§ 27.1. Definitions.

 The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:

   ACIP—The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, United States Department of Health and Human Services.

   AIDS (Acquired Immune Deficiency Syndrome)—As defined by the CDC case definition published in the CDC Morbidity and Mortality Weekly Report (MMWR). (The Department will publish in the Pennsylvania Bulletin a reference to a CDC update of the case definition within 30 days of its publication in the MMWR).

   Act—The Disease Prevention and Control Law of 1955 (35 P. S. § §  521.1—521.21).

   Anonymous HIV Testing—HIV testing performed at a State-designated HIV testing site for an individual who chooses not to provide his name in giving consent for the testing.

   Board—The Advisory Health Board of the Department.

   CDC—Centers for Disease Control and Prevention.

   Caregiver—The entity or individual responsible for the safe and healthful care or education of a child in a child care group setting.

   Carrier—A person who, without any apparent symptoms of a communicable disease, harbors a specific infectious agent and may serve as a source of infection.

   Case—A person or animal that is determined to have or suspected of having a disease, infection or condition.

   Case report form—The form designated by the Department for reporting a case or a carrier.

   Central office—Department headquarters located in Harrisburg.

   Child—A person under 18 years of age.

   Child care group setting—The premises in which care is provided at any one time to four or more children, unrelated to the operator.

   Clinical laboratory—A laboratory for which a permit has been issued to operate as a clinical laboratory under the Clinical Laboratory Act (35 P. S. § §  2151—2165).

   Communicable disease—An illness which is capable of being spread to a susceptible host through the direct or indirect transmission of an infectious agent or its toxic product by an infected person, animal or arthropod, or through the inanimate environment.

   Communicable period—The time during which an etiologic agent may be transferred directly or indirectly from an infected person to another person, or from an infected animal to a person.

   Confidential HIV testing—HIV testing performed for an individual who, in giving his consent for the testing, provides his name and other personal or demographic identifiers.

   Contact—A person or animal known to have had an association with an infected person or animal which presented an opportunity for acquiring the infection.

   County morbidity reporting area—A county so designated by the Board wherein initial reports for communicable and noncommunicable diseases are to be reported to the State health center of the Department.

   Department—The Department of Health of the Commonwealth.

   District office—One of the district headquarters of the Department located within this Commonwealth.

   FDA—Food and Drug Administration.

   HIV services—The range of services, including prevention, counseling, testing, treatment, case management, support and referral services, which are provided to persons infected with or affected by HIV or AIDS, and are intended to alleviate physical and psychosocial problems created by these diseases and conditions.

   Health care facility—

     (i)   A chronic disease, or other type of hospital, a home health care agency, a hospice, a long-term care nursing facility, a cancer treatment center using radiation therapy on an ambulatory basis, an ambulatory surgical facility, a birth center, and an inpatient drug and alcohol treatment facility, regardless of whether the health care facility is operated for profit, nonprofit or by an agency of the Commonwealth or local government.

     (ii)   The term does not include:

       (A)   An office used primarily for the private practice of a health care practitioner.

       (B)   A facility providing treatment solely on the basis of prayer or spiritual means in accordance with the tenets of any church or religious denomination.

       (C)   A facility conducted by a religious organization for the purpose of providing health care services exclusively to clergy or other persons in a religious profession who are members of a religious denomination.

   Health care practitioner—An individual who is authorized to practice some component of the healing arts by a license, permit, certificate or registration issued by a Commonwealth licensing agency or board.

   Health care provider—An individual, a trust or estate, a partnership, a corporation (including associations, joint stock companies and insurance companies), the Commonwealth, or a political subdivision, or instrumentality (including a municipal corporation or authority) thereof, that operates a health care facility.

   Household contact—A person living in the same residence as a case, including a spouse, child, parent, relation or other person, whether or not related to the case.

   Infectious agent—Any organism, such as a virus, bacterium, fungus or parasite, that is capable of being communicated by invasion and multiplication in body tissues and capable of causing disease.

   Isolation—The separation for the communicable period of an infected person or animal from other persons or animals, in such a manner as to prevent the direct or indirect transmission of the infectious agent from infected persons or animals to other persons or animals who are susceptible or who may spread the disease to others.

   LMRO—Local morbidity reporting office—A district office of the Department or a local health department.

   Local health authority—A county or municipal department of health, or board of health of a municipality that does not have a department of health. The term includes a sanitary board.

   Local health department—Each county department of health under the Local Health Administration Law (16 P. S. § §  12001—12028), and each department of health in a municipality approved for a Commonwealth grant to provide local health services under section 25 of the Local Health Administration Law (16 P. S. §  12025).

   Local health officer—The person appointed by a local health authority to head the daily administration of duties imposed upon or permitted of local health authorities by State laws and regulations.

   Medical record—An account compiled by physicians and other health professionals including a patient’s medical history; present illness; findings on physical examination; details of treatment; reports of diagnostic tests; findings and conclusions from special examinations; findings and diagnoses of consultants; diagnoses of the responsible physician; notes on treatment, including medication, surgical operations, radiation, and physical therapy; and progress notes by physicians, nurses and other health professionals.

   Modified quarantine—A selected, partial limitation of freedom of movement determined on the basis of differences in susceptibility or danger of disease transmission which is designated to meet particular situations. The term includes the exclusion of children from school and the prohibition, or the restriction, of those exposed to a communicable disease from engaging in particular activities.

   Monitoring of contacts—The close supervision of persons and animals exposed to a communicable disease without restricting their movement.

   Municipality—A city, borough, incorporated town or township.

   Operator—The legal entity that operates a child care group setting or a person designated by the legal entity to serve as the primary staff person at a child care group setting.

   Outbreak—An unusual increase in the number of cases of a disease, infection or condition, whether reportable or not as a single case, above the number of cases that a person required to report would expect to see in a particular geographic area or among a subset of persons (defined by a specific demographic or other features).

   Perinatal exposure of a newborn to HIV—The potential perinatal transmission of HIV to a newborn indicated by a positive HIV test result for the pregnant woman or mother of a newborn.

   Physician—An individual licensed to practice medicine or osteopathic medicine within this Commonwealth.

   Placarding—The posting on a home or other building of a sign or notice warning of the presence of communicable disease within the structure and the danger of infection therefrom.

   Quarantine—

     (i)   The limitation of freedom of movement of a person or an animal that has been exposed to a communicable disease, for a period of time equal to the longest usual incubation period of the disease, or until judged noninfectious by a physician, in a manner designed to prevent the direct or indirect transmission of the infectious agent from the infected person or animal to other persons or animals.

     (ii)   The term does not exclude the movement of a person or animal from one location to another when approved by the Department or a local health authority under §  27.67 (relating to the movement of persons and animals subject to isolation or quarantine by action of a local health authority or the Department).

   Reportable disease, infection, or condition—A disease, infection, or condition, made reportable by §  27.2 (relating to specific identified reportable diseases, infections and conditions).

   SHC—State Health Center—The official headquarters of the Department in a county, other than a district office.

   Secretary—The Secretary of the Department.

   Segregation—The separation for special control or observation of one or more persons or animals from other persons or animals to facilitate the control of a communicable disease.

   Sexually transmitted disease—A disease which, except when transmitted perinatally, is transmitted almost exclusively through sexual contact.

   State-designated anonymous HIV testing site—An HIV testing site supported by the Department either through direct funding or payment for testing, which provides anonymous and confidential testing and which agrees to adhere to the CDC’s counseling and testing standards and guidelines issued by the Department.

   Surveillance of disease—The continuing scrutiny of all aspects of occurrence and spread of disease that are pertinent to effective control.

   Volunteer—A person who provides services to a school or child care group setting without receiving remuneration.

   The provisions of this §  27.1 amended under section 16(b) of the Disease Prevention and Control Law of 1955 (35 P. S. §  521.16(b)); sections 2102(g), 2106(a) and 2111(b) of The Administrative Code of 1929 (71 P. S. § §  532(g), 536(a) and 541(b)); and section 803 of the Health Care Facilities Act (35 P. S. §  448.803).

 The diseases, infections and conditions in Subchapter B (relating to the reporting of diseases, infections and conditions) are reportable to the Department or the appropriate local health authority by the persons or entities in the manner and within the time frames set out in this chapter.

