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(15) Physicians and surgeons caring for cancer patients not referred to a facility defined as a cancer reporting facility under these regulations shall report each cancer case to the regional cancer registry or to the local health department, the choice to be determined by the regional registry, using the Confidential Morbidity Report (PM-110), within 30 days of seeing the patient for the cancer for the first time. These reports shall conform to California Cancer Reporting System Standards, Volume IV.
(16) Cancer reporting facilities shall submit their cancer cases and follow-up information to the regional cancer registry in machine-readable form. The format and codes used shall be as specified by the Department in the 1986 California Cancer Reporting System Standards Volume II.
(17) Cancer reporting facilities may elect to have the regional cancer registry staff do the cancer data collection. They may do so by a contract with the regional cancer registry to identify and report the cancer cases with the facility reimbursing the regional registry for that registry's expense.
(18) Cancer reporting facilities and physicians shall employ a mechanism to ensure that their patients are informed that cancer has been designated a reportable disease and that the facility will report each patient with cancer to the Department as required by law. Patient information sheets for this purpose will be supplied to physicians by the Department.
(c) Staffing. The identification and collection of cancer data in the regional cancer registries and cancer reporting facilities shall be performed by Certified Tumor Registrars (CTR) or staff eligible to take the certification examination.
(d) Training and Credentialing Period. Reporting facilities so requesting upon application to the regional registry, may be granted a credentialing period of up to 24 months for the purpose of obtaining training to meet the requirements set forth in subsection (c) above. No credentialing period may be granted to extend beyond 30 months from the effective date of mandatory cancer reporting for the region or beyond July 1, 1990. During a credentialing period the reporting facility must meet the quality and other reporting standards. It is the responsibility of the Department, which may be carried out by the regional cancer registries, to assure that adequate tumor registrar training resources are available for no less than 24 months following the initiation of mandatory reporting in a region.
(e) Designation of Agent. The Director may designate and contract with any agency to act as the Department's agent for the maintenance of the regional cancer registry. The designated agent shall comply with all regulations for the regional cancer registry.
(f) Revocation of Designation. The Director shall have the authority to revoke the designation as Departmental agent. Revocation shall be effective no sooner than 30 days after a written notice to revoke the designation has been served.


Note: Authority cited: Sections 208, 210 and 211.3, Health and Safety Code. Reference: Sections 210, 211.3 and 211.5, Health and Safety Code.


s 2594. Pertussis (Whooping Cough).
The patient shall be isolated in accordance with Section 2518 during the early catarrhal period and for 21 days after the appearance of the typical paroxysmal cough. The isolation provisions shall be adequate to prevent exposure of young children to the patient. Restrictions on contacts not required.


s 2595. Physically Handicapped Children
(See subchapter 3).


s 2596. Plague. Cases and Suspect Cases to Be Reported by Telephone.
(See Section 2502(c).)
(a) All laboratory specimens submitted for the purpose of establishing a diagnosis shall be examined only in such laboratories as may be designated by the Director of the State Department of Health Services. Whenever a laboratory receives a specimen for the laboratory diagnosis of suspected human plague, such laboratory shall communicate immediately by telephone with the State Department of Health Services Microbial Diseases Laboratory for instruction.
(b) Isolation. The patient shall be confined in a dwelling free from rodents and fleas and shall be isolated in accordance with Section 2516. The period of isolation shall not be terminated until two days after all symptoms have subsided. In cases of pneumonic plague, strict precautions against respiratory transmission of the disease shall be enforced.
(c) Contacts. Contacts of cases of plague shall be kept under quarantine until the health officer is satisfied that they have not contracted the infection, except that contacts of cases of pneumonic plague shall be kept in quarantine for a period of at least seven days after last exposure.


Note: Authority cited: Sections 100180, 100275, 120130 and 120145, Health and Safety Code. Reference: Sections 100180, 100275, 120145, 120190, 120215 and 120240, Health and Safety Code.


s 2597. Q Fever.
No restrictions on cases or contacts.


s 2598. Pneumonia, Infectious (Except Pneumonic Plague).


s 2600. Poliomyelitis, Acute Anterior.
The case shall be isolated in accordance with Section 2518 for a period of seven days from the onset of illness or for the duration of fever if longer. Restrictions on contacts is not required, except at the discretion of the local health officer.


s 2602. Psittacosis.
The patient shall be isolated in accordance with Section 2518 during the acute stages. There are no restrictions on contacts.


