroy personal identifying information of all persons with CD4 or viral load results if the investigation subsequent to the report finds no evidence of a STI. Section 25-4-411 (1), C.R.S., requires the Department to conduct an anonymous counseling and testing program for persons considered to be at high risk for the acquisition of HIV. The provision of confidential counseling and testing for HIV is the preferred screening service for detection of HIV infection. Local boards of health who provide HIV counseling and testing through a contractual agreement with the Department shall consider the need for an anonymous HIV testing option in their jurisdiction, upon petition. The consideration of this option must provide an opportunity for public comment in a public forum, including anonymous testimony presented in writing or through an organization. Local boards of health electing to provide confidential HIV testing with an anonymous option must do so in conjunction with publicly-funded HIV testing and counseling projects.
Operational standards:
A. All persons providing HIV testing and counseling at a publicly funded HIV testing and counseling project in a non-healthcare setting will have completed an HIV testing and counseling course approved by the Department.
B. All persons performing partner services will have completed courses concerning introduction to STI interviewing and partner notification, and other related courses as specified by the Department.
C. Of all HIV tests performed at a publicly funded HIV testing and counseling project, 99% of those persons testing HIV positive will receive test results and appropriate post-test counseling related to those test results. Publicly funded HIV testing sites shall make a good faith effort to inform all persons of their test results and shall provide pertinent HIV prevention counseling and referrals.
D. All persons newly diagnosed with HIV will be referred for partner services and assessed for linkage to care services. A minimum of 75% of those offered partner services will receive an interview and appropriate referrals. Partner services standards will be determined by the best practices guidance and code of conduct standards for STI prevention providers developed by the Department. These standards shall be made publicly accessible.
E. Operational and evaluation standards for HIV testing and counseling sites will be determined by the best practices guidance developed by the Department.
F. In accordance with § 25-4-404(2), C.R.S., the Department shall create and maintain guidelines, subject to approval by the Board, concerning the public health procedures described in §§ 25-4-412 and 25-4-413, C.R.S. These guidelines will include code of conduct standards for the delivery of partner services and clients’ rights, responsibilities and protections. Regulation 12. Congenital syphilis All healthcare facilities and providers including but not limited to, hospitals, urgent care clinics, community health clinics, freestanding emergency departments, medical offices, correctional facilities, and licensed medical professionals that medically evaluate and treat anyone who is pregnant for any reason shall take all necessary steps to offer syphilis testing using a standardized algorithm for all patients in their care who are pregnant, unless a documented syphilis test has already occurred that meets the requirement or the patient declines testing, in each circumstance that follows:
A. During the first trimester of pregnancy or at the patient’s initial prenatal visit B. During the third trimester of pregnancy (between 28-32 weeks gestational age or up to 32 weeks gestational age)
C. At the time of delivery D. When there is a fetal death after 20 weeks' gestation Appendix A. Reportable diseases, conditions, and related events table Acinetobacter baumannii, Carbapenem-resistant 4 days L All Required Acinetobacter baumannii (species in carbapenem-resistant the A.baumannii (CRAB)5 complex, e.g., A.
nosocomialis, A. pittii, A. seifertii, etc.)