   The provisions of this §  27.2 amended under sections 4 and 16 of the Disease Prevention and Control Law of 1955 (35 P. S. § §  521.4 and 521.16); and sections 2102(g) and 2111(b) of The Administrative Code of 1929 (71 P. S. § §  532 (g) and 541(b)).

   The provisions of this §  27.2 amended November 26, 1982, effective November 27, 1982, 12 Pa.B. 4057; amended January 16, 1987, effective January 17, 1987, 17 Pa.B. 250; amended August 2, 1991, effective October 2, 1991, 21 Pa.B. 3416; amended January 25, 2002, effective January 26, 2002, 32 Pa.B. 491. Immediately preceding text appears at serial pages (243655) to (243656) and (256555).

 (a)  A person required to report under this chapter shall report an outbreak within 24 hours, and in accordance with §  27.4 (relating to reporting cases).

 (b)  A person required to report under this chapter who suspects a public health emergency, shall report an unusual occurrence of a disease, infection or condition not listed as reportable in Subchapter B (relating to reporting of diseases, infections and conditions) or defined as an outbreak, within 24 hours, and in accordance with §  27.4.

 (c)  Any unusual or group expression of illness which the Department designates as a public health emergency shall be reported within 24 hours, and in accordance with §  27.4.

   The provisions of this §  27.3 amended January 25, 2002, effective January 26, 2002, 32 Pa.B. 491. Immediately preceding text appears at serial page (256555).

 (a)  Except for reporting by a clinical laboratory, a case is to be reported to the LMRO serving the area in which a case is diagnosed or identified unless another provision of this chapter directs that a particular type of case is to be reported elsewhere. A clinical laboratory shall make reports to the appropriate office of the Department.

 (b)  Upon the Department’s implementation of its electronic disease surveillance system for certain types of case reports, persons who make those reports shall do so electronically using an application and reporting format provided by the Department. At least 6 months in advance of requiring a type of case report to be reported electronically, the Department will publish a notice in the Pennsylvania Bulletin announcing when electronic reporting is to begin.

 (c)  This section does not prohibit a reporter from making an initial report of a case to the Department or an LMRO by telephone. The reporter will be instructed on how to make a complete case report at the time of the telephone call.

 (d)  Department offices to which this chapter requires specified case reports to be filed are as follows:

   (1)  Cancer Registry, Division of Health Statistics, Bureau of Health Statistics and Research.

   (2)  Division of Infectious Disease Epidemiology, Bureau of Epidemiology.

   (3)  HIV/AIDS Epidemiology Section, Division of Infectious Disease Epidemiology, Bureau of Epidemiology.

   (4)  Division of Newborn Disease Prevention and Identification, Bureau of Family Health.

 (e)  A case shall be reported using the appropriate case report format. Information solicited by the case report form shall be provided by the reporter, irrespective of whether the report is made by submitting the form directly in hard copy or by telecommunication or electronic submission. An appropriate case report form or format may be procured from the office to which the type of case is reportable.

   The provisions of this §  27.4 issued under sections 2101—2111 of The Administrative Code of 1929 (71 P. S. § §  531—561); amended under section 16 of the Disease Prevention and Control Law of 1955 (35 P. S. §  521.16); sections 3 and 5 of the Newborn Child Testing Act (35 P. S. § §  623 and 625); section 16(a) of the Disease Prevention and Control Law of 1955 (35 P. S. §  521.16(a)); and sections 2102(g) and 2111(b) of The Administrative Code of 1929 (71 P. S. § §  532(g) and 541(b)).

   The provisions of this §  27.4 amended October 24, 1980, effective October 25, 1980, 10 Pa.B. 4212; amended August 19, 1988, effective August 20, 1988, 18 Pa.B. 3697; amended January 25, 2002, effective January 26, 2002, 32 Pa.B. 491; amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2435. Immediately preceding text appears at serial pages (287130) to (287131).

 Case reports submitted to the Department or to an LMRO are confidential. Neither the reports, nor any information contained in them which identifies or is perceived by the Department or the LMRO as capable of being used to identify a person named in a report, will be disclosed to any person who is not an authorized employe or agent of the Department or the LMRO, and who has a legitimate purpose to access case information, except for any of the following reasons:

   (1)  When disclosure is necessary to carry out a purpose of the act, as determined by the Department or LMRO, and disclosure would not violate another act or regulation.

   (2)  When disclosure is made for a research purpose for which access to the information has been granted by the Department or an LMRO. Access shall be granted only when disclosure would not violate another act or regulation. The research shall be subject to strict supervision by the LMRO to ensure that the use of information disclosed is limited to the specific research purpose and will not involve the further disclosure of information which identifies or is perceived as being able to be used to identify a person named in a report.

 (a)  Failure of a clinical laboratory to comply with the reporting provisions of this chapter may result in restrictions being placed upon or revocation of the laboratory’s permit to operate as a clinical laboratory, as provided for in the Clinical Laboratory Act (35 P. S. § §  2151—2165) unless failure to report is due to circumstances beyond the control of the clinical laboratory.

 (b)  Failure of a Department licensed health care facility to comply with the reporting provisions of this chapter may result in restrictions being placed upon or revocation of the health care facility’s license, as provided for in the Health Care Facilities Act (35 P. S. § §  448.101—448.904b).

 (c)  Failure of a health care practitioner to comply with the reporting provisions of this chapter may result in referral of that matter to the appropriate licensure board for disciplinary action.

 (d)  Failure of a child care group setting to comply with the reporting provisions of this chapter may result in referral of that matter to the appropriate licensing agency for appropriate action.

 To facilitate the reporting of cases by clinical laboratories, the following is required:

   (1)  When a clinical laboratory is requested to conduct a test which, depending upon the results, would impose a reporting duty upon the clinical laboratory, the clinical laboratory shall provide to the person who orders the testing, a form that solicits all information which is required for completion of the applicable case report form.

   (2)  A person who orders testing subject to paragraph (1) shall, at the time of ordering the test, provide the clinical laboratory with the information solicited by the form which that person either possesses or may readily obtain.

 (a)  A person who violates any provision of the act or this chapter shall, for each offense, upon conviction thereof in a summary proceeding before a district justice in the county wherein the offense was committed, be sentenced to pay a fine of not less than $25 and not more than $300, together with costs, and in default of payment of the fine and costs, shall be imprisoned in the county jail for a period not to exceed 30 days.

 (b)  A person afflicted with communicable tuberculosis, ordered to be quarantined or isolated in an institution, who leaves without consent of the medical director of the institution, is guilty of a misdemeanor, and upon conviction thereof, shall be sentenced to pay a fine of not less than $100 nor more than $500, or undergo imprisonment for not less than 30 days nor more than 6 months, or both.

 (c)  Prosecutions may be instituted by the Department, by a local health authority, or by any person having knowledge of a violation of the act or this chapter.

   The provisions of this §  27.8 adopted January 25, 2002, effective January 26, 2002, 32 Pa.B. 491.

Subchapter B. REPORTING OF DISEASES, INFECTIONS AND CONDITIONS

GENERAL

Sec.

§ 27.21. [Reserved].

 (a)  Except as set forth in this section or as otherwise set forth in this chapter, a health care practitioner or health care facility is required to report a case of a disease, infection or condition in subsection (b) as specified in §  27.4 (relating to reporting cases), if the health care practitioner or health care facility treats or examines a person who is suffering from, or who the health care practitioner or health care facility suspects, because of symptoms or the appearance of the individual, of having a reportable disease, infection or condition:

   (1)  A health care practitioner or health care facility is not required to report a case if that health care practitioner or health care facility has reported the case previously.

   (2)  A health care practitioner or health care facility is not required to report a case of influenza unless the disease is confirmed by laboratory evidence of the causative agent.

   (3)  A health care practitioner or health care facility is not required to report a case of chlamydia trachomatis infection unless the disease is confirmed by laboratory evidence of the infectious agent.

   (4)  A health care practitioner or health care facility is not required to report a case of cancer unless the health care practitioner or health care facility provides screening, therapy or diagnostic services to cancer patients.

   (5)  Only physicians and hospitals are required to report cases of AIDS.

