CCLME.ORG - DIVISION 1. STATE DEPARTMENT OF HEALTH SERVICES

(continued)
(2) A health officer may for purposes of his or her investigation disclose any information contained in an individual case report, including personal information, as may be necessary to prevent the spread of disease or occurrence of additional cases.
(3) A health officer may disclose any information contained in an individual case report to any person or entity if the disclosure may occur without linking the information disclosed to the individual to whom it pertains, and the purpose of the disclosure is to increase understanding of disease patterns, to develop prevention and control programs, to communicate new knowledge about a disease to the community, or for research.
(4) Notwithstanding subsections (1), (2), and (3) above, no information that would directly or indirectly identify an individual as one who has applied for or been given services for alcohol or other drug abuse by a federally assisted drug or alcohol abuse treatment program (as defined in 42 C.F.R. s 2.11) shall be included in an individual case report or otherwise disclosed absent the individual's written consent.
(g) Whenever the health officer collects personal information in order to prepare an individual case report required by subsection (b), the health officer shall notify the individual from whom the information is collected that: (1) supplying personal information related to the individual's disease is mandatory; (2) the only disclosure of personal information will be pursuant to subsections 2502(f(1) and 2502(f)(2); and (3) non-personal information may be disclosed pursuant to subsection 2502(f)(3).

Note: Authority cited: Sections 100180, 100275 and 120130, Health and Safety Code; and Section 555(b), Business and Professions Code. Reference: Sections 7, 1603.1, 100180, 100325, 100330, 103925, 113150, 113155, 120125, 120130, 120140, 120145, 120175, 120190, 120245 and 120250, Health and Safety Code; and Sections 551, 554 and 555, Business and Professions Code; Sections 11181 and 11182, Government Code; 42 U.S.C. sections 290ee-3 and 290dd-3; 42 C.F.R. Sections 2.11 and 2.12.; Cal. Const., art. 1, Section 1; Section 1040, Evidence Code; and Section 1798.3, Civil Code.

s 2503. Reporting Occurrence of Unusual Diseases.

Note: Authority cited: Sections 207, 208 and 3123, Health and Safety Code. Reference: Sections 200, 207, 3053, 3110, 3123, 3124 and 3125, Health and Safety Code.

s 2504. Report by Health Care Provider of Out-of-State Laboratory Findings.
Whenever a health care provider's identification of a case or suspected case of tuberculosis includes laboratory findings from an out-of-state laboratory, the health care provider shall include those findings with the report made pursuant to Section 2500(b), and if the laboratory performed drug susceptibility testing, the results of such testing shall also be so reported.

Note: Authority cited: Sections 207, 208 and 3123, Health and Safety Code. Reference: Sections 200, 207, 3053, 3110, 3123, 3125 and 3285, Health and Safety Code.