Acute flaccid myelitis 4 days P Upon Amebae, free-living Acanthamoeba 4 days L & P All Required
(CMV) if <60 days of age11 (positive results) request Congenital cytomegalovirus CMV DNA by NAAT or 4 days L (ELR Urine Upon (CMV) if <60 days of age11, culture (negative only)12 request 12 results)
Coronavirus–severe or Severe Acute Immed L & P All Upon novel Respiratory request Syndrome coronavirus (SARS- CoV), Middle East Respiratory Syndrome coronavirus (MERS CoV), or other severe or novel coronavirus other than SARS-CoV-2 Coronavirus disease 2019 ● SARS-CoV-2 4 days L (ELR All Upon (COVID-19)12 (positive only)12 request molecular and rapid antigen tests)
(CJD) and other request transmissible spongiform encephalopathies (TSEs)
Cronobacter invasive Cronobacter species 4 days L & P All Required infections if <1 year of age (including C. sakazakii,
Cryptosporidiosis Cryptosporidium 4 days L All Upon species request Cyclosporiasis Cyclospora species 4 days L All Upon Dengue Dengue virus 4 days L All Upon Diphtheria Corynebacterium Immed L & P All Required diphtheriae Enterobacterales, Carbapenem-resistant 4 days L All Required carbapenem resistant Enterobacterales (CRE)13 including, but not limited to, Escherichia species, Klebsiella species, Enterobacter species Citrobacter species, Serratia species, Raoultella species, Providencia species, Proteus species, Morganella species Enterobacterales, Escherichia species, 30 days L All Upon extended-spectrum beta- Klebsiella species. request lactamase (ESBL)8-Boulder,14 Raoultella species Escherichia species, Escherichia species 30 days L Sterile only Upon invasive infections8–Boulder request Giardiasis Giardia lamblia 4 days L All Upon Glanders Burkholderia mallei 1 working L & P All Upon day request Gonorrhea, any site, Neisseria gonorrhoeae 4 days L & P All Upon including disseminated request gonorrhea6 Group A streptococci8-Metro, Streptococcus 4 days L Sterile only Required1 15 pyogenes 5 Group B streptococci8-Metro Streptococcus 30 days L Sterile only Required agalactiae Haemophilus influenzae Haemophilus influenzae 1 working L & P Sterile only Required day Hantavirus disease Hantavirus 4 days L & P All Upon Healthcare-associated 30 days F Not infections16 applicable Hemolytic uremic 4 days P Upon syndrome if <18 years of request age Hepatitis A ● Hepatitis A virus 1 working L & P All Upon (+IgM anti-HAV, day request +PCR or +NAAT)
Hepatitis B, pediatric HBsAg and anti-HBs 4 days L All Upon (children <3 years of age)6 positive, negative, and request inconclusive lab results Hepatitis C, positive ● Any positive 4 days L & P All Upon results6 (reactive) test for request HCV (antibody, antigen or nucleic acid amplification for HCV RNA [including qualitative, quantitative or genotype testing]).
Hepatitis D Hepatitis D virus 4 days L & P All Upon (+anti-HDV IgM, request +anti-HDV total, +HDAg, +HDV DNA, or +HDV RNA)
Hepatitis, other viral ● Positive results 4 days P Upon ● Liver function test values for AST, ALT, and total bilirubin Histoplasmosis Histoplasma species 4 days L All Upon Human immunodeficiency ● Human 4 days L & P All Upon virus (HIV)/ acquired immunodeficiency request immunodeficiency virus syndrome (AIDS) 6 ● CD4 counts (any value)
HIV, genotype HIV genotype 4 days L All Upon Influenza12 ● Influenza virus 4 days L (ELR All Upon (positive only)12 request molecular and rapid antigen tests)
(MRSA) bacteremia18 Mpox 6 Monkeypox virus 1 working L & P All Upon (orthopox virus or day request non-variola orthopox virus)
Multisystem Inflammatory 4 days P Upon Syndrome in Children request (MIS-C) if <21 years Mumps Mumps virus (acute 4 days L & P All Upon infection) request Mycobacterium, Mycobacterium 30 days L All Upon nontuberculous (NTM) 8- species (except request tuberculosis Metro complex, M. leprae, and M. gordonae)
Outbreaks and epidemics - Any pathogen Immed L, P, F & Upon known or suspected of all A request types Pertussis (whooping Bordatella pertussis 1 working L & P All Upon cough) day request Plague Yersinia pestis Immed L & P All Required Poliomyelitis Poliovirus Immed L & P All Upon Pseudomonas, Pseudomonas 4 days L All Upon carbapenem aeruginosa request resistant19 Psittacosis Chlamydia psittaci 4 days L All Upon Q fever Coxiella burnetii 4 days L All Upon Rabies: human (suspected) Rabies virus Immed L & P All Upon (Lyssavirus) request Respiratory syncytial virus ● Respiratory 4 days L (ELR All Upon (RSV)12 syncytial virus only)12 request (positive molecular and rapid antigen tests)