 (b)  The following diseases, infections and conditions in humans are reportable by health care practitioners and health care facilities within the specified time periods and as otherwise required by this chapter:

   (1)  The following diseases, infections and conditions are reportable within 24 hours after being identified by symptoms, appearance or diagnosis:

 
Animal bite.
Anthrax.
Arboviruses.
Botulism.
Cholera.
Diphtheria.
Enterohemorrhagic E. coli.
Food poisoning outbreak.
Haemophilus influenzae invasive disease.
Hantavirus pulmonary syndrome.
Hemorrhagic fever.
Lead poisoning.
Legionellosis.
Measles (rubeola).
Meningococcal invasive disease.
Plague.
Poliomyelitis.
Rabies.
Smallpox.
Typhoid fever.

   (2)  The following diseases, infections and conditions are reportable within 5 work days after being identified by symptoms, appearance or diagnosis:

   
AIDS.
Amebiasis.
Brucellosis.
CD4 T-lymphocyte test result with a count of less than
 200 cells/µL or a CD4 T-lymphocyte percentage of less
 than 14% of total lymphocytes (effective October 18,
 2002).
Campylobacteriosis.
Cancer.
Chancroid.
Chickenpox (varicella) (effective January 26, 2005).
Chlamydia trachomatis infections.
Congential adrenal hyperplasia (CAH) in children under 5 years of age.
Creutzfeldt-Jakob Disease.
Cryptosporidiosis.
Encephalitis.
Galactosemia in children under 5 years of age.
Giardiasis.
Gonococcal infections.
Granuloma inguinale.
Guillain-Barre syndrome.
HIV (Human Immunodeficiency Virus) (effective October 18, 2002).
Hepatitis, viral, acute and chronic cases.
Histoplasmosis.
Influenza.
Leprosy (Hansen’s disease).
Leptospirosis.
Listeriosis.
Lyme disease.
Lymphogranuloma venereum.
Malaria.
Maple syrup urine disease (MSUD) in children under 5
 years of age.
Meningitis (All types not caused by invasive Haemophilus
 influenza or Neisseria meningitis).
Mumps.
Perinatal exposure of a newborn to HIV (effective
 October 18, 2002).
Pertussis (whooping cough).
Phenylketonuria (PKU) in children under 5 years of age.
Primary congenital hypothyroidism in children under 5
 years of age.
Psittacosis (ornithosis).
Rickettsial diseases.
Rubella (German measles) and congenital rubella
 syndrome.
Salmonellosis.
Shigellosis.
Sickle cell disease in children under 5 years
 of age.
Staphylococcus aureus, Vancomycin-resistant (or
 intermediate) invasive disease.
Streptococcal invasive disease (group A).
Streptococcus pneumoniae, drug-resistant invasive
 disease.
Syphilis (all stages).
Tetanus.
Toxic shock syndrome.
Toxoplasmosis.
Trichinosis.
Tuberculosis, suspected or confirmed active disease
 (all sites).
Tularemia.

 (c)  A school nurse shall report to the LMRO any unusual increase in the number of absentees among school children. A caregiver at a child care group setting shall report to the LMRO any unusual increase in the number of absentees among children attending the child care group setting.

 (d)  A health care facility or health care practitioner providing screening, diagnostic or therapeutic services to patients with respect to cancer shall also report cases of cancer as specified in §  27.31 (relating to reporting cases of cancer).

   The provisions of this 27.21a amended under section 16(a) and (b) of the Disease Control and Prevention Act of 1955 (35 P. S. §  521.16(a) and (b)); sections 2102(g), 2106(a) and 2111(b) of The Administrative Code of 1929 (71 P. S. § §  532(g), 536(a) and 541(b)); section 803 of the Health Care Facilities Act (35 P. S. §  448.803); and sections 3 and 5 of the Newborn Child Testing Act (35 P. S. § §  623 and 625).

   The provisions of this §  27.21a adopted January 25, 2002, effective January 26, 2002, 32 Pa.B. 491; amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2435; amended July 19, 2002, effective July 20, 2002, 32 Pa.B. 3597. Immediately preceding text appears at serial pages (288385) to (288388).

 (a)  A person who is in charge of a clinical laboratory in which a laboratory test of a specimen derived from a human body yields microscopical, cultural, immunological, serological, chemical, virologic, nucleic acid (DNA or RNA) or other evidence significant from a public health standpoint of the presence of a disease, infection or condition listed in subsection (b) shall promptly report the findings, no later than the next work day after the close of business on the day on which the test was completed, except as otherwise noted in this chapter.

 (b)  The diseases, infections and conditions to be reported include the following:

   
Amebiasis.
Anthrax.
An unusual cluster of isolates.
Arboviruses.
Botulism—all forms.
Brucellosis.
CD4 T-lymphocyte test result with a count of less than
 200 cells/µL or less than 14% of total lymphocytes
 (effective October 18, 2002).
Campylobacteriosis.
Cancer.
Chancroid.
Chickenpox (varicella).
Chlamydia trachomatis infections.
Cholera.
Congential adrenal hyperplasia (CAH) in children under 5 years of age.
Creutzfeldt-Jakob disease.
Cryptosporidiosis.
Diphtheria infections.
Enterohemorrhagic E. coli 0157 infections, or infections
 caused by other subtypes producing shiga-like toxin.
Galactosemia in children under 5 years of age.
Giardiasis.
Gonococcal infections.
Granuloma inguinale.
HIV (Human Immunodeficiency Virus) (effective October 18, 2002).
Haemophilus influenzae infections—invasive from sterile sites.
Hantavirus.
Hepatitis, viral, acute and chronic cases.
Histoplasmosis.
Influenza.
Lead poisoning.
Legionellosis.
Leprosy (Hansen’s disease).
Leptospirosis.
Listeriosis.
Lyme disease.
Lymphogranuloma venereum.
Malaria.
Maple syrup urine disease (MSUD) in children under 5
 years of age.
Measles (rubeola).
Meningococcal infections—invasive from sterile sites.
Mumps.
Pertussis.
Phenylketonuria (PKU) in children under 5 years of age.
Primary congenital hypothyroidism in children under 5
 years of age.
Plague.
Poliomyelitis.
Psittacosis (ornithosis).
Rabies.
Respiratory syncytial virus.
Rickettsial infections.
Rubella.
Salmonella.
Shigella.
Sickle cell disease in children under 5 years of age.
Staphylococcus aureus Vancomycin-resistant (or
 intermediate) invasive disease.
Streptococcus pneumoniae, drug-resistant invasive
 disease.
Syphilis.
Tetanus.
Toxoplasmosis.
Trichinosis.
Tuberculosis, confirmation of positive smears or cultures,
 including results of drug susceptibility testing.
Tularemia.
Typhoid.

 (c)  The report shall include the following, except as provided in subsection (d):

   (1)  The name, age, address and telephone number of the person from whom the specimen was obtained.

   (2)  The date the specimen was collected.

   (3)  The source of the specimen (such as, serum, stool, CSF, wound).

   (4)  The name of the test or examination performed and the date it was performed.

   (5)  The results of the test.

   (6)  The range of normal values for the specific test performed.

   (7)  The name, address and telephone number of the physician for whom the examination or test was performed.

   (8)  Other information requested in case reports or formats specified by the Department.

 (d)  Laboratory test results shall be reported by the person in charge of a laboratory directly to the Department’s Bureau of Epidemiology through secure electronic mechanisms in a manner specified by the Department, except for the following: Reports of CAH, galactosemia maple syrup urine disease, phenylketonuria, primary congenital hypothyroidism, sickle cell disease, cancer, CD4 T-lymphocyte test results with a count of less than 200 cells/µL or less than 14% of total lymphocytes, HIV (Human Immunodeficiency Virus), and lead poisoning shall be made in the manner and to the location specifically designated in this subchapter. See § §  27.30, 27.31, 27.32a and 27.34.

 (e)  A clinical laboratory shall submit isolates of salmonella and shigella to the Department’s Bureau of Laboratories for serotyping within 5 work days of isolation.

 (f)  A clinical laboratory shall submit isolates of Neisseria meningitidis obtained from a normally sterile site to the Department’s Bureau of Laboratories for serogrouping within 5 work days of isolation.

 (g)  A clinical laboratory shall send isolates of enterohemorrhagic E. coli to the Department’s Bureau of Laboratories for appropriate further testing within 5 work days of isolation.

 (h)  A clinical laboratory shall send isolates of Haemophilus influenzae obtained from a normally sterile site to the Department’s Bureau of Laboratories for serotyping within 5 work days of isolation.