s 2505. Notification by Laboratories.
(a) To assist the local health officer, the laboratory director, or the laboratory director's designee, of a clinical laboratory, an approved public health laboratory or a veterinary laboratory in which a laboratory examination of any specimen derived from the human body (or from an animal, in the case of rabies or plague testing) yields microscopical, cultural, immunological, serological, or other evidence suggestive of those diseases listed in subsections (e)(1) and (e)(2) below, shall report such findings to the health officer of the local health jurisdiction where the health care provider who first submitted the specimen is located.
(1) For those diseases listed in subsection (e)(1), the report of such findings shall be made within one hour after the laboratory notifies the health care provider or other person authorized to receive the report. If the laboratory that makes the positive finding received the specimen from another laboratory, the laboratory making the positive finding shall notify the health officer of the jurisdiction in which the health care provider is located within one hour from the time the laboratory notifies the referring laboratory that submitted the specimen.
(2) For those diseases listed in subsection (e)(2), the report of such findings shall be made within one working day from the time that the laboratory notifies the health care provider or other person authorized to receive the report. If the laboratory that makes the positive finding received the specimen from another laboratory, the laboratory making the positive finding shall notify the health officer of the jurisdiction in which the health care provider is located within one working day from the time the laboratory notifies the referring laboratory that submitted the specimen.
(b) To permit local health officer follow-up of laboratory findings, all specimens submitted for laboratory tests or examinations related to a disease or condition listed in subsections 2505(e)(1) or 2502(e)(2) shall be accompanied by a test requisition which includes the name, gender, and age or date-of-birth of the person from whom the specimen was obtained and the name, address and telephone number of the health care provider or other authorized person who submitted the specimen. Whenever the specimen, or an isolate therefrom, is transferred between laboratories, a test requisition with the above patient and submitter information shall accompany the specimen. The laboratory that first receives a specimen shall be responsible for obtaining the patient and submitter information at the time the specimen is received by that laboratory.
(c) Each notification to the local health officer shall include the date the specimen was obtained, the patient identification number, the specimen accession number or other unique specimen identifier, the laboratory findings for the test performed, the date that any positive laboratory findings were identified, the name, gender, address, telephone number (if known) and age or date of birth of the person from whom the specimen was obtained, and the name, address, and telephone number of the health care provider for whom such examination or test was performed.
(d) The notification shall be submitted as specified in subsections (e)(1) and (e)(2) of this Section to the local health officer in the jurisdiction where the health care provider who submitted the specimen is located. When the specimen is from an out-of-state submitter, the state epidemiologist of the submitter shall be provided the same positive findings per subsections (e)(1) and (e)(2) of this Section. If the laboratory that finds evidence for any of those diseases listed in subsections (e)(1) and (e)(2) is an out-of-state laboratory, the California clinical laboratory that receives a report of such findings from the out-of-state laboratory shall notify the local health officer in the same way as if the finding had been made by the California laboratory.
(e) Laboratory reports to the local health officer shall include the information as specified in (c) of this Section and laboratories shall submit the reports within the following timeframes:
(1) The diseases specified shall be reported within one hour after the health care provider or other person authorized to receive the report has been notified. Laboratories shall make the initial reports to the local health officer by telephone and follow the initial report within one working day by a report in writing submitted by electronic facsimile transmission or electronic mail to the local health officer. The diseases reported pursuant to this requirement are:
Anthrax
Botulism
Brucellosis, by isolation of Brucellaspecies from a clinical specimen, or demonstration by immunofluorescence of Brucellaspecies in a clinical specimen, or fourfold or greater rise in antibody titer to Brucellaantigen between acute and convalescent phase serum specimens obtained two or more weeks apart and studied at the same laboratory, or elevated serum antibody to Brucellaantigen at a titer of 1:160 or greater in a single serum specimen.
Plague, animal or human
Smallpox (Variola)
Tularemia, by isolation of Francisella tularensisin a clinical specimen, or demonstration by immunofluorescence of F. tularensisin a clinical specimen, or fourfold or greater rise in antibody titers to F. tularensisantigen between acute and convalescent phase serum specimens obtained two or more weeks apart and studied at the same laboratory, or elevated antibody to F. tularensisantigen at a titer of 1:160 or greater in a single serum specimen.
Viral Hemorrhagic Fever agents (e.g., Crimean-Congo, Ebola, Lassa, and Marburg viruses)
(2) The diseases specified shall be reported within one working day after the health care provider or other person authorized to receive the report has been notified. Laboratories shall transmit these reports to the local health officer by courier, mail, electronic facsimile or electronic mail. The diseases reported pursuant to this requirement are:
Borrelia burgdorferiinfection
Chlamydial infections
Cryptosporidiosis
Diphtheria
Encephalitis, arboviral
Escherichia coliO157:H7 infection
Gonorrhea
Hepatitis A, acute infection, by lgM anitbody test or positive viral antigen test
Hepatitis B, acute infection, by lgM anti-HBc anitbody test
Hepatitis B surface antigen positively (specify gender)
Listeriosis
Malaria
Measles (Rubeola), acute infection, by lgM anitbody test or positive viral antigen test
Rabies, animal or human
Syphilis
Tuberculosis
Typhoid
Vibriospecies infections
West Nile virus infection
(f) In addition to notifying the local health officer pursuant to subsection (a), any clinical laboratory or approved public health laboratory that isolates Mycobacterium tuberculosisfrom a patient specimen shall:
(1) submit a culture as soon as available from the primary isolate on which a diagnosis of tuberculosis was established. Such a culture shall be submitted to the public health laboratory designated in Title 17 California Code of Regulations, Section 1075 for the local jurisdiction where the health care provider's office is located. The following information shall be submitted with the culture: the name, address, and the date of birth of the person from whom the specimen was obtained, the patient identification number, the specimen accession number or other unique specimen identifier, the date the specimen was obtained from the patient, and the name, address, and telephone number of the health care provider for whom such examination or test was performed. The public health laboratory shall retain the culture received (one culture from each culture-positive patient) in a viable condition for at least six months.
(2) Unless drug susceptibility testing has been performed by the clinical laboratory on a strain obtained from the same patient within the previous three months or the health care provider who submitted the specimen for laboratory examination informs the laboratory that such drug susceptibility testing has been performed by another laboratory on a culture obtained from that patient within the previous three months, the clinical laboratory shall:
(A) perform or refer for drug susceptibility testing on at least one isolate from each patient from whom Mycobacterium tuberculosiswas isolated; and
(B) report the results of drug susceptibility testing to the local health officer of the city or county where the submitting physician's office is located within one working day from the time the health care provider or other authorized person who submitted the specimen is notified; and
(C) If the drug susceptibility testing determines the culture to be resistant to at least isoniazid and rifampin, in addition, submit one culture or subculture from each patient from whom multidrug-resistant Mycobacterium tuberculosiswas isolated to the official public health laboratory designated in Title 17 California Code of Regulations Section 1075 for the local health jurisdiction in which the health care provider's office is located. The local public health laboratory shall forward such cultures to the Department's Microbial Diseases Laboratory. The following information shall be submitted with the culture: the name, address, and the date of birth of the person from whom the specimen was obtained, the patient identification number, the specimen accession number or other unique specimen identifier, the date the specimen was obtained from the patient, and the name, address, and telephone number of the health care provider for whom such examination or test was performed.
(g) Whenever a clinical laboratory finds that a specimen from a patient with known or suspected tuberculosis tests positive for acid fast bacillus (AFB) staining and the patient has not had a culture which identifies that acid fast organism within the past 30 days, the clinical laboratory shall culture and identify the acid fast bacteria or refer a subculture to another laboratory for those purposes.
(h) In addition to notifying the local health officer pursuant to subsection (a), any clinical laboratory that makes a finding of malaria parasites in the blood film of a patient shall immediately submit one or more such blood film slides for confirmation to the public health laboratory designated in Title 17 California Code of Regulations Section 1075 for the local health jurisdiction where the health care provider is located. When requested, all blood films shall be returned to the submitter.
(i) All laboratory notifications herein required are acquired in confidence and shall not be disclosed by the local health officer except (1) as authorized by these regulations; (2) as required by state or federal law; or (3) with the written consent of the individual to whom the information pertains or the legal representative of that individual.
(j) The local health officer shall disclose any information, including personal information, contained in a laboratory notification to state, federal or local public health officials in order to determine the existence of the disease, its likely cause and the measures necessary to stop its spread.