E. coli O157)20 Shigellosis Shigella species 4 days L All Required Smallpox Variola virus Immed L & P All Upon (Orthopox virus) request Staphylococcus aureus, Vancomycin non- 4 days L All Required Vancomycin non- susceptible susceptible21 Staphylococcus aureus Streptococcus pneumoniae Streptococcus 4 days L Sterile only Required pneumoniae for 5- county Denver metro area; upon outside this area Syphilis, positive results 6, Treponema pallidum 1 working L & P All Upon 22 (positive results) day request Syphilis, negative results 6, Treponema pallidum 1 working L (ELR All Upon 12, 22 (negative results) day only)12 request Tetanus Clostridium tetani 4 days P All Upon Tick-borne relapsing fever Borrelia species and 4 days L & P All Upon spirochetemia except request burgdorferi species Toxic shock syndrome Streptococcus 4 days P All Upon (streptococcal and non- pyogenes and non- request15 streptococcal)15 streptococcal bacteria Trichinosis Trichinella species 4 days P All Upon Tuberculosis disease Mycobacterium 1 working L & P All Required (active)6 tuberculosis 23 day Tuberculosis immune Mycobacterium 4 days L (ELR All Upon reactivity indicated by a tuberculosis only)12 request positive interferon gamma release assay test (IGRA)
Tuberculosis immune Mycobacterium 4 days P & F All Upon reactivity indicated by a tuberculosis request positive IGRA or tuberculin skin test (defined as equal to or greater than 5 mm induration) in a healthcare, correctional facility, or detention facility worker exposed to an infectious tuberculosis case Tularemia Francisella tularensis 1 working L & P All Required day Typhoid fever Salmonella Typhi 1 working L & P All Required day Varicella (chicken pox) Varicella virus 4 days L & P All Upon Vibriosis Vibrio species, non- 4 days L All Required cholera Viral hemorrhagic fever Crimean-Congo Immed L & P All Required hemorrhagic fever virus, Ebola virus, Lassa fever virus, Lujo virus, Marburg virus, Guanarito virus, Junin virus, Machupo virus, Sabia virus, Rift Valley fever West Nile virus (acute West Nile virus 4 days L All Upon infection) request Yellow fever Yellow fever virus 4 days L All Upon Yersiniosis8-Seven Yersinia non-pestis 4 days L All Required species Zika virus Zika virus 4 days L All Upon 1. Time: (1) “Immed” = by phone, within 4 hours of suspected diagnosis. (2) Unless the term “working day” is specified, “days” refers to calendar days.
2. Reporter: The party or parties responsible for reporting as defined in the definitions section and in Regulation 2. A = additional reporters; F = healthcare facility; L = laboratory; P = healthcare provider; V = veterinarian. When multiple letters are present in a row, all parties listed must report.
3. Specimen sources: A condition is reportable when the pathogen is isolated or detected from any specimen source unless otherwise indicated. A normally “sterile site” is defined in the “Definitions” section of these rules.
4. Specimen submission requirements are described in Regulation 3 and do not replace the requirement to report.
5. Acinetobacter baumannii (including species in the A. baumannii complex, e.g., A. baumannii, A. calcoaceticus, A. lactucae, A. nosocomialis, A. pittii, A. seifertii, etc.) that are resistant to at least one carbapenem (including imipenem, meropenem, or doripenem).
6. Refer to Appendix B for condition-specific data elements that must be reported.
7. Candida auris identified, or any suspected Candida auris. Clinical material may not be available for screening tests.
8. The condition is reportable only among residents of a specific catchment area. 8–Metro Condition reportable only among residents of Denver Metropolitan Area (Adams, Arapahoe, Denver, Douglas, and Jefferson Counties) 8–Seven Condition reportable only among residents of seven-county Denver Metropolitan Area (Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, and Jefferson counties)
9. Clinical or screening test positive for a carbapenemase using a phenotypic, molecular test, or next generation sequencing. Common carbapenemase genes include: blaKPC, blaNDM, blaVIM,blaIMP, blaOXA-48, but other carbapenemase genes include but are not limited to: blaSIM, blaGIM, blaSPM, other OXA genes,
10. Any positive tests must be reported. All positive results from multi-step algorithms (including non toxin detecting tests such as antigen tests (e.g., glutamate dehydrogenase or GDH, and cultures, etc.) must also be reported, regardless of where the test falls within the algorithm.
