6 Colo. Code Regs. § 1009-1-A

Current through Register Vol. 47, No. 11, June 10, 2024

Appendix 6 CCR 1009-1-A - Reportable Diseases, Condition, and Related Event Table

Disease/Event	Pathogen/Organism	Time*	Reporter¹	Specimen Source(s)²	Send Clinical Material³
Acinetobacter baumannii, carbapenem-resistant (CRAB)⁴	Carbapenem-resistant Acinetobacter baumannii (including Acinetobacter baumannii complex and, Acinetobacter baumannii-calcoaceticus complex, Acinetobacter pittii, Acinetobacter nosocomialis, or any combination of these species or with the word 'complex' added afterwards)	4 days	L	All	Required
Acute flaccid myelitis	4 days	P	Upon request
Animal bites by dogs, cats, bats, skunks, foxes, raccoons, coyotes, or other wild carnivores ^5,6	24 hrs	P	Not applicable
Animal bites by mammals not listed above⁵	4 hrs	P	Not applicable
Anthrax⁵	Bacillus anthracis	Immed	L & P	All	Required
Arboviral Disease	Eastern equine encephalitis, Japanese encephalitis, LaCrosse encephalitis virus, California encephalitis serogroup, Powassan virus, St. Louis encephalitis virus and Western equine encephalitis virus	4 days	L	All	Upon request
Botulism⁵	Clostridium botulinum	Immed	L & P	All	Upon request
Brucellosis⁵	Brucella species	4 days	L & P	All	Required
Campylobacteriosis	Campylobacter species	4 days	L & P	All	Upon request
Candida auris⁷	Candida auris, Candida haemulonii	Immed	L & P	All	Required
Candidemia^8-Metro	Candida species	30 days	L	Blood	Upon request
Catheter-associated urinary tract infection (CAUTI)⁹	Any	Per CMS	P	Urine	Not applicable
Chancroid	Haemophilus ducreyi	4 days	L & P	All	Upon request
Chikungunya	Chikungunya virus	4 days	L	All	Upon request
Chlamydia	Chlamydia trachomatis	4 days	L & P	All	Upon request
Cholera⁵	Vibrio cholerae	Immed	L & P	All	Required
CJD and other transmissible spongiform encephalopathies (TSEs)⁵	4 days	P	All	Upon request
Clostridium difficile infection^8-Metro	Clostridium difficile	30 days	L	All	Upon request
Colorado tick fever	Colorado tick fever virus	4 days	L	All	Upon request
COVID-19¹⁰	* SARS-CoV-2 (positive result on Any test type) * COVID-19 lineage or sequencing	1 working day	L & P	All	Upon request
COVID-19¹⁰	SARS-CoV-2 (negative or inconclusive result on any test type)	1 working day	L & P	All	Upon request
COVID-19-Associated Hospitalization	SARS-CoV-2	4 days	L & P	All	Upon request
Coronavirus - severe or novel	Severe Acute Respiratory Syndrome coronavirus (SARS-CoV), Middle East Respiratory Syndrome coronavirus, (MERS-CoV) or other severe or novel coronavirus	Immed	L & P	All	Upon request
Cryptosporidiosis	Cryptosporidium species	4 days	L & P	All	Upon request
Cyclosporiasis	Cyclospora species	4 days	L & P	All	Upon request
Dengue	Dengue virus	4 days	L	All	Upon request
Diphtheria⁵	Corynebacterium diphtheriae	Immed	L & P	All	Required
Encephalitis⁵	4 days	P	All	Upon request
Enterobacteriaceae, carbapenem-resistant (CRE)¹¹	Carbapenem-resistant Escherichia coli, Klebsiella species, Enterobacter species Citrobacter species, Serratia species, Raoultella species, Providencia species, Proteus species, Morganella species, and any carbapenemase-producing Enterobacteriaceae of any genus and species	4 days	L	All	Required
Enterobacteriaceae, extended-spectrum beta-lactamase (ESBL)^8-Boulder,12	Escherichia coli and Klebsiella species	4 days	L	All	Upon request
Escherichia coli O157:H7 and Shiga toxin-producing Escherichia coli	Shiga toxin-producing Escherichia coli¹³	4 days	L & P	All	Required
Giardiasis	Giardia lamblia	4 days	L & P	All	Upon request
Gonorrhea, any site	Neisseria gonorrhoeae	4 days	L & P	All	Upon request
Group A streptococci^14,8-Metro	Streptococcus pyogenes	4 days	L	Sterile only	Required
Group B streptococci^8-Metro	Streptococcus agalactiae	30 days	L	Sterile only	Required
Haemophilus influenzae	Haemophilus influenzae	1 working day	L & P	Sterile only	Required
Hantavirus disease⁵	Hantavirus	4 days	L & P	All	Upon request
Healthcare-associated infections¹⁵	4 days	P	Not applicable
Hemolytic uremic syndrome if <18 years⁵	4 days	P	Upon request
Hepatitis A⁵	Hepatitis A virus (+IgM anti-HAV, +PCR or +NAAT),	1 working day	L & P	All	Upon request
Hepatitis B	Hepatitis B virus (+HBsAg, +IgM anti- HBc, +HBeAg, or +HBV DNA)	4 days	L & P	All	Upon request
Hepatitis C¹⁶	Hepatitis C virus (+ serum antibody titer and/or + confirmatory assays)	4 days	L & P	All	Upon request