Note: Authority cited: Sections 100180, 100275, 120130 and 125095, Health and Safety Code. Reference: Sections 100180, 120125, 120130, 120140, 120175, 120575, 121365 and 125100, Health and Safety Code; Sections 1209, 1246.5 and 1288, Business and Professions Code; Cal. Const., art. 1, Section 1; and Section 1040, Evidence Code.

s 2508. Reporting by Schools.
It shall be the duty of anyone in charge of a public or private school, kindergarten, boarding school, or day nursery to report at once to the local health officer the presence or suspected presence of any of the communicable diseases.

s 2509. Records of Local Health Officer.
The local health officer shall maintain such records as he deems necessary in the performance of his duties, or as requested by the State Department of Health Services.

s 2510. Outbreaks of Nonreportable Diseases.

s 2511. Determination of Morbidity Level.
It shall be the duty of the local health officer to determine the amount and kind of communicable disease occurring in his area by such methods as he deems necessary in order to obtain knowledge of the general level of morbidity in his jurisdiction.

s 2512. Investigation of the Case.

s 2514. Instructions to Household.
It shall be the duty of the health care provider in attendance on a case or suspected case of any disease or condition listed in Sections 2500, or of any other disease considered to be communicable, to give detailed instructions to the members of the household in regard to precautionary measures to be taken for preventing the spread of the disease or condition. Such instructions shall conform to these regulations and local ordinances. It is the responsibility of each health care provider to be informed as to these regulations and the local ordinances which are in effect in the communities in which the health care provider practices.

Note: Authority cited: Sections 207, 208 and 3123, Health and Safety Code. Reference: Sections 207, 208, 3123 and 3285, Health and Safety Code.

s 2515. Definition of Isolation.
Isolation is defined as separation of infected persons from other persons for the period of communicability in such places and under such conditions as will prevent the transmission of the infectious agent. Isolation will be applied as instructed below.

s 2516. Strict Isolation.
If the disease is one requiring strict isolation, the health officer shall insure that instructions are given to the patient and members of the household, defining the area within which the patient is to be isolated and stating the measures to be taken to prevent the spread of the disease.
Strict isolation shall include the following measures:
(a) The patient shall have a separate bed in a room protected against flies.
(b) All persons, except those caring for the patient, shall be excluded from the sick room.
(c) The persons caring for the patient shall avoid coming in contact with any other persons within the household or elsewhere until every precaution has been taken to prevent the spread of infectious material from the patient's room.
(d) The persons caring for the patient shall wear a washable outer garment and shall thoroughly wash their hands with soap and hot water after handling the patient or any object he may have contaminated. On leaving the room in which the patient is isolated, the attendant shall take off the washable outer garment and hang it in the room until disinfected.
(e) All discharges from the nose and mouth shall be burned or disinfected. The discharges should be received in pieces of soft tissue or cloth and dropped into a paper bag which can be burned.
(f) Objects which may have been contaminated by the patient shall be thoroughly cleansed before being removed from the contaminated area.
(g) The feces and urine of patients suffering from diseases in which the infectious agent appears in the feces or urine shall be disposed of according to instructions given be the local health officer.

s 2518. Modified Isolation.
If the disease is one in which only a modified isolation is required, the local health officer shall issue appropriate instructions, prescribing the isolation technique to be followed. The isolation technique will depend upon the disease.

s 2520. Quarantine.
Quarantine is defined as the limitation of freedom of movement of persons or animals that have been exposed to a communicable disease for a period of time equal to the longest usual incubation period of the disease, in such manner as to prevent effective contact with those not so exposed. If the disease is one requiring quarantine of the contacts in addition to isolation of the case, the local health officer shall determine the contacts who are subject to quarantine, specify the place to which they shall be quarantined, and issue instructions accordingly. He shall insure that provisions are made for the medical observation of such contacts as frequently as necessary during the quarantine period.

