PURPOSE: This rule designates the diseases, disabilities, conditions and findings that must be reported to the local health authority or the Department of Health and Senior Services. It also establishes when they must be reported.

PUBLISHER’S NOTE: The secretary of state has determined that the publication of the entire text of the material which is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive. This material as incorporated by reference in this rule shall be maintained by the agency at its headquarters and shall be made available to the public for inspection and copying at no more than the actual cost of reproduction. This note applies only to the reference material. The entire text of the rule is printed here.

1. (1) The diseases within the immediately reportable disease category pose a risk to national security because they: can be easily disseminated or transmitted from person to person; result in high mortality rates and have the potential for major public health impact; might cause public panic and social disruption; and require special action for public health preparedness. Immediately reportable diseases or findings shall be reported to the local health authority or to the Department of Health and Senior Services immediately upon knowledge or suspicion by telephone (1 (800) 392-0272), facsimile or other rapid communication. Immediately reportable diseases or findings are—

   1. (A) Selected high priority diseases, findings or agents that occur naturally, from accidental exposure, or as the result of a bioterrorism event: Anthrax Botulism Plague Rabies (Human) Ricin toxin Severe Acute Respiratory syndromeassociated Coronavirus (SARS-CoV) Disease Smallpox 19 CSR 20-20

      Tularemia (pneumonic) Viral hemorrhagic fevers (filoviruses

(e.g., Ebola, Marburg) and arenaviruses (e.g., Lassa, Machupo))

1. (B) Instances, clusters, or outbreaks of unusual diseases or manifestations of illness and clusters or instances of unexplained deaths which appear to be a result of a terrorist act or the intentional or deliberate release of biological, chemical, radiological, or physical agents, including exposures through food, water, or air.
2. (C) Instances, clusters, or outbreaks of unusual, novel, and/or emerging diseases or findings not otherwise named in this rule, appearing to be naturally occurring, but posing a substantial risk to public health and/or social and economic stability due to their ease of dissemination or transmittal, associated mortality rates, or the need for special public health actions to control.

1. (2) Reportable within one (1) day diseases or findings shall be reported to the local health authority or to the Department of Health and Senior Services within one (1) calendar day of first knowledge or suspicion by telephone, facsimile or other rapid communication. Reportable within one (1) day diseases or findings are—

   1. (A) Diseases, findings or agents that occur naturally, or from accidental exposure, or as a result of an undetected bioterrorism event: Acute respiratory distress syndrome (ARDS) in patients under fifty (50) years of age (without a contributing medical history) Animal (mammal) bite, wound, humans Brucellosis Cholera Dengue fever Diphtheria Glanders Haemophilus influenzae, invasive disease Hantavirus pulmonary syndrome Hemolytic uremic syndrome (HUS), postdiarrheal Hepatitis A Influenza-associated pediatric mortality (eighteen (18) years of age or younger) Influenza-associated public and/or private school closures Lead (blood) level greater than or equal to forty-five micrograms per deciliter (≥45 μg/dl) in any person equal to or less than seventy-two (≤72) months of age Measles (rubeola) Meningococcal disease, invasive Novel Influenza A virus infections, human Outbreaks (including nosocomial) or epidemics of any illness, disease or condition that may be of public health concern, including any illness in a food SENIOR SERVICES

   handler that is potentially transmissible through food Pertussis Poliomyelitis Poliovirus infection, nonparalytic Q fever Rabies (animal) Rubella, including congenital syndrome Shiga toxin-producing Escherichia coli (STEC) Shiga toxin positive, unknown organism Shigellosis Staphylococcal enterotoxin B Streptococcus pneumoniae, drug resistant invasive disease Syphilis, including congenital syphilis T-2 mycotoxin Tetanus Tuberculosis disease Tularemia (non-pneumonic) Typhoid fever (Salmonella typhi) Vancomycin-intermediate Staphylococcus aureus (VISA), and Vancomycin-resistant Staphylococcus aureus (VRSA) Venezuelan equine encephalitis virus neuroinvasive disease Venezuelan equine encephalitis virus nonneuroinvasive disease Yellow fever

