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. Therefore, the material which is so incorporated is on file with the agency who filed this rule, and with the Office of the Secretary of State. Any interested person may view this material at either agency’s headquarters or the same will be made available at the Office of the Secretary of State at a cost not to exceed actual cost of copy reproduction. The entire text of the rule is printed here. This note refers only to the incorporated by reference material.

1. (1) Category I diseases or findings shall be reported to the local health authority or to the that occur as a result of inoculation to prevent Department of Health and Senior Services smallpox, including but not limited to the folwithin twenty-four (24) hours of first knowllowing: edge or suspicion by telephone, facsimile or other rapid communication. Category I diseases or findings are—

   1. (A) Diseases, findings or agents that occur naturally or from accidental exposure: Animal (mammal) bite, wound, humans Diphtheria Haemophilus influenza, invasive disease Hantavirus pulmonary syndrome Hepatitis A Hyperthermia Hypothermia Influenza, suspected—nosocomial outbreaks and public or private school closures Lead (blood) level greater than or equal to forty-five micrograms per deciliter (≥45 (2) Category II diseases or findings shall be reported to the local health authority or the :g/dl) in any person equal to or less than seventy-two (≤72) months of age Department of Health and Senior Services Measles (rubeola) within three (3) days of first knowledge or Meningococcal disease, invasive suspicion. Category II diseases or findings Outbreaks or epidemics of any illness, disare— ease or condition that may be of public health concern Pertussis Poliomyelitis Rabies, animal or human Rubella, including congenital syndrome Staphylococcus aureus, vancomycin resistant Streptococcus pneumoniae, invasive in children less than five (5) years Syphilis, including congenital syphilis Tuberculosis disease Typhoid fever
   2. (B) Diseases, findings or agents that occur naturally or that might result from a terrorist attack involving biological, radiological, or chemical weapons: Adult respiratory distress syndrome (ARDS) in patients under 50 years of age (without a contributing medical history) Anthrax Botulism Brucellosis Cholera Encephalitis/meningitis, Venezuelan equine Glanders Hemorrhagic fever (e.g., dengue, yellow fever) Plague Q fever Ricin Smallpox (variola) Staphylococcal enterotoxin B T-2 mycotoxins Tularemia
2. (C) Diseases, findings or adverse reactions

Accidental administration Accidental implantation (inadvertent autoinoculation) Bacterial infection of site of inoculation Congenital vaccinia Contact vaccinia (i.e., vaccinia virus infection in a contact of a smallpox vaccinee) Eczema vaccinatum Erythema multiforme Generalized vaccinia Post-vaccinial encephalitis Progressive vaccinia (vaccinia necrosum, vaccinia gangrenosa, disseminated vaccinia) Vaccinia keratitis

Acquired immunodeficiency syndrome (AIDS) Arsenic poisoning Blastomycosis California serogroup viral encephalitis/ meningitis Campylobacter infections 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 19 CSR 20-20

Cyclosporidiosis Eastern equine viral encephalitis/meningitis Ehrlichiosis, human granulocytic, monocytic, or other/unspecified agent Escherichia coli O157:H7 Escherichia coli, shiga toxin positive, serogroup non-O157:H7 Giardiasis Gonorrhea Hansen disease (leprosy) Heavy metal poisoning including, but not limited to, cadmium and mercury Hemolytic uremic syndrome (HUS), postdiarrhea Hepatitis B, acute Hepatitis B surface antigen (prenatal HBsAg) in pregnant women Hepatitis C 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 results (including both positive and negative results) for children less than two

1. (2) years of age whose mothers are infected with HIV Human immunodeficiency virus (HIV) viral load measurement (including nondetectable results) Influenza, laboratory-confirmed Lead (blood) level less than forty-five micrograms per deciliter (<45 :g/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 Listeria monocytogenes Lyme disease Malaria Methemoglobinemia Mumps Mycobacterial disease other than tuberculosis (MOTT) Nosocomial outbreaks Occupational lung diseases including silicosis, asbestosis, byssinosis, farmer’s lung and toxic organic dust syndrome SENIOR SERVICES

Pesticide poisoning Powassan viral encephalitis/meningitis Psittacosis Respiratory diseases triggered by environmental contaminants including environmentally or occupationally induced asthma and bronchitis Rocky Mountain spotted fever Saint Louis viral encephalitis/meningitis Salmonellosis Shigellosis Streptococcal disease, invasive, Group A Streptococcus pneumoniae, drug resistant invasive disease Tetanus Toxic shock syndrome, staphylococcal or streptococcal Trichinosis Tuberculosis infection Varicella deaths West Nile fever West Nile viral encephalitis/meningitis Western equine viral encephalitis/meningitis Yersinia enterocolitica

1. (3) The occurrence of an outbreak or epidemic of any illness, disease or condition which may be of public health concern, including any illness in a food handler that is potentially transmissible through food. This also includes public health threats than could result from terrorist activities such as clusters of unusual diseases or manifestations of illness and clusters of unexplained deaths. Such incidents shall be reported to the local health authority or the Department of Health and Senior Services by telephone, facsimile, or other rapid communication within twentyfour (24) hours of first knowledge or suspicion.

2. (4) 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)–(3) 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)–(3) 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.

3. (5) A case report as required in section (4) 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 section (3) 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.
4. (6) 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)–(3) of this rule according to the specified time frames.
5. (7) All local health authorities shall forward to the Department of Health and Senior Services reports of all diseases or findings listed in sections (1)–(3) of this rule. All reports shall be forwarded within twenty-four (24) hours after being received, according to procedures established by the Department of Health and Senior Services director. Reports will be forwarded as expeditiously as possible 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).
6. (8) 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.
7. (9) Reporters specified in section (4) of this rule will not be held liable for reports made in good faith in compliance with this rule. Communicable Disease Prevention

8. (10) The following material is incorporated into this rule by reference:

   1. (A) Agency for Toxic Substances and Disease Registry (ATSDR) Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) Priority List of Hazardous Substances (http://www.atsdr.cdc. gov:8080/97list.html)

AUTHORITY : sections 192.006, 192.020, 192.139, 210.040 and 210.050, RSMo 2000.* 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, 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. *Original authority: 192.006.1, RSMo 1993, amended 1995; 192.020, RSMo 1939, amended 1945, 1951; 192.139, RSMo 1988; 210.040, RSMo 1941, amended 1993; and 210.050, RSMo 1941, amended 1993.