Section 410 IAC 1-2.5-90 - Cholera; specific control measuresAuthority: IC 16-19-3-4; IC 16-41-2-1
Affected: IC 16-41-2; IC 16-41-9
Sec. 90.
The specific control measures for cholera (infectious agent: Vibrio cholerae 01 or 0139) 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 history of the following prior to symptom onset:(i) Food and drink consumption.(iii) Domestic and international travel.(C) Determine if the case is part of an outbreak.(D) Determine if the case is a:(iii) health care worker; or(iv) daycare attendee, a school attendee, or anyone who lives at a residential institution.(E) Interview individuals who consumed food and water with the patient to identify additional cases and determine the contaminated food or water source. If suspicion centers on water, a commercial food product, or a restaurant as a potential source, active surveillance shall be carried out to identify additional cases.(2) In addition to standard precautions, contact precautions shall be followed for diapered or incontinent people for the duration of illness. For others, the following guidelines apply: (A) Cases employed as food employees shall be excluded from employment involving food handling 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.(ii) One (1) negative stool culture has been confirmed.(iii) The case has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.(iv) 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 all employees.(CC) The correction of any observed lapses in hygienic measures by employees.(B) Cases employed as daycare workers, health care workers, or in similar positions shall be excluded from employment involving direct care of children or hospitalized 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.(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 schools, 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 twenty-four (24) hours.(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, 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) If an outbreak of the infection occurs in a daycare facility or preschool the following may occur: (i) All attendees and staff may be required to submit stool specimens for examination.(ii) Instead of exclusion, 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 and staff 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.(3) Feces, vomitus, and articles soiled by feces or vomitus, or both, shall receive concurrent disinfection. Feces and vomitus may be discarded in a sanitary sewer without prior disinfection.(4) Quarantine is not required.(5) No cholera vaccines are available in the United States. Cholera immunization is not required for travelers entering the United States from cholera-affected areas, and it is not recommended for travel to or from areas with cholera infection. Observe individuals who consume food and drink from the same sources as the patient for five (5) days from the last exposure. The administration of doxycycline, tetracycline, ciprofloxacin, ofloxacin, or trimethoprim-sulfamethoxazole within twenty-four (24) hours of identification of the index case may prevent coprimary cases of cholera among household contacts. However, because secondary transmission of cholera is rare, prophylaxis of contacts is not recommended, except in special circumstances in which the probability of fecal exposure is high and medication can be delivered rapidly.(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.Indiana State Department of Health; 410 IAC 1-2.5-90; filed 11/25/2015, 2:54 p.m.: 20151223-IR-410150039FRAReadopted filed 11/12/2021, 8:41 a.m.: 20211208-IR-410210385RFA