s 2522. Observation.
For the purposes of definition, the term "observation," as used in these regulations, shall refer to a frequent check upon the person under observation to determine whether such person is free of the disease for which he has been placed under observation, or has contracted the disease. Unless otherwise specified, it does not mean the isolation or quarantine of the individual.

s 2524. Terminal Disinfection.
Each person released from quarantine or isolation shall bathe and wash his hair with soap and hot water and put on clean clothes. The area of isolation shall be disinfected according to the instructions of the local health officer.

s 2526. Exclusion and Readmission by School Authorities.
It shall be the duty of the principal or other person in charge of any public, private or Sunday School to exclude therefrom any child or other person affected with a disease presumably communicable, until the expiration of the prescribed period of isolation for the particular communicable disease. If the attending physician, school physician, or health officer finds upon examination that the person is not suffering from a communicable disease, he may submit a certificate to this effect to the school authority who shall readmit the person.

Note: Authority cited: Sections 207, 208 and 3123, Health and Safety Code. Reference: Sections 200, 207, 3051, 3053, 3110, 3118 and 3123, Health and Safety Code.

s 2528. Contamination by Pathogenic Organisms of Milk, Milk Products or Products Resembling Milk Products.
(a) The State Department of Health Services finds that the presence of any of the following pathogenic organisms in milk, milk product, or product resembling milk products make such product unsafe for human consumption: Mycobacterium tuberculosis; Brucella spp.; Streptococcus pyogenes, group A hemolytic; Corynebacterium diphtheria; Salmonella paratyphi; Salmonella schottmuelleri; Salmonella hirschfeldi; Salmonella typhi; Salmoneela dublin; Salmonella typhimurium; Shigella spp. Whenever a health officer finds that milk, milk product, or product resembling milk products, is unsafe for human consumption because it contains any of the above named organisms, he shall issue a written order to the producer or distributor of the product (1) summarizing the laboratory findings, and (2) prohibiting the sale or disposal of such milk, milk product, or product resembling milk products, except by a method approved by him, until such time as he finds the product or products to be safe for human consumption.
(b) Whenever a health officer has evidence that milk, milk product, or product resembling milk products has caused human illness or contains toxins which make such product unsafe for human consumption, he may issue a written order to the producer or distributor of the product (1) stating the facts upon which his conclusions are based, and (2) prohibiting the use, sale, or disposal of such milk, milk product, or product resembling milk products, except by a method approved by him, until such time as he finds it to be safe for human consumption.
(c) The health officer shall immediately forward a copy of any order issued pursuant to this section to the State Director of Health Services.
(d) Any producer or distributor of milk, milk product, or product resembling milk products, subject to an order of a health officer pursuant to this section may appeal to the State Department of Health Services solely upon the question of whether such products are, in fact, safe for human consumption. Such appeal shall be made in writing, stating which of the facts set forth in the order are admitted and denied. Upon receipt of the written appeal, the State Director of Health Services, after such investigation of the matter as he deems necessary, may amend or rescind the order, or set the matter for hearing before a hearing officer designated by him. In the event the order is not rescinded or amended to the satisfaction of the appellant, the matter shall be set for hearing. The hearing shall, if possible, be set within 14 days from the date of receipt of the appeal, unless additional time is required by the appellant. Insofar as is practicable, the procedures of the Administrative Procedure Act (Ch. 5, Pt. 1, Div. 3, Title 2, of the Government Code) shall apply. The hearing officer shall submit a proposed decision to the State Department of Health Services which shall issue its decision in accordance with Section 11517 of the Administrative Procedure Act. The decision shall be subject to judicial review.
(e) The procedures of this section authorize a health officer to take immediate action to protect the public health in the event he finds that milk, milk products, or products resembling milk products constitutes the applicability of other provisions of law pertaining to the regulation of such products, including but not limited to, the provisions of the Agricultural Code and the California Pure Foods Act (Ch. 3, Div. 21, Health and Safety Code).

Note: Authority cited: Sections 102 and 208, Health and Safety Code. Reference: Sections 3110-3125, Health and Safety Code.

s 2530. Public Food Handlers.
No person known to be infected with a communicable disease or suspected of being infected with a communicable disease shall engage in the commercial handling of food, or be employed on a dairy or on premises handling milk or milk products, until he is determined by the health officer to be free of such disease, or incapable of transmitting the infection. (See Chapter 7, Article 1, Section 28295, Health and Safety Code.)