s 2603. Control of Pet Birds.
(a) The department or local health officers may quarantine any species of pet birds imported into this State from states and countries where psittacosis or other diseases transmitted by pet birds to human beings have been reported by an official agency to be currently prevalent in pet birds. Such quarantine shall remain in effect until removed by the department, or local health officers, following proof that the quarantined birds are not infected with psittacosis or other diseases transmissible by pet birds to human beings.
(b) Whenever a pet bird or birds are suspected to be a source of human disease or a pet bird or birds are infected with a disease which is a potential source of human disease and, in the opinion of the department or local health officers, it is deemed necessary for the protection of the public, the pet bird or birds shall be quarantined. Such quarantine shall remain in effect until the quarantine authority has evidence that the quarantined bird or birds are not a hazard to the public's health. Such evidence may be obtained by the following actions:
(1) A sufficient number of birds, such numbers to be specified by the quarantine authority, are to be provided for laboratory testing in a laboratory approved by the department.
(2) If, upon completion of the necessary laboratory test no evidence is found that the birds are infected with a disease hazardous to human health, they may be released from quarantine. Such release shall be made only by the quarantine authority.
(3) If upon completion of the necessary laboratory test there is evidence that the bird or birds are infected with a disease hazardous to human health, the bird or birds shall remain under quarantine until the hazard has been eliminated to the satisfaction of the quarantine authority.
(4) If, following treatment methods or other methods which may be used to eliminate the hazard in the quarantined bird or birds, the quarantine authority finds that the hazard to humans no longer exists, it may release the bird or birds from quarantine.
(5) The owner of the quarantined bird or birds shall have the option to destroy the quarantined bird or birds if he so desires. In such case the quarantine will be lifted following evidence that the infected premises are thoroughly disinfected.


Note: Authority cited: Sections 100275 and 121745, Health and Safety Code. Reference: Section 121745, Health and Safety Code.


s 2603.5. Control of Psittacine Birds.


Note: Authority cited: Sections 208 and 2100, Health and Safety Code.


s 2604. Rabies, Human.
The patient shall be isolated in accordance with Section 2518 during the course of the disease. There are no restrictions on contacts of a human case.


Note: Authority cited: Sections 102, 208 and 1900-2000, Health and Safety Code.


s 2606. Rabies, Animal.
(a) Reporting. Any person having knowledge of the whereabouts of an animal known to have or suspected of having rabies shall report the facts immediately to the local health officer. The health officer shall likewise be notified of any person or animal bitten by a rabid or suspected rabid animal.
In those areas declared by the Director of the State Department of Health Services to be rabies areas (See Section 1901.2, California Health and Safety Code) the local health officer shall be notified when any person is bitten by an animal of a species subject to rabies, whether or not the animal is suspected of having rabies.
(b) Isolation. Any rabid animal, clinically suspected rabid animal, or biting animal shall be isolated in strict confinement as follows:
(1) Isolation of Rabid Animals or Clinically Suspected Rabid Animals. Any rabid animal or clinically suspected rabid animal shall be isolated in strict confinement under proper care and under the observation of a licensed veterinarian, in a pound, veterinary hospital, or other adequate facility in a manner approved by the local health officer, except where such responsibility has been delegated to a comparable officer by the governing body, and shall not be killed or released for at least 10 days after the onset of symptoms suggestive of rabies, with the exception that such animals may be sacrificed with permission of the local health officer for the purpose of laboratory examination for rabies using the fluorescent rabies antibody (FRA) test in an approved public health laboratory.
(2) Isolation of Biting Animals. At the discretion of the local health officer, any animal which bites or otherwise exposes a person shall be isolated in strict confinement in a place and manner approved by the local health officer and observed for at least 14 days (dogs and cats 10 days) after the day of infliction of the bite, with the exception that the following alternative to the 10 day isolation of dogs and cats is permitted -dogs or cats which have been isolated in strict confinement under proper care and under observation of a licensed veterinarian, in a pound, veterinary hospital, or other adequate facility in a manner approved by the local health officer, may be released from isolation by the local health officer after five days of veterinary observation if upon conducting a thorough physical examination on the fifth day or more after infliction of the bite, the observing veterinarian certifies that there are no clinical signs or symptoms of any disease. Notwithstanding the foregoing provisions, a local health officer may authorize, with permission of the owner and other legal restrictions permitting, the euthanasia of a biting animal for the purpose of laboratory examination for rabies using the fluorescent rabies antibody (FRA) test in an approved public health laboratory.
(3) Isolation of Biting Animals in Officially Declared Rabies Areas. In officially declared rabies areas (see Section 1901.2, California Health and Safety Code) the isolation described in paragraph (2) above shall be mandatory for any animal of a species subject to rabies that has bitten or otherwise exposed a person, with the exception of rodents (members of the order Rodentia) and rabbits and hares (members of the order Lagomorpha).
(4) Laboratory Examination of Rabid Animals, Clinically Suspected Rabid Animals or Biting Animals Which Die or Have Been Killed. If any rabid animal, clinically suspected rabid animal or biting animal dies or has been killed, adequate specimens shall be obtained and examined in a public health laboratory approved by the department. No person shall destroy or allow to be destroyed the brain of an animal of a species subject to rabies that has bitten or otherwise exposed a person before the destruction of such brain has been authorized by the local health department; provided, however, that the provisions of this paragraph (4) shall not apply to rodents (members of the order Rodentia ) and rabbits or hares (members of the order Lagomorpha ).
(c) Animal Contacts. Any animal of a species subject to rabies which has been bitten by a known rabid or suspected rabid animal or has been in intimate contact with a rabid or suspected rabid animal shall be quarantined in a place and manner approved by the local health officer, except where such responsibility has been delegated to a comparable officer by the local governing body, for a period of six months or destroyed, with the exception that the following alternatives are permitted in the case of dogs and cats as follows:
(1) If a dog over one year of age has been vaccinated against rabies within 36 months but not less than 30 days with a rabies vaccine of a type approved by the Department for a maximum immunity duration of at least 36 months, the dog may be revaccinated immediately (within 48 hours) in a manner prescribed by the Department and quarantined in a place and manner approved by the local health officer for a period of 30 days following revaccination.
(2) If a dog under one year of age has been vaccinated against rabies within 12 months but not less than 30 days with a rabies vaccine of a type approved by the Department, the dog may be revaccinated immediately (within 48 hours) in a manner prescribed by the Department and quarantined in a place and a manner approved by the local health officer for a period of 30 days.
(3) If a cat has been vaccinated within one year but not less than 30 days with an annual type feline rabies vaccine or if a cat has been vaccinated under one year of age with a 36-month type of feline rabies vaccine within 12 months but not less than 30 days, the cat may be revaccinated immediately (within 48 hours) in a manner prescribed by the Department and quarantined in a place and manner approved by the local health officer for a period of 30 days following revaccination.
(4) If a cat over one year of age has been vaccinated against rabies and has been vaccinated within 36 months and more than 30 days with a 36-month type feline rabies vaccine, the cat may be revaccinated immediately (within 48 hours) in a manner prescribed by the Department and quarantined in a place and manner approved by a local health officer for a 30-day period following revaccination.


