410 Ind. Admin. Code 1-2.5-131

Current through May 29, 2024

Section 410 IAC 1-2.5-131 - Shigellosis; specific control measures

Authority: IC 16-19-3-4; IC 16-41-2-1

Affected: IC 16-41-2; IC 16-41-9

Sec. 131.

The specific control measures for shigellosis (infectious agent: Shigella species) are as follows:

(1) An investigation by the local health officer shall meet the following conditions:

(A) Be performed immediately.

(B) Include a five (5) day food and drink consumption history.

(C) Determine if the case is part of an outbreak.

(D) Determine if the case is a:

(i) food employee;

(ii) daycare worker;

(iii) health care worker; or

(iv) daycare attendee, a school attendee, or anyone who lives at a residential institution.

(E) Determine if the case is a contact of a food employee serving a highly susceptible population.

(F) Identify household members and close contacts who are food employees, health care workers, or daycare workers. Any such identified contact shall have one (1) stool culture, whether asymptomatic or not, to identify other infected individuals.

(2) In addition to standard precautions, contact precautions are indicated for the duration of illness. For others, the following guidelines apply:

(A) Cases who are food employees shall abide by the following:

(i) If the case works in a food establishment serving a highly susceptible population, exclude from employment involving food handling until asymptomatic and all of the following have occurred:

(AA) The case has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.

(BB) The local health officer has discussed the following topics with the employer:

(aa) The employer's duty to comply with local and state rules pertaining to prevention of infectious diseases.

(bb) The availability of required proper hand washing facilities for employees.

(cc) The correction of any observed lapses in hygienic measures by employees.

(CC) The person in charge obtains approval from the regulatory authority.

(DD) One (1) of the following has been met:

(aa) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours, and the food employee is free of a Shigella species infection based on test results that show two (2) consecutive negative stool cultures have been collected at least forty-eight (48) hours after cessation of antimicrobial treatment.

(bb) The local health officer has determined that the symptoms of vomiting and diarrhea have resolved and more than seven (7) calendar days have passed since the food employee became asymptomatic.

(cc) The local health officer has determined the case did not develop symptoms and more than seven (7) days have passed since the food employee was diagnosed.

(ii) If the case works in a food establishment not serving a highly susceptible population, exclude from employment involving food handling until asymptomatic from vomiting and diarrhea for at least twenty-four (24) hours, then restrict until all of the following have occurred:

(AA) The case has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.

(BB) The local health officer has discussed the following topics with the employer:

(aa) The employer's duty to comply with local and state rules pertaining to prevention of infectious diseases.

(bb) The availability of required proper hand washing facilities for employees.

(cc) The correction of any observed lapses in hygienic measures by employees.

(CC) The person in charge obtains approval from the regulatory authority.

(DD) One (1) of the following has been met:

(aa) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours and the food employee is free of a Shigella species infection based on test results that show two (2) consecutive negative stool cultures have been collected at least forty-eight (48) hours after cessation of antimicrobial treatment.

(bb) The local health officer has determined that the symptoms of vomiting and diarrhea have resolved and more than seven (7) days have passed since the food employee became asymptomatic.

(cc) The local health officer has determined the case did not develop symptoms and more than seven (7) days have passed since the food employee was diagnosed.

(B) Cases employed as daycare workers, health care workers, or in similar positions shall be excluded from employment involving direct care of children, hospitalized patients, or institutionalized patients until all of the following have occurred:

(i) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours, or one (1) negative stool specimen has been collected at least forty-eight (48) hours after completion of any antimicrobial therapy.

(ii) The case has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.

(iii) The local health officer has discussed the following topics with the employer:

(AA) The employer's duty to comply with local and state rules pertaining to prevention of infectious diseases.

(BB) The availability of required proper hand washing facilities for employees.

(CC) The correction of any observed lapses in hygienic measures by employees.

