Amanda Reiff, MPH Epidemiologist Jefferson County Public Health Changes to Rules and Regulations Pertaining to Epidemic and Communicable Disease Control Training Amanda Reiff, MPH Epidemiologist Jefferson County Public Health

Update from CDPHE Board of Health accepted the proposed changes on September 16, 2015 for the Rules and Regulations Pertaining to Epidemic and Communicable Disease Control (6 CCR 1009-1). Will be effective on November 14, 2015 For newly reportable conditions, the Colorado Electronic Disease Reporting System (CEDRS) will be available to receive reports on November 14, 2015

Effective: October 15, 2014

Changes To better explain who must report conditions (Labs and/or individuals) and the required timing (24hrs vs 7 days): Regulations 1-3 were combined to create a single table.

Changes Accession number is required on all reported diseases with supporting laboratory results to comply with CDC reporting requirements and be able to link multiple tests performed on the same specimen.

Changes Clinical and reference laboratories are required to submit cultures or original clinical material for specific reportable conditions as listed in the reportable disease table. Laboratories will submit bacterial culture isolates or patient clinical material that yields positive findings to the CDPHE Laboratory Services Division.

Changes Methicillin-resistant Staphylococcus aureus (MRSA) is deleted from the “Conditions Reportable by all Laboratories.”

Changes The definition of carbapenem-resistant Enterobacteriaceae (CRE) is changed. See regulations for new definition. CDPHE will reach out individually to labs that are part of the Emerging Infections Program (EIP) to discuss reporting. CRE remains a 7 day reportable condition CDC 2013

Changes Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is added as a 7 day reportable condition by laboratories. CDPHE will reach out individually to labs that are part of the Emerging Infections Program (EIP) to discuss reporting. Image Left: CDC staff show 2 plates growing bacteria in the presence of discs containing various antibiotics. The isolate on the left plate is susceptible to the antibiotics on the discs and unable to grow around the discs. The disc on the right has a CRE that is resistant to all the antibiotics tested and is able to grow near the discs. Image Right: This is a plate that demonstrates the modified Hodge Test which identifies resistance in Enterobacteriaceae. Bacteria that are resist to Carbapenems, which are typically “last resort” antibiotics, produce distinctive clover-leaf shape.

Changes Viral hemorrhagic fever is added as a 24hr reportable condition by individuals AND laboratories. Includes: Ebola virus disease, Crimean-Congo hemorrhagic fever, Lassa fever, Marburg fever, and more.

Changes Severe or Novel Coronavirus is added as a 24hr reportable condition by individuals AND Laboratories. Includes: SARS and MERS-CoV

Changes Tularemia is changed from a 7 day reportable to 24hr reportable disease.

Changes Acute flaccid myelitis (AFM) is added as a 7 days reportable condition. Definition can be found on CDPHE website

Changes When a laboratory performs a culture that is positive for Mycobacterium tuberculosis, the lab shall store the isolate until it receives a request from the state or local health department for the isolate OR the lab may fulfill this requirement by submitting the isolate to the state public health lab. Once the isolate is received by the state public health laboratory it will be submitted to a CDC-contracted laboratory for genotype testing.

Questions?