11. Reportable when the specimen was collected at < 60 days of age, regardless of the date that testing was performed.
12. Test results must only be reported by ELR by laboratories capable of ELR.
13. Enterobacterales including, but not limited to, Escherichia species, Klebsiella species, Enterobacter species, Citrobacter species, Serratia species, and Raoultella species that are resistant to at least one carbapenem (including imipenem, meropenem, doripenem, or ertapenem); or Providencia species, Proteus species, Morganella species that are resistant to at least one carbapenem (including meropenem, doripenem, or ertapenem; but not including imipenem); or Enterobacterales of any genus and species that test positive for production of carbapenemase (e.g., KPC, NDM, VIM, IMP, OXA-48, others).
14. Escherichia species, Klebsiella species, or Raoultella species resistant to at least one extended spectrum cephalosporin (ceftazidime, cefotaxime or ceftriaxone) or Escherichia species, Klebsiella species, or Raoultella species that test positive for production of an extended-spectrum beta-lactamase (ESBL) demonstrated by a recognized test (e.g., broth microdilution, disk diffusion).
15. In addition to reporting and submitting specimens from normally sterile sites, if group A streptococci is isolated from a wound or surgical tissue/specimen and is accompanied by necrotizing fasciitis or streptococcal toxic shock syndrome, the case must be reported and the clinical material must be submitted.
16. Reportable only by facilities that are voluntarily participating in applied public health projects. This does not cover required reporting of healthcare-associated infections under 25-3-601-607 C.R.S.
17. Submission of urine specimens is not required. If respiratory samples are available on patients positive for legionellosis by urine antigen or any other test, submit a respiratory sample.
18. Reporting requirement is fulfilled through the Department’s access to the National Healthcare Safety Network (NHSN) for those healthcare facilities that are required to report methicillin resistant Staphylococcus aureus (MRSA) bacteremia to the Centers for Medicare & Medicaid services (CMS). In these instances these healthcare facilities must confer rights to the Department to access the NHSN data for these conditions.
19. Pseudomonas aeruginosa resistant to at least one of the following carbapenems: imipenem, meropenem, or doripenem; OR P. aeruginosa that tests positive for production of a carbapenemase (i.e., KPC, NDM, VIM, IMP, OXA, others).
20. This includes any Shiga toxin test or O157 antigen test that is positive, even if no culture is performed.
21. Staphylococcus aureus that are non-susceptible to vancomycin, which include isolates with minimum inhibitory concentration (MIC) of ≥4 mcg/ml.
22. All associated results for syphilis must be reported for positive syphilis test findings including treponemal tests (Enzyme Immunoassay [EIA], Chemoluminescence Assay [CIA], Fluorescent Treponemal Antibody Absorption [FTA-ABS], Polymerase Chain Reaction [PCR], Multiplex Flow Immunoassay [MFI], Treponema pallidum Particle Agglutination [TP-PA], Treponema pallidum Antibody [TPA]) and Non-treponemal Tests (Rapid Plasma Reagin [RPR], Venereal Disease Research Laboratory [VDRL], Cerebrospinal Fluid [CSF] Quantitative Titers).
