105 C.M.R. 300.200
Upon the report of a case or suspected case of disease declared dangerous to the public health, the local board of health and the Department are authorized to implement and enforce the requirements outlined in 105 CMR 300.200. Minimum requirements for the isolation and quarantine of diseases dangerous to the public health are set forth in 105 CMR 300.200(A). Depending on the specific circumstances related to the exposure, case and/or contact with respect to any disease or condition listed in 105 CMR 300.200(A) or (B), additional control measures may be required.
Disease M inimum Period of Isolation of Patient M inimum Period of Quarantine of Contacts Amebiasis After diarrhea has resolved, food handlers Contacts with diarrhea, who are food handlers,
may only return to food handling duties shall be considered the same as a case and after producing one negative stool handled in the same fashion. In outbreak specimen. If a case has been treated with circumstances, asymptomatic contacts who are an antimicrobial, the stool specimen shall food handlers shall be required to produce two not be collected until at least 48 hours negative stool specimens produced at least 24 after cessation of therapy. In outbreak hours apart prior to returning to food handling circumstances, two negative stool duties. Otherwise, no restrictions. specimens produced at least 24 hours apart will be required prior to returning to food handling duties.
Anaplasmosis No restrictions No restrictions Anthrax For cutaneous anthrax, place on contact No restrictions
precautions until lesions are healed or free from anthrax bacilli.
Arbovirus infection No restrictions No restrictions Babesiosis No restrictions except for exclusion from No restrictions
blood donation.
B. miyamotoi No restrictions No restrictions
Disease M inimum Period of Isolation of Patient M inimum Period of Quarantine of Contacts Botulism No restrictions No restrictions Brucellosis No restrictions No restrictions Campylobacteriosis After diarrhea has resolved, food handlers Contacts with diarrhea, who are food handlers,
may only return to food handling duties shall be considered the same as a case and after producing one negative stool handled in the same fashion. In outbreak specimen. If a case has been treated with circumstances, asymptomatic contacts who are an antimicrobial, the stool specimen shall food handlers shall be required to produce two not be collected until at least 48 hours negative stool specimens produced at least 24 after cessation of therapy. In outbreak hours apart prior to returning to food handling circumstances, two negative stool duties. Otherwise, no restrictions. specimens produced at least 24 hours apart will be required prior to returning to food handling duties.
Cholera After diarrhea has resolved, food handlers Contacts with diarrhea, who are food handlers,
may only return to food handling duties shall be considered the same as a case and after producing two negative stool handled in the same fashion. In outbreak specimens produced at least 24 hours circumstances, asymptomatic contacts who are apart. If a case has been treated with an food handlers shall be required to produce two antimicrobial, the stool specimen shall not negative stool specimens produced at least 24 be collected until at least 48 hours after hours apart prior to returning to food handling cessation of therapy. duties. Otherwise, no restrictions.
Clostridium difficile No restrictions No restrictions Infection due to coronaviruses Subject to recommendations based on the Subject to recommendations based on the
specific coronavirus infection as specific coronavirus exposure as determined by determined by the Department based on the Department. the most current recommendations by the Centers for Disease Control and Prevention.
Creutzfeldt-Jakob disease or No restrictions No restrictions variant Creutzfeldt-Jakob disease Cryptosporidiosis After diarrhea has resolved, food handlers Contacts with diarrhea, who are food handlers,
may only return to food handling duties shall be considered the same as a case and after producing one negative stool handled in the same fashion. In outbreak specimen. If a case has been treated with circumstances, asymptomatic contacts who are an antimicrobial, the stool specimen shall food handlers shall be required to produce two not be collected until at least 48 hours negative stool specimens produced at least 24 after cessation of therapy. In outbreak hours apart prior to returning to food handling circumstances, two negative stool duties. Otherwise, no restrictions. specimens produced at least 24 hours apart will be required prior to returning to food handling duties.
Cyclosporiasis Food handlers may return to food Contacts with diarrhea, who are food handlers,
handling duties after diarrhea has shall be considered the same as a case and resolved. In certain situations however, handled in the same fashion. In certain food handlers may be required to produce outbreak situations, asymptomatic contacts who one or two negative stool specimens are food handlers may be required to produce before returning to food handling duties. one or two negative stool specimens prior to If a case has been treated with an returning to food handling duties. Otherwise, antimicrobial, the stool specimen shall not no restrictions. be collected until at least 48 hours after cessation of therapy.