Note: Authority cited: Sections 207, 208 and 3123, Health and Safety Code. Reference: Sections 200, 207, 3051, 3053, 3110, 3123, 3131, 3132 and 28295, Health and Safety Code

s 2534. Laboratory Tests for the Release of Cases of Carriers of Communicable Diseases.
Whenever laboratory tests are required for the release of cases or carriers, the tests shall be taken by the health officer or his representatives and shall be submitted to a public health officer or his representatives and shall be submitted to a public health laboratory approved by the State Department of Health Services. Specimens may be sent to laboratories not so approved, provided the specimens are divided and a portion of the specimens are sent to an approved laboratory. Release shall be considered on the basis of the report of the approved laboratory only.

s 2536. Transportation of Communicable Disease Cases.
No person with a communicable disease subject to isolation not any contact subject to quarantine shall travel or be transported from one place to another within the local health jurisdiction, without the permissions of the local health officer, and no such person shall travel or be transported outside the area of jurisdiction of the health officer until the permission of the health officer into whose jurisdiction the patient is to be brought is obtained. An exception may be made in instances where the patient is to be admitted directly to a hospital for the treatment of the communicable disease,provided that the health officer from whose jurisdiction the case to be transported shall insure that adequate precautions are taken to prevent dissemination of the disease by the patient or his contacts en route to the hospital.

s 2538. Funerals.
Funeral services for individuals who have died of a communicable disease shall be conducted in accordance with instructions of the health officer. In diseases requiring quarantine of contacts, a public funeral service may be permitted only if the casket remains closed and those contacts subject to quarantine who attend the funeral are adequately segregated from the public.

s 2540. General Clause.
In addition to the requirements stipulated in these regulations, the local health officer shall, after suitable investigation, take such additional steps as he deems necessary to prevent the spread of communicable disease or a disease suspected of being communicable in order to protect the public health.

s 2550. Amebiasis.
(a) Under ordinary circumstances, isolation of cases and quarantine of contacts are not required.
(b) Persons who are found to be excreting Endamoeba histolytica in the feces shall be prohibited from public food handling until three feces specimens, taken at intervals of not less than three days, shall be proved negative for the organism by a public health laboratory approved by the State Department of Health Services.

s 2551. Anthrax. Cases and Suspect Cases to Be Reported by Telephone.
(See Section 2502(c).)
(a) Patient. The patient shall be isolated in accordance with Section 2518. Wound isolation precautions shall be instituted until lesions are free of anthrax bacilli. There are no restrictions on contacts.
(b) Laboratory. Whenever a laboratory receives a specimen for the laboratory diagnosis of suspected human anthrax, such laboratory shall communicate immediately by telephone with the Microbial Diseases Laboratory of the State Department of Health Services for instruction.

Note: Authority cited: Sections 100180, 100275, 120130 and 120145, Health and Safety Code. Reference: Sections 120130, 120175, 120190, 120195 and 120215, Health and Safety Code.

s 2552. Botulism. Cases and Suspect Cases to Be Reported by Telephone.
(See Section 2502(c).) The health officer shall make an immediate investigation of every case or suspected case of botulism in an effort to establish the diagnosis and determine the source. In the event that a commercial food product is suspected as the source, special instructions will be given by the State Department of Health Services. The local health officer shall take all necessary steps to prevent distribution and consumption of the suspected food. There are no restrictions on case or contacts. Whenever a laboratory receives a specimen for the laboratory diagnosis of suspected human botulism, such laboratory shall communicate immediately by telephone with the Microbial Diseases Laboratory of the Department of Health Services for instruction.

Note: Authority cited: Sections 100180, 100275 and 120130, Health and Safety Code. Reference: Sections 100180, 100275, 120175, 120185 and 120190, Health and Safety Code.

s 2553. Brucellosis (Undulant Fever). Cases and Suspect Cases to Be Reported by Telephone.
(See Section 2502(c).) There are no restrictions on case or contacts. Whenever a laboratory receives a specimen for the laboratory diagnosis of suspected human brucellosis, such laboratory shall communicate immediately by telephone with the Microbial Diseases Laboratory of the Department of Health Services for instruction.

Note: Authority cited: Sections 100180, 100275 and 120130, Health and Safety Code. Reference: Sections 100180, 100275, 120185 and 120190, Health and Safety Code.

s 2554. Chancroid.
(See Section 2636 on Venereal Diseases.)

s 2555. Chickenpox.

s 2556. Cholera. Cases and Suspect Cases to Be Reported by Telephone or Telegraph.
(See Section 2501(c).) The case shall be isolated in accordance with Section 2516 and the intimate contacts quarantined pending receipt of instructions from the State Health Services Department.

s 2558. Coccidioidomycosis.
Report active cases only primary (including cavitary) or disseminated. There are no restrictions on case or contacts.

s 2560. Conjunctivitis, Acute Infectious of the Newborn.
(a) Acute infectious conjunctivitis of the newborn includes gonorrheal ophthalmia and ophthalmia neonatorum.
(b) Prophylaxis for acute infectious conjunctivitis of the newborn shall be administered to all infants within two hours after birth in accordance with Sections 551-556 of the Business and Professions Code.
(c) The approved prophylaxis for acute infectious conjunctivitis of the newborn shall be any one of the following.
(1) One percent silver nitrate in wax ampules administered without saline irrigation.
(2) Ophthalmic ointments or drops containing tetracycline or erythromycin.
(d) An infant with acute infectious conjunctivitis shall be isolated in accordance with Section 2516, Title 17, California Administrative Code, until clinical recovery occurs and negative laboratory tests are obtained.

