Communicable Disease (CD) Manual
The purpose of this Communicable Disease (CD) Manual is to provide guidance and instruction to San Benito County Public Health Services CD staff for responding to a local communicable disease incident as well as ongoing surveillance. It is also designed to be a reference for our healthcare partners such as Hazel Hawkins Memorial Hospital (HHMH), HHMH laboratory and local healthcare providers for infectious disease information from a public health perspective. The CD Manual will, therefore, also serve as an educational tool to assist us in working collaboratively with our partners on prevention, control, and reporting of infectious disease in our community.
Communicable Disease Manual 2016
Public Health Reporting Guidelines – Confidential Morbidity Report
California Code of Regulations, Title 17, Section 2500, requires healthcare providers knowing of or in attendance on a case or suspected case of any of the diseases or conditions listed below to report to the local health department within the indicated timeframe. San Benito County Public Health Services Communicable Disease Prevention and Control Unit places the highest priority on preserving the confidentiality of whom it serves. Public health officials rely on healthcare providers, laboratorians, and other public health personnel to report the occurrence of reportable diseases to their local health departments. Timely and accurate reporting of disease provides public health data necessary to reduce and prevent morbidity. For example, removing individuals from sensitive occupations such as food handling prevents the spread of diseases such as salmonellosis and hepatitis A. Similarly, the detection and treatment of patients with tuberculosis, the identification and treatment of asymptomatic carriers of typhoid or gonorrhea, and the rapid immunization of people exposed to vaccine-preventable diseases are additional examples of successful public health prevention and interventions made possible by the timely reporting of communicable disease. Failure to report can result in increased disease in the community, increased absences from work or school, increased costs for diagnosis and treatment, increased hospitalization, and increased poor health outcomes.
Title 17, California Code of Regulations (CCR)§2500, §25931 §2641.5-2643.20, and §2800-2812 Reportable Diseases and Conditions
§ 2500. REPORTING TO THE LOCAL HEALTH AUTHORITY.
-§2500(b) It shall be the duty of every health care provider, knowing of or in attendance on a case or suspected case of any of the diseases or condition listed below, to report to the local health officer for the jurisdiction where the patient resides. Where no health care provider is in attendance, any individual having knowledge of a person who is suspected to be suffering from one of the diseases or conditions listed below may make such a report to the local health officer for the jurisdiction where the patient resides.
2500(c) The administrator of each health facility, clinic, or other setting where more than one health care provider may know of a case, a suspected case or an outbreak of disease within the facility shall establish and be responsible for administrative procedures to assure that reports are made to the local officer.
2500(a)(14) “Health care provider” means a physician and surgeon, a veterinarian, a podiatrist, a nurse practitioner, a physician assistant, a registered nurse, a nurse midwife, a school nurse, an infection control practitioner, a medical examiner, a coroner, or a dentist.
How to Report a Disease
For Clusters, Outbreaks, and Diseases that Require Immediate Reporting:
Please call 831-637-5367 immediately to report any of the diseases or conditions below. During weekends and after hours, please call 831-471-1170 for immediate reporting and ask for the on-call Health Officer.
Report Immediately by Telephone:
|Anthrax, Human or Animal||Hantavirus Infections||Shiga Toxin (detected in feces)|
|Botulism (infant, food borne, wound, or other)||Hemolytic Uremic Syndrome||Smallpox (Variola)|
|Brucellosis, Human (all Brucella spp.)||Measles (Rubeola)||Tularemia, Human|
|Cholera||Meningococcal Infections||Viral Hemorrhagic Fevers, Human or Animal (e.g., Crimean-Congo, Ebola, Lassa, and Marburg viruses)|
|Ciguatera Fish Poisoning||Paralytic Shellfish Poisoning||Yellow Fever|
|Dengue||Plague, Human or Animal||Occurrences of Any Unusual Diseases|
|Diphtheria||Rabies, Human or Animal||Outbreaks of Any Disease (including diseases not listed in Title 17 Section 2500)|
|Domoic Acid Poisoning (Amnesic Shellfish Poisoning)||Scombroid Fish Poisoning|
|Escherichia coli: shiga toxin producing (SETC) including E. coli O157||Severe Acute Respiratory Syndrome (SARS)|
For diseases that require reporting within 1 to 7 Days:
- Select the appropriate Confidential Morbidity Report (CMR) form based on the disease/condition you are reporting. Diseases and conditions are listed in the tables below separated by their reporting timeframes.
