In addition to the definitions contained in 50-1-101, MCA, unless otherwise indicated, the following definitions apply throughout this chapter:

(1) "Case" means a person who is confirmed or suspected to have a reportable disease or condition as listed in ARM 37.114.203.

(2) "Contact" means a person or animal that may have had an opportunity to acquire an infection due to the contact's association with a suspected or confirmed infected person or animal or a contaminated environment.

(3) "Contamination" means the presence of a disease-causing agent upon a living body surface or within or upon any inanimate article or substance.

(4) "Control of Communicable Diseases Manual" means the publication adopted and incorporated by reference in ARM 37.114.105(1)(a).

(5) "Day care facility" has the meaning provided for under 52-2-703, MCA.

(6) "Directly observed therapy (DOT)" means the method whereby a trained health care worker or another trained designated person watches a patient swallow each dose of antituberculosis medication and documents it. DOT can include electronic directly observed therapy (eDOT) utilizing a video conferencing application only with express permission from the state TB program.

(7) "Form" means a paper form or electronically submitted information consisting of data elements necessary to implement effective surveillance, investigation, or mitigation of reportable diseases and outbreaks.

(8) "Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings" means the publication adopted and incorporated by reference in ARM 37.114.105(1)(b).

(9) "Health care" means health care as defined in 50-16-504, MCA.

(10) "Health care facility" is a facility as defined in 50-5-101, MCA.

(11) "Health care provider" means a health care provider as defined in 50-16-504, MCA.

(12) "HIV infection" means infection with the human immunodeficiency virus.

(13) "Household contact" is a person or animal living within the household of an infected person.

(14) "Infected person" means a person who harbors an infectious agent whether or not illness is currently discernible.

(15) "Infection" means the entry and development or multiplication of an infectious agent in the body of man or animals.

(16) "Infection control precautions" means those measures necessary to prevent the transmission of disease from an infected person to another person, taking into consideration the specific suspected or confirmed communicable disease and the specific circumstances of the case. The infection control precautions required for a case admitted to a hospital or other health care facility are those measures identified as isolation precautions applicable to the specific disease in the "Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings" adopted and incorporated by reference in ARM 37.114.105(1)(b). The infection control precautions required for a case not admitted to a hospital or other health care facility are those measures identified as methods of control applicable to the specific disease in the "Control of Communicable Diseases Manual", adopted and incorporated by reference in ARM 37.114.105(1)(a). Infection control precautions are required, as stated in this rule, whether or not the person is subject to isolation.

(17) "Infectious agent" means an organism including virus, rickettsia, bacteria, fungus, protozoan, prion, or helminth that is capable of producing an infection or infectious disease.

(18) "Infectious disease" means a clinically manifest disease of man or animals resulting from an infection.

(19) "Infectious person" means a person from whom another person may acquire an infectious agent by touch or proximity.

(20) "Laboratory" means any facility or other area used by microbiological, serological, chemical, hematological, immunohematological, molecular, biophysical, cytological, pathological or other examinations of human body fluids, secretions, excretions, or excised or exfoliated tissues, for the purpose of providing information for the diagnosis, prevention or treatment of any human disease or impairment, for the assessment of human health.

(21) "Laboratory Professional" means any person who supervises or works in a laboratory.

(22) "Multidrug-Resistant Organisms (MDRO)" means microorganisms, predominantly bacteria, that are resistant to one or more classes of antimicrobial agents.

(23) "Outbreak" means the occurrence of more cases of a disease than would normally be expected in a specific place or group of people over a given period of time.

(24) "Potential outbreak" means the presence or suspected presence of a communicable disease in a population where the number of susceptible persons and the mode of transmission of the disease may cause further transmission of that disease.

(25) "Reportable disease" means any disease, the occurrence or suspected occurrence of which is required to be reported by ARM 37.114.203.

(26) "Sensitive occupation" means an occupation described in ARM 37.114.301.

(27) "Sexually transmitted infection" means human immunodeficiency virus (HIV) infection, syphilis, gonorrhea, chancroid, lymphogranuloma venereum, granuloma inguinale, or all chlamydia trachomatis infections including chlamydial genital infections.

(28) "Sexually Transmitted Infections Treatment Guidelines" means the guidelines adopted and incorporated by reference in ARM 37.114.105(1)(c).

(29) "Surveillance" means scrutiny of all aspects of occurrence and transmission of a disease that are pertinent to effective control.

(30) "Susceptible" means having insufficient resistance against a disease and likely to contract the disease if exposed.

(31) "Toxic Metals" means individual metals and metal compounds that may negatively affect an individual's health and shall include arsenic, cadmium, lead, and mercury for the purposes of these rules.

(32) "Youth camp" has the meaning provided for under 50-52-101, MCA. 

(1) The department adopts and incorporates by reference the following publications:

(a) The "Control of Communicable Diseases Manual, An Official Report of the American Public Health Association", 21st edition, 2022, which lists and specifies control measures for communicable diseases.

(b) The "2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings," published by the U.S. Centers for Disease Control and Prevention, which specifies precautions that should be taken to prevent transmission of communicable diseases for cases admitted to a hospital or other health care facility.

(c) The "Sexually Transmitted Infections Treatment Guidelines, 2021,"  published by the U.S. Centers for Disease Control and Prevention in the July  23, 2021, Morbidity and Mortality Weekly Report, volume 70, hereafter referred to as "Sexually Transmitted Infections Treatment Guidelines, 2021," and specify the most currently accepted effective treatments for sexually transmitted infections.

(d) The "Food Code, 2013, Recommendations of the United States Public Health Service, Food and Drug Administration," published by the National Technical Information Service.

(e) The Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis, published in Clinical Infectious Diseases, October 1, 2016.

(f) The "Guidelines for the Investigation of Contacts of Persons with Infectious Tuberculosis," which provide recommendations from the National Tuberculosis Controllers Association and the U.S. Centers for Disease Control and Prevention, published December 16, 2005.

(g) The "Interim Guidance for a Public Health Response to Contain Novel or Targeted Multidrug-resistant Organisms (MDROs)", updated January 2019, published by the U.S. Centers for Disease Control and Prevention, which serves as general guidance to state and local health departments and healthcare facilities in relation to the initial response for the containment of novel or targeted MDROs or resistance mechanisms.

(2) To obtain, or for information on how to obtain, any document or publication incorporated by reference, contact the Department of Public Health and Human Services, Public Health and Safety Division, Epidemiology and Scientific Support, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951, phone: (406) 444-0273, or by visiting its website at: https://dphhs.mt.gov/publichealth/cdepi/reporting.  