Hepatitis C¹⁶	Hepatitis C virus (- confirmatory assays)	4 days	L	All	Upon request
Hepatitis, other viral	4 days	P	Upon request
Human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS)	* Human immunodeficiency virus * CD4 counts (any value) * HIV viral load (any value) * HIV genotype	4 days	* L & P * L & P * L & P * L	All	Upon request
Influenza-associated death if <18 years	4 days	P	Upon request
Influenza-associated hospitalization	Influenza Virus	4 days	L & P	All	Upon request
Legionellosis	Legionella species	4 days	L & P	All	Upon request
Leprosy (Hansen's Disease)	4 days	P	Upon request
Listeriosis	Listeria monocytogenes	4 days	L & P	All	Required
Lyme disease	Borrelia burgdorferi	4 days	L & P	All	Upon request
Lymphogranuloma venereum (LGV)	Chlamydia trachomatis	4 days	L & P	All	Upon request
Malaria⁵	Plasmodium species	4 days	L & P	All	Upon request
Measles (rubeola)⁵	Measles virus	Immed	L & P	All	Upon request
Meningococcal disease⁵	Neisseria meningitidis or gram-negative diplococci	Immed	L & P	Sterile only	Required
Methicillin-Resistant Staphylococcus aureus (MRSA) bacteremia⁹	Methicillin-Resistant Staphylococcus aureus (MRSA)	Per CMS⁹	P	Blood	Not applicable
Multisystem Inflammatory Syndrome in Children (MIS-C) if <21 years	4 days	P	Upon request
Mumps⁵	Mumps virus (acute infection)	4 days	L & P	All	Upon request
Mycobacterium, nontuberculous (NTM) 8- Metro	Mycobacterium species (except tuberculosis complex and leprae)	30 days	L	All	Upon request
Outbreaks - known or suspected of all types - including those transmitted from food, water, person-to-person, and related to a healthcare setting ⁵	Immed	L & P	Upon request
Pertussis (whooping cough)⁵	Bordatella pertussis	1 working day	L & P	All	Upon request
Plague⁵	Yersinia pestis	Immed	L & P	All	Required
Poliomyelitis⁵	Poliovirus	Immed	L & P	All	Upon request
Pseudomonas, carbapenem-resistant¹⁷	Pseudomonas aeruginosa	4 days	L	All	Upon request
Psittacosis	Chlamydia psittaci	4 days	L & P	All	Upon request
Q fever⁵	Coxiella burnetii	4 days	L & P	All	Upon request
Rabies: human (suspected)⁵	Rabies virus (Lyssavirus)	Immed	L & P	All	Upon request
Respiratory Syncytial Virus-associated hospitalizations^8-Metro	Respiratory Syncytial Virus	4 days	L & P	All	Upon request
Rickettsiosis	Rickettsia species, including Rocky Mountain spotted fever and typhus groups	4 days	L & P	All	Upon request
Rubella (acute infection)⁵	Rubella virus	1 working day	L & P	All	Upon request
Rubella (congenital)⁵	Rubella virus	4 days	L & P	All	Upon request
Salmonellosis	Salmonella species	4 days	L & P	All	Required
Shigellosis	Shigella species	4 days	L & P	All	Required
Smallpox⁵	Variola virus (Orthopox virus)	Immed	L & P	All	Upon request
Staphylococcus aureus, Vancomycin-non-susceptible¹⁸	Vancomycin non-susceptible Staphylococcus aureus	4 days	L	All	Required
Streptococcal toxic shock syndrome¹⁹	Streptococcus pyogenes	4 days	P	All	Required
Streptococcus pneumoniae¹⁹	Streptococcus pneumoniae	4 days	L	Sterile only	Required
Syphilis⁵	Treponema pallidum	1 working day	L & P	All	Upon request
Tetanus⁵	Clostridium tetani	4 days	P	All	Upon request
Tick-borne relapsing fever⁵	Borrelia species	4 days	L & P	All	Upon request
Toxic shock syndrome (non-streptococcal)	4 days	P	Upon request
Trichinosis⁵	Trichinella species	4 days	P	All	Upon request
Tuberculosis disease (active)⁵	Mycobacterium tuberculosis ²⁰	1 working day	L & P	All	Required
Tuberculosis immune reactivity indicated by a positive interferon gamma release assay test (IGRA)	Mycobacterium tuberculosis²¹	4 days	L	All	Not Required
Tularemia⁵	Francisella tularensis	1 working day	L & P	All	Required
Typhoid fever⁵	Salmonella Typhi	1 working day	L & P	All	Required
Varicella (chicken pox) ⁵	Varicella virus	4 days	L & P	All	Upon request
Vibriosis	Vibrio species, non-cholera	4 days	L	All	Required
Viral hemorrhagic fever	Crimean-Congo hemorrhagic virus, Ebola virus, Lassa fever virus, Lujo virus, Marburg virus, Guanarito virus, Junin virus, Machupo virus, Sabia virus	Immed	L & P	All	Required
West Nile virus (acute infection)	West Nile virus	4 days	L	All	Upon request
Yellow fever	Yellow fever virus	4 days	L	All	Upon request
Yersiniosis^8-Seven	Yersinia non-pestis species	4 days	L	All	Required
Zika virus	Zika virus	4 days	L	All	Upon request

