Health and Human Services

Population Health, Environmental Epidemiology

Rule 702: Communicable Disease Rule

Effective Date: 06/01/2026

Admin. Code Reference: R386-702

Rule Type: Current Rule

R386. Health and Human Services, Population Health, Environmental Epidemiology.

R386-702. Communicable Disease Rule.R386-702-1. Authority and Purpose.

(1) Sections 26B-1-202, 26B-7-202, and 26B-7-207 authorize this rule.

(2) This rule:

(a) outlines a multidisciplinary approach to communicable and infectious disease control and emphasizes reporting, surveillance, isolation, treatment, and epidemiological investigation to identify and control preventable causes of infectious diseases;

(b) specifies reporting requirements and authorization for any communicable or infectious disease, outbreak, or unusual occurrence of any disease; and

(c) is intended to reduce disease morbidity and mortality through the rapid implementation of established practices and procedures.

R386-702-2. Definitions.

(1) "Acute care hospital" means a hospital that:

(a) offers emergency care 24 hours a day; and

(b) has at least one physician on staff or the medical roster who is available to the emergency care area within 30 minutes of a request.

(2) "Assisted living facility" means the same as defined in Section 26B-2-201.

(3) "Bioterrorism" means the same as defined in Section 26B-7-301.

(4) "Blood and plasma center" means:

(a) a blood bank;

(b) a blood storage facility;

(d) a hospital;

(e) any facility that collects blood or blood products; or

(f) any facility that provides blood services.

(5) "Care facility" means a facility licensed through the department, including any:

(a) adult day care facility;

(b) adult foster care facility;

(d) domestic violence shelter and treatment center;

(e) foster care home;

(f) mental health treatment facility;

(g) residential treatment and day treatment facility for persons with disabilities;

(h) substance abuse treatment facility; or

(i) youth treatment facility.

(6) "Carrier" means the same as defined in Section 26B-7-201.

(7) "Case" means any person, living or deceased, identified as having a communicable disease, condition, or syndrome that meets criteria for being reportable under this rule or that is otherwise under public health investigation.

(8) "Category one laboratory" means a facility that conducts any type of CLIA-certified testing, which identifies reportable conditions listed in Sections R380-702-4, R380-702-6, and R380-702-7.

(9) "Category two laboratory" means a facility that only conducts CLIA-waived testing, which identifies reportable conditions listed in Sections R380-702-4, R380-702-6, and R380-702-7.

(10) "Child care" means the same as defined in Section 26B-2-401.

(11) "Clinic" means any facility where a health care provider practices.

(12) "Clinical material" means:

(a) an isolate containing an organism listed in Subsections R386-702-6(3) and R386-702-6(4); or

(b) if an isolate is not available, material containing the organism, in the following order of preference:

(i) a patient specimen;

(ii) nucleic acid; or

(iii) other laboratory material.

(13) "Communicable disease" means the same as defined in Section 26B-7-201.

(14) "Condition" means an abnormal state of health that may interfere with a person's regular feelings of wellbeing.

(15) "Contact" means the same as defined in Section 26B-7-201.

(16) "Correctional facility" means a facility that forcibly confines an individual under the authority of the government, including any:

(a) detention center;

(b) jail;

(d) prison.

(17) "Department" means the Department of Health and Human Services.

(18) "Diagnostic facility" means the facility where a case or suspect case was seen and evaluated by a health care provider.

(19) "Dispensary" means an office in a hospital, industrial plant, school, or other organization that dispenses medication or medical supplies.

(20) "Electronic case reporting" or "eCR" means the transmission of clinical, diagnostic, laboratory, and treatment-related data from a reporting entity to the department using the HL7 CDA R2 Implementation Guide: Public Health Case Report, the Electronic Initial Case Report (eICR) Release 3.1.1 -- US Realm or higher.

(21) "Electronic laboratory reporting" or "ELR" means the transmission of laboratory or health-related data from a reporting entity to the department using HL7 ORU-R01 2.5.1, LOINC, or SNOMED standard message structure and vocabulary.

(22) "Electronic reporting" means the transmission of laboratory or health-related data in a structured, computer-readable, department-approved format that reflects comparable content to HL7 messaging.