Note: Authority cited: Sections 208, 1905 and 3123, Health and Safety Code. Reference: Sections 1901, 1903, 1905, 1907 and 3123, Health and Safety Code.


s 2606.2. Rabies Quarantine.
If rabies is known to exist within an area, the local health officer may establish a rabies quarantine and shall define the boundaries of the quarantine area and specify the animals subject to quarantine, and all such animals within the quarantined area shall be kept in strict confinement upon the private premises of the owner, keeper or harborer at all times until the quarantine is terminated by the local health officer.


Note: Authority cited: Sections 102, 208 and 1900-2000, Health and Safety Code.


s 2606.4. Officially Declared Rabies Areas.
(a) Administration and Enforcement. For purposes of administration and enforcement of Section 1920, California Health and Safety Code, in officially declared rabies areas, the following shall apply:
(1) Licensing and Vaccination Procedure. The vaccination of dogs four months of age or older as required by subdivision (b), Section 1920, California Health and Safety Code, shall be held a requisite to licensing as required under subdivision (a) therein. Completion of the licensing procedure consists of issuance of a license tag or a vaccination tag bearing the license data and shall be carried out only after presentation of a current valid official vaccination certificate. Current copies of the Compendium of Canine Rabies Vaccines approved by the Department, together with the maximum immunity duration periods prescribed by the Department for each type product, are available upon request from the Veterinary Public Health Unit, Infectious Disease Section, California Department of Health Services, 2151 Berkeley Way, Berkeley, California, 94704, telephone (415) 540-2391.
(2) Vaccination Certificates. Official vaccination certificates must show:
(A) the name, address and telephone number of the dog's owner;
(B) the description of the dog, including breed, color, age, and sex;
(C) the date of immunization;
(D) the type of rabies vaccine administered;
(E) the name of the manufacturer; and
(F) the lot number of the vaccine used.
Such certificates shall bear the signature of the veterinarian administering the vaccine or a signature authorized by him, and in addition such certificate shall be stamped, printed, or typed with his name, address and telephone number for legibility, with the exception that at dog vaccination clinics conducted pursuant to Section 1920(f) of the Health and Safety Code, vaccination certificates approved by the local health officer may be used provided that the specific clinic is identified upon the vaccination certificate and records are maintained containing the information specified under items (E) and (F) above.
(3) Interval Permitted for Procurement of License. The vaccination of dogs four months of age against rabies as required under subdivision (b), Section 1920, California Health and Safety Code, and the license required by subdivision (a) of said section shall be procured not later than 30 days after the dog attains the age of four months. The license renewal shall be procured not later than 60 days after expiration of the previously issued license.
(4) Rabies Control Activities Reporting. During such time as a county is under official declaration as a rabies area, each local official responsible for the various phases of local dog or rabies control within each city, county and city or cities, or county shall make quarterly rabies control activities reports to and on forms furnished by the Department. Such reports shall be submitted to the Department by the local officials responsible for the various phases of local dog or rabies control through the local health officer so as to reach the Department not later than 30 days following each quarter.
(b) Vaccination of Dogs Against Rabies. Dogs shall be considered to be properly vaccinated for the purposes of Section 1920, California Health and Safety Code, when injected at four months of age or older with an approved canine rabies vaccine and revaccinated in accordance with the following conditions:
(1) Primary Immunization. Primary immunization shall be defined as the initial inoculation of an approved canine rabies vaccine administered to young dogs between the ages of 4 to 12 months.
(2) Minimum Age for Rabies Vaccination. The minimum age for which rabies immunization of dogs shall be accepted for purposes of dog-owner compliance with requirements for rabies vaccination and for purposes of issuance of dog licenses (See Section 2606.4(a)(1)) is 4 months.
(3) Revaccination Intervals. Dogs shall be revaccinated one year (12 months) after the primary immunization with an approved type of rabies vaccine. Dogs receiving vaccination after primary immunization or any dog receiving its initial rabies vaccination over 12 months of age shall be revaccinated thereafter at least once every three years (36 months) with an approved type rabies vaccine.
(c) Issuance of Dog Licenses. In no instances shall a dog license be issued for a period beyond the date upon which revaccination is due except, following primary immunization in a local jurisdiction which is on a fixed one-year licensing period, a license may be issued for a period beyond the revaccination date if early revaccination cannot be required in accordance with subdivision (d).
(d) Notwithstanding the rabies revaccination intervals specified in Section 2606.4(b)(3) above, local authorities may require revaccination prior to issuance of a license provided that revaccination against rabies in no instance shall be required sooner than one year (12 months) follow ing a primary immunization or sooner than 2 years (24 months) following a vaccination of dogs vaccinated over one year (12 months) of age.