 (i)  The Department, upon publication of a notice in the Pennsylvania Bulletin, may authorize changes in the requirements for submission of isolates based upon medical or public health developments when such departure is determined by the Department to be necessary to protect the health of the people of this Commonwealth. The change will not remain in effect for more than 90 days after publication unless the Board acts to affirm the change within that 90-day period.

   The provisions of this §  27.22 issued under sections 2101—2111 of The Administrative Code of 1929 (71 P. S. § §  531—561); amended under sections 4 and 16 of the Disease Prevention and Control Law of 1955 (35 P. S. § §  521.4 and 521.16); sections 2102(g), 2106(a) and 2111(b) of The Administrative Code of 1929 (71 P. S. § §  532(g), 536(a) and 541(b)); section 803 of the Health Care Facilities Act (35 P.S. §  448.803); and sections 3 and 5 of the Newborn Child Testing Act (35 P. S. § §  623 and 625).

   The provisions of this §  27.22 amended March 28, 1980, effective March 29, 1980, 10 Pa.B. 1387; amended January 16, 1987, effective January 17, 1987, 17 Pa.B. 250; amended August 19, 1988, effective August 20, 1988, 18 Pa.B. 3697; amended August 2, 1991, effective October 2, 1991, 21 Pa.B. 3416; amended January 25, 2002, effective January 26, 2002, 32 Pa.B. 491; amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2435; amended July 19, 2002, effective July 20, 2002, 32 Pa.B. 3597. Immediately preceding text appears at serial pages (288388) to (288391).

   Except with respect to reporting cancer, AIDS, CD4 T-lymphocyte test result with a count of less than 200 cells/µL or less than 14% of total lymphocytes, HIV test results or perinatal exposure of a newborn to HIV, individuals in charge of the following types of group facilities identifying a disease, infection or condition listed in §  27.21a (relating to reporting of cases by health care practitioners and health care facilities) by symptom, appearance or diagnosis shall make a report within the timeframes required in §  27.21a (relating to reporting of cases by health care practitioners and health care facilities):

   (1)  Institutions maintaining dormitories and living rooms.

   (2)  Orphanages.

   (3)  Child care group settings.

   The provisions of this §  27.23 amended under section 16(b) of the Disease Prevention and Control Law of 1955 (35 P. S. §  521.16(b)); sections 2102(g), 2106(a) and 2111(b) of The Administrative Code of 1929 (71 P. S. § §  532(g), 536(a) and 541(b)); and section 803 of the Health Care Facilities Act (35 P. S. §  448.803).

 A veterinarian is required to report a case, as specified in §  27.4 (relating to reporting cases), only if the veterinarian treats or examines an animal which the veterinarian suspects of having a disease set forth in §  27.35(a) (relating to reporting cases of disease in animals).

 A person in charge of a hospital or other institution for the treatment of disease shall, upon request of the Department, make reports of a disease or condition for which the Board has approved a specific study to enable the Department to determine and employ the most efficient and practical means to protect and to promote the health of the people by the prevention and control of the disease or condition. The reports shall be made on forms prescribed by the Department and shall be transmitted to the Department or to local health authorities as directed by the Department.

   The provisions of this §  27.29 amended January 25, 2002, effective January 26, 2002, 32 Pa.B. 491. Immediately preceding text appears at serial page (243664).

DISEASES AND CONDITIONS REQUIRING SPECIAL REPORTING

§ 27.30. Reporting cases of certain diseases in the newborn child.

 Reports of congenital adrenal hyperplasia (CAH), galactosemia, maple syrup urine disease, phenylketonuria, primary congenital hypothyroidism and sickle cell disease shall be made to the Division of Newborn Disease Prevention and Identification, Bureau of Family Health, as specified in Chapter 28 (relating to screening and follow-up for diseases of the newborn) and those provisions of §  27.4 (relating to reporting cases) consistent with Chapter 28 and this section.

   The provisions of this §  27.30 amended under section 16(a) of the Disease Control and Prevention Act of 1955 (35 P. S. §  521.16(a)); sections 2102(g) and 2111(b) of The Administrative Code of 1929 (71 P. S. § §  532(g) and 541(b)); and sections 3 and 5 of the Newborn Child Testing Act (35 P. S. § §  623 and 625).

   The provisions of this §  27.30 adopted January 27, 1978, effective January 28, 1978, 8 Pa.B. 248; amended March 28, 1980, effective March 29, 1980, 10 Pa.B. 1387; amended January 25, 2002, effective January 26, 2002, 32 Pa.B. 491; amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2435. Immediately preceding text appears at serial pages (287142) to (287143).

 (a)  A hospital, clinical laboratory, or other health care facility providing screening, diagnostic or therapeutic services for cancer to cancer patients shall report each case of cancer to the Department in a format prescribed by the Cancer Registry, Bureau of Health Statistics and Research, within 180 days of the patient’s discharge, if an inpatient or, if an outpatient, within 180 days following diagnosis or initiation of treatment.

 (b)  A health care practitioner providing screening, diagnostic or therapeutic services to cancer patients for cancer shall report each cancer case to the Department in a format prescribed by the Cancer Registry, Bureau of Health Statistics and Research, within 5 work days of diagnosis. Cases directly referred to or previously admitted to a hospital or other health care facility providing screening, diagnostic or therapeutic services to cancer patients in this Commonwealth, and reported by those facilities, are exceptions and do not need to be reported by the health care practitioner.

 (c)  The Department or its authorized representative shall be afforded physical access to all records of physicians and surgeons, hospitals, outpatient clinics, nursing homes and all other facilities, individuals or agencies providing services to patients which would identify cases of cancer or would establish characteristics of the cancer, treatment of the cancer or medical status of any identified cancer patient.

 (d)  Reports submitted under this section are confidential and may not be open to public inspection or dissemination. Information for specific research purposes may be released in accordance with procedures established by the Department with the advice of the Pennsylvania Cancer Control, Prevention and Research Advisory Board.

 (e)  Case reports of cancer shall be sent to the Cancer Registry, Division of Health Statistics, Bureau of Health Statistics and Research, unless otherwise directed by the Department.

   The provisions of this §  27.31 issued under The Administrative Code of 1929 (71 P. S. § §  531—545); the Disease Prevention and Control Law of 1955 (35 P. S. § §  521.1—521.21); and the Pennsylvania Cancer Control, Prevention and Research Act (35 P. S. § §  5631—5637).

   The provisions of this §  27.31 adopted November 26, 1982, effective November 27, 1982, 12 Pa.B. 4057; amended January 25, 2002, effective January 26, 2002, 32 Pa.B. 491. Immediately preceding text appears at serial pages (243664) to (243665).

 (a)  Reporting by clinical laboratories.

   (1)  A person in charge of a clinical laboratory shall report CD4 T-lymphocyte test results as defined in §  27.22(b) (relating to reporting of cases by clinical laboratories) electronically to the HIV/AIDS Epidemiology Section, Division of Infectious Disease Epidemiology, Bureau of Epidemiology, within 5 days of obtaining the test results.

   (2)  A person in charge of a clinical laboratory shall report positive test results of any test approved by the FDA to establish the presence of HIV, including a serologic, virologic, nucleic acid (DNA or RNA) or any other type of test the FDA approves to establish the presence of HIV. The report shall be made to the HIV/AIDS Epidemiology Section, Division of Infectious Disease Epidemiology, Bureau of Epidemiology, within 5 days of obtaining the test results.

   (3)  The report shall include the following information:

     (i)   The individual’s name and the address, city, county, and zip code of the individual’s residence.

     (ii)   The patient identifying number assigned to the individual by the physician or at the facility requesting the laboratory test.

     (iii)   The individual’s date of birth (month, day, year).

     (iv)   The individual’s sex.

     (v)   The individual’s race/ethnicity.

     (vi)   The date of each test performed.

     (vii)   The type of tests performed.

     (viii)   The results of the tests.

     (ix)   The name of the person or entity submitting the specimen for testing.

     (x)   The address of the person or entity submitting the specimen for testing, including the zip code, physical address and telephone number of the submitter.

   (4)  To enable the laboratory to complete the report it is required to file with the Department, a person or entity that requests a laboratory test for HIV or a CD4 T-lymphocyte count shall provide to the laboratory the information in subsection (a)(3), with the exception of subparagraphs (vi)—(ix). In addition to the information included in subsection (a)(3), a person or entity that requests a laboratory test for HIV or a CD4 T-lymphocyte count shall provide to the laboratory the date each test was requested and the type of test or tests requested.