(23) "Encounter" means a documented interaction between a patient and a health care provider when medical services are provided.

(24) "Epidemic" means the same as defined in Section 26B-7-201.

(25) "Event" means any instance of a communicable disease, condition, epidemic, laboratory result, outbreak, syndrome, or other public health hazard that is of concern to the public and meets criteria for being reportable under Section R386-702-4.

(26) "Good Samaritan" means a person who gives reasonable aid to a stranger in grave physical distress.

(27) "Health care facility" means the same as defined in Section 78B-3-403.

(28) "Health care provider" means the same as defined in Section 78B-3-403.

(29) "Infection" means the same as defined in Section 26B-7-201.

(30) "Invasive" means infection occurring in any part of the body where organisms are not normally present, including the bloodstream, meninges, or an organ.

(31) "Laboratory" means any facility that receives, refers, or analyzes clinical specimens.

(32) "Local health department" means the same as defined in Section R386-80-2.

(33) "Mental health facility" means the same as defined in Section 26B-5-301.

(34) "Normally sterile site" means a part of the body where organisms are not normally present, including the bloodstream, meninges, or an organ.

(35) "Office" means the Office of Communicable Diseases under the Department of Health and Human Services.

(36) "Outbreak" means:

(a) the increased occurrence of any communicable disease, health condition, or syndrome in a community, institution, or region; or

(b) two or more cases of a communicable disease, health condition, or syndrome in persons with a common exposure.

(37) "Public health hazard" means the presence of an infectious organism or condition in the environment that endangers the health of a specified population.

(38) "SARS-CoV-2 NAAT" means any SARS-CoV-2 Nucleic Acid Amplification Test (NAAT) conducted in a facility certified under CLIA to perform a moderate- or high-complexity test.

(39) "School" means the same as defined in Section 26B-7-201.

(40) "Suspect case" means any person, living or deceased, who:

(a) has not yet been proven to meet the necessary criteria to be classified a case; and

(b) the department, a local health department, or a reporting entity has reason to believe might be a case.

(41) "Syndrome" means a set of signs or symptoms that often occur together.

(42) "Syndromic surveillance" means the systematic, ongoing collection and transmission of health data from the point of care, for public health purposes, to the department using HL7 version 2.5.1 or higher.

(43) "UPHL" means the Utah Public Health Laboratory.

R386-702-3. Incorporations by Reference.

If an individual or animal has, or is suspected of having, a communicable or infectious disease that is required to be reported pursuant to this rule, any entity treating or managing that individual or animal shall comply with the following documents, incorporated by reference in this rule:

(1) HL7 CDA R2 Implementation Guide: Public Health Case Report, the Electronic Initial Case Report (eICR) Release 3.1.1 -- US Realm, October 2024;

(2) HL7 Version 2.5.1 Implementation Guide: Laboratory Results Interface (LRI), Release 1 STU Release 4 - US Realm, October 2022;

(3) eCR Supplemental Document, Utah Department of Health and Human Services, 2025, Version 1;

(4) ELR Supplemental Document, Utah Department of Health and Human Services, 2025, Version 1;

(5) Syndromic Surveillance Reporting Requirement Supplemental Document, Utah Department of Health and Human Services, 2025, Version 1;

(6) HL7 Version 2.5.1 Implementation Guide: Syndromic Surveillance, Release 1 - US Realm, July 2019;

(7) Compendium of Animal Rabies Prevention and Control, 2016, National Association of State Public Health Veterinarians Committee, March 1, 2016;

(8) Sexually Transmitted Infections Treatment Guidelines, Centers for Disease Control and Prevention, 2021;

(9) Red Book: 2021-2024 Report of the Committee on Infectious Diseases, American Academy of Pediatrics, 2021, 32nd Edition;

(10) Control of Communicable Diseases Manual, American Public Health Association, 2022, 21st Edition; and

(11) Compendium of Measures to Prevent Disease Associated with Animals in Public Settings, 2017, National Association of State Public Health Veterinarians Animal Contact Compendium Committee 2017.

R386-702-4. Reportable Events.