All cases are to be reported with patient's name, date of birth, sex, race, ethnicity, phone number, physical address (including city and county), email address, preferred language and name and address of responsible physician or other healthcare provider; and such other information as is needed in order to locate the patient for follow up. In addition, all laboratory information reported shall include specimen accession number.

*Time: 1) "Immed" = by phone, within 4 hours of suspected diagnosis. 2) Unless the term "working day" is specified, "days" refers to calendar days.

1 Reporter: The party responsible for reporting is indicated by one of the following: L = Laboratory (whether or not associated with a hospital; by out-of-state laboratories that maintain an office or collection facility in Colorado; and by in-state laboratories which send specimens to an out-of-state laboratory referral laboratory), P = healthcare provider or other person knowing of or suspecting a case (including but not limited to coroners, persons in charge of hospitals or other institutions licensed by the Department (or their designees), persons in charge of schools (including nursing staff) and licensed day care centers), L & P = Both.

2 Specimen sources: A condition is reportable when the pathogen is isolated or detected from any specimen source unless where otherwise indicated. A normally "sterile site" is defined as blood, cerebrospinal fluid (CSF), pleural fluid (includes chest fluid, thoracentesis fluid), peritoneal fluid (includes abdominal fluid, ascites), pericardial fluid, bone (includes bone marrow), joint or synovial fluid, needle aspirate or culture of any specific joint, internal body sites (sterilely obtained from biopsy/tissue/abscess/ aspirate/fluid/swab from lymph node, brain, heart, liver, spleen, vitreous fluid, kidney, pancreas, vascular tissue, or ovary). Skin and skin abscesses are not considered sterile sites.

3 Testing laboratories shall routinely submit bacterial culture isolates or patient clinical material that yields positive findings to the Department, Laboratory Services Division. The isolate or clinical material shall be received at the Department, Laboratory Services Division no later than one working day after the observation of positive findings.

Clinical material is defined as:

(i) A culture isolate containing the infectious organism for which submission of material is required, or

(ii) If an isolate is not available, material containing the infectious organism for which submission of material is required, in the following order of preference:

(A) a patient specimen;

(B) nucleic acid; or

(C) other laboratory material. All specimens shall be accompanied by the following information:

(a) Patient's name, date of birth, sex, race, ethnicity, phone number, email address, preferred language and physical address;

(b) Name and address of responsible physician or other healthcare provider;

(c) Name of disease or condition; and

(d) Laboratory information - test name, collection date and specimen type.

4 Acinetobacter baumannii (including Acinetobacter baumannii complex, and Acinetobacter baumannii-calcoaceticus complex, Acinetobacter pittii, Acinetobacter nosocomialis, or any combination of these species or with the word 'complex' added afterwards) that are resistant to at least one carbapenem (including imipenem, meropenem, or doripenem)

5 Report shall be based on the diagnosis or suspected diagnosis of the attending physician or other healthcare provider, whether or not supporting laboratory data are available.

6 For animal bites by dogs, cats, bats, skunks, foxes, raccoons, coyotes, and other wild carnivores, the name and locating information of the owner of the biting animal shall be reported, if known, by the healthcare provider or reporter.

7 Candida auris identified, or any suspected Candida auris (e.g., Candida haemulonii identified by a laboratory instrument not equipped to detect Candida auris).