Note: Authority cited: Sections 208 and 1905, Health and Safety Code. Reference: Sections 1905 and 1920, Health and Safety Code.


s 2606.6. Importation of Dogs.
All dogs four months of age or older imported into this State for any purpose shall be accompanied by a certificate issued by a licensed veterinarian, stating that the dog or dogs have been vaccinated against rabies within 30 months of the date of importation for dogs vaccinated over 12 months of age or within 12 months for dogs vaccinated under 12 months of age with a canine rabies vaccine of a type approved by the Department for an immunity duration of at least 36 months.


Note: Authority cited: Sections 208 and 1905, Health and Safety Code. Reference: Sections 1905 and 1920(b), Health and Safety Code.


s 2606.8. Skunk Rabies.
(a) Due to the presence of rabies in skunks in California and in many other states and the resultant hazard to the public health of rabies developing in skunks kept as pets, no person shall:
(1) trap or capture skunks for pets,
(2) trap, capture or hold skunks in captivity for sale, barter, exchange or gift,
(3) transport skunks from or into the state except as provided under (b) below.
(b) The importation of skunks into California or the exportation of skunks from the State is prohibited except by permit from the California State Department of Health Services to a recognized zoological garden or a research institution.


Note: Authority cited: Sections 208 and 1905, Health and Safety Code. Reference: Section 1905, Health and Safety Code.


s 2608. Relapsing Fever.
(a) (Tick-borne). There are no restrictions on case or contacts.
(b) (Louse-borne) Cases and Suspect Cases to Be Reported by Telephone or Telegraph. (See Section 2501(c).) The patient shall be confined during the clinical phase of the disease in a dwelling or room free of rodents or lice. There are no restrictions on contacts. All lice and louse eggs on the patient's body, hair, or clothing shall be destroyed. Household contacts shall be louse-free.


s 2610. Rheumatic Fever, Acute.
There are no restrictions on case or contacts.


s 2611. Rocky Mountain Spotted Fever.
There are no restrictions on case or contacts.