Disease M inimum Period of Isolation of Patient M inimum Period of Quarantine of Contacts Diphtheria Maintain isolation until two successive All contacts (both symptomatic and
pairs of nose and throat cultures (and asymptomatic) who are food handlers must be cultures of skin lesions in cutaneous excluded from work until two successive pairs diphtheria) obtained greater than 24 of nose and throat cultures obtained greater hours apart and at least 24 hours after than two weeks after completion of completion of antimicrobial therapy are antimicrobial prophylaxis (if any) and greater negative. If there was no antimicrobial than 24 hours apart are negative. Symptomatic therapy, these two sequential pairs of contacts who are not food handlers shall be cultures shall be taken after symptoms considered the same as a case until their culture resolve and greater than two weeks after results are negative and they are cleared by the their onset. If an avirulent (nontoxigenic) appropriate public health authority. strain is documented, isolation is not Asymptomatic contacts who are not necessary. foodhandlers must be on appropriate antibiotics
and personal surveillance.
Ehrlichiosis No restrictions No restrictions Encephalitis, any case No restrictions No restrictions Food poisoning and toxicity No restrictions No restrictions Giardiasis After diarrhea has resolved, food handlers Contacts with diarrhea, who are food handlers,
may only return to food handling duties shall be considered the same as a case and after producing one negative stool handled in the same fashion. In outbreak specimen. If a case has been treated with circumstances, asymptomatic contacts who are an antimicrobial, the stool specimen shall food handlers shall be required to produce two not be collected until at least 48 hours negative stool specimens produced at least 24 after cessation of therapy. In outbreak hours apart prior to returning to food handling circumstances, two negative stool duties. Otherwise, no restrictions. specimens produced at least 24 hours apart will be required prior to returning to food handling duties.
Glanders No restrictions No restrictions Group A streptococcus, Persons with streptococcal pharyngitis or Personal surveillance and prophylaxis with an invasive infection skin infections, with or without invasive antimicrobial when appropriate. Otherwise, no
disease, shall not return to school or child restrictions. care until at least 24 hours after initiating antimicrobial treatment.
Group B streptococcus, No restrictions No restrictions invasive infection Haemophilus influenzae, invasive infection a) type B Until 24 hours after initiating Personal surveillance and prophylaxis with an
antimicrobial treatment. appropriate antimicrobial when indicated by
clinical situation of the contact or by potential for transmission. Otherwise, no restrictions.
b) non type B No restrictions No restrictions Hansen’s disease No restrictions if under medical care. No restrictions Hantavirus infection No restrictions No restrictions Hemolytic uremic syndrome After diarrhea has resolved, food handlers Contacts with diarrhea, who are food handlers,
may only return to food handling duties shall be considered the same as a case and after producing two negative stool handled in the same fashion. In outbreak specimens, produced at least 24 hours circumstances, asymptomatic contacts who are apart. If a case was treated with an food handlers shall be required to produce two antimicrobial, the stool specimen shall not negative stool specimens produced at least 24 be collected until at least 48 hours after hours apart prior to returning to food handling cessation of therapy. duties. Otherwise, no restrictions.
Disease M inimum Period of Isolation of Patient M inimum Period of Quarantine of Contacts
Hepatitis A Isolation until one week after onset of No restrictions except for susceptible food
symptoms or for cases where the onset handlers, who shall be excluded from their date is not known, one week past the date occupations for 28 days unless they receive a the specimen positive for IgM antibody to prophylactic dose of immune globulin (IG) HAV was provided. and/or hepatitis A vaccine within 14 days of
exposure, or in accordance with the latest recommendations from the Department.
Hepatitis B No restrictions except for exclusion from Personal surveillance for high-risk contacts
organ and blood donation. Case shall who should receive hepatitis B immune receive counseling to modify activities in globulin (HBIG) and vaccine. Infants born to order to prevent transmission. infected women should also receive HBIG and
vaccine. Otherwise, no restrictions.
Hepatitis C No restrictions except for exclusion from Personal surveillance for high-risk contacts.
organ and blood donation. Case shall Otherwise, no restrictions. receive counseling to modify activities in order to prevent transmission.