(1) With the exceptions noted in (3), (4), and (5), any person, including a physician, dentist, nurse, medical examiner, other health care practitioner, administrator of a health care facility or laboratory, public or private school administrator, day care facility or youth camp personnel, or laboratory professional, who knows or has reason to believe that a case exists of a reportable disease or condition defined in ARM 37.114.203 must immediately report to the local health officer the information specified in ARM 37.114.205(1) and (2).

(2) A local health officer must submit to the department, on the schedule noted in ARM 37.114.204, the information specified in ARM 37.114.205 concerning each confirmed or suspected case of which the officer is informed.

(3) A state-funded anonymous testing site for HIV infection is not subject to the reporting requirement in (1) with regard to HIV testing.

(4) With the exception of a licensed healthcare provider, reporters under (1) may report directly to the department at the department's request with approval of the local health authority.

(5) With the exception of diseases listed in ARM 37.114.204(1) and (2)(a), laboratories, with the consent of the local health officer, may utilize electronic laboratory reporting (ELR) to satisfy (1).

(1) The following communicable diseases and conditions and other conditions of public health importance are reportable:

(a) AIDS, as defined by the Centers for Disease Control and Prevention, and HIV infection, as determined by a positive result from a test approved by the Federal Food and Drug Administration for the detection of HIV, including antibody, antigen, and all HIV nucleic acid tests;

(b) Anaplasmosis;

(c) Anthrax;

(d) Arboviral diseases, neuroinvasive and nonneuroinvasive (California serogroup, Chikungunya, Eastern equine encephalitis, Powassan, Saint Louis encephalitis, West Nile virus, Western equine encephalitis, Zika virus infection);

(e) Arsenic poisoning (≥ 70 micrograms per liter (µg/L) total arsenic in urine; or ≥ 35 µg/L methylated plus inorganic arsenic in urine);

(f) Babesiosis;

(g) Botulism (including infant, foodborne, other, and wound botulism);

(h) Brucellosis;

(i) Cadmium poisoning (≥ five µg/L total blood cadmium levels; or ≥ three µg/L total cadmium in urine);

(j) Candida auris (C. auris);

(k) Campylobacteriosis;

(l) Chancroid;

(m) Chlamydia trachomatis infection;

(n) Cholera;

(o) Coccidioidomycosis;

(p) Colorado tick fever;

(q) Coronavirus Disease 2019 (COVID-19); 

(r) Cryptosporidiosis;

(s) Cyclosporiasis;

(t) Dengue virus infections;

(u) Diphtheria;

(v) Ehrlichiosis;

(w) Escherichia coli, Shiga toxin-producing (STEC);

(x) Gastroenteritis outbreak;

(y) Giardiasis;

(z) Gonorrheal infection;

(aa) Granuloma inguinale;

(ab) Haemophilus influenzae invasive disease;

(ac) Hansen's disease (leprosy);

(ad) Hantavirus pulmonary syndrome or infection;

(ae) Hemolytic uremic syndrome, post diarrheal;

(af) Hepatitis A, acute;

(ag) Hepatitis B, acute, chronic, perinatal;

(ah) Hepatitis C, acute, chronic;

(ai) Influenza;

(aj) Lead levels in a capillary blood specimen of ≥ 3.5 micrograms per deciliter(µg/dL) in a person less than 16 years of age;

(ak) Lead levels in a venous blood specimen at any level;

(al) Legionellosis;

(am) Leptospirosis;

(an) Listeriosis;

(ao) Lyme disease;

(ap) Lymphogranuloma venereum;

(aq) Malaria;

(ar) Measles (rubeola);

(as) Melioidosis;

(at) Meningococcal disease (Neisseria meningitidis);

(au) Mercury poisoning (≥ ten µg/L total mercury in urine; or ≥ ten  µg elemental mercury/g creatinine in urine; or ≥ ten µg/L elemental, organic, and inorganic blood mercury levels);

(av) Monkeypox;

(aw) Mumps;

(ax) Pertussis;

(ay) Plague;

(az) Poliomyelitis, paralytic or nonparalytic;

(ba) Psittacosis;

(bb) Q-fever (acute and chronic);

(bc) Rabies in a human or animal; exposure to a human by a species susceptible to rabies infection;

(bd) Rubella (including congenital);

(be) Salmonella Paratyphi infection;

(bf) Salmonella Typhi infection; 

(bg) Salmonellosis;

(bh) Severe acute respiratory syndrome-associated coronavirus (SARS-CoV) disease;

(bi) Shigellosis;

(bj) Smallpox;

(bk) Spotted fever rickettsiosis;

(bl) Streptococcus pneumoniae, invasive disease;

(bm) Streptococcal toxic shock syndrome (STSS);

(bn) Syphilis;

(bo) Tetanus;

(bp) Tickborne relapsing fever;

(bq) Toxic shock syndrome (TSS) (nonstreptococcal);

(br) Transmissible spongiform encephalopathies (including Creutzfeldt Jakob Disease);

(bs) Trichinellosis (trichinosis);

(bt) Tuberculosis (TB) including latent tuberculosis infection;

(bu) Tularemia;

(bv) Varicella (chickenpox);

(bw) Vibriosis;

(bx) Viral hemorrhagic fevers; and

(by) Yellow fever.

(2) Also reportable is an outbreak of any communicable disease listed in the "Control of Communicable Diseases Manual" that occurs in an institutional or congregate setting and any unusual incident of unexplained illness or death in a human or animal with potential human health implications.

(1) A local health officer must immediately report (within four hours) to the department by telephone the information cited in ARM 37.114.205(1) through (2) whenever a case of one of the following diseases or other condition of public health importance is suspected or confirmed:

(a) Anthrax;

(b) Botulism;

(c) Plague;

(d) Poliomyelitis, paralytic or nonparalytic;

(e) Severe acute respiratory syndrome-associated coronavirus (SARS-CoV) disease;

(f) Smallpox;

(g) Tularemia; or

(h) Viral hemorrhagic fevers.

(2) A local health officer must transmit by telephone or secure electronic means to the department the information required by ARM 37.114.205(1) and (2) for each suspected or confirmed case of one of the following diseases, within the time limit noted for each:

(a) Information about a case of one of the following diseases should be submitted within 24 hours after it is received by the local health officer:

(i) an outbreak of a disease or condition specified in ARM 37.114.203;

(ii) any unusual incident of illness or death in a human or animal with potential human health implications;

(iii) Brucellosis;

(iv) Diphtheria;

(v) Gastroenteritis outbreak;

(vi) Influenza-associated hospitalization and mortality;

(vii) Measles;

(viii) Melioidosis;

(ix) Monkeypox; 

(x) Rabies in a human;

(xi) Rabies in an animal;

(xii) Rubella; and

(xiii) Syphilis.

