Subchapter C. QUARANTINE AND ISOLATION

§ 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.