 (b)  Reporting by physicians, hospitals, persons or entities, who diagnose AIDS or who receive or provide HIV and CD4 T-lymphocyte test results.

   (1)  A physician, hospital, person providing HIV services or person in charge of an entity providing HIV services, who makes a diagnosis of AIDS or who receives HIV or CD4 T-lymphocyte test results or provides HIV or CD4 T-lymphocyte test results to patients, shall report the following to the LMRO responsible for the geographic area in which the person is tested or diagnosed within 5 business days of the diagnosis of AIDS or the receipt of the results of the test:

     (i)   A diagnosis of AIDS.

     (ii)   A positive result of any test approved by the FDA to establish the presence of HIV, including a serologic, virologic, nucleic acid (DNA or RNA) or any other type of test the FDA approves to establish the presence of HIV (effective October 18, 2002).

     (iii)   A CD4 T-lymphocyte test result with a count of less than 200 cells/µL or a CD4 T-lymphocyte percentage of less than 14% of total lymphocytes (effective October 18, 2002).

     (iv)   A perinatal exposure of a newborn to HIV (effective October 18, 2002).

   (2)  A report of an HIV test result, CD4 T-lymphocyte count, AIDS case based on the CDC case definition, or perinatal exposure of a newborn to HIV shall include the following information:

     (i)   The individual’s name and the address, city, county and zip code of the individual’s residence.

     (ii)   The patient identifying number assigned to the individual by the physician or at the facility requesting the laboratory test.

     (iii)   The individual’s date of birth.

     (iv)   The individual’s sex.

     (v)   The individual’s race or ethnicity.

     (vi)   The date of each test performed.

     (vii)   The type of tests performed.

     (viii)   The test results.

     (ix)   The patient’s history on probable modes of transmission.

     (x)   The treatment provided.

     (xi)   The name, address and telephone number of the physician, hospital, or other person or entity that secured a specimen from the individual and submitted it for laboratory testing.

     (xii)   The name, address and telephone number of the entity in which the diagnosis was made or that received the HIV test result or CD4 T-lymphocyte count.

   (3)  In addition to reporting the AIDS diagnosis or the receipt of test results, the reporter shall maintain the data required in paragraph (2) in the patient file on the Department’s HIV/AIDS report form.

   (4)  An LMRO receiving reports of diagnoses of AIDS, positive HIV test results, reportable CD4 T-lymphocyte counts, and perinatal exposures to HIV shall forward completed case reports containing the information included in paragraph (2) electronically to the Department’s Bureau of Epidemiology through a secure electronic mechanism specified by the Department.

   The provisions of this §  27.32a adopted under section 16(b) of the Disease Prevention and Control Law of 1955 (35 P. S. §  521.16(b)); sections 2102(g), 2106(a) and 2111(b) of The Administrative Code of 1929 (71 P. S. § §  532(g), 536(a) and 541(b)); and section 803 of the Health Care Facilities Act (35 P. S. §  448.803).

 (a)  Anonymous testing for HIV, except for blinded HIV testing authorized under section 5(f) of the Confidentiality of HIV-Related Information Act (35 P. S. §  7605(f)), may only be provided at State-designated anonymous testing sites. All other HIV testing shall be conducted confidentially with the name of the tested individual collected, and the name of the individual reported when the result of the test is reportable. A person or entity reporting as required in this section shall offer all HIV and AIDS-related services confidentially and may not provide anonymous testing, or consider any test or its results to be anonymous, unless it is a State-designated anonymous HIV testing site.

 (b)  Anonymous test results shall be reported in accordance with §  27.32a(b)(2) (relating to reporting AIDS, HIV, CD4 T-lymphocyte counts and perinatal exposure of newborns to HIV). In lieu of the information required in §  27.32a(b)(2)(i), the report of an anonymous test shall include an assigned number preprinted on the HIV counseling and testing report form. The report shall also include the individual’s county of residence.

 (c)  The Department may create and fund an additional anonymous HIV-testing site in a particular area when it finds, based on demographic information reported to it under this chapter, that there is a lack of access to anonymous HIV testing in that particular area.

   (1)  The Department may begin the process of designating an anonymous HIV testing site either by contacting a provider or by responding to a request from a provider to increase the number of sites in the geographic area specified by the request.

   (2)  If a provider is designated as an anonymous HIV-testing site, the provider shall adhere to the CDC’s Guidelines for Counseling, Testing, Referral and Partner Notification and to the terms set out by the Department in any grant agreement.

   The provisions of this §  27.32b adopted under section 16(b) of the Disease Prevention and Control Law of 1955 (35 P. S. § §  521.16(b)); sections 2102(g), 2106(a) and 2111(b) of The Administrative Code of 1929 (71 P. S. § §  532(g), 536(a) and 541(b)); and section 803 of the Health Care Facilities Act (35 P. S. §  448.803).

 Counseling, testing, referral and partner notification services shall be performed in accordance with the Confidentiality of HIV-Related Information Act (35 P. S. § §  7601—7612). A person providing HIV test results to a patient may ask for the Department’s assistance with counseling if the person chooses to do so.

   The provisions of this §  27.32c adopted under section 16(b) of the Disease Prevention and Control Law of 1955 (35 P. S. § §  521.1—521.21); sections 2102(g), 2106(a) and 2111(b) of The Administrative Code of 1929 (71 P. S. § §  532(g), 536(a) and 541(b)); and section 803 of the Health Care Facilities Act (35 P. S. §  448.803).

 The Department will have access to and may review the patient records of physicians, hospitals, persons providing HIV services and persons in charge of entities providing HIV services, who make diagnoses of AIDS, or who receive or provide HIV and CD4 T-lymphocyte test results. Access and review will enable the Department to conduct case investigations, to determine whether under-reporting is occurring, to investigate reporting delays and to investigate other reporting problems.

   The provisions of this §  27.32d adopted under section 16(b) of the Disease Prevention and Control Law of 1955 (35 P. S. §  521.16(b)); sections 2102(g), 2106(a) and 2111(b) of The Administrative Code of 1929 (71 P. S. § §  532(g), 536(a) and 541(b)); and section 803 of the Health Care Facilities Act (35 P. S. §  448.803).

 (a)  The Department may conduct record audits of the records of physicians, hospitals, persons providing HIV services and persons in charge of entities providing HIV services who make diagnoses of AIDS or who receive or provide HIV test results for the purpose of obtaining information allowing the Department to complete HIV and CD4 T-lymphocyte case reports to aid it in tracking trends in disease and obtaining additional funding for prevention and treatment programs. The Department may audit records going back to January 1, 2000, for this purpose.

 (b)  The Department may require special reports of persons or entities required to report under this chapter to ensure compliance with this chapter.

   The provisions of this §  27.32e adopted under section 16(b) of the Disease Prevention and Control Law of 1955 (35 P. S. § §  521.1—521.21); sections 2102(g), 2106(a) and 2111(b) of The Administrative Code of 1929 (71 P. S. § §  532(g), 536(a) and 541(b)); and section 803 of the Health Care Facilities Act (35 P. S. §  448.803).

 (a)  Reportable sexually transmitted diseases and infections are as follows:

   (1)  Chancroid.

   (2)  Chlamydia trachomatis infections.

   (3)  Gonococcal infections.

   (4)  Granuloma inguinale.

   (5)  Lymphogranuloma venereum.

   (6)  Syphilis.

 (b)  Health care practitioners and health care facilities shall make case reports of these diseases to the LMRO where the case is diagnosed or identified.

 (c)  A clinical laboratory making a case report by paper shall make the reportto the LMRO where the case is diagnosed or idenitifed. A clinical laboratory making a case report electronically shall make the report to the Division of Infectious Disease Epidemiology, Bureau of Epidemiology.

 (a)  Reporting by clinical laboratories.

   (1)  A clinical laboratory shall report all blood lead test results on both venous and capillary specimens for persons under 16 years of age to the Childhood Lead Poisoning Prevention Program, Division of Maternal and Child Health, Bureau of Family Health.