(b) Information about a case of one of the following diseases must be submitted within seven calendar days after it is received by the local health officer:

(i) AIDS or HIV infection;

(ii) Anaplasmosis;

(iii) Arboviral diseases, neuroinvasive and non-neuroinvasive (California serogroup, Chikungunya, Eastern equine encephalitis, Powassan, Saint Louis encephalitis, West Nile virus, Western equine encephalitis, Zika virus infection);

(iv) Arsenic poisoning (≥ 70 µg/L total arsenic in urine; or ≥ 35 µg/L methylated plus inorganic arsenic in urine);

(v) Babesiosis;

(vi) Cadmium poisoning (≥ five µg/L total blood cadmium levels; or ≥ three µg/L total cadmium in urine);

(vii) Campylobacteriosis;

(viii) Candida auris (C. auris);

(ix) Chancroid;

(x) Chlamydial trachomatis infection;

(xi) Cholera;

(xii) Coccidioidomycosis;

(xiii) Colorado tick fever;

(xiv) Coronavirus Disease 2019 (COVID-19);

(xv) Cryptosporidiosis;

(xvi) Cyclosporiasis;

(xvii) Dengue virus infections;

(xviii) Giardiasis;

(xix) Gonorrhea;

(xx) Haemophilus influenzae, invasive disease;

(xxi) Hansen's disease (leprosy);

(xxii) Hantavirus pulmonary syndrome or infection;

(xxiii) Hemolytic uremic syndrome, post diarrheal;

(xxiv) Hepatitis A, acute;

(xxv) Hepatitis B, acute, chronic, perinatal;

(xxvi) Hepatitis C, acute, chronic;

(xxvii) Lead levels in a capillary blood specimen of ≥ 3.5 micrograms per deciliter(µg/dL) in a person less than 16 years of age;

(xxviii) Lead levels in a venous blood specimen at any level;

(xxix) Legionellosis;

(xxx) Leptospirosis;

(xxxi) Listeriosis;

(xxxii) Lyme disease;

(xxxiii) Malaria;

(xxxiv) Meningococcal disease (Neisseria meningitidis);

(xxxv) Mercury poisoning (≥ ten µg/L total mercury in urine; or ≥ ten µg elemental mercury/g in creatinine in urine; or ≥ ten µg/L elemental, organic, and inorganic blood mercury levels);

(xxxvi) Mumps;

(xxxvii) Pertussis;

(xxxviii) Psittacosis;

(xxxix) Q-fever (acute and chronic);

(xl) Salmonella Paratyphi infection;

(xli) Salmonella Typhi infection;

(xlii) Salmonellosis;

(xliii) Shigellosis;

(xliv) Spotted fever rickettsiosis;

(xlv) Streptococcus pneumoniae, invasive disease;

(xlvi) Streptococcal toxic shock syndrome (STSS);

(xlvii) Tetanus;

(xlviii) Tickborne relapsing fever;

(xlix) Toxic shock syndrome (nonstreptococcal) (TSS);

(l) Transmissible spongiform encephalopathies;

(li) Trichinellosis (trichinosis);

(lii) Tuberculosis (TB) including latent tuberculosis infection;

(liii) Varicella (chickenpox);

(liv) Vibrio cholera infection (cholera);

(lv) Vibriosis; and

(lvi) Yellow fever.

(3) Each week during which a laboratory-confirmed case of influenza is reported to the local health officer, the officer must transmit by secure electronic means to the department on Friday of that week the total number of the cases of influenza reported.

(4) For any animal exposure that may result in a risk of rabies transmission to a human by a species susceptible to rabies infection, the local health officer must report by secure electronic means to the department documentation of a rabies post-exposure prophylaxis recommendation or administration on a form provided by the department within seven calendar days of the recommendation or administration.

(5) A laboratory that performs testing associated with HIV infection must report:

(a) any test result or combination of test results that indicate HIV infection;

(b) all CD4 T-lymphocyte test results unless it is known that the test was performed in association with a disease other than HIV infection or HIV-related illness;

(c) HIV nucleic acid tests, RNA or DNA, irrespective of result;

(d) all test results for assays designed to assess HIV infection subtype and resistance to antiretroviral drugs, including nucleotide sequences, in a format designated by the department; and

(e) submit a specimen utilized for surveillance purposes only, to the department's public health laboratory upon request.

(1) A report of a case of reportable disease or a condition which is required by ARM 37.114.204(1) or (2) must include, if available:

(a) first and last name and middle initial, physical address including city, state and zip code, date of birth, gender, race, and ethnicity of the case;

(b) dates of onset of the disease or condition and the date the disease or condition was reported to the health officer;

(c) whether or not the case is suspected or confirmed;

(d) name and address of the case's physician; and

(e) name of the reporter or other person the department can contact for further information regarding the case.

(2) The information required by (1) must be supplemented by any other information in the possession of the reporter which the department or local health officer requests and which is related to case management and/or investigation of the case.

(3) The name or other identifying information of any case with a reportable disease or condition and the name and address of the reporter of any such case are confidential and not open to public inspection.

(1) A local health officer or the department may restrict a person employed or engaged in direct care of children, the elderly, or individuals who are otherwise at a high risk for disease from practicing an occupation or activity while infected by a reportable disease if, given the means of transmission of the disease in question, the nature of the person's work would tend to transmit the disease.

(2) No infectious person may engage in any occupation or activity involving the preparation, serving, or handling of food, including milk, to be consumed by others than their immediate family, until a local health officer determines them to be free of the infectious agent or unlikely to transmit the infectious agent due to the nature of their particular work.

(3) Persons involved in food preparation, serving, or handling of food may be subject to additional restrictions as specified in: "Food Code, 2013, Recommendations of the United States Public Health Service, Food and Drug Administration" published by National Technical Information Service, Publication PB2013-110462, ISBN 978-1-935239-02-4, November 3, 2013.

(4) Persons attending or residing in congregate settings may be subject to additional restrictions and exclusions to prevent further transmission as determined by the local health authority.

(2) If a person dies from a disease requiring quarantine of contacts, a funeral service for that person may be open to the public only if the casket remains closed and those contacts subject to the quarantine who attend the funeral are segregated from the rest of those attending, unless the contacts have been determined by a local health officer to be incapable of transmitting the infection or disease which caused the death.

(3) Transportation of dead human bodies must be in accord with ARM 37.116.103.