(C) Cases shall be excluded from attending preschools and daycare facilities until all of the following have occurred:

(i) The local health officer has determined the case has been asymptomatic for at least forty-eight (48) hours or treatment or testing has determined the case to be no longer infectious by either:

(AA) completion of effective antimicrobial therapy supported by antimicrobial susceptibility testing; or

(BB) one (1) negative stool culture has been collected at least forty-eight (48) hours after cessation of antimicrobial therapy, if case was treated with antimicrobials.

(ii) The case or case's guardian has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.

(iii) The local health officer has discussed with the appropriate preschool or daycare facility staff the need: (AA) for proper hand washing procedures and other infection control practices; and (BB) to comply with all local and state rules pertaining to prevention of infectious diseases.

(D) Cases shall be excluded from attending school until all of the following have occurred:

(i) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours or treatment or testing has determined the case to be no longer infectious by either:

(AA) initiation of effective antimicrobial therapy for at least forty-eight (48) hours supported by antimicrobial susceptibility testing; or

(BB) one (1) negative stool culture has been collected at least forty-eight (48) hours after cessation of antimicrobial therapy, if case was treated with antimicrobials.

(ii) The case or case's guardian has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.

(iii) The local health officer has discussed with the appropriate school staff the need:

(AA) for proper hand washing procedures and other infection control practices; and

(BB) to comply with all local and state rules pertaining to prevention of infectious diseases.

(E) If an outbreak occurs in a school, cases may be excluded until the following has occurred:

(i) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours.

(ii) Treatment or testing has determined the case to be no longer infectious by either:

(AA) initiation of effective antimicrobial therapy for at least forty-eight (48) hours supported by antimicrobial susceptibility testing; or

(BB) one (1) negative stool culture has been collected:

(aa) at least twenty-four (24) hours apart; and

(bb) at least forty-eight (48) hours after cessation of antimicrobial therapy, if case was treated with antimicrobials.

(F) If an outbreak occurs in a daycare facility or preschool, the following shall occur:

(i) All attendees and staff may be required to submit stool specimens for examination.

(ii) Instead of exclusion until stool negative, attendees and staff may be isolated from other attendees and staff in the same facility based on symptoms, laboratory testing, and treatment. This alternative shall only be considered if the physical structure and staff organization of the facility can accommodate isolation of various attendee groups from one another. If this alternative is selected, increased emphasis on hand washing procedures and environmental cleaning is necessary.

(iii) Admission of all new attendees may be suspended while the outbreak continues.

(G) A case contact who is a food employee in a food establishment serving a highly susceptible population must abide by the following criteria:

(i) Restrict the contact if the contact meets one (1) of the following criteria:

(AA) Attended or worked in a setting of a confirmed disease outbreak of shigellosis within the past three (3) days of last exposure.

(BB) Lives in the same household as, and has knowledge about, an individual who works in or attends a setting where there is a confirmed disease outbreak of shigellosis within the past three (3) days of last exposure.

(CC) Lives in the same household as, and has knowledge about, an individual diagnosed with an illness caused by shigellosis within the past three (3) days of last exposure.

(DD) Consumed food prepared by a person infected with shigellosis within the past three (3) days of last exposure.

(EE) Consumed or prepared food implicated in a confirmed disease outbreak of shigellosis within the past three (3) days of last exposure.

(ii) Reinstate the food employee who was restricted when one (1) of the following has occurred:

(AA) More than three (3) calendar days have passed since the last day the food employee was potentially exposed.

(BB) More than three (3) calendar days have passed since the food employee's household contact became asymptomatic.

(3) Concurrent disinfection of feces and soiled articles is required. Feces may be discarded in a sanitary sewer without prior disinfection.

(4) Reporting of disease is required to follow the "When to Report (from probable diagnosis)" time frame and Shigella species antimicrobial susceptibility testing results are to be reported as soon as they become available.

(5) Quarantine is not required.

(6) Immunization is not available. Protection of contacts is not applicable.

(7) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.

410 IAC 1-2.5-131

Indiana State Department of Health; 410 IAC 1-2.5-131; filed 11/25/2015, 2:54 p.m.: 20151223-IR-410150039FRA

Readopted filed 11/12/2021, 8:41 a.m.: 20211208-IR-410210385RFA