   (2)  A clinical laboratory shall report an elevated blood lead level in a person 16 years of age or older to the Division of Environmental Health Epidemiology, Bureau of Epidemiology or to other locations as designated by the Department. An elevated blood lead level is defined by the National Institute

For Occupational Safety And Health (NIOSH). As of January 26, 2002, NIOSH defines an elevated blood lead level as a venous blood lead level of 25 micrograms per deciliter (µg/dL) or higher. The Department will publish in the Pennsylvania Bulletin any NIOSH update of the definition within 30 days of NIOSH’s notification to the Department.

   (3)  A clinical laboratory which conducts blood lead tests of 100 or more specimens per month shall submit results electronically in a format specified by the Department.

   (4)  A clinical laboratory which conducts blood lead tests of less than 100 blood lead specimens per month shall submit results either electronically or by hard copy in the format specified by the Department.

   (5)  A laboratory which performs blood lead tests on blood specimens collected in this Commonwealth shall be licensed as a clinical laboratory and shall be specifically approved by the Department to conduct those tests.

   (6)  Blood lead analyses requested for occupational health purposes on blood specimens collected in this Commonwealth shall be performed only by laboratories which are licensed and approved as specified in paragraph (5), and which are also approved by the Occupational Safety and Health Administration of the United States Department of Labor under 29 CFR 1910.1025(j)(2)(iii) (relating to lead).

   (7)  A clinical laboratory shall complete a blood lead test within 5 work days of the receipt of the blood specimen and shall submit the case report to the Department by the close of business of the next work day after the day on which the test was performed. The clinical laboratory shall submit a report of lead poisoning using either the hard-copy form or electronic transmission format specified by the Department.

   (8)  When a clinical laboratory receives a blood specimen without all of the information required for reporting purposes, the clinical laboratory shall test the specimen and shall submit the incomplete report to the Department

 (b)  Reporting by health care practitioners or health care facilities. A health care practitioner or health care facility shall report all cases of lead poisoning for persons under 16 years of age and pregnant women to the Lead Poisoning Prevention Program, Child and Adult Health Services Division, Bureau of Family Health. A case of lead poisoning shall be a lead level of 20 µg/dL or greater or a persistent elevated blood lead level ( 2 or more venous blood lead levels of 15 to 19 µg/dL (inclusive) at least three months apart).

   The provisions of this §  27.34 adopted January 25, 2002, effective January 26, 2002, 32 Pa.B. 491.

 (a)  The following diseases, infections and conditions in animals are reportable to the Division of Infectious Disease Epidemiology, Bureau of Epidemiology, as specified in §  27.4 (relating to reporting cases) within 5 work days after being identified:

 Anthrax.

 Arboviruses.

 Brucellosis.

 Plague.

 Psittacosis.

 Rabies.

 Transmissible Spongiform Encephalopathies.

 Tuberculosis.

 Tularemia.

 Any disease, infection or condition covered by §  27.3(b) (relating to reporting outbreaks and unusual diseases, infections and conditions).

 (b)  This chapter applies only to animals having or suspected of having one of the diseases, infections or conditions listed in subsection (a).

   The provisions of this §  27.35 adopted January 25, 2002, effective January 26, 2002, 32 Pa.B. 491.

   This section cited in 28 Pa. Code §  27.24a (relating to reporting of cases by veterinarians).

REPORTING BY LOCAL MORBIDITY OFFICES

§ 27.41. [Reserved].

 An LMRO that is not one of the Department’s district offices shall report a case that has been reported to it to the district office for the State health district in which it is located, or to the central office when this chapter directs that reports are to be filed with that office.

 An LMRO that is not one of the Department’s district offices shall submit, on a weekly basis, a case investigation report of the information from each case investigation which has resulted in confirmation of the incidence of a reportable disease, infection or condition. The report shall be submitted to the appropriate Department office as follows in a format and within the length of time set forth in this chapter:

   (1)  AIDS. To the HIV/AIDS Epidemiology Section, Division of Infectious Disease Epidemiology, Bureau of Epidemiology.

   (2)  Chickenpox, diphtheria, measles, mumps, pertussis, polio, rubella, and tetanus. To the Division of Immunizations, Bureau of Communicable Diseases.

   (3)  Chancroid, chlamydia trachomatis infections, gonococcal infections, granuloma inguinale, lymphogranuloma venereum, syphilis and tuberculosis. To the Division of Tuberculosis and Sexually Transmitted Diseases, Bureau of Communicable Diseases.

   (4)  Other reportable diseases and conditions. To the Division of Infectious Disease Epidemiology, Bureau of Epidemiology.

 (a)  An LMRO that is not one of the Department’s district offices shall report an outbreak by telephone on the same day that the outbreak is reported or otherwise made known to it, as follows:

   (1)  AIDS. To the HIV/AIDS Epidemiology Section, Division of Infectious Disease Epidemiology, Bureau of Epidemiology.

   (2)  Chancroid, chlamydia trachomatis infections, gonococcal infections, granuloma inguinale, lymphogranuloma venereum, syphilis and tuberculosis. To the Division of Tuberculosis and Sexually Transmitted Diseases, Bureau of Communicable Diseases.

   (3)  Chickenpox, diphtheria, measles, mumps, pertussis, polio, rubella and tetanus. To the Division of Immunizations, Bureau of Communicable Diseases.

   (4)  Other reportable diseases and conditions. To the Division of Infectious Disease Epidemiology, Bureau of Epidemiology.

 (b)  An LMRO that is not one of the Department’s district offices shall report by telephone on the same day any of the following diseases is reported or otherwise made known to it, as follows:

   (1)  Diphtheria, measles, pertussis and polio. To the Division of Immunizations, Bureau of Communicable Diseases.

   (2)  Anthrax, arbovirus disease, cholera, enterohemorrhagic Escherichia coli, hantavirus pulmonary syndrome, food borne botulism, Haemophilus influenzae invasive disease in a child under 15 years of age, hemorrhagic fever, hepatitis E, human rabies, Legionellosis, plague, smallpox, typhoid fever and yellow fever. To the Division of Infectious Disease Epidemiology, Bureau of Epidemiology.

   The provisions of this §  27.51 reserved January 25, 2002, effective January 26, 2002, 32 Pa.B. 491. Immediately preceding text appears at serial page (243667).

Subchapter C. QUARANTINE AND ISOLATION

GENERAL PROVISIONS

Sec.

§ 27.60. Disease control measures.

 (a)  The Department or local health authority shall direct isolation of a person or an animal with a communicable disease or infection; surveillance, segregation, quarantine or modified quarantine of contacts of a person or an animal with a communicable disease or infection; and any other disease control measure the Department or the local health authority considers to be appropriate for the surveillance of disease, when the disease control measure is necessary to protect the public from the spread of infectious agents.

 (b)  The Department and local health authority will determine the appropriate disease control measure based upon the disease or infection, the patient’s circumstances, the type of facility available and any other available information relating to the patient and the disease or infection.

 (c)  If a local health authority is not an LMRO, it shall consult with and receive approval from the Department prior to taking any disease control measure.

 When the isolation of a person or animal that is suspected of harboring an infectious agent is appropriate, the Department or local health authority shall cause the isolation to be done promptly following receipt of the case report.

   (1)  If the local health authority is not an LMRO, the local health officer shall consult with and receive approval from the Department prior to requiring isolation.

   (2)  If more than one jurisdiction is involved, the local health officer shall cause a person or animal to be isolated only after consulting with and receiving approval from the Department.

   (3)  The Department or local health authority shall ensure that instructions are given to the case or persons responsible for the care of the case and to members of the household or appropriate living quarters, defining the area within which the case is to be isolated and identifying the measures to be taken to prevent the spread of disease.

 If the disease is one which the Department, or a local health authority which is also an LMRO, determines to require the quarantine of contacts in addition to isolation of the case, the Department or local health officer of the LMRO shall determine which contacts shall be quarantined, specify the place to which they shall be quarantined, and issue appropriate instructions.

   (1)  When any other local health authority is involved, the local health officer shall quarantine contacts only after consulting with and receiving approval from the Department.

   (2)  The Department or local health officer shall ensure that provisions are made for the medical observation of the contacts as frequently as necessary during the quarantine period.

 Whenever the Department or a local health officer has reason to believe that a case, a contact or others will not fully comply with the isolation or quarantine as required for the protection of the public health and the Department or local health officer deems it necessary to use placards, placards may be utilized. Placards may be utilized by a local health officer of a local health authority that is not an LMRO only if the specific use is approved by the Department.