s 2612. Salmonella Infections (Other Than Typhoid Fever).
(a) Any illness in which organisms of the genus Salmonella (except the typhoid bacillus) have been isolated from feces, blood, urine or pathological material shall be reported as a Salmonella infection. A culture of the organisms on which the diagnosis is established shall be submitted first to a local public health laboratory and then to the State Microbial Diseases Laboratory for definitive identification. The period of isolation in accordance with Section 2518 shall be until clinical recovery. The patient shall be subject to supervision by the local health officer who may require, at his discretion, release specimens of feces for testing in a laboratory approved by the State Department of Health Services.
However, no patient shall be released from supervision to engage in any occupation involving the preparation, serving or handling of food, including milk, to be consumed by individuals other than his immediate family, nor to engage in any occupation involving the direct care of children or of the elderly or of patients in hospitals or other institutional settings until two successive authentic specimens of feces taken at intervals of not less than 24 hours, beginning at least 48 hours after cessation of specific therapy, if any was administered, have been determined, by a public health laboratory approved by the State Department of Health Services to be negative for Salmonella organisms. (See Section 2534.)
(b) Carriers. Any person who harbors Salmonella organisms three months after onset is defined as a convalescent carrier and may be restricted at the discretion of the local health officer.
Any person continuing to harbor Salmonella organisms one year after onset is a chronic carrier. Any person who gives no history of having had Salmonellosis or who had the illness more than one year previously who is found to harbor Salmonella organisms on two successive specimens taken not less than 48 hours apart is also considered to be a chronic carrier.
Chronic carriers of Salmonella, other than S. typhosa, shall be restricted at the discretion of the local health officer.
(c) Contacts. Restrictions on contacts shall be at the discretion of the local health officer.


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


s 2612.1. Turtle Salmonellosis.
(a) Except as otherwise provided in this section, it shall be unlawful to import, sell or offer for sale or distribution to the public any live turtle(s) with a carapace length of less than 4 inches.
(b) The Department or any authorized representative thereof, or any local health officer or his representative may order the humane destruction of any turtle(s) that are unlawful to import, sell or offer for sale or distribution to the public under subsection (a) above.
(c) The Department or any authorized representative thereof, or any local health officer or his representative may quarantine turtles, take samples of tank water or any other appropriate samples of or from turtles offered for sale or distribution for the purpose of testing for Salmonella and Arizona organisms. The Department or any local health officer may order the immediate humane destruction of any lot of turtles found contaminated with Salmonella, Arizona, or other organisms which may cause or have caused disease in humans.
(d) Shipments of turtles under 4 inches in carapace length are permitted to a governmental agency, or to a recognized research or educational institution for research or teaching purposes or to a zoological garden for display.
(e) The following warning shall be posted conspicuously for buyer information at every display of turtles for retail sale or distribution or where the public may come in contact with turtles:
CAUTION: Turtles may transmit bacteria causing disease in humans. It is important to wash the hands thoroughly after handling turtles or material that had contact with turtles. Do not allow water or any other substance that had contact with turtles to come in contact with food or areas where food is prepared. Make sure that these precautions are followed by children and others handling turtles.
(f) For each sale of turtle(s) at retail, a sales slip shall be issued by the seller to the purchaser at time of the sale. The sales slip shall include the name, address and telephone number of the purchaser and the seller, and the date of sale. The sales slip shall have printed legibly on its front the warning statement contained in subsection (e) above. The seller shall keep a copy of the sales slip, which shall include the name, address and telephone number of the purchaser for not less than one year, and keep a complete record of all purchases, losses and other dispositions of turtles.


Note: Authority cited: Sections 102 and 208, Health and Safety Code. Reference: Sections 205, 3051-3053, Health and Safety Code.


s 2613. Shigella Infections (Dysentery, Bacillary).
(a) The period of isolation in accordance with Section 2518 shall be until the acute symptoms have subsided.
The patient shall be subject to supervision by the local health officer who may require, at his discretion, release specimens of feces for testing in a laboratory approved by the State Department of Health Services. However, no patient shall be released from supervision to engage in any occupation involving the preparation, serving or handling of food, including milk, to be consumed by individuals other than his immediate family, nor to engage in any occupation involving the direct care of children or of the elderly or of patients in hospitals or other institutional settings until two successive authentic specimens of feces or of rectal swabs, taken at intervals of not less than 24 hours, beginning at least 48 hours after cessation of specific therapy, if any was administered, have been determined, by a public health laboratory approved by the State Department of Health Services, to be negative for Shigella organisms. (See Section 2534.)
(b) Contacts. Restrictions on contacts shall be at the discretion of the local health officer.


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


s 2614. Smallpox (Variola). Cases and Suspect Cases to Be Reported by Telephone.
(See Section 2502(c).)
(a) Patient. The patient shall be isolated in accordance with Section 2516 until the scabs have separated and the scars have completely healed.
(b) Household Contacts. Household contacts shall be quarantined for at least 17 days after last exposure, except that the local health officer may, at his discretion, when the patient is properly isolated, release from quarantine persons who shall submit to vaccination against smallpox and prove to the satisfaction of the local health officer that the vaccination is successful. Such persons shall remain in quarantine until released by the local health officer.
(c) Casual Contacts. A person who has been exposed to the risk of contracting the disease by proximity to a case or to a suspected case of smallpox, shall be quarantined for a period not less than 17 days from the last date of exposure. Such persons may be released from quarantine if evidence of protection against smallpox is established to the satisfaction of the local health officer.
(d) Vaccination. The local health officer shall provide at public expense, as available, smallpox vaccination for persons who have been exposed to a case or suspected case of smallpox.
(e) Laboratory. Whenever a laboratory receives a specimen for the laboratory diagnosis of smallpox (variola), such laboratory shall communicate immediately by telephone with the State Department of Health Services Viral Rickettsial Disease Laboratory for instruction.