Note: Authority cited: Section 555(b), Business and Professions Code. Reference: Sections 551 through 556, Business and Professions Code.

s 2562. Dengue. Cases and Suspect Cases to Be Reported by Telephone or Telegraph.
(See Section 2501(c).) The case shall be confined during the clinical phase of the disease in a room or dwelling satisfactorily protected against mosquitos. There are no restrictions on contacts.

s 2564. Diarrhea of the Newborn.
(a) Any infant under 1 month of age in a hospital or institution, or any infant hospitalized because of prematurity, who has two or more watery or otherwise apparently abnormal stools within a 24-hour period, with or without other signs of illness, shall be considered a suspicious case of diarrhea of the newborn and immediately isolated. Any newborn, who within four days after discharge from a hospital has two or more watery or otherwise apparently abnormal stools within a 24-hour period, with or without other signs of illness, shall be considered a suspicious case and kept under close observation. If the diarrhea continues for more than two days the infant shall be immediately reported as a case of diarrhea of the newborn to the local health officer by telephone or other equally prompt means. An exception may be made in the case of entirely breastfed infants who show no signs of illness and are gaining weight.
(b) Isolation of Case. The case shall be placed in strict isolation until discharged from the hospital.
(c) Quarantine of Infants in Nursery. If two or more cases occur, all infants in the nursery shall be quarantined and no infants shall be admitted until all exposed infants have been discharged and the nursery thoroughly cleaned, and personnel, equipment, and procedures involved have been investigated by the health officer and found adequate.
(d) Care of Noncontacts. Infants born subsequent to quarantine of infants in the newborn nursery for diarrhea of the newborn shall be cared for in a separate clean newborn nursery by a separate nursing staff.
(e) Closure of Hospital to Maternity Admissions. If cases of diarrhea of the newborn as defined above occur also in the temporary clean nursery, the hospital shall be closed to maternity admissions until all cases and contacts are discharged and all nursery rooms and equipment thoroughly cleaned.

s 2566. Diphtheria.
(a) Isolation of Patient. The patient shall be isolated in accordance with Section 2516 until 2 cultures from the throat and 2 from the nose, taken not less than 24 hours apart, fail to show the presence of diphtheria bacilli, except that upon clinical recovery and where antibiotics have been used as therapy, isolation may be modified in accordance with Section 2518. Release cultures may not be taken less than seven days after discontinuance of such therapy. Isolation may be terminated if the bacilli cultured from the case are proved to be virulent.
(b) Control of Household Contacts. All household contacts shall be kept under daily medical observation for clinical evidence of diphtheria for seven days after last exposure. These contacts shall be isolated if they are found to have sore throat or nasal discharge until proved by culture not to have diphtheria. All household contacts under the age of 15 shall be quarantined for at least seven days after the last exposure to the case. Nose and throat cultures for diphtheria should then be taken and the contacts may be released from quarantine if such cultures are negative. If the contact has received an antibiotic, release cultures may not be taken less than seven days after discontinuation of such medication.
(c) Release of Carriers From Isolation. Convalescent or healthy carriers of diphtheria bacilli may be released from quarantine if the bacilli are shown to be avirulent by appropriate laboratory tests. Any person who has been free from the symptoms of diphtheria for four weeks or longer and who harbors virulent diphtheria bacilli is defined as a chronic carrier. Efforts should be made to eliminate the carrier state in such persons by appropriate medical or surgical measures. If these measures are unsuccessful or are refused the health officer may release the carrier from isolation when, in his judgment, such release is not detrimental to the public health, except that the carrier may not be permitted to engage in any occupation which involves handling of foods of close association with children outside his own family.
(d) Laboratory Tests for the Release of Cases or Carriers. Cultures or virulence tests for the release of diphtheria cases or carriers shall be taken not less than seven days after discontinuation of antibiotic therapy and examined in accordance with the provisions of Section 2534.
(e) Cases on Dairies. When a case of diphtheria occurs or is confined on the premises where milk or milk products are handled, the health officer shall prohibit the use, sale or disposal of such milk or milk product, except by a method approved by him, until he is satisfied that such products are safe for human consumption.
(f) Immunization. The health officer shall take appropriate measures to encourage and facilitate a continuing program of active immunization against diphtheria for all children within his jurisdiction.

s 2570. Encephalitis, Acute (Including Arthropod-Borne Viral, Post-Infectious, and Others).
The patient shall be isolated in accordance with Section 2518 for seven days from the onset of the infection. There are no restrictions on contacts.

s 2572. Disorders Characterized by Lapses of Consciousness, Alzheimer's Disease and Related Disorders.