 (a)  A person or animal subject to isolation or quarantine by action of a local health authority or the Department may be removed to another location only with permission of the local health authority or the Department. If the local health authority is not an LMRO, the local health authority shall consult with and receive approval from the Department prior to permitting removal. Permission for removal may be given by the Department if the local health officer is not available.

 (b)  Removal of a person or animal under isolation or quarantine by action of the Department or a local health authority, from the jurisdiction of the Department or a local health authority to the jurisdiction of the Department or another local health authority may occur only with permission of the Department, if it is involved, and with the permission of the local health authorities concerned. If both of the local health authorities involved are not LMROs, the local health authorities shall consult with and receive approval from the Department prior to permitting removal. Permission for removal may be given by the Department if a local health officer from whom permission would otherwise be required is not available.

 (c)  Interstate transportation to or from this Commonwealth of a person or animal under isolation or quarantine may be made only with permission of the Department.

 (d)  Transportation of a person or animal under isolation or quarantine shall be made by private conveyance or as otherwise ordered by the local health authority or the Department. If the local health authority is not an LMRO, it shall consult with the Department prior to issuing an order. The sender, the receiver and the transporter of the person or animal shall be responsible to take due care to prevent the spread of the disease.

 (e)  When a person or animal under isolation or quarantine is transported, isolation or quarantine shall be resumed for the period of time required for the specific disease immediately upon arrival of the person or animal at the point of destination.

   The provisions of this §  27.67 amended January 25, 2002, effective January 26, 2002, 32 Pa.B. 491. Immediately preceding text appears at serial pages (243669) to (243670).

 The Department or a local health authority may order that a person or animal isolated or quarantined under the direction of the Department or to the appropriate health authority be released from isolation or quarantine when the Department or the local health authority determines that the person or animal no longer presents a public health threat. If the local health authority involved is not an LMRO, it shall consult with, and receive approval from, the Department prior to making the order.

 Whenever a laboratory specimen is to be examined for the presence of etiologic organisms to determine the duration of isolation or quarantine or to determine the eligibility of a person or animal for release from isolation or quarantine, the specimen shall be examined in a laboratory approved by the Department to conduct that type of examination.

   The provisions of this §  27.69 amended January 25, 2002, effective January 26, 2002, 32 Pa.B. 491. Immediately preceding text appears at serial page (243670).

COMMUNICABLE DISEASES IN CHILDREN AND STAFF ATTENDING SCHOOLS AND CHILD CARE GROUP SETTINGS

§ 27.71. Exclusion of children, and staff having contact with children, for specified diseases and infectious conditions.

 A person in charge of a public, private, parochial, Sunday or other school or college shall exclude from school a child, or a staff person, including a volunteer, who has contact with children, who is suspected by a physician or the school nurse of having any of the communicable diseases, infections or conditions. Readmission shall be contingent upon the school nurse or, in the absence of the school nurse, a physician, verifying that the criteria for readmission have been satisfied. The diseases, the periods of exclusion and the criteria for readmission are as follows:

   (1)  Diphtheria. Two weeks from the onset or until appropriate negative culture tests.

   (2)  Measles. Four days from the onset of rash. Exclusion may also be ordered by the Department as specified in §  27.160 (relating to special requirements for measles).

   (3)  Mumps. Nine days from the onset or until subsidence of swelling.

   (4)  Pertussis. Three weeks from the onset or 5 days from institution of appropriate antimicrobial therapy.

   (5)  Rubella. Four days from the onset of rash.

   (6)  Chickenpox. Five days from the appearance of the first crop of vesicles, or when all the lesions have dried and crusted, whichever is sooner.

   (7)  Respiratory streptococcal infections including scarlet fever. At least 10 days from the onset if no physician is in attendance or 24 hours after institution of appropriate antimicrobial therapy.

   (8)  Infectious conjunctivitis (pink eye). Until judged not infective; that is, without a discharge.

   (9)  Ringworm. The person shall be allowed to return to school, child care or other group setting immediately after the first treatment, if body lesions are covered. Neither scalp nor body lesions that are dried need to be covered.

   (10)  Impetigo contagiosa. Twenty-four hours after the institution of appropriate treatment.

   (11)  Pediculosis capitis. The person shall be allowed to return to either the school, child care or other group setting immediately after first treatment. The person shall be reexamined for infestation by the school nurse, or other health care practitioner, 7 days posttreatment.

   (12)  Pediculosis corpora. After completion of appropriate treatment.

   (13)  Scabies. After completion of appropriate treatment.

   (14)  Trachoma. Twenty-four hours after institution of appropriate treatment.

   (15)  Tuberculosis. Following a minimum of 2 weeks adequate chemotherapy and three consecutive negative morning sputum smears, if obtainable. In addition, a note from the attending physician that the person is noncommunicable shall be submitted prior to readmission.

   (16)  Neisseria meningitidis. Until judged noninfective after a course of rifampin or other drug which is effective against the nasopharyngeal carriage state of this disease, or until otherwise shown to be noninfective.

   The provisions of this §  27.71 amended January 25, 2002, effective January 26, 2002, 32 Pa.B. 491. Immediately preceding text appears at serial pages (243670) to (243671).

   Exclusion; Removal

   A student who was excluded from school due to head lice was not ‘‘removed’’ for disciplinary reasons as contemplated by Federal regulations, was not denied free appropriate public education and was not entitled to compensatory education. Souderton Area School District v. Elisabeth S., 820 A.2d 863 (Pa. Cmwlth. 2003).

 (a)  A person in charge of a public, private, parochial, Sunday or other school or college shall, following consultation with a physician or school nurse, exclude immediately a child, or staff person, including a volunteer, having contact with children, showing any of the following symptoms, unless that person is determined by the school nurse, or a physician, to be noncommunicable:

   (1)  Mouth sores associated with inability to control saliva.

   (2)  Rash with fever or behavioral change.

   (3)  Purulent discharge from the eyes.

   (4)  Productive cough with fever.

   (5)  Oral or axillary temperature equal to or greater than 102° F.

   (6)  Unusual lethargy, irritability, persistent crying, difficulty breathing or other signs of severe illness.

   (7)  Persistent vomiting.

   (8)  Persistent diarrhea.

 (b)  The school shall maintain a record of the exclusion and the reasons prompting the exclusion and shall review the record to determine when unusual rates of absenteeism occur.

   The provisions of this §  27.72 amended January 25, 2002, effective January 26, 2002, 32 Pa.B. 491. Immediately preceding text appears at serial page (243671).

 (a)  A child or staff person, including a volunteer, having contact with children, excluded from a public, private, parochial or other school or college under §  27.72 (relating to exclusion of children, and staff having contact with children, for showing symptoms) may not be readmitted until the school nurse or, in the absence of a school nurse, a physician, is satisfied that the condition for which the person was excluded is not communicable or until the person presents a statement from a physician that the person has recovered or is noninfectious.

 (b)  A child, or staff person, including a volunteer, having contact with children, excluded for the following reasons shall be readmitted only when a physician has determined the illness to be either resolved, noncommunicable or in a noncommunicable stage:

   (1)  Rash with fever or behavioral change.

   (2)  Productive cough with fever.

   The provisions of this §  27.73 adopted January 25, 2002, effective January 26, 2002, 32 Pa.B. 491. Immediately preceding text appears at serial page (243671).

 A child, or staff person, including a volunteer, having contact with children, who has been absent from school by reason of having had or because of residing on premises where there has been a disease for which isolation is required, may not be readmitted to school without the permission of the LMRO.

   The provisions of this §  27.74 adopted January 25, 2002, effective January 26, 2002, 32 Pa.B. 491. Immediately preceding text appears at serial page (243671).

 Children, and staff, including a volunteer, having contact with children, shall be excluded from school during a measles outbreak under the procedures described in §  27.160 (relating to special requirements for measles).

   The provisions of this §  27.75 adopted April 4, 1980, effective April 5, 1980, 10 Pa.B. 1434; amended January 25, 2002, effective January 26, 2002, 32 Pa.B. 491. Immediately preceding text appears at serial page (243672).