(1) As required or authorized by Sections 26B-1-202, 26B-7-202, and 26B-7-207, each entity shall report to the department every event of:

(a) acute flaccid myelitis;

(b) adverse event resulting from smallpox vaccination (vaccinia virus, orthopox virus);

(d) anthrax (Bacillus anthracis) or anthrax-like illness caused by any Bacillus cereus strain that expresses any anthrax toxin gene;

(e) an antibiotic-resistant organism, from any specimen, that:

(i) is resistant to vancomycin in Staphylococcus aureus (VRSA); or

(ii) is resistant to a carbapenem in:

(A) Acinetobacter species;

(B) any Enterobacterales organism, including:

(I) Enterobacter species;

(II) Escherichia coli; or

(III) Klebsiella species; or

(I) ceftolozane/tazobactam; or

(II) cefepime or ceftazidime when ceftolozane/tazobactam resistance is unknown; or

(iii) demonstrates carbapenemase production in:

(A) Acinetobacter species;

(B) any Enterobacterales organism, including:

(I) Enterobacter species;

(II) Escherichia coli; or

(III) Klebsiella species; or

(f) arbovirus disease, including:

(i) chikungunya virus disease;

(ii) Oropouche virus disease, congenital and non-congenital;

(iii) St. Louis encephalitis virus disease;

(iv) West Nile virus disease; and

(v) Zika disease including congenital;

(g) babesiosis (Babesia spp.);

(h) botulism (Clostridium botulinum);

(i) brucellosis (Brucella spp.);

(j) campylobacteriosis (Campylobacter spp.);

(k) Candida auris or Candida haemulonii from any body site;

(l) Chagas disease (Trypanosoma cruzi);

(m) chancroid (Haemophilus ducreyi);

(n) chickenpox (varicella zoster virus or VZV, human herpesvirus 3 or HHV-3);

(o) chlamydia (Chlamydia trachomatis);

(p) coccidioidomycosis (Coccidioides spp.), also known as valley fever;

(q) Colorado tick fever (Colorado tick fever virus, Coltivirus spp.), also known as American mountain tick fever;

(r) novel coronavirus disease including Middle East respiratory syndrome (MERS-CoV), and severe acute respiratory syndrome (SARS-CoV);

(s) COVID-19 (SARS-CoV-2);

(t) Cronobacter sakazakii, from a normally sterile site, in a person less than 12 months old;

(u) cryptosporidiosis (Cryptosporidium spp.);

(v) cyclosporiasis (Cyclospora spp.);

(w) dengue fever (dengue virus);

(x) diphtheria (Corynebacterium diphtheriae);

(y) ehrlichiosis (Ehrlichia spp.);

(z) Shiga toxin-producing Escherichia coli (STEC) infection;

(aa) Free-living amebae, from any human source;

(i) acanthamoeba spp.;

(ii) Balamuthia mandrillaris (B. mandrillaris);

(iii) Naegleria fowleri (N. fowleri);

(bb) giardiasis (Giardia spp.);

(cc) gonorrhea (Neisseria gonorrhoeae), including sexually transmitted and ophthalmia neonatorum;

(dd) Haemophilus influenzae, invasive;

(ee) hantavirus infection (Sin Nombre virus);

(ff) hemolytic uremic syndrome, postdiarrheal;

(gg) hepatitis, viral, including:

(i) hepatitis A;

(ii) hepatitis B (acute, chronic, and perinatal);

(iii) hepatitis C (acute, chronic, and perinatal);

(iv) hepatitis D; and

(v) hepatitis E;

(hh) human immunodeficiency virus (HIV) infection, including acquired immune deficiency syndrome (AIDS);

(ii) influenza virus infection:

(i) associated with a hospitalization;

(ii) associated with a death in a person under 18 years of age; or

(iii) suspected or confirmed to be caused by a non-seasonal influenza strain;

(jj) Legionellosis (Legionella spp.), also known as Legionnaires' disease;

(kk) leptospirosis (Leptospira spp.);

(ll) listeriosis (Listeria spp., including Listeria monocytogenes);

(mm) Lyme disease (Borrelia burgdorferi, Borrelia mayonii);