(1) Neither an infected person with a communicable disease for which subchapter 5 of this chapter prescribes isolation nor a contact made subject to quarantine by that subchapter may travel or be transported from one location to another without the permission of the local health officers with jurisdiction over the places of departure and arrival, except if, in the case of an infected person:

(a) the infected person is to be admitted directly to a hospital for the treatment of the communicable disease; and

(b) both local health officers are satisfied that adequate precautions are taken to prevent dissemination of the disease by the infected person en route to the hospital.

(1) If a communicable disease requires quarantine of contacts, a local health officer or the department shall institute whatever quarantine measures are necessary to prevent transmission, specifying in writing the person or animal to be quarantined, the place of quarantine, the frequency with which possible or known contacts must be medically observed to determine if physiological signs of the disease are occurring, and the duration of the quarantine.

(2) A local health officer or the department must ensure such contacts are medically observed as frequently as necessary during the quarantine period.

(2) A local health officer or the department may inspect the place of isolation during the period of isolation to determine compliance with the isolation.

(1) No person who has a reportable disease for which subchapter 5 of this chapter prescribes isolation may be brought within the boundaries of the state without prior notice to the department and approval of measures to be taken within Montana to prevent disease transmission.

(1) Subject to the limitation in (2), if a local health officer receives information about a case of any of the following diseases, the officer must work with the department to ensure that a specimen from the case is submitted to the department, when possible, which will be analyzed to confirm the existence or absence of the disease in question, or for further examination associated with surveillance or investigation of disease transmission:

(a) Anthrax;

(b) Arboviral diseases, neuroinvasive and non-neuroinvasive (California serogroup, Chikungunya, Eastern equine encephalitis, Powassan, Saint Louis encephalitis, West Nile virus, Western equine encephalitis, Zika virus infection);

(c) Botulism;

(d) Brucellosis;

(e) Candida auris (C. auris);

(f) Carbapenem-Resistant Organisms;

(g) Cholera;

(h) Diphtheria;

(i) Escherichia coli, Shiga toxin-producing (STEC);

(j) Haemophilus influenzae invasive disease;

(k) Hantavirus pulmonary syndrome or infection;

(l) Influenza;

(m) Listeriosis;

(n) Measles (rubeola);

(o) Meningococcal disease (Neisseria meningitidis);

(p) Plague;

(q) Poliomyelitis, paralytic or non-paralytic;

(r) Rabies (human);

(s) Rubella (including congenital);

(t) Salmonellosis (including Salmonella Typhi and Paratyphi);

(u) Severe acute respiratory syndrome-associated coronavirus (SARS-CoV) disease;

(v) Shigellosis;

(w) Smallpox;

(x) Trichinellosis (Trichinosis);

(y) Tuberculosis disease;

(z) Tularemia;

(aa) Vancomycin-intermediate staphylococcus aureus (VISA);

(ab) Vancomycin-resistant staphylococcus aureus (VRSA); and

(ac) Vibriosis.

(2) In the event of an outbreak, emergence of a communicable disease or a disease of public health importance, specimens must be submitted at the request of the department until a representative sample has been reached as determined by the department. 

(3) A laboratory professional or any other person in possession of a specimen from a case of a disease listed in (1) must submit the specimen to the department upon request.

(4) If no specimen from the case is otherwise available and the case refuses to allow a specimen to be taken for purposes of (1), the case will be assumed to be infected and must comply with whatever control measures are imposed by the department, or the local health officer.

(1) Immediately after being notified of a case or an outbreak of a reportable disease, a local health officer must investigate and take whatever steps are necessary to prevent transmission of the disease.

(2) If the local health officer finds that the nature of the disease and the circumstances of the case or outbreak warrant such action, the local health officer must:

(a) examine or ensure that a health care provider examines any infected person in order to verify the diagnosis;

(b) make an epidemiologic investigation to determine the source and possible transmission of infection;

(c) take appropriate steps, as outlined in the "Control of Communicable Diseases Manual", to prevent or control the transmission of disease; and

(d) notify contacts as defined in ARM 37.114.101 of the case and give them the information needed to prevent contracting the disease.

(3) Whenever the identified source of a reportable disease or a person infected with or exposed to a reportable disease who should be isolated, quarantined, interviewed, or placed under surveillance is located outside of the jurisdiction of the local health officer, the local health officer must coordinate with the department to notify the health officer of the relevant jurisdiction. 

(1) Whenever a communicable disease listed in ARM 37.114.203, or the "Control of Communicable Diseases Manual", or other communicable disease that constitutes a threat to the health of the public, becomes so prevalent as to endanger an area outside of the jurisdiction where it first occurred, the local health officer of the jurisdictional area in which the disease occurs must notify and cooperate with the department to control the transmission of the disease in question.

(1) Infection control precautions must be employed until laboratory tests indicate what organism is responsible for the outbreak, after which, control measures must be taken which are specific for the organism in question.

(1) The control measures described in the "Control of Communicable Diseases Manual" must be employed, unless otherwise provided in this subchapter. Unless a particular control measure specifies who is responsible, the local health officer or the authorized representative of a local health officer must:

(a) employ the minimum control measures; or

(b) ensure that minimal control measures are employed by a health care provider or other person caring for a person with a reportable disease.

(1) Whenever human immunodeficiency virus (HIV) infection occurs, infection control fluid precautions must be used for the duration of the infection.

(2) The department or local health officer must ensure that the following actions are taken:

(a) instruct the case how to prevent transmitting the HIV infection to others;

(b) provide the case with information about any available services relevant to the case's health status and refer the case to appropriate services;

(c) interview the infected person to determine the person's contacts; and

(d) locate each contact, counsel each contact, advise the contact to receive testing to determine the contact's HIV status, and refer the contact for appropriate services.

(3) The health care provider may perform the required actions under (2) at the discretion of the department or local health officer.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) The local health officer or the department must either employ or ensure that control measures as outlined in the ″Sexually Transmitted Infections Treatment Guidelines″ are followed.

This rule has been repealed.

(1) The local health officer or the department must either employ or ensure that control measures as outlined in the "Sexually Transmitted Infections Treatment Guidelines" are followed.

(2) The local health officer must interview an individual who contracts the infection in order to determine the person's sexual contacts, and must ensure that those contacts are examined and receive the medical treatment indicated by clinical or laboratory findings.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) The local health officer or the department must ensure that a child attending day care or child care as defined in ARM 37.95.102 must be excluded from such care until diarrhea resolves and two stool specimens collected at least 24 hours apart, obtained at least 48 hours after antimicrobial therapy has been discontinued, are negative.