 (a)  Sections 27.71—27.75 apply to child care group settings, with the exception that readmission of excluded persons as provided in those sections, as well as provided in this subsection, shall be contingent upon a physician verifying that the criteria for readmission have been satisfied. The following conditions and circumstances also govern exclusion from and readmission to a child care group setting of a child, or a staff person, including a volunteer, who has contact with children attending the child care group setting:

   (1)  Meningococcal meningitis or meningococcemia. Until made noninfective by a course of rifampin or other drug which is effective against the nasopharyngeal carriage stage of this disease, or otherwise shown to be noninfective.

   (2)  Haemophilus influenzae (H. flu) meningitis or other invasive H. flu disease. Until made noninfectious by a course of rifampin or other drug which is effective against the nasopharyngeal carriage stage of this disease, or otherwise shown to be noninfective.

   (3)  Persistent diarrhea. Until resolved or judged to be noninfective when associated with any of the following:

     (i)   Inability to prevent contamination of the environment with feces.

     (ii)   Fever.

     (iii)   Identified bacterial or parasitic pathogen.

   (4)  Fever in children younger than 4 months of greater than 101° F. rectally or 100° F. axillary; in children 4-24 months of greater than 102° F. rectally or 101° F. axillary. Until resolved or judged to be noninfective.

   (5)  Hepatitis A, viral hepatitis unspecified, or jaundice of unspecified etiology. Until 1 week following the onset of jaundice, or 2 weeks following symptom onset or IgM antibody positivity if jaundice is not present.

   (6)  Shigellosis. Until the etiologic organism is eradicated. See §  27.158 (relating to special requirements for shigellosis).

   (7)  Typhoid fever or paratyphoid fever. Until the etiologic organism is eradicated. See §  27.159 (relating to special requirements for typhoid and paratyphoid fever).

   (8)  Exposure to an individual with meningococcal disease. Until the institution of treatment with appropriate antibiotic to eradicate the nasopharyngeal carrier state, or until proven noninfectious with nasopharyngeal cultures, or until 30 days following the exposure. Exclusion shall be postponed, until the second day following notice that exclusion will be required, to give the individual sufficient time to arrange for institution of appropriate antibiotic treatment.

 (b)  To facilitate the proper exclusion of sick children and staff, the caregiver at a child care group setting shall arrange for the following:

   (1)  Instruction of staff, including volunteers, regarding exclusion and screening criteria that apply to themselves and attending children.

   (2)  Instruction of parents and guardians regarding exclusion criteria and that they are to notify the caregiver within 24 hours after it is determined or suspected that a child has an illness or condition for which exclusion is required.

   (3)  Followup after exclusion of a child by staff at the time the child is brought to the child care group setting to ensure that the condition which required exclusion has been resolved.

   The provisions of this §  27.76 adopted January 25, 2002, effective January 26, 2002, 32 Pa.B. 491.

 (a)  Caregiver responsibilities.

   (1)  Except as exempted in subsection (d), effective March 27, 2002, the caregiver at a child care group setting may not accept or retain a child 2 months of age or older at the setting, for more than 60 days, unless the caregiver has received a written objection to a child being vaccinated on religious grounds from a parent or guardian, or one of the following:

     (i)   For all children not exempt under subsection (d)(1)(ii), an initial written verification from a physician, the Department or a local health department of the dates (month, day and year) the child was administered any vaccines recommended by ACIP. The verification shall also specify any vaccination not given due to medical condition of the child and shall state whether the condition is temporary or permanent. The verification shall show compliance with the vaccination requirements in subsection (b).

     (ii)   For all children for whom vaccinations remain outstanding following the caregiver’s receipt of the initial written verification, subsequent written verifications from a physician, the Department or a local health department as additional vaccinations become due. These verifications shall be prepared in the same manner as set forth in subparagraph (i), but need not repeat information contained in a previously submitted verification. The verifications shall demonstrate continuing compliance with the vaccination requirements in subsection (b).

   (2)  If the caregiver receives a written verification under paragraph (1) explaining that timely vaccination did not occur due to a temporary medical condition, the caregiver shall exclude the child from the child care group setting after an additional 30 days unless the caregiver receives, within that 30-day period, written verification from a physician, the Department or a local health department that the child was vaccinated or that the temporary medical condition still exists. If the caregiver receives a written verification that vaccination has not occurred because the temporary condition persists, the caregiver shall require the presentation of a new verification at 30-day intervals. If a verification is not received as required, the caregiver shall exclude the child from the child care group setting and not readmit the child until the caregiver receives a verification that meets the requirements of this section.

   (3)  The caregiver shall retain the written verification or objection referenced in paragraphs (1) and (2) for 60 days following the termination of the child’s attendance.

   (4)  The caregiver shall ensure that a certificate of immunization is completed and signed for each child enrolled in the child care group setting. The certificates shall be updated by the caregiver to include the information provided to the caregiver under subsection (a) when that additional information is received. The immunization status of each enrolled child shall be summarized and reported on an annual basis to the Department at the time prescribed by the Department and on the form provided by the Department.

 (b)  Vaccination requirements. Each child enrolled in a child care group setting shall be immunized in accordance with ACIP standards in effect on January 1, 1999, governing the issuance of ACIP recommendations for the immunization of children.

   (1)  The standards are as follows:

     (i)   The immunization practice is supported by both published and unpublished scientific literature as a means to address the morbidity and mortality of the disease.

     (ii)   The labeling and packaging inserts for the immunizing agent are considered.

     (iii)   The immunizing agent is safe and effective.

     (iv)   The schedule for use of the immunizing agent is administratively feasible.

   (2)  The Department will deem an ACIP recommendation pertaining to the immunization of children to satisfy the standards in this subsection unless ACIP alters its standards for recommending immunizations for children by eliminating a standard set forth in this subsection and the recommendation is issued under those changed standards.

 (c)  Notice. The Department will place a notice in the Pennsylvania Bulletin listing publications containing ACIP recommendations issued under the standards in subsection (b). The Department will publish the initial notice at 32 Pa.B. 539 (January 26, 2002), contemporaneously with the adoption of amendments to this chapter. The Department will update that list in a notice which it will publish in the Pennsylvania Bulletin within 30 days after ACIP issues a recommendation which satisfies the criteria of this section.

 (d)  Exemptions.

   (1)  This section does not apply to the following:

     (i)   Kindergarten, elementary school or higher school. These caregivers shall comply with § §  23.81—23.87 (relating to immunization).

     (ii)   Children who are known by the caregiver to be 6 years of age or older or to attend a kindergarten, elementary school or high school.

     (iii)   A caregiver who does not serve as a caregiver for at least 40 hours during at least 1 month.

   (2)  The requirement imposed by subsection (a), to not accept a child into a child care group setting without receiving an initial written verification or objection specified in subsection (a), does not apply during a month the caregiver does not serve as a caregiver for at least 40 hours.

 (e)  Exclusion when disease is present. Whenever one of the diseases in §  27.76 (relating to exclusion and readmission of children, and staff having contact with children, in child care group settings) has been identified within a child care group setting, the Department or a local health department may order the exclusion from the child care group setting or any other child care group setting which is determined to be at high-risk of transmission of that disease, of an individual susceptible to that disease in accordance with public health standards as determined by the Department.

   The provisions of this §  27.77 adopted January 25, 2002, effective January 26, 2002, 32 Pa.B. 491.

Subchapter D. SEXUALLY TRANSMITTED DISEASES, TUBERCULOSIS AND OTHER COMMUNICABLE DISEASES

Sec.

§ 27.81. Examination of persons suspected of being infected.

 Whenever the Department or a local health authority has reasonable grounds to suspect a person of being infected with an organism causing a sexually transmitted disease, tuberculosis or other communicable disease, or of being a carrier, but lacks confirmatory medical or laboratory evidence, the Department or the local health authority may require the person to undergo a medical examination and any other approved diagnostic procedure to determine whether or not the person is infected or is a carrier. If the local health authority involved is not an LMRO, the local health authority shall consult with and receive approval from the Department prior to requiring any medical examination or other approved diagnostic procedure.

   The provisions of this §  27.81 amended January 25, 2002, effective January 26, 2002, 32 Pa.B. 491. Immediately preceding text appears at serial page (243672).

 (a)  If a person refuses to submit to the examination required in §  27.81 (relating to examination of persons suspected of being infected), the Department or the local health authority may direct the person to be quarantined until it is determined that the person does not pose a threat to the public health by reason of being infected with a disease causing organism or being a carrier.

 (b)  If the person refuses to abide by an order issued under subsection (a), the Departm