105 Mass. Reg. 300.200

Current through Register Vol. 1409, January 24, 2020
Section 300.200 - Isolation and Quarantine Requirements

Upon the report of a case or suspected case of disease declared dangerous to the public health, the local board of health and the Department are authorized to implement and enforce the requirements outlined in 105 CMR 300.200. Minimum requirements for the isolation and quarantine of diseases dangerous to the public health are set forth in 105 CMR 300.200(A). Depending on the specific circumstances related to the exposure, case and/or contact with respect to any disease or condition listed in 105 CMR 300.200(A) or (B), additional control measures may be required.

(A) Diseases Reportable to Local Boards of Health.

Disease

Minimum Period of Isolation of Patient

Minimum Period of Quarantine of Contacts

Amebiasis

After diarrhea has resolved, food handlers may only return to food handling duties after producing one negative stool specimen. If a case has been treated with an antimicrobial, the stool specimen shall not be collected until at least 48 hours after cessation of therapy. In outbreak circumstances, two negative stool specimens produced at least 24 hours apart will be required prior to returning to food handling duties.

Contacts with diarrhea, who are food handlers, shall be considered the same as a case and handled in the same fashion. In outbreak circumstances, asymptomatic contacts who are food handlers shall be required to produce two negative stool specimens produced at least 24 hours apart prior to returning to food handling duties. Otherwise, no restrictions.

Anaplasmosis

No restrictions

No restrictions

Anthrax

For cutaneous anthrax, place on contact precautions until lesions are healed or free from anthrax bacilli.

No restrictions

Arbovirus infection

No restrictions

No restrictions

Babesiosis

No restrictions except for exclusion from blood donation.

No restrictions

B. miyamotoi

No restrictions

No restrictions

Botulism

No restrictions

No restrictions

Brucellosis

No restrictions

No restrictions

Campylobacteriosis

After diarrhea has resolved, food handlers may only return to food handling duties after producing one negative stool specimen. If a case has been treated with an antimicrobial, the stool specimen shall not be collected until at least 48 hours after cessation of therapy. In outbreak circumstances, two negative stool specimens produced at least 24 hours apart will be required prior to returning to food handling duties.

Contacts with diarrhea, who are food handlers, shall be considered the same as a case and handled in the same fashion. In outbreak circumstances, asymptomatic contacts who are food handlers shall be required to produce two negative stool specimens produced at least 24 hours apart prior to returning to food handling duties. Otherwise, no restrictions.

Cholera

After diarrhea has resolved, food handlers may only return to food handling duties after producing two negative stool specimens produced at least 24 hours apart. If a case has been treated with an antimicrobial, the stool specimen shall not be collected until at least 48 hours after cessation of therapy.

Contacts with diarrhea, who are food handlers, shall be considered the same as a case and handled in the same fashion. In outbreak circumstances, asymptomatic contacts who are food handlers shall be required to produce two negative stool specimens produced at least 24 hours apart prior to returning to food handling duties. Otherwise, no restrictions.

Clostridium difficile

No restrictions

No restrictions

Severe infection due to novel coronaviruses

Isolate for duration of illness. Isolation beyond the resolution of symptoms may be required and will be determined by the Department based on the most current recommendations by the Centers for Disease Control and Prevention.

Asymptomatic contacts should practice personal surveillance for symptoms and should any occur within 14 days of the individual's last contact with the case, report them to their health care provider immediately. Febrile contacts or contacts with respiratory symptoms only, shall be treated the same as a case for 72 hours, after which further management shall be in consultation with the Department.

Creutzfeldt-Jakob disease or variant Creutzfeldt-Jakob disease

No restrictions

No restrictions

Cryptosporidiosis

After diarrhea has resolved, food handlers may only return to food handling duties after producing one negative stool specimen. If a case has been treated with an antimicrobial, the stool specimen shall not be collected until at least 48 hours after cessation of therapy. In outbreak circumstances, two negative stool specimens produced at least 24 hours apart will be required prior to returning to food handling duties.

Contacts with diarrhea, who are food handlers, shall be considered the same as a case and handled in the same fashion. In outbreak circumstances, asymptomatic contacts who are food handlers shall be required to produce two negative stool specimens produced at least 24 hours apart prior to returning to food handling duties. Otherwise, no restrictions.

Cyclosporiasis

Food handlers may return to food handling duties after diarrhea has resolved. In certain situations however, food handlers may be required to produce one or two negative stool specimens before returning to food handling duties. If a case has been treated with an antimicrobial, the stool specimen shall not be collected until at least 48 hours after cessation of therapy.