This rule has been repealed.

This rule has been repealed.

(1) The local health officer or the department must either employ or ensure that control measures as outlined in the "Sexually Transmitted Infections Treatment Guidelines" are followed.

(2) The local health officer must interview an individual who contracts the infection in order to determine the person's sexual contacts, and must ensure that those contacts are examined and receive the medical treatment indicated by clinical or laboratory findings.

(1) The local health officer or the department must either employ or ensure that control measures as outlined in the "Sexually Transmitted Infections Treatment Guidelines" are followed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) For a case of type B hepatitis not involving a pregnant woman, control measures outlined in Control of Communicable Diseases Manual must be applied.

(2) In the event a hepatitis B surface antigen (HbsAg) is positive in a pregnant woman, the local health officer must:

(a) ensure appropriate health care providers and the birthing facility are aware of the mother's status and the infant's need for prophylaxis;

(b) ensure that hepatitis B immunoglobulin (HBIG) and vaccine are readily available at the birthing facility at the expected time of delivery;

(c) confirm the administration of HBIG and vaccine after delivery and submit the report form provided by the department within seven days after delivery and counsel the mother and provider regarding the need for further vaccination and testing;

(d) at one to two months and again at six to seven months after delivery contact the health care provider or guardian of the infant to confirm the vaccine was given and provide an update to the department using a form provided by the department; and

(e) at nine to 15 months after delivery, confirm testing of the infant for the surface antigen and antibody to the hepatitis B virus (HBV), counsel as appropriate, and provide an update to the department using a form provided by the department.

(1) The local health officer must ensure that each case is counseled regarding prevention of transmission to others and provided with referrals to counseling and medical care as appropriate.

(2) In cases of acute Hepatitis C, the local health officer must identify, notify, and refer at-risk contacts for testing.

(3) In cases of chronic Hepatitis C, the local health officer may notify and refer at-risk contacts for testing, or encourage the case to do so.

This rule has been repealed.

(1) The health officer must gather information about the circumstances and nature of the exposure using forms developed by the department.

(2) The local health officer must ensure that the following actions are performed when a biological sample derived from the human body is reported that exceeds reportable toxic metal levels indicated in ARM 37.114.203(1)(e), (i), (ai), and (ar). The health officer or health-care provider must provide:

(a) counseling about the health consequences of their toxic metals exposure;

(b) information about ways to reduce or eliminate their exposure(s) to toxic metals; and

(c) referral of the case and household members potentially at risk of exposure to a health-care provider for additional follow-up and testing as appropriate.

(3) The department will provide consultation, assist with investigations, and coordinate responses in occupational and community settings at the request of the health officer. 

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) The local health officer or the department must either employ or ensure that control measures as outlined in the "Sexually Transmitted Infections Treatment Guidelines" are followed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) For cases or outbreaks of Multidrug-Resistant Organisms (MDROs), control measurers outlined in the "Interim Guidance for a Public Health Response to Contain Novel or Targeted Multidrug-resistant Organisms (MDROs)," updated January 2019, must be applied and infection control precautions appropriate to the event must be implemented. 

(2) The department will provide consultation, assist with investigations, and coordinate responses in healthcare facility and community settings at the request of the local health officer.

This rule has been repealed.

(1) For a case of Psittacosis, control measures outlined in Control of Communicable Diseases Manual must be applied.

(2) The local health officer must inquire whether a bird epidemiologically linked to a case of psittacosis was obtained from an aviary, and if so, determine the location of the aviary and report it to the Montana State Veterinarian, Department of Livestock.

(1) Infection control precautions must be imposed upon a case of pertussis for five days after the start of antibiotic therapy, or 21 days after the date of onset of symptoms if no antibiotic therapy is given.

(2) An individual identified by the local health officer as a household contact or individual at high risk of severe illness or an individual who has close contact with a person at high risk of severe illness must be referred by the officer to a physician for chemoprophylaxis. Persons at high risk for severe illness include infants under 12 months, pregnant women, or individuals with preexisting health conditions that may be exacerbated by a pertussis infection. Other individuals identified as close contacts may be referred for chemoprophylaxis depending on the circumstances of the case or cases.

(3) An individual identified by the local health officer as a close contact must be monitored by the local health officer for respiratory symptoms for 21 days after the person's last contact with the case.

(4) If an individual identified as a close contact shows respiratory symptoms consistent with pertussis, the health officer must order the individual to avoid contact with anyone outside of the individual's immediate family until a medical evaluation indicates that the individual is not developing pertussis.

(5) Surveillance for susceptible close contacts must be initiated immediately by the local health officer and immediate immunizations recommended by the officer must be administered to identified susceptible close contacts.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) Control measures outlined in the Control of Communicable Diseases Manual must be applied for confirmed or suspected exposures to a human by a species susceptible to rabies infection.

(2) The local health officer must investigate each report of possible rabies exposure and gather, at a minimum, information about the circumstances of the possible rabies exposure; nature of the exposure; name, age, and address of the exposed individual; vaccination status of the animal in question; treatment of the exposed person; and eventual outcome for both animal and person involved.

(3) As soon as possible, after investigating a report of possible rabies exposure, the local health officer must inform the exposed person or the individual responsible for the exposed person if that person is a minor, whether or not treatment is recommended to prevent rabies and provide a referral to a health care provider.

(4) Whenever the circumstances involve a dog, cat, or ferret, the local health officer must:

(a) arrange for the animal to be observed for signs of illness during a ten-day observation period at an animal shelter, veterinary facility, or other adequate facility, and ensure that any illness in the animal during the confinement or before release is evaluated by a veterinarian for signs suggestive of rabies; and

(b) if the symptoms observed are consistent with rabies, order the animal euthanized and the head sent to the Department of Livestock's diagnostic laboratory in Bozeman for rabies analysis. The local health officer may also order an animal euthanized subsequent to isolation, and the brain analyzed. 

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) The local health officer or the department must either employ or ensure that control measures as outlined in the "Sexually Transmitted Infections Treatment Guidelines" are followed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) The local health officer or the department must ensure that a child attending child care in facilities defined in ARM 37.95.102 must be excluded from such care until diarrhea resolves and three stool cultures collected at least 24 hours apart, obtained at least 48 hours after antimicrobial therapy has been discontinued, are negative.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

The following definitions, together with the definitions contained in 20-5-402, MCA, apply throughout this subchapter:

(1) "ACIP" means the advisory committee on immunization practices of the U.S. Public Health Service.

(2) "Adequate documentation" means documentation which meets the specifications set forth in ARM 37.114.703.