Hepatitis D Same as co-infecting hepatitis B Same as co-infecting hepatitis B Hepatitis E Isolation until one week after onset of No restrictions, except for susceptible food
symptoms, or for cases where the onset handlers, who shall be excluded from their date is not known, one week past the date occupations for 28 days. of the specimen positive for evidence of acute hepatitis E was provided.
Influenza No restrictions No restrictions Legionellosis No restrictions No restrictions Listeriosis No restrictions No restrictions Lyme disease No restrictions No restrictions Lymphocytic choriomeningitis No restrictions, except for exclusion from No restrictions virus infection organ and blood donation Malaria No restrictions except for exclusion from No restrictions
blood donation.
Measles Through four days after onset of rash Contacts born in or after 1957, who are not
(counting the day of rash onset as day appropriately immunized or do not have zero). laboratory evidence of immunity, will be
excluded from work, classes or other public
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activities from the fifth through the 21 day after their exposure even if they receive immune globulin. If exposure was continuous and/or if multiple cases occur, susceptibles will
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be excluded through the 21 day after rash onset in the last case. Health care workers and inpatients, regardless of year of birth, who are not appropriately immunized or do not have laboratory evidence of immunity, will be excluded from work (health care workers) or isolated with airborne precautions (inpatients) from the fifth day after their first exposure
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through the 21 day after their last exposure. These restrictions for health care workers and inpatients remain even if the contact received IG or was vaccinated post-exposure.
Melioidosis No restrictions No restrictions
Disease M inimum Period of Isolation of Patient M inimum Period of Quarantine of Contacts Meningitis a) bacterial, community- If infected with H. influenzae or N. Personal surveillance and antibiotic acquired meningitidis, droplet precautions until 24 prophylaxis, where appropriate, if case has H.
hours after initiation of appropriate influenzae or N. meningitidis. Otherwise, no antibiotic therapy. Otherwise, no restrictions. restrictions.
b) viral (aseptic), and other No restrictions No restrictions non-bacterial Meningococcal disease, Droplet precautions until 24 hours after Personal surveillance and antibiotic invasive infection initiation of appropriate antibiotic therapy. prophylaxis, where appropriate. Otherwise no
Otherwise, no restrictions. restrictions.
Monkeypox Until lesions have dried and crusts have Personal surveillance. Otherwise no
separated. If no lesions, until seven days restrictions. after onset of fever.
Mumps Through five days after onset of gland Contacts born in or after 1957, who are not
swelling (counting the initial day of gland appropriately immunized or do not have swelling as day zero). laboratory evidence of immunity, will be
excluded from work, classes or other public
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activities from the 12 through the 25 day after their exposure. W hen multiple cases occur, susceptibles need to be excluded through 25 days after the onset of the last case. Health care workers, and inpatients, regardless of year of birth, who are not appropriately immunized or do not have laboratory evidence of immunity will be excluded from work (health care workers) or isolated with droplet precautions
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(inpatients) from the 12 through the 25 date after their exposure.
Noroviruses Food handlers must be excluded from Contacts with diarrhea or vomiting who are
food handing duties for either 72 hours food handlers shall be excluded from food past the resolution of symptoms or 72 handling duties for 72 hours past the resolution hours past the date the specimen positive of symptoms. for norovirus was produced, which ever occurs last.
Pertussis Until 21 days from onset of cough or five If the contact is symptomatic, use same
days after initiation of appropriate restrictions as for cases. If the contact is an antibiotic therapy. asymptomatic healthcare worker not receiving
antibiotic prophylaxis, exclude from the workplace for 21 days after last exposure or, if unknown, for 21 days after the onset of the last case in the setting. If the contact is asymptomatic, not a healthcare worker, and exposed within the last 21 days, s/he should receive antibiotic prophylaxis but no exclusion is generally required. In certain situations deemed to be high-risk, the public health authority may require exclusion of asymptomatic contacts not receiving antibiotic prophylaxis and/or other contacts, and/or may extend the exclusion period beyond 21 days up to a maximum of 42 days.
Disease M inimum Period of Isolation of Patient M inimum Period of Quarantine of Contacts Plague For pneumonic plague, droplet Contacts of cases of pneumonic plague should
precautions until 72 hours after initiation be provided prophylaxis and placed under of appropriate antibiotic therapy. For personal surveillance for seven days; those who bubonic plague, case shall be placed on refuse prophylaxis shall be placed in quarantine contact precautions until 48 hours after and under personal surveillance for seven days. initiation of effective therapy.