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


s 2616. Streptococcal Infections, Hemolytic (Including Scarlet Fever and Streptococcal Sore Throat).
(a) The patient shall be isolated in accordance with Section 2518 for not less than seven days from onset. Patients treated with an effective antibiotic may be released upon clinical recovery.
(b) Contacts. Household contacts should be kept under frequent medical observation for the development of streptococcal disease. Restriction on contacts is not required, except at the discretion of the local health officer.


s 2617. Syphilis.
(See Section 2636 on Venereal Diseases.)


s 2618. Tetanus.
There are no restrictions on case or contacts.


s 2620. Trachoma.
The patient shall be isolated in accordance with Section 2518 during the acute stages and when not under medical treatment satisfactory to the health officer. There are no restrictions on contacts.


s 2622. Trichinosis.
The local health officer shall make an investigation to determine the source of infection. If the suspected source is a commercial food product, the health officer shall report the fact at once to the State Department of Public Health. There are no restrictions on case or contacts.


s 2624. Tuberculosis.
A person having or suspected of having tuberculosis in a communicable stage shall be considered as fulfilling the requirements of modified isolation as long as he is under adequate medical supervision and observes the instructions issued by the local health officer. The isolation shall be adequate for the protection of persons residing within the household as well as the public.
A person having tuberculosis in a communicable stage, who refuses to observe the instructions of the local health officer and thereby needlessly exposes others to infection, shall be placed in strict isolation at home until such time as the local health officer feels that such isolation is no longer necessary for the protection of the public; and, in the event that such household isolation proves inadequate for the protection of members of the household or community, the patient shall be placed in isolation in quarters designated by the local health officer, until such time as such isolation is no longer necessary for the protection of the public.
The person officially in charge of a sanatorium or other place where tuberculosis patients are cared for shall be responsible for immediately notifying the health officer in whose territory a patient resides whenever such patient having tuberculosis in a communicable stage leaves the institution.
In every case in which a non-communicable tuberculous patient has been placed in a nursing home the local health officer or his deputy shall be responsible for the continued surveillance of such a patient to ensure that he remains non-communicable.


s 2626. Tularemia. 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 tularemia, such laboratory shall communicate immediately by telephone with the State Department of Health Services Microbial Diseases Laboratory for instruction.