Note: Authority cited: Sections 100275 and 103900, Health and Safety Code. Reference: Section 103900, Health and Safety Code.

s 2574. Food Poisoning.
(Excluding Botulism and Salmonella infections). A reportable case of food poisoning is defined as follows: any person with symptoms of acute gastroenteritis, vomiting, diarrhea, or neurologic symptoms whose illness occurs in association with a group of other persons who may have consumed a common food or beverage. The etiologic agents include:
(a) Organic poisons present in normal animal or plant tissues, including mushrooms, fish, and mussels.
(b) Mineral or organic poisons, including arsenic, lead, cadmium, and fluorine, introduced into food by accident, or with the intent to improve the appearance or as preservatives.
(c) Toxins preformed in food by the growth of microorganisms, including staphylococci. (Botulism is reported separately. See Section 2552.)
Upon receiving the report, the health officer shall make or cause to be made an investigation in an effort to determine the source and cause of the outbreak. If the responsible food is one distributed outside the area over which he has jurisdiction, he shall immediately report his findings to the Director of the State Department of Health Services and to those local health officers concerned. There are no restrictions on cases or contacts.

s 2575. German Measles (Rubella).
The patient shall be isolated in accordance with Section 2518 until clinically recovered. There are no restrictions on contacts.

s 2577. Gonococcus Infection.
(See Section 2636 on Venereal Diseases.)

s 2578. Granuloma Inguinale.
(See Section 2636 on Venereal Diseases.)

s 2579. Hepatitis, Infectious.
(This term includes cases diagnosed as acute catarrhal jaundice, epidemic hepatitis and epidemic jaundice.) The patient shall be isolated in accordance with Section 2518 during the acute symptoms. There are no restrictions on contacts.

s 2580. Influenza, Epidemic.

s 2581. Hepatitis, Serum (Homologous Serum Jaundice).
The patient shall be isolated in accordance with Section 2518 during the acute symptoms. There are no restrictions on contacts.

s 2582. Leprosy (Hansen's Disease).
The patient shall be isolated in accordance with Section 2518 if determined by clinical observation or by laboratory findings to be infectious. The degree of isolation shall be determined by the local health officer, who should, whenever possible, be advised by a physician specially qualified in this disease. If isolation of the patient is required and cannot be carried out at home or if adequate therapy is not available, the State Department of Public Health shall be notified and shall designate a hospital where the patient shall be isolated and treated. Apparently arrested or inactive cases, and persons who have been in close contact with a case for a prolonged period, shall be kept under observation as long as deemed necessary by the local health officer to determine if they have become infected or the disease reactivated.
All reports pertaining to cases of leprosy are confidential and the identity of patients shall not be divulged except as may be necessary for the protection of the public health.

s 2584. Leptospirosis (Including Weil's Disease).
There are no restrictions on case or contacts.

s 2585. Lymphogranuloma Venereum.
(See Section 2636 on Venereal Diseases.)

s 2586. Malaria.
The patient shall be confined during the clinical phases of the disease in a room or dwelling satisfactorily protected against mosquitoes.

s 2588. Measles.
The patient shall be isolated in accordance with Section 2518 during the period of catarrhal symptoms and for seven days after the appearance of the rash. Restriction on contacts is not required, except at the discretion of the local health officer.

s 2590. Meningitis, Meningococcal or Meningococcemia.
(a) The patient shall be isolated in accordance with Section 2518 until the end of the febrile period and until all acute symptoms have subsided.
(b) Contacts. Quarantine of contacts is not required, except at the discretion of the local health officer, but intimate contacts should be kept under frequent medical observation for a minimum of three days subsequent to diagnosis of the case. Prophylactic treatment of household contacts under medical supervision may be required by the health officer prior to release.

s 2592. Mumps.
The patient shall be isolated in accordance with Section 2518 until the swelling of the salivary glands has subsided. There are no restrictions on contacts.