Contacts with diarrhea, who are food handlers, shall be considered the same as a case and handled in the same fashion. In certain outbreak situations, asymptomatic contacts who are food handlers may be required to produce one or two negative stool specimens prior to returning to food handling duties. Otherwise, no restrictions.

Diphtheria

Maintain isolation until two successive pairs of nose and throat cultures (and cultures of skin lesions in cutaneous diphtheria) obtained greater than 24 hours apart and at least 24 hours after completion of antimicrobial therapy are negative. If there was no antimicrobial therapy, these two sequential pairs of cultures shall be taken after symptoms resolve and greater than two weeks after their onset. If an avirulent (nontoxigenic) strain is documented, isolation is not necessary.

All contacts (both symptomatic and asymptomatic) who are food handlers must be excluded from work until two successive pairs of nose and throat cultures obtained greater than two weeks after completion of antimicrobial prophylaxis (if any) and greater than 24 hours apart are negative. Symptomatic contacts who are not food handlers shall be considered the same as a case until their culture results are negative and they are cleared by the appropriate public health authority. Asymptomatic contacts who are not foodhandlers must be on appropriate antibiotics and personal surveillance.

Ehrlichiosis

No restrictions

No restrictions

Encephalitis, any case

No restrictions

No restrictions

Food poisoning and toxicity

No restrictions

No restrictions

Giardiasis

After diarrhea has resolved, food handlers may only return to food handling duties after producing one negative stool specimen. If a case has been treated with an antimicrobial, the stool specimen shall not be collected until at least 48 hours after cessation of therapy. In outbreak circumstances, two negative stool specimens produced at least 24 hours apart will be required prior to returning to food handling duties.

Contacts with diarrhea, who are food handlers, shall be considered the same as a case and handled in the same fashion. In outbreak circumstances, asymptomatic contacts who are food handlers shall be required to produce two negative stool specimens produced at least 24 hours apart prior to returning to food handling duties. Otherwise, no restrictions.

Glanders

No restrictions

No restrictions

Group A streptococcus, invasive infection

Persons with streptococcal pharyngitis or skin infections, with or without invasive disease, shall not return to school or child care until at least 24 hours after initiating antimicrobial treatment.

Personal surveillance and prophylaxis with an antimicrobial when appropriate. Otherwise, no restrictions.

Group B streptococcus, invasive infection

No restrictions

No restrictions

Haemophilus influenzae, invasive infection

a) type B

Until 24 hours after initiating antimicrobial treatment.

Personal surveillance and prophylaxis with an appropriate antimicrobial when indicated by clinical situation of the contact or by potential for transmission. Otherwise, no restrictions.

b) non type B

No restrictions

No restrictions

Hansen's disease

No restrictions if under medical care.

No restrictions

Hantavirus infection

No restrictions

No restrictions

Hemolytic uremic syndrome

After diarrhea has resolved, food handlers may only return to food handling duties after producing two negative stool specimens, produced at least 24 hours apart. If a case was treated with an antimicrobial, the stool specimen shall not be collected until at least 48 hours after cessation of therapy.

Contacts with diarrhea, who are food handlers, shall be considered the same as a case and handled in the same fashion. In outbreak circumstances, asymptomatic contacts who are food handlers shall be required to produce two negative stool specimens produced at least 24 hours apart prior to returning to food handling duties. Otherwise, no restrictions.

Hepatitis A

Isolation until one week after onset of symptoms or for cases where the onset date is not known, one week past the date the specimen positive for IgM antibody to HAV was provided.

No restrictions except for susceptible food handlers, who shall be excluded from their occupations for 28 days unless they receive a prophylactic dose of immune globulin (IG) and/or hepatitis A vaccine within 14 days of exposure, or in accordance with the latest recommendations from the Department.

Hepatitis B

No restrictions except for exclusion from organ and blood donation. Case shall receive counseling to modify activities in order to prevent transmission.

Personal surveillance for high-risk contacts who should receive hepatitis B immune globulin (HBIG) and vaccine. Infants born to infected women should also receive HBIG and vaccine. Otherwise, no restrictions.

Hepatitis C

No restrictions except for exclusion from organ and blood donation. Case shall receive counseling to modify activities in order to prevent transmission.

Personal surveillance for high-risk contacts. Otherwise, no restrictions.