8. Condition reportable only among residents of a specific catchment area.

8-METRO Condition reportable only among residents of Denver Metropolitan Area (Adams,

Arapahoe, Denver, Douglas, and Jefferson Counties)

8-SEVEN Condition reportable only among residents of seven-county Denver Metropolitan

Area (Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, and Jefferson counties)

8-BOULDER Condition only reportable among residents of Boulder county

9. Reporting requirement is fulfilled through the Department's access to the National Healthcare Safety Network (NHSN) for those healthcare facilities that are required to report catheter-associated urinary tract infection (CAUTI) and/or methicillin-resistant Staphylococcus aureus (MRSA) bacteremia to the Centers for Medicare & Medicaid services (CMS). In these instances these healthcare facilities shall confer rights to the Department to access the NHSN data for these conditions.

10. All SARS-CoV-2 results for all test types are reportable. Any individual as defined in Regulation 2, entity or facility that collects, performs, or tests for SARS-CoV-2 2 on specimens in Colorado is responsible for reporting all positive, negative and inconclusive SARS-CoV-2 test results and SARS-CoV-2 sequencing lineage and mutation profile results to public health within one working day of the result. All entities required to report COVID-19 test result information shall report through CDPHE's electronic laboratory reporting (ELR) platform. For entities that cannot report through the ELR platform, electronic submission of the information required shall occur through HL7 or CDPHE-approved flat file format via secure file transfer protocol (FTP), via the CDPHE web-based reporting portal, or other CDPHE-approved method.

11. Escherichia coli, Klebsiella species, Enterobacter species, Citrobacter species, Serratia species, and Raoultella species that are resistant to at least one carbapenem (including imipenem, meropenem, doripenem, or ertapenem); or Providencia species, Proteus species, Morganella species that are resistant to at least one carbapenem (including meropenem, doripenem, or ertapenem); but not including imipenem); or Enterobacteriaceae of any genus and species that test positive for production of carbapenemase (e.g., KPC, NDM, VIM, IMP, OXA-48) demonstrated by a recognized test (e.g., modified carbapenem inactivation method [mCIM], polymerase chain reaction [PCR], nucleic acid amplification test [NAAT], metallo-beta-lactamase test, modified-hodge test [MHT], carba-NP).

12. Escherichia coli and Klebsiella species resistant to at least one extended-spectrum cephalosporin (ceftazidime, cefotaxime or ceftriaxone) or Escherichia coli and Klebsiella species that test positive for production of an extended-spectrum beta-lactamase (ESBL) demonstrated by a recognized test (e.g., broth microdilution, disk diffusion).

13. This includes any Shiga toxin test or O157 antigen test that is positive, even if no culture is performed. If the laboratory does not have the capacity to perform H (flagellar) antigen tests, then Escherichia coli O157 should be reported.

14. If group A streptococci is isolated from a wound or surgical tissue/specimen and is accompanied by necrotizing fasciitis or streptococcal toxic shock syndrome, the case shall be reported and the isolate shall be submitted.

15. Reportable only by facilities that are voluntarily participating in applied public health projects. Appendix B includes a definition of healthcare-associated infections, a list of included infections, and a list of included health facility types.

16 All associated results, including negative (nonreactive) and positive (reactive) HCV confirmatory assays from persons who have been diagnosed with or who have laboratory evidence of HCV infection are reportable (e.g., antigen or nucleic acid amplification for HCV RNA [including qualitative, quantitative or genotype testing]).

17. Pseudomonas aeruginosa resistant to at least one of the following carbapenems: imipenem, meropenem, or doripenem; OR Pseudomonas aeruginosa that tests positive for production of a carbapenemase (i.e., KPC, NDM, VIM, IMP, OXA).

18 Staphylococcus aureus that are non-susceptible to vancomycin, which include isolates with minimum inhibitory concentration (MIC) of >=4 mcg/ml.

19 Clinical material shall be submitted from laboratories when the material is from residents of the 5-county metro area (Adams, Arapahoe, Denver, Douglas and Jefferson counties).

20. Including (+) AFB sputum smear, culture (regardless of specimen site) and nucleic acid amplification tests (NAAT). See regulation 4f.

21. All positive interferon gamma release assays (IGRAs) will be reported by labs capable of electronic laboratory reporting (ELR), and only reported by ELR.

6 CCR 1009-1-A

37 CR 18, September 25, 2014, effective 10/15/2014

38 CR 20, October 25, 2015, effective 11/14/2015

40 CR 08, April 25, 2017, effective 5/15/2017

41 CR 12, June 25, 2018, effective 7/15/2018

42 CR 10, May 25, 2019, effective 7/1/2019

44 CR 18, September 25, 2021, effective 10/15/2021

46 CR 06, March 25, 2023, effective 2/15/2023

46 CR 10, May 25, 2023, effective 6/14/2023