(3) "CLIA" means the federal clinical laboratory improvement amendments of 1988.

(4) "Commencing attendance for the first time" means the first occasion a pupil attends any Montana school, and does not include transfers from one Montana school to another.

(5) "Department" means the Department of Public Health and Human Services.

(6) "DT vaccine" means a vaccine containing a combination of diphtheria and tetanus toxoids.

(7) "DTP vaccine" and "DTAP vaccine" mean vaccines containing diphtheria and tetanus toxoids and pertussis (whooping cough) vaccine combined.

(8) "Healthcare provider" is a person who is licensed, certified, or otherwise authorized by any U.S. state or Canada to provide health care and who meets the additional qualifying criteria specified in 20-5-405, MCA.

(9) "Hib vaccine" means a vaccine immunizing against infection by Haemophilus influenzae type B disease.

(10) "Immunization information system" means a confidential, computerized, population-based system managed and maintained by the department that collects and consolidates vaccination data from vaccine providers.

(11) "MMR vaccine" means a vaccine containing a combination of measles, mumps, and rubella vaccine.

(12) "Montana Certificate of Immunization Form (HES 101)" means the form provided by the department to consolidate immunization history. Copies of the form are electronically accessible at https://dphhs.mt.gov/publichealth/immunization/.

(13) "MR vaccine" means a vaccine containing a combination of measles and rubella vaccine.

(14) "Official immunization record" means a standard electronic or paper record that is maintained by the department, by another state's principal health agency, or by a healthcare provider to record the immunization status of a child, and includes the following:

(a) child's legal name;

(b) birthdate;

(c) sex; and

(d) vaccination date (month, day, and year) by vaccine type, or, in the case of a postsecondary record, the month and year of vaccine administration.

(15) "Physician" is a person licensed to practice medicine in any jurisdiction in the United States or Canada and who holds a degree as a doctor of medicine or of osteopathy.

(16) "Polio vaccine" means a trivalent polio vaccine, known by the abbreviation OPV, or enhanced inactivated polio vaccine, known by the abbreviation of IPV.

(17) "Preschool" means any facility that is established chiefly for educational purposes, limits its services to children who are at least three years of age, and meets the definition of a preschool in 20-5-402, MCA.

(18) "Pupil" means a person who receives school instruction:

(a) in a preschool or kindergarten through grade 12 setting, including a foreign exchange student, regardless of the length of attendance or whether credit is received;

(b) in a home school, but only while participating in a group activity with pupils in a school otherwise subject to the requirements of Title 20, chapter 5, part 4, MCA, such as laboratories, libraries, gymnasiums, and team activities; or

(c) in a postsecondary school who is attending classes on the school's campus and who has either matriculated into a degree program or is registered for more than one-half of the full-time credit load that is normal for that school.

(19) "Td vaccine" means a vaccine containing tetanus and diphtheria toxoids.

(20) "Tdap vaccine" means a vaccine containing tetanus and diphtheria toxiods, and acellular pertussis.

(21) "Transfer" means to change school attendance, at any time, from one public school district to another, between private schools, or between public and private schools, and includes a change which occurs between the end of one school year and commencement of the next.

(22) "Vaccine" means:

(a) if administered in the United States, an immunizing agent recommended by the ACIP and approved by the Food and Drug Administration, U.S. Public Health Service; or

(b) if administered outside of the United States, an immunizing agent:

(i) administered by a person licensed to practice medicine in the country where it is administered or by an agent of the principal public health agency of that country; and

(ii) having adequate documentation.

(23) "Varicella vaccine" means a vaccine containing a live-attenuated varicella vaccine.

(1) This subchapter specifies the immunization requirements of 20-5-403, MCA.

(2) Administration of a vaccine is only acceptable if it is done in accordance with the standards and schedules for vaccine use adopted by ACIP of the U.S. Public Health Service.

(3) Half doses of vaccine are unacceptable for purposes of meeting the school immunization requirements of these rules.

(4) Vaccine doses given up to four days before the minimum interval or age are counted as valid. Live vaccines not administered at the same visit must be separated by at least four weeks.

(5) Documentation of immunity from varicella, measles, mumps, or rubella by laboratory evidence, or diagnosis/verification of disease by physician, nurse practitioner, or physician's assistant, may be used in lieu of the vaccine requirement.

(1) The following are considered adequate documentation of immunization for the purposes of this subchapter, subject to the restriction in (2):

(a) a record from any local health department in the United States, signed by a local health officer or nurse;

(b) a certificate signed by a local health officer or nurse;

(c) any official immunization record, if information has been recorded and signed or stamped by a physician, physician's designee, local health officer, or that officer's designee; or an official report from the statewide immunization information system, or a healthcare provider's medical record system;

(d) a form approved by the U.S. federal government;

(e) any state's official parent maintained immunization record;

(f) the international certificates of vaccination approved by the world health organization; or

(g) in the case of vaccine administered outside of the United States, a record of the vaccination signed by an official of the principal public health agency of the country where the vaccination occurred.

(2) Vaccine administration data may not be filled out by a parent, guardian or other person unless they are a physician, health department official or person otherwise authorized to do so by this subchapter.

(3) The following are considered adequate documentation in lieu of receiving required vaccines:

(a) the conditional enrollment form prescribed by the department;

(b) a medical exemption statement prepared in accordance with the requirements of 20-5-405, MCA;

(c) a religious exemption prepared in accordance with the requirements of 20-5-405, MCA; or

(d) documentation of immunity from varicella, measles, mumps, or rubella by laboratory evidence or diagnosis/verification of disease by physician, nurse practitioner, or physician's assistant. The tests must indicate serological evidence of immunity and must be performed by a CLIA-approved lab. A copy of the test results must be attached to the pupil's official immunization record.

(1) Before a prospective pupil may attend a Montana preschool, that school must be provided with adequate documentation that the prospective pupil has been immunized in accordance with the following standards:

(a) the prospective pupil must have received three doses of polio vaccine and four doses of DTP/DTaP vaccine or DT vaccine, subject to the requirement that DT vaccine administered to children is acceptable only if accompanied by a medical exemption for that prospective pupil from pertussis vaccination;

(b) the prospective pupil must receive one dose of MMR vaccine, administered no earlier than 12 months of age;

(c) one dose of Hib vaccine must be administered on or after the first birthday, unless the prospective pupil is older than 59 months of age; and

(d) the prospective pupil must have received one dose of varicella vaccine, administered no earlier than 12 months of age.

(2) If a prospective pupil is not vaccinated with all of the vaccines required in (1), the prospective pupil may be admitted conditionally in accordance with the requirements of ARM 37.114.710.