Hepatitis D

Same as co-infecting hepatitis B

Same as co-infecting hepatitis B

Hepatitis E

Isolation until one week after onset of symptoms, or for cases where the onset date is not known, one week past the date of the specimen positive for evidence of acute hepatitis E was provided.

No restrictions, except for susceptible food handlers, who shall be excluded from their occupations for 28 days.

Influenza

No restrictions

No restrictions

Legionellosis

No restrictions

No restrictions

Listeriosis

No restrictions

No restrictions

Lyme disease

No restrictions

No restrictions

Lymphocytic choriomeningitis virus infection

No restrictions, except for exclusion from organ and blood donation

No restrictions

Malaria

No restrictions except for exclusion from blood donation.

No restrictions

Measles

Through four days after onset of rash (counting the day of rash onset as day zero).

Contacts born in or after 1957, who are not appropriately immunized or do not have laboratory evidence of immunity, will be excluded from work, classes or other public activities from the fifth through the 21st day after their exposure even if they receive immune globulin. If exposure was continuous and/or if multiple cases occur, susceptibles will be excluded through the 21st day after rash onset in the last case. Health care workers and inpatients, regardless of year of birth, who are not appropriately immunized or do not have laboratory evidence of immunity, will be excluded from work (health care workers) or isolated with airborne precautions (inpatients) from the fifth day after their first exposure through the 21st day after their last exposure. These restrictions for health care workers and inpatients remain even if the contact received IG or was vaccinated post-exposure.

Melioidosis

No restrictions

No restrictions

Meningitis

a) bacterial, community-acquired

If infected with H. influenzae or N. meningitidis, droplet precautions until 24 hours after initiation of appropriate antibiotic therapy. Otherwise, no restrictions.

Personal surveillance and antibiotic prophylaxis, where appropriate, if case has H. influenzae or N. meningitidis. Otherwise, no restrictions.

b) viral (aseptic), and other non-bacterial

No restrictions

No restrictions

Meningococcal disease, invasive infection

Droplet precautions until 24 hours after initiation of appropriate antibiotic therapy. Otherwise, no restrictions.

Personal surveillance and antibiotic prophylaxis, where appropriate. Otherwise no restrictions.

Monkeypox

Until lesions have dried and crusts have separated. If no lesions, until seven days after onset of fever.

Personal surveillance. Otherwise no restrictions.

Mumps

Through five days after onset of gland swelling (counting the initial day of gland swelling as day zero).

Contacts born in or after 1957, who are not appropriately immunized or do not have laboratory evidence of immunity, will be excluded from work, classes or other public activities from the 12th through the 25th day after their exposure. When multiple cases occur, susceptibles need to be excluded through 25 days after the onset of the last case. Health care workers, and inpatients, regardless of year of birth, who are not appropriately immunized or do not have laboratory evidence of immunity will be excluded from work (health care workers) or isolated with droplet precautions (inpatients) from the 12th through the 25th date after their exposure.

Noroviruses

Food handlers must be excluded from food handing duties for either 72 hours past the resolution of symptoms or 72 hours past the date the specimen positive for norovirus was produced, which ever occurs last.

Contacts with diarrhea or vomiting who are food handlers shall be excluded from food handling duties for 72 hours past the resolution of symptoms.

Pertussis

Until 21 days from onset of cough or five days after initiation of appropriate antibiotic therapy.

If the contact is symptomatic, use same restrictions as for cases. If the contact is an asymptomatic healthcare worker not receiving antibiotic prophylaxis, exclude from the workplace for 21 days after last exposure or, if unknown, for 21 days after the onset of the last case in the setting. If the contact is asymptomatic, not a healthcare worker, and exposed within the last 21 days, s/he should receive antibiotic prophylaxis but no exclusion is generally required. In certain situations deemed to be high-risk, the public health authority may require exclusion of asymptomatic contacts not receiving antibiotic prophylaxis and/or other contacts, and/or may extend the exclusion period beyond 21 days up to a maximum of 42 days.

Plague

For pneumonic plague, droplet precautions until 72 hours after initiation of appropriate antibiotic therapy. For bubonic plague, case shall be placed on contact precautions until 48 hours after initiation of effective therapy.

Contacts of cases of pneumonic plague should be provided prophylaxis and placed under personal surveillance for seven days; those who refuse prophylaxis shall be placed in quarantine and under personal surveillance for seven days.