- Use the CDPH110A-Public Health Form for reporting all conditions except Tuberculosis and conditions reportable to the DMV. Please indicate the disease at the top of the page under CONDITION BEING REPORTED.
- Use the CDPH110B-Tuberculosis Form to report suspected and confirmed cases of Tuberculosis.
- Use the CDPH110C-DMV Conditions Form to report Lapses of Consciousness or Control, Alzheimer’s disease or other conditions which may impair the ability to operate a motor vehicle safely (pursuant to H&S 103900). Please indicate specific disorder under CONDITION BEING REPORTED.
- Complete the CMR form (type electronically and print or print and complete by hand), and fax it0 to the San Benito County Communicable Disease Unit at 831- 637-9073. Reports can also be mailed to:
San Benito County Public Health Services
351 Tres Pinos Road, Suite A-202
Hollister, CA 95023
Phone: (831) 637-5367
Fax: (831) 637-9073
Report by Fax, Telephone, or Mail within 1 Working Day of Identification:
|Babesiosis||Malaria||Staphylococcus aureus Infection (only in a case resulting in death or admission to an ICU in a person who has not been hospitalized or had surgery, dialysis, or residency in a long-term care facility in the past year and did not have an indwelling catheter or percutaneous medical device at the time of culture)|
|Campylobacteriosis||Meningitis, Specify Etiology: Viral, Bacterial, Fungal, Parasitic||Syphilis|
|Chickenpox (Varicella) (only hospitalizations and deaths)||Pertussis (Whooping Cough)||Trichinosis|
|Encephalitis, Specify Etiology: Viral, Bacterial, Fungal, Parasitic||Psittacosis, Human||Typhoid Fever, Cases and Carriers|
|Foodborne Disease||Q Fever||Vibrio Infections|
|Haemophilus influenza, Invasive Disease (<15 years of age)||Relapsing Fever||West Nile Virus (WNV) Infection|
|Hepatitis A||Salmonellosis (Other than Typhoid Fever)||Yersiniosis|
Report by Fax, Telephone, or Mail within 7 Days of Identification:
|Acquired Immune Deficiency Syndrome (AIDS)||Gonococcal Infections||Lyme Disease|
|Anaplasmosis/Ehrlichiosis||Hepatitis B (specify acute or chronic)||Mumps|
|Brucellosis Animal (except infections due to B. canis)||Hepatitis C (specify acute or chronic)||Pelvic Inflammatory Disease (PID)|
|Chancroid||Hepatitis D (specify acute or chronic)||Rickettsial Disease (non-Rocky Mountain Spotted Fever), including Typhus and Typhus-like illness)|
|Chlamydia trachomatis Infections, Including Lymphogranuloma venereum (LGV)||Hepatitis E||Rocky Mountain Spotted Fever|
|Coccidioidomycosis (Valley Fever)||Human Immunodeficiency Virus (HIV) Infection||Rubella (German Measles)|
|Creutzfeldt-Jakob Disease (CJD) and Other Transmissible Spongiform Encephalopathies (TSE)||Influenza, ICU Admission or Death||Rubella Syndrome, Congenital|
|Cyclosporiasis||Influenza, Novel Strain (human)||Tetanus|
|Cysticercosis or Taeniasis||Legionellosis||Toxic Shock Syndrome|
|Giardiasis||Leprosy (Hansen Disease)||Tularemia, Animal|
If you are a multi-provider facility and interested in using a web-based portal to submit CMRs to the Health Department, please call 831-637-5367.
The California Code of Regulations, Title 17, Section 2505, requires laboratories to report laboratory testing results suggestive of specified diseases of public health importance to the local health jurisdiction. In addition, Title 17 Section 2505 (I) requires clinical laboratories to submit a culture or specimen to a local public health laboratory for certain diseases and conditions.
Laboratory findings are reportable to the health officer of the local health jurisdiction where the healthcare provider who first submitted the specimen is located within 1 hour (List (e)(1) diseases) or within 1 working day (List (e)(2) diseases) from the time that the laboratory notifies that healthcare provider or other person authorized to receive the report.
