10.06.01.21

.21 Typhoid Fever (Salmonella Typhi) and Paratyphoid Fever (Salmonella Paratyphi A, Salmonella Paratyphi B tartrate negative, and Salmonella Paratyphi C).

A. Control of a Case.

(1) A case may not attend a child care facility until fecal specimens are Salmonella-free on three consecutive specimens collected not less than 24 hours apart and not sooner than 48 hours following discontinuation of antibiotics, or until a health officer approves readmission based on the low likelihood of transmission.

(2) A case may not participate in occupations involving food handling, patient care, or care of young children or the elderly until fecal specimens are Salmonella-free on three consecutive specimens collected not less than 24 hours apart, and not sooner than 48 hours after discontinuation of antibiotics.

(3) A health officer shall supervise a case and release a case from supervision only after fecal specimens are culture negative for Salmonella Typhi or Paratyphi on three consecutive specimens collected not:

(a) Less than 24 hours apart;

(b) Sooner than 48 hours following discontinuation of antibiotics; and

(c) Earlier than 1 month after onset or date of first positive culture if asymptomatic.

(4) If any one of the specimens required in §A(3) of this regulation is positive, at least three consecutive negative cultures of feces at intervals of 1 month within the 12 months following onset shall be required for release from supervision.

(5) If a person continues to excrete Salmonella Typhi or Paratyphi at 12 months, the requirements of §D of this regulation apply.

B. Control of Contacts of a Case. Household, sexual, and other close contacts of a case may not attend a child care facility or participate in occupations involving food handling, patient care, or care of young children or the elderly until two consecutive cultures of feces taken at least 24 hours apart are negative for Salmonella Typhi or Paratyphi.

C. Infection Control. A health care provider shall practice standard precautions.

D. Control of Carriers.

(1) A health officer shall:

(a) Monitor the location, occupation, and bacteriological status of a carrier of Salmonella Typhi or Paratyphi;

(b) Keep a complete file of all pertinent data on the carrier;

(c) Issue written instructions to the carrier concerning the restrictions upon and responsibilities of the carrier;

(d) Notify the carrier of the availability of treatments that may eliminate carriage;

(e) Contact each carrier in the health officer's jurisdiction at intervals of not more than 1 year to check on the carrier's occupation and address and to determine if all instructions are being followed;

(f) Release a carrier from supervision only after there have been three consecutive negative cultures of feces, taken 1 month apart at least 48 hours after antibiotic treatment; and

(g) Forward immediately to the Secretary a report of a carrier who has relocated outside the health officer's territorial jurisdiction for referral to the health officer of the proper jurisdiction.

(2) A case or a case's physician shall submit the fecal specimens to the State Laboratory for the release of a carrier.

(3) A carrier:

(a) May not participate in occupations involving:

(i) Food handling;

(ii) Patient care; or

(iii) Care of young children or the elderly;

(b) Shall abide by Regulation .06D and E; and

(c) Shall keep a health officer informed at all times of the carrier's address and occupation, and shall notify the health officer at once of any change in address or occupation.

E. Control of Contacts of a Carrier.

(1) A health officer shall require culture of feces of those household and close contacts:

(a) Who attend a child care facility; or

(b) Whose occupations involve:

(i) Food handling; or

(ii) Care of patients, young children, or the elderly.

(2) A contact shall submit for examination two fecal specimens taken at an interval of not less than 24 hours apart.

(3) If either of the specimens required in §E(2) of this regulation is positive for Salmonella Typhi or Paratyphi, then the health officer shall consider the contact to be a case, and the control measures specified in §A of this regulation apply.