Poliomyelitis

Place case on enteric precautions for six weeks after onset of symptoms or until poliovirus can no longer be recovered from feces (the number of negative specimens required will be determined by the Department on a case-by-case basis).

According to applicable Department guidelines, administer an appropriate preparation of polio virus vaccine if the immune status is unknown or incomplete. Otherwise, no restrictions.

Powassan

No restrictions

No restrictions

Psittacosis

No restrictions

No restrictions

Q Fever

No restrictions

No restrictions

Rabies- human

For duration of illness

Post-exposure prophylaxis of contacts when appropriate, using recommendations of the Department. Otherwise, no restrictions.

Reye Syndrome

No restrictions

No restrictions

Rickettsialpox

No restrictions

No restrictions

Rocky Mountain spotted fever

No restrictions

No restrictions

Rubella

a) Congenital

Isolation from susceptible persons for the first year of life or until two cultures of clinical specimens (nasopharyngeal secretions or urine) obtained one month apart after age three months are negative for rubella virus.

No restrictions except for susceptibles, then same as for non-congenital rubella.

b) Non-Congenital

Until seven days after onset of rash (counting the day of rash onset as day zero).

Contacts born in or after 1957, who are not appropriately immunized or do not have laboratory evidence of immunity, will be excluded from work, classes or other public activities from the seventh through the 23rd day after their last exposure. When multiple cases occur, susceptibles need to be excluded until 23 days after the onset of the last case.Health care workers inpatients, regardless of year of birth, who are not appropriately immunized or do not have laboratory evidence of immunity, will be excluded from work (health care workers) or isolated with droplet precautions (inpatients) from the seventh day after first exposure through the 23rd day after their last exposure.

Salmonellosis

a) Not including typhoid fever

After diarrhea has resolved, food handlers may only return to food handling duties after producing one negative stool specimen. If a case was treated with an antimicrobial, the stool specimen shall not be collected until at least 48 hours after cessation of therapy. In outbreak circumstances, two negative stool specimens produced at least 24 hours apart will be required prior to returning to food handling duties.

Contacts with diarrhea, who are food handlers, shall be considered the same as a case and handled in the same fashion. In outbreak circumstances, asymptomatic contacts who are food handlers shall be required to produce two negative stool specimens produced at least 24 hours apart prior to returning to food handling duties. Otherwise, no restrictions.

b) S. typhi

(typhoid fever)

Food handlers may only return to food handling duties after producing three consecutive negative stool specimens each produced no less than 48 hours apart and one month after onset of first symptoms. If one culture is positive, repeat cultures shall be collected at one month intervals until three consecutive negative cultures are obtained. If the case has been treated with an antimicrobial, the first stool specimen shall not be collected until 48 hours after cessation of therapy.

All food handlers, symptomatic or asymptomatic, who are contacts of a typhoid case shall be considered the same as a case and handled in the same fashion.

Shiga toxin-producing organisms, including E. coli O157:H7

After diarrhea has resolved, food handlers may only return to food handling duties after producing two negative stool specimens, produced at least 24 hours apart. If a case was treated with an antimicrobial, the stool specimen shall not be collected until at least 48 hours after cessation of therapy.

Contacts with diarrhea, who are food handlers, shall be considered the same as a case and handled in the same fashion. In outbreak circumstances, asymptomatic contacts who are food handlers shall be required to produce two negative stool specimens produced at least 24 hours apart prior to returning to food handling duties. Otherwise, no restrictions.

Shigellosis

After diarrhea has resolved, food handlers may only return to food handling duties after producing two negative stool specimens produced at least 24 hours apart. If a case was treated with an antimicrobial, the stool specimen shall not be collected until at least 48 hours after cessation of therapy.

Contacts with diarrhea, who are food handlers, shall be considered the same as a case and handled in the same fashion. In outbreak circumstances, asymptomatic contacts who are food handlers shall be required to produce two negative stool specimens produced at least 24 hours apart prior to returning to food handling duties. Otherwise, no restrictions.

Smallpox

In conjunction with public health authorities, place case(s) on highest level of isolation to prevent direct contact, droplet contact and airborne exposure until lesions have dried and crusts have separated.

Afebrile contacts shall be placed under fever surveillance (quarantine) for 18 days from the last contact or 14 days from successful vaccination (which ever comes first), with monitoring and recording of temperature twice daily (morning and evening). Febrile contacts with or without rash shall be considered the same as a case and handled in the same fashion (isolation). If no rash develops after five days and the fever is diagnosed as being caused by recent vaccination or some other non-smallpox etiology, contact may be released from isolation to home to continue fever surveillance for 18 days following their last contact with a case or 14 days following successful vaccination (whichever comes first).