List (e)(1) – Within 1 Hour:
|Anthrax, Animal (B. anthracis)||Burkholderia pseudomallei and B. mallei (detection or isolation from a clinical specimen)||Smallpox (Variola)|
|Anthrax, Human (B. anthracis)||Influenza, Novel Strains (human)||Tularemia, Human (F. tularensis)|
|Botulism||Plague, Animal||Viral Hemorrhagic Fever Agents, Animal (e.g., Crimean-Congo, Ebola, Lassa, and Marburg Viruses)|
|Brucellosis, Human (all Brucella spp.)||Plague, Human||Viral Hemorrhagic Fever Agents, Human (e.g., Crimean-Congo, Ebola, Lassa, and Marburg Viruses)|
List (ee)(2) List – Within 1 Working Day:
|Acid-Fast Bacillus (AFB)||Hantavirus Infections||Q Fever (Coxiella burnetti)|
|Anaplasmosis/Ehrlichiosis||Hepatitis A, Acute Infection||Rabies, Animal or Human|
|Bordetella pertussis acute infection, by culture or molecular identification||Hepatitis B, Acute or Chronic Infection (specify gender)||Relapsing Fever (Borrelia spp.) (identification of Borrelia spp. spirochetes on peripheral blood smear)|
|Borrelia burgdorferi Infection||Hepatitis C, Acute or Chronic Infection||Rickettsia, any species, acute infection (detection from a clinical specimen or positive serology)|
|Brucellosis, Animal (Brucella spp. except Brucella canis)||Hepatitis D, Acute or Chronic Infection||Rocky Mountain Spotted Fever (Rickettsia rickettsia)|
|Campylobacteriosis (Campylobacter spp.) (detection or isolation from a clinical specimen)||Hepatitis E (detection of hepatitis E virus RNA from a clinical specimen or positive serology)||Rubella, Acute Infection|
|Chancroid (Haemophilus ducreyi)||Legionellosis (Legionella spp.) (antigen or culture)||Salmonellosis (Salmonella spp.)|
|Chlamydia trachomatis Infections, including lymphogranuloma venereum||Leprosy (Hansen Disease) (Mycobacterium leprae)||Shiga Toxin (detected in feces)|
|Coccidioidomycosis||Leptospirosis (Leptospira spp.)||Shigellosis (Shigella spp.)|
|Cyclosporiasis (Cyclospora cayetanensis)||Malaria||Trichinosis (Trichinella)|
|Dengue (dengue virus)||Measles (Rubeola), Acute Infection||Tuberculosis|
|Diphtheria||Mumps (Mumps Virus), Acute Infection||Tularemia, Animal (F. tularensis)|
|Encephalitis, arboviral||Mycobacterium tuberculosis||Typhoid|
|Escherichia coli: shiga toxin producing (STEC) including E. coli O157||Neisseria meningitidis (sterile site location)||Vibrio species Infection|
|Giardiasis (Giardia lamblia, intestinalis, or duodenailis)||Plague (Yersinia pestis), Human or Animal)||West Nile Virus Infection|
|Gonorrhea||Poliovirus||Yellow Fever (Yellow Fever Virus)|
|Haemophilus influenza (report an incident <15 years of age, from sterile site)||Psittacosis (Chlamydophila psittaci)||Yersiniosis (Yersinia spp., non-pestis)(isolation from a clinical specimen)|
Additional Laboratory Requirements:
- Tuberculosis: Any laboratory that isolates M. tuberculosis from a patient specimen must submit a culture to the local public health jurisdiction as soon as available AND perform or refer for drug susceptibility testing.
- Malaria: Any clinical laboratory that makes a finding of malaria parasite in the blood film shall immediately submit one or more such blood film slides to the local public health jurisdiction for confirmation.
- Salmonella: A culture of the organisms on which a diagnosis of salmonellosis is established must be submitted to the local public health jurisdiction.
- Listeria monocytogenes isolates, Measles immunoglobulin M (IgM)-positive sera, Neisseria meningitidis isolates from sterile sites, Shiga toxin-positive fecal broths, Shiga toxin-producing Escherichia coli (STEC) O157 and non-O157 isolates: cultures or specimens must be submitted as soon as available to the local public health jurisdiction.