Poliomyelitis Place case on enteric precautions for six According to applicable Department guidelines,
weeks after onset of symptoms or until administer an appropriate preparation of polio poliovirus can no longer be recovered virus vaccine if the immune status is unknown from feces (the number of negative or incomplete. Otherwise, no restrictions. specimens required will be determined by the Department on a case-by-case basis).
Powassan No restrictions No restrictions Psittacosis No restrictions No restrictions Q Fever No restrictions No restrictions Rabies- human For duration of illness Post-exposure prophylaxis of contacts when
appropriate, using recommendations of the Department. Otherwise, no restrictions.
Reye Syndrome No restrictions No restrictions Rickettsialpox No restrictions No restrictions Rocky Mountain spotted fever No restrictions No restrictions Rubella a) Congenital Isolation from susceptible persons for the No restrictions except for susceptibles, then
first year of life or until two cultures of same as for non-congenital rubella. clinical specimens (nasopharyngeal secretions or urine) obtained one month apart after age three months are negative for rubella virus.
b) Non-Congenital Until seven days after onset of rash Contacts born in or after 1957, who are not
(counting the day of rash onset as day appropriately immunized or do not have zero). laboratory evidence of immunity, will be
excluded from work, classes or other public
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activities from the seventh through the 23 day after their last exposure. W hen multiple cases occur, susceptibles need to be excluded until 23 days after the onset of the last case.Health care workers inpatients, regardless of year of birth, who are not appropriately immunized or do not have laboratory evidence of immunity, will be excluded from work (health care workers) or isolated with droplet precautions (inpatients) from the seventh day after first exposure
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through the 23 day after their last exposure.
Disease M inimum Period of Isolation of Patient M inimum Period of Quarantine of Contacts Salmonellosis a) Not including typhoid After diarrhea has resolved, food handlers Contacts with diarrhea, who are food handlers, fever may only return to food handling duties shall be considered the same as a case and
after producing one negative stool handled in the same fashion. In outbreak specimen. If a case was treated with an circumstances, asymptomatic contacts who are antimicrobial, the stool specimen shall not food handlers shall be required to produce two be collected until at least 48 hours after negative stool specimens produced at least 24 cessation of therapy. In outbreak hours apart prior to returning to food handling circumstances, two negative stool duties. Otherwise, no restrictions. specimens produced at least 24 hours apart will be required prior to returning to food handling duties.
b) S. typhi Food handlers may only return to food All food handlers, symptomatic or (typhoid fever) handling duties after producing three asymptomatic, who are contacts of a typhoid
consecutive negative stool specimens each case shall be considered the same as a case and produced no less than 48 hours apart and handled in the same fashion. one month after onset of first symptoms. If one culture is positive, repeat cultures shall be collected at one month intervals until three consecutive negative cultures are obtained. If the case has been treated with an antimicrobial, the first stool specimen shall not be collected until 48 hours after cessation of therapy.
Shiga toxin-producing After diarrhea has resolved, food handlers Contacts with diarrhea, who are food handlers, organisms, including E. coli may only return to food handling duties shall be considered the same as a case and O157:H7 after producing two negative stool handled in the same fashion. In outbreak
specimens, produced at least 24 hours circumstances, asymptomatic contacts who are apart. If a case was treated with an food handlers shall be required to produce two antimicrobial, the stool specimen shall not negative stool specimens produced at least 24 be collected until at least 48 hours after hours apart prior to returning to food handling cessation of therapy. duties. Otherwise, no restrictions.
Shigellosis After diarrhea has resolved, food handlers Contacts with diarrhea, who are food handlers,
may only return to food handling duties shall be considered the same as a case and after producing two negative stool handled in the same fashion. In outbreak specimens produced at least 24 hours circumstances, asymptomatic contacts who are apart. If a case was treated with an food handlers shall be required to produce two antimicrobial, the stool specimen shall not negative stool specimens produced at least 24 be collected until at least 48 hours after hours apart prior to returning to food handling cessation of therapy. duties. Otherwise, no restrictions.