23. Including (+) AFB sputum smear, culture (regardless of specimen site) and nucleic acid amplification tests (NAAT). See Regulation 4. Appendix B. Required data elements* Required data element Condition(s) for Laboratory Healthcare provider (P) Healthcare which it is required (L) must veterinarian (V), and facility (F)** report additional reporters (A) must report must report Patient's name All*** Yes Yes Yes Date of birth All Yes Yes Yes Sex assigned at birth All Yes Yes Yes Race All Yes Yes Yes Ethnicity All Yes Yes Yes Phone number All Yes Yes Yes Physical address, city, and All*** Yes Yes Yes county Email address All Yes Yes Yes Preferred language All Yes Yes Yes Healthcare provider name All Yes Yes Yes Healthcare provider address All Yes Yes Yes Healthcare provider phone All Yes Yes Yes Other information as is All Yes Yes Yes needed to locate the patient for follow up Specimen accession All Yes - Yes number Laboratory test name All Yes Yes Yes Required data element Condition(s) for Laboratory Healthcare provider (P) Healthcare which it is required (L) must veterinarian (V), and facility (F)** report additional reporters (A) must report must report Collection date All Yes Yes Yes Specimen type All Yes Yes Yes Test result All Yes Yes Yes Laboratory name All Yes Yes Yes Laboratory address All Yes Yes Yes Laboratory phone All Yes Yes Yes Pregnancy status Syphilis, HIV, Yes Yes - hepatitis B, and hepatitis C (including negative result reports for syphilis, hepatitis B, and hepatitis C)
Relevant treatment Chlamydia, - Yes - chancroid, gonorrhea, HIV, lymphogranuloma venereum, and syphilis Gender identity Chlamydia, Yes Yes - chancroid, gonorrhea, HIV, lymphogranuloma venereum, syphilis, and mpox Required data element Condition(s) for Laboratory Healthcare provider (P) Healthcare which it is required (L) must veterinarian (V), and facility (F)** report additional reporters (A) must report must report Hospital admission date When hospitalization Yes - Yes is a criteria for reporting (Influenza, COVID-19, RSV)
Name of facility where When hospitalization Yes - Yes hospitalized is a criteria for reporting (Influenza, COVID-19, RSV)
Hospital discharge date When requested by - - Yes the Department and when hospitalization is a criteria for reporting Ventilator use When requested by - - Yes the Department and when hospitalization is a criteria for reporting Intensive care unit (ICU) use When requested by - - Yes the Department and when hospitalization is a criteria for reporting Other fields as needed When requested by - - Yes the Department and when hospitalization is a criteria for reporting Required data element Condition(s) for Laboratory Healthcare provider (P) Healthcare which it is required (L) must veterinarian (V), and facility (F)** report additional reporters (A) must report must report Name, phone number, and Animal bites by - Yes - locating information of an owned dogs and cats animal's owner Location of the wild animal For bites by bats, - Yes - skunks, foxes, raccoons, coyotes, and other wild carnivores, as well as non-bite bat exposures Evidence upon which the TB - Yes - diagnosis of tuberculosis (TB) was made or is being considered The affected body part TB - Yes - (suspected or confirmed)
Whether the TB diagnosis is TB - Yes - confirmed or suspected *Outbreaks are highly variable and generally require additional information beyond the data elements listed here, depending on the suspected pathogen, setting, and route of transmission. At the time an outbreak is reported, public health will inform the reporter about what additional information is needed. See Regulation 5 for details on investigative authority.
**Facilities may report healthcare provider-reportable conditions on behalf of individual providers. When a facility reports on behalf of a provider, the healthcare facility must include all data elements listed in Appendix B under “provider.” ***For reports from a publicly funded anonymous testing site, as provided in § 25-4-411, C.R.S., the patient’s name and address are not required. ______________________________________________________________________ Editor’s Notes History Regulations 1, 3 eff. 05/30/2007.
Regulation 3 eff. 03/30/2008.
Regulation 8 eff. 03/02/2010.
Regulations 1, 3, 11 eff. 04/14/2010.
Regulations 1, 3, Appendix A eff. 12/30/2010.
Regulations 1, 3 eff. 11/30/2012.
Regulations 1-3, 5, 9 eff. 10/15/2014.
Regulations 1-4, 8, 10, Appendices A-B eff. 11/14/2015. Entire rule eff. 05/15/2017.
Entire rule eff. 07/15/2018.
Regulations 1, 4, 8.B, 9, 10 paragraph 1, 11, 11.F, Appendix A eff. 06/14/2019. Regulations 1, 3, 4, 5, 8, Appendix A eff. 10/15/2021.
Regulation 1, Appendix A emer. rules eff. 02/15/2023.
Regulations 1-5, 8, 10, 11, Appendices A, B eff. 06/14/2023. Entire rule eff. 01/14/2025.
Entire rule eff. 03/17/2026.