(3) A preschool must keep immunization data for each enrolled pupil, including the date, month, and year of administration of all required vaccines. The HES 101 may be used for this purpose, but is not mandatory.

(4) If a religious or medical exemption is claimed, the preschool must maintain the record of that exemption in accord with the requirements of ARM 37.114.715 or 37.114.716, whichever applies.

(1) Before a prospective pupil may unconditionally attend a Montana school offering any portion of kindergarten through grade 12, that school must be provided with adequate documentation that the prospective pupil has been immunized through administration of the vaccines and on the schedules specified in this rule.

(2) Vaccines immunizing against diphtheria, pertussis, and tetanus must be administered as follows:

(a) A pupil or prospective pupil less than seven years of age must be administered four or more doses of DTP or DTAP vaccine, at least one dose of which must be given after the fourth birthday;

(b) A pupil or prospective pupil seven years old or older who has not completed the requirement in (2)(a) must receive additional doses of Tdap vaccine or Td vaccine to become current in accordance with the ACIP schedule;

(c) Prior to entering the seventh grade, a pupil must receive a dose of Tdap vaccine if the following criteria are met:

(i) the pupil is 11 years of age or older; or

(ii) a dose of Tdap vaccine was not given to the pupil at ten years of age or older;

(d) If a pupil enters the seventh grade before reaching 11 years of age, a booster shot of Tdap vaccine must be administered to the pupil as soon as possible after the pupil attains that age, unless the pupil already was administered a dose of Tdap vaccine at ten years of age or older.

(3) Polio vaccine must be administered to a prospective pupil in three or more doses of trivalent poliomyelitis vaccine, at least one dose of which must be given after the fourth birthday.

(4) A pupil or prospective pupil must have received two doses of live measles, mumps, and rubella vaccine no earlier than 12 months of age.

(5) A pupil or prospective pupil must have received two doses of live varicella vaccine no earlier than 12 months of age.

(1) After receiving the documentation set forth in ARM 37.114.703, a school must obtain and keep the following immunization data for each pupil:

(a) legal name;

(b) birthdate;

(c) sex; and

(d) the vaccination date (month, day and year) of each vaccine administered.

(2) HES 101 may be accepted by the school without reference to other adequate documentation if:

(a) sections I and II are completed and signed by a physician, local health department official, the designee of either, or the form is directly obtained from the immunization information system; and

(b) the pupil claims no exemptions.

(3) If the information required by (1) has not been provided to the school on HES 101:

(a) immunization data may be transferred onto HES 101 from adequate documentation; and

(b) a copy of the adequate documentation must be attached to the official immunization record.

(2) If a prospective pupil was born in 1957 or later, the school must receive either:

(a) adequate documentation that:

(i) the prospective pupil was administered two doses of live MMR or MR vaccine, or any equivalent combination of measles and rubella vaccines, subject to the restrictions in ARM 37.114.712(2); and

(ii) dose one was administered at or after 12 months of age, and dose two was administered at least 28 days after dose one; or

(b) a CLIA approved laboratory report that meets the requirements of ARM 37.114.712(2) and indicates the prospective pupil is immune to measles and rubella.

(3) If a prospective pupil was born prior to 1957, the school must receive either:

(a) one of the forms of proof of measles and rubella immunity cited in (2); or

(b) the evidence of date of birth before January 1, 1957, required by ARM 37.114.712(2).

(4) In the event of an outbreak of either measles or rubella, a pupil must provide the documentation required by either (2)(a) or (b) or be excluded from classes and other school sponsored activities until the local health officer indicates to the school that the outbreak is over. If the laboratory documentation required by (2)(b) is provided, the laboratory report need only show immunity to whichever of the two diseases is the cause of the outbreak.

(5) The school must maintain a list of pupils who were born prior to 1957 and who provide the school only with the documentation specified in (3)(b). In the event of an outbreak of measles or rubella, the school must exclude those pupils as required by (4).

(6) A pupil who enters a postsecondary school may be conditionally enrolled as allowed by ARM 37.114.711 if that pupil has received only one dose of MMR or MR, but must have received the second dose before being eligible to attend during the next school term.

(a) A physician or local health department must indicate on the department's conditional attendance form that immunization of the prospective pupil has already been initiated by the prospective pupil receiving, at a minimum, one dose of each of the vaccines required in ARM 37.114.705. If a prospective pupil is exempt from any of the foregoing vaccinations, the requirements of this rule apply to the remaining immunizations for which no exemption exists.

(b) The conditional attendance form must include the date each dose of the required vaccines are to be administered, the signature of the physician, the physician's designee or the school or public health official who established the foregoing immunization schedule, and the signature of a parent or guardian acknowledging the immunization schedule; and

(c) The parent or guardian must return the form to the school before the prospective pupil may attend.

(2) The conditional attendance form prescribed by the department must be used to document conditional attendance status and must be retained in the pupil's school record.

(3) If the pupil who is attending school conditionally fails to receive vaccines on the date they are due, as stated on the conditional exemption form, the pupil must:

(a) be vaccinated;

(b) qualify for and claim an exemption from the immunizations not received and documented; or

(c) be excluded immediately from school by the school administrator or by their designee.

(4) A pupil who is excluded from school due to failure to meet the requirements of the conditional exemption may return to school only after the school receives the required documentation that the pupil has been administered the vaccines that were due according to the immunization schedule on the conditional form. If additional immunizations are still required, a physician, physician's designee or the school or public health official must reestablish the schedule as stated in (1)(b).

(a) the prospective pupil must receive a second dose of live measles and rubella vaccine before the beginning of the succeeding school term and no earlier than 28 days after administration of the first dose of measles and rubella vaccine; and

(b) the conditional enrollment form must be signed by the prospective pupil, acknowledging the measles and rubella immunization schedule and deadline date for compliance.

(2) If the pupil attending school conditionally fails to complete measles and rubella immunization within the time period indicated in (1)(a), the pupil must either qualify for and claim an exemption from measles and rubella immunization or be excluded immediately from school by the school administrator or that person's designee.

(3) A pupil excluded from school due to failure to receive the second dose of measles and rubella vaccine by the deadline specified in (1)(a) may continue school only after the pupil has received a second dose of measles and rubella vaccine or claims an exemption from immunization.

(1) Postsecondary schools must keep immunization data for each pupil either on HES 101 or on another document that includes, at a minimum:

(a) the pupil's name and birth date;

(b) the vaccination dose type administered to the pupil; and

(c) the month, day, and year each dose was administered, unless only the month and year of administration are known, in which case the administration date will be considered to be the first day of that month.