2. (B) Diseases, findings or adverse reactions that occur as a result of inoculation to prevent smallpox, including but not limited to the following: Accidental administration Contact transmission (i.e., vaccinia virus infection in a contact of a smallpox vaccinee) Eczema vaccinatum Erythema multiforme (roseola vaccinia, toxic urticaria) Fetal vaccinia (congenital vaccinia) Generalized vaccinia Inadvertent autoinoculation (accidental implantation) Myocarditits, pericarditis, or myopericarditis Ocular vaccinia (can include keratitis, conjunctivitis, or blepharitis) Post-vaccinial encephalitis or encephalamyelitis Progressive vaccinia (vaccinia necrosum, vaccinia gangrenosa, disseminated vaccinia) Pyogenic infection of the vaccination site Stevens-Johnson Syndrome

3. (3) Reportable within three (3) days diseases or findings shall be reported to the local health authority or the Department of Health and Senior Services within three (3) calendar days of first knowledge or suspicion. These diseases or findings are— Acquired immunodeficiency syndrome (AIDS) Arsenic poisoning California serogroup virus neuroinvasive disease California serogroup virus non-neuroinvasive disease Campylobacteriosis Carbon monoxide poisoning CD4+ T cell count Chancroid Chemical poisoning, acute, as defined in the most current ATSDR CERCLA Priority List of Hazardous Substances; if terrorism is suspected, refer to subsection (1)(B) Chlamydia trachomatis, infections Coccidioidomycosis Creutzfeldt-Jakob disease Cryptosporidiosis Cyclosporiasis Eastern equine encephalitis virus neuroinvasive disease Eastern equine encephalitis virus non-neuroinvasive disease Ehrlichiosis, human granulocytic, monocytic, or other/unspecified agent Giardiasis Gonorrhea Hansen’s disease (Leprosy) Heavy metal poisoning including, but not limited to, cadmium and mercury Hepatitis B, acute Hepatitis B, chronic Hepatitis B surface antigen (prenatal HBsAg) in pregnant women Hepatitis B Virus Infection, perinatal (HBsAg positivity in any infant aged equal to or less than twenty-four (≤24) months who was born to an HBsAg-positive mother) Hepatitis C, acute Hepatitis C, chronic Hepatitis non-A, non-B, non-C Human immunodeficiency virus (HIV)- exposed newborn infant (i.e., newborn infant whose mother is infected with HIV) Human immunodeficiency virus (HIV) infection, as indicated by HIV antibody testing (reactive screening test followed by a positive confirmatory test), HIV antigen testing (reactive screening test followed by a positive confirmatory test), detection of HIV nucleic acid (RNA or DNA), HIV viral culture, or other testing that indicates HIV infection Human immunodeficiency virus (HIV) test

   1. (4) Reportable weekly diseases or findings

   results (including both positive and negshall be reported directly to the Department ative results) for children less than two (2) years of age whose mothers are of Health and Senior Services weekly. These diseases or findings are: infected with HIV

Human immunodeficiency virus (HIV) Public Health

viral load measurement (including nondetectable results) Hyperthermia Hypothermia Lead (blood) level less than forty-five micrograms per deciliter (<45 μg/dl) in any person equal to or less than seventytwo (≤72) months of age and any lead (blood) level in persons older than seventy-two (>72) months of age Legionellosis Leptospirosis Listeriosis Lyme disease Malaria Methemoglobinemia, environmentallyinduced Mumps Mycobacterial disease other than tuberculosis (MOTT) Occupational lung diseases including silicosis, asbestosis, byssinosis, farmer’s lung and toxic organic dust syndrome Pesticide poisoning Powassan virus neuroinvasive disease Powassan virus non-neuroinvasive disease Psittacosis Rabies Post-Exposure Prophylaxis (Initiated) Respiratory diseases triggered by environmental contaminants including environmentally or occupationally induced asthma and bronchitis Rocky Mountain spotted fever Saint Louis encephalitis/virus neuroinvasive disease Saint Louis encephalitis virus non-neuroinvasive disease Salmonellosis Streptococcal disease, invasive, Group A Streptococcus pneumoniae, invasive in children less than five (5) years Toxic shock syndrome, staphylococcal or streptococcal Trichinellosis Tuberculosis infection Varicella (Chickenpox) Varicella deaths Vibriosis (non-cholera Vibrio species infections) West Nile virus neuroinvasive disease West Nile virus non-neuroinvasive disease Western equine encephalitis virus neuroinvasive disease Western equine encephalitis virus non-neuroinvasive disease Yersiniosis