Smallpox In conjunction with public health Afebrile contacts shall be placed under fever
authorities, place case(s) on highest level surveillance (quarantine) for 18 days from the of isolation to prevent direct contact, last contact or 14 days from successful droplet contact and airborne exposure vaccination (which ever comes first), with until lesions have dried and crusts have monitoring and recording of temperature twice separated. daily (morning and evening). Febrile contacts
with or without rash shall be considered the same as a case and handled in the same fashion (isolation). If no rash develops after five days and the fever is diagnosed as being caused by recent vaccination or some other non-smallpox etiology, contact may be released from isolation to home to continue fever surveillance for 18 days following their last contact with a case or 14 days following successful vaccination (whichever comes first).
Disease M inimum Period of Isolation of Patient M inimum Period of Quarantine of Contacts Streptococcus pneumoniae, No restrictions No restrictions invasive infection Tetanus No restrictions No restrictions Toxic shock syndrome No restrictions No restrictions Trichinosis No restrictions No restrictions Tularemia No restrictions No restrictions Typhus No restrictions No restrictions Varicella (chickenpox) If vesicles are present, until lesions have Contacts in non-health care settings, who are
dried and crusted, or until no new lesions not appropriately immunized or are without appear, usually by the fifth day (counting laboratory evidence of immunity or a reliable the day of rash onset as day zero). If no history of chickenpox, shall be excluded from vesicles are present, until the lesions have school, work or other public activities from the
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faded (i.e. the skin lesions are in the eighth through the 21 days after their exposure process of resolving; lesions do not need to the case during the case's infectious period. to be completely resolved) or no new If the exposure was continuous, contacts shall lesions appear within a 24-hour period, be excluded from the eighth through the 21st whichever is later. days after the case's rash onset. Neonates born
to mothers with active varicella shall be isolated from susceptibles until 21 days of age. Health care workers who are not appropriately immunized or are without laboratory evidence of immunity shall be excluded from work (health care workers) or isolated with airborne precautions (inpatients) from the eighth day
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after their first exposure through the 21 day after the last exposure. In all settings, anyone receiving varicella zoster immune globulin (VZIG) or intravenous immune globulin (IVIG) shall extend their exclusion to 28 days post-exposure.
Vibriosis (non- Cholera) Food handlers with diarrhea may return to No restrictions
work after diarrhea has resolved.
Viral hemorrhagic fevers Place on hemorrhagic fever specific Personal surveillance
barrier precautions with airborne, contact, and droplet precautions, and double gloving, with strict hand hygiene, impermeable gowns, face shields, eye protection, and leg and shoe coverings until clinical illness has resolved.
Yersiniosis After diarrhea has resolved, food handlers Contacts with diarrhea, who are food handlers,
may only return to food handling duties shall be considered the same as a case and after producing one negative stool handled in the same fashion. In outbreak specimen. If a case was treated with an circumstances, asymptomatic contacts who are antimicrobial, the stool specimen shall not food handlers shall be required to produce two be collected until at least 48 hours after negative stool specimens produced at least 24 cessation of therapy. In outbreak hours apart prior to returning to food handling circumstances, two negative stool duties. Otherwise, no restrictions. specimens produced at least 24 hours apart will be required prior to returning to food handling duties.
Disease M inimum Period of Isolation of M inimum Period of Quarantine of Contacts
Patient
Tuberculosis a) Active tuberculosis: Clearance from isolation in the No restrictions of asymptomatic contacts Pulmonary (also includes community requires one or more of the required. mediastinal, laryngeal, following: three appropriately collected pleural, or miliary) and processed sputum smears that are
collected in eight – 24 hour intervals (one of which should be an early morning specimen); or other FDA cleared/approved or generally accepted laboratory tests indicating tuberculosis is unlikely or infectiousness is unlikely, as per guidelines such as those of the CDC, the Advisory Council of the Elimination of Tuberculosis (ACET) or the American Thoracic Society (ATS); or until the patient has undergone a period of effective chemotherapy in accordance with current treatment standards, such as those of CDC, ACET or ATS, and there is demonstration of clinical improvement (i.e. decreasing cough, reduced fever, resolving lung infiltrates).
b) Active tuberculosis: No restrictions except for appropriate No restrictions Extra-pulmonary handling of infected fluids.
c) Latent TB infection No restrictions No restrictions