Laboratory reports must be made in writing and include the following information:
- Date the specimen was obtained
- Patient identification number
- Specimen accession number or other unique specimen identifier
- Laboratory findings for the test performed
- The date that any positive laboratory findings were identified
- The name, gender, address, telephone number (if known), and age or date of birth of the patient
- The name, address, and telephone number of the healthcare provider who ordered the test
Disease Reporting Frequently Asked Questions (FAQs)
What is the legal basis for disease reporting in California?
Disease reporting requirements have been set forth by the California Legislature in Title 17 of the California Code of Regulations (CCR). Title 17 requires that health care providers report certain diseases to the local health authority using the Confidential Morbidity Report (CMR). CCR Title 17, Section 2500 describes reportable disease requirements in detail and is available ONLINE. Click on Title 17 Public Health, Chapter 4, Preventive Medical Services, Article 1, Reporting, and see Sections 2500-2511. See Section 2641.5, and for Alzheimer’s Disease and Related Disorders, see Sections 2800-2812.
Which diseases must be reported?
Refer to the back (page 2) of the Confidential Morbidity Report (CMR) for a complete and current list of all reportable diseases and conditions.
Who must report diseases?
According to Title 17 of the California Code of Regulations, healthcare providers, including physicians, podiatrists, nurse practitioners, physician assistants, registered nurses, nurse midwives, school nurses, infection control practitioners, medical examiners, coroners, veterinarians, and dentists. These health care providers are required to report certain diseases to the local health authority. Title 17, Section 2500 describes reportable disease requirements in detail (refer to ‘What is the Legal Basis for Reporting in California’ FAQ above.)
Why must healthcare providers report?
Failure to report a reportable disease is a citable offense for health care providers; however, this is not and should not be the primary motivating factor for reporting. Health care providers are the first and only line of defense in recognizing emerging public health issues. The window of opportunity afforded by early reporting directly impacts the effectiveness of any public health response. Reporting of other diseases (e.g., sexually transmitted diseases including HIV) also directly determines federal and state funds that communities may receive for prevention, treatment and case management.
How quickly must diseases be reported?
Refer to the back (page 2) of the CMR for required deadlines. In general, any disease that may require an immediate public health response (e.g., measles) must be called in as soon as possible. Other diseases may be reported by CMR within one working day or within seven calendar days according to page two of the CMR.
How does the Health Insurance Portability and Accountability Act (HIPAA) affect disease reporting?
HIPAA does not preclude disease reporting and, in fact, makes special allowances for the transfer of Public Health Information (PHI) to the local health authority.
Don’t labs report all of these diseases anyway?
No. Title 17 requires health care providers to submit a CMR for all reportable diseases, regardless of whether or not it is also reported by the lab. Labs are only required to report a subset of diseases. Additionally, labs often lack demographic information, risk information, and a clinical interpretation of the lab results all of which are required for an appropriate public health response.
Should I wait for lab confirmation before reporting a disease?
For diseases that require an immediate public health response (e.g., measles), DO NOT WAIT TO REPORT – REPORT THESE DISEASES AS SOON AS THEY ARE SUSPECTED. Unusual illnesses or illnesses that may be related to an outbreak or bioterrorism should also be reported as soon as they are identified. For all other diseases where an immediate public health response is not required (e.g., sexually transmitted diseases, hepatitis C), report it when a diagnosis is confirmed.
What if my patient is not a resident of San Benito County?
If the patient was examined or treated in San Benito County, then report to the San Benito County Public Health Office as required in Title 17 of the California Code of Regulations. If they were treated in another county and you are aware that they reside in San Benito County, report this to our office. Local health departments in California routinely forward the reports to the appropriate jurisdiction as needed.
Is someone available to answer communicable disease questions?
San Benito Health Department Communicable Disease Unit staff is available to answer questions related to communicable disease during business hours by calling 831-637-5367. We have a Public Health Officer on staff that can answer questions and assist local providers with any Communicable Disease questions or concerns. We will also link you to providers in the area that can assist you with further testing and/or treatment