Influenza, laboratory-confirmed (5) Reportable quarterly diseases or findings shall be reported directly to the Department of Health and Senior Services quarterly. These diseases or findings are: Methicillin-resistant Staphylococcus aureus (MRSA), nosocomial Vancomycin-resistant enterococci (VRE), nosocomial

1. (6) A physician, physician’s assistant, nurse, hospital, clinic, or other private or public institution providing diagnostic testing, screening or care to any person with any disease, condition or finding listed in sections (1)–(4) of this rule or who is suspected of having any of these diseases, conditions or findings, shall make a case report to the local health authority or the Department of Health and Senior Services, or cause a case report to be made by their designee, within the specified time.

   1. (A) A physician, physician’s assistant, or nurse providing care in an institution to any patient with any disease, condition or finding listed in sections (1)–(4) of this rule may authorize, in writing, the administrator or designee of the institution to submit case reports on patients attended by the physician, physician’s assistant, or nurse at the institution. But under no other circumstances shall the physician, physician’s assistant, or nurse be relieved of this reporting responsibility.
   2. (B) Duplicate reporting of the same case by health care providers in the same institution is not required.

2. (7) Except for influenza, laboratory-confirmed and Varicella (Chickenpox); a case report as required in section (6) of this rule shall include the patient’s name, home address with zip code, date of birth, age, sex, race, home phone number, name of disease, condition or finding diagnosed or suspected, the date of onset of the illness, name and address of the treating facility (if any) and the attending physician, any appropriate laboratory results, name and address of the reporter, treatment information for sexually transmitted diseases, and the date of report.

   1. (A) A report of an outbreak or epidemic as required in subsections (1)(B) and (1)(C) of this rule shall include the diagnosis or principal symptoms, the approximate number of cases, the local health authority jurisdiction within which the cases occurred, the identity of any cases known to the reporter, and the name and address of the reporter.
   2. (B) Influenza, laboratory-confirmed reporting as required in section (4) of this rule shall include the patient’s age group (i.e., 0–4, 5–24, 25–64, and 65+ years) and serology/serotype (i.e., A, B, and unknown), the local health authority jurisdiction within which the cases occurred, and the date of report. Aggregate patient data shall be reported weekly.
   3. (C) Varicella (Chickenpox) reporting as required in section (3) of this rule shall include the patient’s name, date of birth, vaccination history, and severity of illness; the local health authority jurisdiction within which the cases occurred, and the date of report.
3. (8) Any person in charge of a public or private school, summer camp or child or adult care facility shall report to the local health authority or the Department of Health and Senior Services the presence or suspected presence of any diseases or findings listed in sections (1)–(4) of this rule according to the specified time frames.
4. (9) All local health authorities shall forward to the Department of Health and Senior Services reports of all diseases or findings listed in sections (1)–(4) of this rule. All reports shall be forwarded according to procedures established by the Department of Health and Senior Services director as listed in sections (1)–(4). Reports will be forwarded immediately if a terrorist event is suspected or confirmed. The local health authority shall retain from the original report any information necessary to carry out the required duties in 19 CSR 20-20.040(2) and (3).
5. (10) Information from patient medical records received by local public health agencies or the Department of Health and Senior Services in compliance with this rule is to be considered confidential records and not public records.
6. (11) Reporters specified in section (6) of this rule will not be held liable for reports made in good faith in compliance with this rule.