Streptococcus pneumoniae, invasive infection

No restrictions

No restrictions

Tetanus

No restrictions

No restrictions

Toxic shock syndrome

No restrictions

No restrictions

Trichinosis

No restrictions

No restrictions

Tularemia

No restrictions

No restrictions

Typhus

No restrictions

No restrictions

Varicella (chickenpox)

If vesicles are present, until lesions have dried and crusted, or until no new lesions appear, usually by the fifth day (counting the day of rash onset as day zero). If no vesicles are present, until the lesions have faded (i.e. the skin lesions are in the process of resolving; lesions do not need to be completely resolved) or no new lesions appear within a 24-hour period, whichever is later.

Contacts in non-health care settings, who are not appropriately immunized or are without laboratory evidence of immunity or a reliable history of chickenpox, shall be excluded from school, work or other public activities from the eighth through the 21st days after their exposure to the case during the case's infectious period. If the exposure was continuous, contacts shall be excluded from the eighth through the 21st days after the case's rash onset. Neonates born to mothers with active varicella shall be isolated from susceptibles until 21 days of age. Health care workers who are not appropriately immunized or are without laboratory evidence of immunity shall be excluded from work (health care workers) or isolated with airborne precautions (inpatients) from the eighth day after their first exposure through the 21st day after the last exposure. In all settings, anyone receiving varicella zoster immune globulin (VZIG) or intravenous immune globulin (IVIG) shall extend their exclusion to 28 days post-exposure.

Vibriosis (non- Cholera)

Food handlers with diarrhea may return to work after diarrhea has resolved.

No restrictions

Viral hemorrhagic fevers

Place on hemorrhagic fever specific barrier precautions with airborne, contact, and droplet precautions, and double gloving, with strict hand hygiene, impermeable gowns, face shields, eye protection, and leg and shoe coverings until clinical illness has resolved.

Personal surveillance

Yersiniosis

After diarrhea has resolved, food handlers may only return to food handling duties after producing one negative stool specimen. If a case was treated with an antimicrobial, the stool specimen shall not be collected until at least 48 hours after cessation of therapy. In outbreak circumstances, two negative stool specimens produced at least 24 hours apart will be required prior to returning to food handling duties.

Contacts with diarrhea, who are food handlers, shall be considered the same as a case and handled in the same fashion. In outbreak circumstances, asymptomatic contacts who are food handlers shall be required to produce two negative stool specimens produced at least 24 hours apart prior to returning to food handling duties. Otherwise, no restrictions.

(B) Diseases Reportable Directly to the Department of Public Health.

Disease

Minimum Period of Isolation of Patient

Minimum Period of Quarantine of Contacts

Tuberculosis

a) Active tuberculosis: Pulmonary (also includes mediastinal, laryngeal, pleural, or miliary)

Clearance from isolation in the community requires one or more of the following: three appropriately collected and processed sputum smears that are collected in eight - 24 hour intervals (one of which should be an early morning specimen); or other FDA cleared/approved or generally accepted laboratory tests indicating tuberculosis is unlikely or infectiousness is unlikely, as per guidelines such as those of the CDC, the Advisory Council of the Elimination of Tuberculosis (ACET) or the American Thoracic Society (ATS); or until the patient has undergone a period of effective chemotherapy in accordance with current treatment standards, such as those of CDC, ACET or ATS, and there is demonstration of clinical improvement (i.e. decreasing cough, reduced fever, resolving lung infiltrates).

No restrictions of asymptomatic contacts required.

b) Active tuberculosis: Extra-pulmonary

No restrictions except for appropriate handling of infected fluids.

No restrictions

c) Latent TB infection

No restrictions

No restrictions

(C) Standard Precautions. In addition to the specific practices set out in 105 CMR 300.000, standard precautions should be followed when treating all patients and contacts. The Department adopts, by reference, as standard practice for infection control, the most current version of the guidelines on the prevention of transmission of infection published by the U.S. Centers for Disease Control and Prevention and its Healthcare Infection Control Practices Advisory Committee.
(D) Work-related Diseases and Injuries Reportable Directly to the Department of Public Health. As these diseases are not communicable, each case should be evaluated individually regarding a return to work.

105 CMR 300.200

Amended by Mass Register Issue S1331, eff. 1/27/2017.