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


s 2628. Typhoid Fever.
(a) Case. A culture of the organism on which the diagnosis of typhoid fever is established shall be submitted first to a local public health laboratory and then to the State Microbial Diseases Laboratory for phage typing. The patient shall be isolated in accordance with Section 2518 until clinical recovery. The patient shall remain subject to supervision by the local health officer until three successive specimens of feces and urine taken at least 24 hours apart, beginning at least one week after discontinuation of specific therapy and not earlier than one month after onset of disease, have been found negative for typhoid bacilli at a public health laboratory approved by the State Department of Health Services. If any one of this series is positive, cultures of both urine and feces shall be repeated at intervals of 1 month during the 12-month period following onset, until at least three sets of negative cultures are obtained. The patient shall not take any part in the preparation, serving, or handling of milk or other food to be consumed by individuals other than his immediate family, or participate in the management of a dairy, milk distributing plant, boarding house, restaurant, food store, or any place where food is prepared or stored, or engage in any occupation involving the direct care of young children or the elderly or of patients in hospitals or other institutional settings until release specimens have been obtained, as described above, and are negative for typhoid organisms. (See Section 2534.)
(b) Contacts. There are no restrictions on contacts, except that any member of the patient's household shall not take part in the preparation, serving, or handling of milk or other food to be consumed by individuals, other than the immediate family except at the discretion and under the restrictions of the local health officer.
(c) Definition of Carriers. (1) Convalescent Carriers: Any person who harbors typhoid bacilli for three or more months after onset is defined as a convalescent carrier. Convalescent carriers may be released when three consecutive negative specimens of feces and urine taken at intervals of not less than one month, beginning at least one week after discontinuation of specific therapy are obtained. Such release may be granted at any time from 3- 12 months after onset.
(2) Chronic Carriers: If the person continues to excrete typhoid bacilli for more than 12 months after onset of typhoid fever, he is defined as a chronic carrier. Any person who gives no history of having had typhoid fever or who had the disease more than one year previously, and whose feces or urine are found to contain typhoid bacilli on two separate examinations at least 48 hours apart, confirmed by State Microbial Diseases Laboratory, is also defined as a chronic carrier. All carriers shall be reported to the local health officer. Such reports shall be kept confidential and shall not be divulged to persons other than the carrier and his immediate family, except as may be required for the protection of the public health.
(3) Other Carriers: A person should be held under surveillance if typhoid bacilli are isolated from surgically removed tissues, organs, e.g., gallbladder, kidney, etc., or from draining lesions such as osteomyelitis. If the person continues to excrete typhoid bacilli for more than 12 months he is defined as a chronic carrier and may be released after satisfying the criteria for other chronic carriers.
(d) Carrier Restrictions and Supervision. When any known or suspected carrier of this disease is reported to the local health officer, he shall make an investigation and submit a report to the State Department of Health Services. He shall have performed laboratory work as defined in subsection (e) below. Any known or suspected carrier of this disease shall be subject to modified isolation and the provisions of this isolation shall be considered as fulfilled during such period as he complies with the instructions issued by the State Department of Health Services and the local health officer.
(1) Restrictions. Instructions shall be given to the carrier in writing by the local health officer.
(2) Supervision. The local health officer or his representative shall communicate with each carrier living within his jurisdiction at least twice a year to learn of any changes in the carrier's address, occupation or activities and to determine whether all instructions are being carried out. The local health officer shall submit a report to the State Department of Health Services every six months on each carrier in his jurisdiction. Any changes of address shall be reported immediately.
(e) Laboratory Tests. Whenever laboratory tests are required for the release of typhoid cases or carriers, the tests shall be taken by the local health officer or his representatives under such conditions that he can certify as to their being authentic specimens of the individual, and shall be submitted to a public health laboratory approved by the State Department of Health Services. Cultures from release specimens which are found positive by the approved laboratory shall be forwarded to the State Division of Laboratories for phage typing.
(f) Requirements for Release of Chronic Carriers. Authority for Release of Carriers. Any person ascertained to be a chronic typhoid carrier may be released from supervision by the Director of the State Department of Health Services or his designated representative provided the carrier applies for such release through his local health officer and fulfills the requirements specified by the Director of the State Health Department or his designated representative.
(1) Fecal Carriers. A person who has been determined to be a chronic fecal carrier may be released if six successive authentic stool and urine specimens taken at intervals of not less than one month are determined to be negative by a public health laboratory approved by the State Department of Health Services. If any one of these specimens is positive, he shall not be released unless the carrier condition has been cured by cholecystectomy, or by such other methods as are acceptable to the State Department of Health Services. The necessary requirements for such release will be submitted to the carrier and to the local health officer by the State Department of Health Services when application for the release is submitted.
(2) Cholecystectomy. The local health officer or, in areas not served by a local health department, the Director of the State Department of Health Services, shall be notified before a cholecystectomy is undertaken unless a specimen of duodenal contents, containing bile, has been found positive for typhoid bacilli, since in some cases the infection is not localized in the gall bladder. The patient shall be released under the same conditions as outlined for a fecal carrier.
(3) Urinary Carriers. A person who has been determined to be a chronic urinary carrier may be released if six successive authentic urine specimens taken at intervals of not less than one month are determined to be negative by a public health laboratory approved by the State Department of Health Services. If any one of these specimens is positive, he may be released following the surgical removal of the infected kidney or by such other methods as are acceptable to the State Department of Health Services. The necessary requirements for such release will be submitted to the carrier and to the local health officer by the State Department of Health Services when application for the release is submitted.


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


s 2630. Typhus Fever (Flea-Borne, Endemic Type).
The patient shall be confined during the clinical phase of the disease in a dwelling or room free of rodents, fleas or lice. There are no restrictions on contacts.


s 2632. Typhus Fever (Louse-Borne, Epidemic Type). Cases and Suspect Cases to Be Reported by Telephone or Telegraph.
(See Section 2501(c).) The patient shall be confined during the clinical phase of the disease in a dwelling or room free of rodents or lice. All lice and louse eggs on the patient's body, hair, or clothing shall be destroyed. Household contacts shall be louse-free. There are no other restrictions on contacts.