7. (12) The following material is incorporated into this rule by reference:

   1. (A) 2005 Agency for Toxic Substances and Disease Registry (ATSDR) 1825 Century Blvd., Atlanta, GA 30345, Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) Priority List of Hazardous Substances, available at: http://www.atsdr.cdc.gov/cercla. This rule does not incorporate any subsequent amendments or additions.
8. (13) Each hospital and ambulatory surgical center shall report on a quarterly basis antibiogram data for infection, not colonization, from all body sites monitored by that health 19 CSR 20-20

care facility. Antibiogram data to be reported shall include nosocomial methicillin sensitive Staphylococcus aureus (S. aureus), nosocomial S. aureus, nosocomial vancomycin sensitive enterococci, and nosocomial enterococci isolates. Data shall be reported directly to the Department of Health and Senior Services. Reporting shall include only a patient’s first diagnostic nosocomial isolate per admission of Staphylococcus aureus (S. aureus) and enterococci and the isolates corresponding methicillin or vancomycin sensitivity; irrespective of location or of other antimicrobial sensitivity(ies). Intermediate methicillin or vancomycin sensitivity shall be reported as resistant (i.e., methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE), respectively).

1. (A) Isolates from cultures performed for routine surveillance purposes are excluded from the requirement to report. Methicillinresistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) nosocomial infections to be reported to the Department of Health and Senior Services are limited to those body sites monitored by the individual hospital or ambulatory surgical center.

2. (B) Aggregate antibiogram data for patients’ non-duplicative isolates, per admission, of nosocomial MRSA and VRE infections shall reflect susceptibility patterns and shall be reported as the:

   1. 1. Number of nosocomial isolates of S.

aureus sensitive to methicillin (oxacillin, etc.);

1. 2. Number of nosocomial isolates S.

aureus;

1. 3. Number of nosocomial isolates of

enterococci sensitive to vancomycin; and

1. 4. Number of nosocomial isolates ente-

rococci.

1. (C) Aggregate data shall be reported for the quarters January–March, April–June, July–September, and October–December within ten (10) days of the end of the quarter. Each quarter’s aggregate report shall include only those data that are available within a ten (10)-day reporting period from the end of that quarter.

AUTHORITY : sections 192.006, 210.040, and 210.050, RSMo 2000 and section 192.020, RSMo Supp. 2007.* This rule was previously filed as 13 CSR 50-101.020. Original rule filed July 15, 1948, effective Sept. 13, 1948. Amended: Filed Sept. 1, 1981, effective Dec. 11, 1981. Rescinded and readopted: Filed Nov. 23, 1982, effective March 11, 1983. Emergency amendment filed June 10, 1983, effective June 20, 1983, expired Sept. 10, SENIOR SERVICES 1983. Amended: Filed June 10, 1983, effective Sept. 11, 1983. Amended: Filed Nov. 4, 1985, effective March 24, 1986. Amended: Filed Aug. 4, 1986, effective Oct. 11, 1986. Amended: Filed June 3, 1987, effective Oct. 25, 1987. Emergency amendment filed June 16, 1989, effective June 26, 1989, expired Oct. 23, 1989. Amended: Filed July 18, 1989, effective Sept. 28, 1989. Amended: Filed Nov. 2, 1990, effective March 14, 1991. Emergency amendment filed Oct. 2, 1991, effective Oct. 12, 1991, expired Feb. 8, 1992. Amended: Filed Oct. 2, 1991, effective Feb. 6, 1992. Amended: Filed Jan. 31, 1992, effective June 25, 1992. Amended: Filed Aug. 14, 1992, effective April 8, 1993. Amended: Filed Sept. 15, 1994, effective March 30, 1995. Amended: Filed Sept. 15, 1995, effective April 30, 1996. Emergency amendment filed June 1, 2000, effective June 15, 2000, expired Dec. 11, 2000. Amended: Filed June 1, 2000, effective Nov. 30, 2000. Emergency amendment filed Dec. 16, 2002, effective Dec. 26, 2002, expired June 23, 2003. Amended: Filed Dec. 16, 2002, effective June 30, 2003. Amended: Filed Oct. 1, 2004, effective April 30, 2005. Amended: Filed Feb. 15, 2006, effective Sept. 30, 2006. Amended: Filed Nov. 15, 2007, effective May 30, 2008. *Original authority: 192.006, RSMo 1993, amended 1995; 192.020, RSMo 1939, amended 1945, 1951, 2004; 210.040, RSMo 1941, amended 1993; and 210.050, RSMo 1941, amended 1993.