s 2593. Neoplasm, Cancer.
(a) Definitions.
(1) Department means Department of Health Services.
(2) Director means the Director of the Department of Health Services.
(3) Regional cancer registry means the organization authorized to receive and collect cancer data for a designated area of the state and which maintains the system by which the collected information is reported to the Department.
(4) Cancer means all malignant neoplasms, including carcinoa in situ, which are specified in Volume I of the 1986 California Cancer Reporting System Standards and as set forth in the International Classification of Diseases for Oncology Field Trial Edition 1986.
(5) Case means a cancer diagnosis for an individual who is either a resident of the designated area of the regional cancer registry, regardless of where the individual was treated or diagnosed, or seen at a cancer reporting facility, other facility or by a physician within the designated area of the regional cancer registry, regardless of where the individual resides.
(6) Active follow-up program means a system for determining the vital status of each reported case no later than twelve months after the date of the last reported contact. This date is defined in Volume I of the 1986 California Cancer Reporting System Standards.
(7) Cancer reporting facility means a hospital or other facility which treats or diagnoses cancer and is also one of the following:
(A) A facility currently licensed as a health facility under the provisions of Chapter 2, commencing with Section 1250, of Division 2 of the Health and Safety Code;
(B) A surgical clinic licensed under Chapter 1, Section 1204, of Division 2 of the Health and Safety Code;
(C) A facility covered by the provisions of Section 1206, except for subsection (f), of the Health and Safety Code which, while not licensed as a clinic, is operated for the predominant purpose of diagnosing or treating cancer or where a minimum of 100 or more cancer cases are diagnosed or treated in a year.
(8) Quality Control System means operational procedures by which the accuracy, completeness and timeliness of the information reported to the Department can be determined and verified. These criteria are defined in Volume I of the 1986 California Cancer Reporting System Standards.
(9) Certified Tumor Registrar (CTR) means the designation given to individuals who pass the certification examination given by the National Tumor Registrars Association (NTRA).
(10) Population-based means that all cases are drawn from a defined population of known size and characteristics, usually one within a defined geographic area.
(11) Cancer incidence data means information on new cases of cancer including the required data listed in the 1986 California Cancer Reporting System Standards and counts of these cases by their characteristics such as age, sex and ethnicity, and by anatomic site and morphology.
(12) Instance of cancer means case of cancer as defined in subsection (a)(5) above.
(13) Modeled after the Cancer Surveillance Program of Orange County means a population-based registry that collects treatment data, has a phased implementation, collects follow-up data, has a community advisory component and receives data in a machine-readable format from cancer reporting facilities as defined in subsection (a)(7) above.
(b) Reporting requirements. The Director shall designate cancer as a disease to be mandatorily reported for all counties within the State. All counties shall be assigned to a designated regional cancer registry. When the Director designates cancer as a disease to be mandatorily reported within an area, the Director shall designate the initial mandatory reporting period, which may be less than a full calendar year, for which the regional registry will submit cases to the Department.
(1) A regional cancer registry shall establish and maintain a cancer reporting system which is able to report 97 percent of the incident cases in the initial designated reporting period and each calendar year.
(2) The regional cancer registry shall have suitable arrangements to obtain data for reporting resident cases diagnosed or treated outside the designated area of the regional cancer registry.
(3) The regional cancer registry shall report to the Department all cases diagnosed or treated in a calendar year or initial reporting period within twelve months after the close of that calendar year or initial reporting period.
(4) The regional cancer registry shall submit, for each reportable case, the required data specified in Volume I, Section 13, of the 1986 California Cancer Reporting System Standards.
(5) The regional cancer registry shall report to the Department all follow-up information provided by cancer reporting facilities with an active follow-up program no later than six months after the cancer reporting facility provides the information to the regional registry. In addition, each regional registry shall implement within three years of the designation of mandatory cancer reporting for the region a program of active follow-up for all resident cases not otherwise being followed by a cancer reporting facility. The results of the active follow-up program of the regional registry shall be reported to the Department quarterly.
(6) Data submitted to the Department by the regional cancer registry shall be in machine-readable form. The format and codes used shall be as specified by the Department.
(7) The regional cancer registry shall maintain a system of quality control in accordance with procedures approved by the Department.
(8) Representatives of the Department shall have access to the source data and the stored data in the regional cancer registry for the purpose of quality control assessments. This includes access to all cancer records maintained by a reporting facility, physician, individual or agency providing diagnostic or treatment services to cancer patients within the region.
(9) The regional cancer registry shall maintain confidentiality of data as required in Section 211.5, Health and Safety Code, and shall maintain a security system for records which contain identifying data. This system shall be reviewed and approved by the Department.
(10) When cancer is designated a reportable disease in a region, the corresponding regional cancer registry shall inform the public that cancer has been designated as a disease required to be reported in that region and that each patient diagnosed or treated with a Reportable Neoplasm will be reported to the Department as required by law.
(11) Cancer reporting facilities within a reporting region shall report to the regional cancer registry the required data as listed in Volumes I and III of the 1986 California Cancer Reporting System Standards. These reports shall conform to Volumes I, II and III of the 1986 California Cancer Reporting System Standards. When a cancer reporting facility fails to produce reports meeting the standards cited above, the regional cancer registry may perform the data collection and collect compensation from the facility for the activity at cost.
(12) Cancer reporting facilities shall report to their regional cancer registry each reportable case within six months of the time the case comes under the care of, or is admitted to, the facility.
(13) Cancer reporting facilities with an active follow-up program shall report follow-up information to the regional cancer registry no less frequently than quarterly.
(14) A facility not already defined as a cancer reporting facility under these regulations which diagnoses or treats cancer and is a primary care clinic as defined in Section 1204, Health and Safety Code or an acute psychiatric hospital as defined in Section 1250, Health and Safety Code shall report each cancer case to its regional cancer registry, or to the local health department, the choice to be determined by the regional registry, using the Confidential Morbidity Report (Form PM-110), shown below, within 30 days of the date the patient is admitted to the facility or treated in the facility for the first time. These reports shall conform to California Cancer Reporting System Standards, Volume IV. (continued)