s 2636. Venereal Diseases.
(a) Sections 2636 to 2636(m) inclusive pertain to the venereal diseases and, unless otherwise specified, shall include syphilis, gonococcus infection, granuloma inguinale, lymphogranuloma venereum, and chancroid. (See Chapter 765, Statutes 1947; also Section 21100, Health and Safety Code.)
(b) Reports Confidential. Reports of examinations, cases, investigations and all records thereof made under the regulations for the control of venereal diseases shall be confidential and not open to public inspection and no part thereof divulged, except as may be necessary for the preservation of the public health.
(c) Report of Unusual Prevalence. When the local health officer, through investigation, becomes aware of unusual prevalence of venereal diseases, or of unusual local conditions favoring the spread of these diseases, he shall report the fact at once to the State Department of Health Services.
(d) Parents or Guardians Responsible for Compliance of Minors. The parents or guardians of minors suffering from a venereal disease shall be legally responsible for the compliance of such minors with the requirements of the regulations relating to the venereal diseases.
(e) Certification. Each local health officer shall take every proper means of repressing prostitution, inasmuch as it is the most prolific source of the venereal diseases. Health officers and physicians shall not issue certificates of freedom from venereal diseases to known prostitutes, as such certificates may be used for purposes of solicitation.
(f) Diagnosis. The local health officer may require the submission of such specimens as may be designated from cases of venereal disease for examination in a laboratory approved by the State Department of Health Services. The local health officer may require any physician in attendance on a person infected with a venereal disease or suspected of being infected with a venereal disease to submit such specimens as approved by the State Department of Health Services provided, however, nothing shall prevent the physician or individual from having additional examination made elsewhere.
(g) Instruction to the Patient. It shall be the duty of the physician in attendance on a person having a venereal disease, or suspected of having a venereal disease, to instruct such patient in precautionary measures for preventing the spread of the disease, the seriousness of the disease, and the necessity for treatment and prolonged medical supervision, and the physician shall, in addition, furnish approved literature on these subjects. Approved literature for distribution to patients may be secured from the State Department of Public Health and the local health departments free of charge.
(h) Investigation. All city, county and other local health officers are hereby directed to use every available means to ascertain the existence of, and immediately to investigate, all reported or suspected cases of venereal disease in the infectious stages within their several territorial jurisdictions, and to ascertain the sources of such infections. The attending physician, in every case of venereal disease coming to him for treatment, shall endeavor to discover the source of infection, as well as any sexual or other intimate contacts which the patient was in the communicable stage of the disease. The physician shall make an effort, through the cooperation of the patient, to bring these cases in for examination and, if necessary , treatment. If, within 10 days of identification, any such source of infection or any such contact has not given satisfactory evidence of being under the care of a physician, such person shall be reported to the health officer, the physician's name being kept confidential in any investigation by the health department. In cases in which prostitutes are named as sources of infection, all obtainable information as to name, description, residence, etc., shall be given to the health officer at once.
In carrying out such investigations, all health officers are hereby invested with full powers of inspection, examination and isolation of all persons known to be infected with a venereal disease in an infectious stage, or suspected of being infected with a venereal disease in an infectious stage and are hereby directed:
(1) To make such examinations as are deemed necessary of persons reasonably suspected of having a venereal disease in an infectious stage.
(2) When the individual to be examined is a woman, to provide the services of a woman physician if such physician is available, when so requested by the individual to be examined.
(3) To isolate such person, whenever deemed necessary for the protection of the public health. In establishing isolation the health officer shall proceed as provided in Sections 2636(i), 2636(j), 2636(l) and 2636(m).
(4) Pursuant to Section 3194.5 of the Health and Safety Code, a person employed by a Public Health Department shall meet the following training requirements as a prerequisite to the performance of venipuncture or skin puncture:
(A) Possess a statement signed by a licensed physician and surgeon stating that the individual named in such statement has received adequate training in the proper procedure to be employed in the performance of venipuncture and skin puncture.
(B) In order to receive such statement, the venereal disease case investigator shall be trained by a licensed physician and surgeon. The trainee shall observe and receive sufficient instruction and demonstration of the proper technique and procedure to be employed in the performance of venipunctures and skin punctures; in turn, the physician and surgeon shall then observe the procedure and technique of the trainee.
(C) When such training has been completed by the trainee to the satisfaction of the physician and surgeon, such physician and surgeon shall execute a statement that the venereal disease case investigator has received adequate training in the proper procedure to be employed in the performance of venipuncture and skin puncture.
Satisfaction of these training requirements shall be in addition to other requirements of Section 3194.5 of the Health and Safety Code.
(i) Isolation. Any person who presents himself (or herself) to any physician or person for treatment or diagnosis of any venereal disease except late syphilis shall be considered to be in modified isolation. The requirements of this isolation shall be considered fulfilled if the patient remains under adequate and proper treatment until the completion of the course of treatment, except in instances in which, because of occupation, suspicion of prostitution, or other reason, the health officer deems more strict isolation necessary to safeguard other persons.
(j) Violation of Isolation to be Reported. Whenever any person while in the infectious or potentially infectious stage of a venereal disease, lapses from treatment for a period of more than 10 days after the time appointed for such treatment, the said diseased person shall be deemed to have violated the requirements of isolation, and the physician or person in attendance upon such case shall report the same at once to the local health department, giving the person's name, address, and report number, together with such other information as requested on the card provided for this purpose, except that this shall not be required in instances in which a report has been received that the patient is under treatment elsewhere. (continued)