(2) Documentation of the proof of measles and rubella immunity required by ARM 37.114.709 must meet the following standards:

(a) there must be adequate documentation of the doses required by ARM 37.114.709, subject to the following restrictions:

(i) no measles vaccination given before 1967 is valid; and

(ii) no rubella vaccination given before 1969 is valid;

(b) if the pupil was born prior to January 1, 1957, proof of age must be made through a driver's license, school transcript, birth certificate, or passport, as long as the date of birth is indicated on the document;

(c) if a laboratory report is submitted to prove immunity, it must come from a CLIA approved laboratory report and:

(i) indicate that the person is immune to either measles and rubella;

(ii) specify the type of test performed and the test date; and

(iii) include a determination from the clinician interpreting the laboratory results.

(3) The documentation of immunization status must be kept on file with the immunization records required by (1).

(1) A prospective pupil seeking to attend school is not required to have any immunizations which are medically contraindicated. A medical exemption statement prepared and signed in accordance with the requirements of 20-5-405, MCA, will exempt a prospective pupil from those immunization requirements specified in the exemption.

(2) It is preferred, but not mandatory, that the medical exemption be recorded on the HES 101A "Medical Exemption Statement" form provided by the department.

(3) The medical exemption statement must be maintained by the school as part of the immunization record of the pupil qualifying for the exemption. In preschool and kindergarten through grade 12 settings, the medical exemption statement must be attached to the official immunization record.

(1) A prospective pupil seeking to attend school is exempt from those immunization requirements specified in a religious exemption that is prepared and signed in accordance with the requirements of 20-5-405, MCA. The religious exemption must be prepared using form HES 113 "Affidavit of Exemption on Religious Grounds from Montana School Immunization Law and Rules" provided by the department.

(2) The form must be provided to the school prior to attendance by the pupil. 

(3) The original copy of the claim of religious exemption must be kept by the school as part of the pupil's school record.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) A case of active tuberculosis disease exists if the case meets the laboratory or clinical criteria in (2) or (3).

(2) Laboratory criteria for active tuberculosis diagnosis:

(a) isolation of M. tuberculosis complex from a clinical specimen;

(b) demonstration of M. tuberculosis complex from a clinical specimen by nucleic acid amplification test; or

(c) demonstration of acid-fast bacilli in a clinical specimen when a culture has not been or cannot be obtained or is falsely negative or contaminated.

(3) Clinical criteria for active tuberculosis diagnosis:

(a) usually a positive tuberculin skin test result or positive interferon gamma release assay for M. tuberculosis;

(b) other signs and symptoms compatible with tuberculosis are for example: abnormal chest radiograph, abnormal chest computerized tomography scan or other chest imaging study, or clinical evidence of current disease;

(c) treatment with two or more antituberculosis medications; and

(d) a completed diagnostic evaluation.

(4) A case of latent tuberculosis infection exists if the case meets the laboratory and clinical criteria in (5) and (6).

(5) Laboratory criteria for latent tuberculosis infection:

(a) a positive tuberculin skin test (TST); or

(b) a positive interferon gamma release assay (IGRA).

(6) Clinical criteria for latent tuberculosis infection:

(a) no clinical evidence compatible with TB disease including no signs or symptoms consistent with TB disease; and

(b) chest imaging without abnormalities consistent with TB disease (chest radiograph or CT scan); or

(c) abnormal chest imaging that could be consistent with TB disease with microbiologic testing that is negative for abnormal chest imaging that could be consistent with TB disease with microbiologic testing that is negative for Mycobacterium Tuberculosis Complex and where TB disease has been clinically ruled out. 

(1) A person will be considered to have active tuberculosis until either the diagnosis of active tuberculosis is ruled out or adequate treatment is completed as determined by the local health officer or the department.

(2) When a person with active tuberculosis is an in-patient at a healthcare facility, either for diagnosis, acute care, or long-term care, the facility must notify the local health officer or department before the patient is discharged from their facility.

(1) Isolation must be imposed upon a case of active tuberculosis until the patient is considered not able to transmit tuberculosis as determined by the local health officer and the department's tuberculosis program.

(2) The local health officer or department's tuberculosis program may require contacts of a case to be tested for tuberculosis infection and disease.

(3) No quarantine of contacts is required unless the contact is symptomatic for active tuberculosis disease and has not completed a diagnostic evaluation to rule out active tuberculosis disease.

(1) Treatment of drug-susceptible active tuberculosis must be consistent with the standards contained in the Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis, published in Clinical Infectious Diseases, October 1, 2016.

(2) For patients with multi-drug resistant tuberculosis or other findings beyond the scope of the above guidelines in (1), the opinion of a tuberculosis expert physician with experience in treating drug-resistant or medically complicated tuberculosis will be sought and approved by the local health officer and the department's tuberculosis program.

(3) A person with active tuberculosis will be treated using directly observed therapy (DOT) until treatment is completed. The DOT plan will be approved by the local health officer and the department's tuberculosis program.

This rule has been repealed.

(1) The local health officer must ensure that each case of active tuberculosis within their jurisdiction obtains the follow-up tests, treatment, and monitoring recommended in the Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis, published in Clinical Infectious Diseases, October 1, 2016.

(2) The local health officer must submit a report to the department every month documenting the course of treatment and treatment completion date of each reported active tuberculosis case.

(3) The local health officer must ensure that a contact investigation is completed for each active case of tuberculosis considered able to transmit tuberculosis, following the "Guidelines for the Investigation of Contacts of Persons with Infectious Tuberculosis," December 16, 2005, a publication from the National Tuberculosis Controllers Association and the U.S. Centers for Disease Control and Prevention.

(4) The local health officer must submit reports to the department documenting the progress of the contact investigation and a final summary on forms provided by the department.

(5) A case of latent tuberculosis must be referred to a health-care provider to rule out active TB disease. Once active TB disease has been ruled out, the individual should be:

(a) educated on risks of conversion to active TB disease; and

(b) referred for treatment for latent tuberculosis infection.

(6) Local health officers must ensure that a latent tuberculosis infection report form, provided by the department, is completed and submitted.

(1) Whenever a physician diagnoses a case of tuberculosis, they must ensure that a specimen or culture from the tuberculosis case is sent to the department's public health laboratory for confirmation of the results, drug susceptibility testing, and genotyping.

(2) Whenever a laboratory finds a specimen or culture is positive for M. tuberculosis, the laboratory must submit the specimen or culture to the department's public health laboratory for confirmation of the results, drug susceptibility testing, and genotyping.