(nn) malaria (Plasmodium spp.);

(oo) measles (rubeola);

(pp) melioidosis (Burkholderia pseudomallei);

(qq) meningococcal disease (Neisseria meningitidis), invasive;

(rr) mpox;

(ss) mumps (mumps virus);

(tt) mycobacterial infections, including:

(i) tuberculosis (Mycobacterium tuberculosis complex);

(ii) leprosy (Mycobacterium leprae), also known as Hansen's disease; or

(iii) any other mycobacterial infections (Mycobacterium spp.);

(uu) pertussis (Bordetella pertussis);

(vv) plague (Yersinia pestis);

(ww) poliomyelitis (poliovirus), paralytic and nonparalytic;

(xx) psittacosis (Chlamydophila psittaci), also known as ornithosis;

(yy) Q fever (Coxiella burnetii);

(zz) rabies (rabies virus), human and animal;

(aaa) relapsing fever (Borrelia spp.), tick-borne;

(bbb) rubella (rubella virus), including congenital syndrome;

(ccc) salmonellosis (Salmonella spp.);

(ddd) shigellosis (Shigella spp.);

(eee) smallpox (Variola major and Variola minor);

(fff) spotted fever rickettsioses (Rickettsia spp.), including Rocky Mountain spotted fever (Rickettsia rickettsii);

(ggg) streptococcal disease, invasive, due to:

(i) Streptococcus pneumoniae;

(ii) group A streptococcus (Streptococcus pyogenes); or

(iii) group B streptococcus (Streptococcus agalactiae);

(hhh) Syphilis (Treponema pallidum), including:

(i) any stage;

(ii) congenital; and

(iii) syphilitic stillbirths;

(iii) tetanus (Clostridium tetani);

(jjj) toxic shock syndrome, staphylococcal (Staphylococcus aureus) or streptococcal (Streptococcus pyogenes);

(kkk) transmissible spongiform encephalopathies (prion diseases), including Creutzfeldt-Jakob disease;

(lll) trichinellosis (Trichinella spp.);

(mmm) tularemia (Francisella tularensis);

(nnn) typhoid (Salmonella typhi), cases and carriers;

(ooo) vibriosis (Vibrio spp.), including cholera (Vibrio cholerae);

(ppp) viral hemorrhagic fevers including:

(i) Ebola virus disease (Ebolavirus spp.);

(ii) Lassa fever (Lassa virus); and

(iii) Marburg fever (Marburg virus); or

(qqq) yellow fever (yellow fever virus).

(2) Pregnancy is a reportable event for a subset of communicable diseases, and reporting is required even if the communicable disease was reported to the department before the pregnancy. Perinatally transmissible conditions reportable by an entity are any:

(a) hepatitis B infection;

(b) hepatitis C infection;

(d) listeriosis;

(e) Oropouche virus disease;

(f) rubella;

(g) syphilis infection; or

(h) Zika virus disease.

(3) Antimicrobial susceptibility tests reportable by an entity are as follows:

(a) full panel antimicrobial susceptibility test results, including minimum inhibitory concentration and results suppressed to the ordering clinician, are reportable when performed on the following organisms:

(i) Candida auris or Candida haemulonii from any body site;

(ii) Mycobacterium tuberculosis;

(iii) Neisseria gonorrhoeae;

(iv) Salmonella species;

(v) Shigella species;

(vi) Streptococcus pneumoniae;

(vii) Staphylococcus aureus from any specimen that is resistant to vancomycin (VRSA); or

(viii) organisms resistant to a carbapenem in:

(A) Acinetobacter species;

(B) any Enterobacterales organism, including:

(I) Enterobacter species;

(II) Escherichia coli; or

(III) Klebsiella species; or

(I) ceftolozane/tazobactam; or

(II) cefepime or ceftazidime when ceftolozane/tazobactam resistance is unknown;

(b) individual carbapenemase test results including positive, negative, equivocal, indeterminate and the method used, are reportable when performed on an organism resistant to a carbapenem, or with demonstrated carbapenemase, in:

(i) Acinetobacter species;

(ii) any Enterobacterales organism, including:

(A) Enterobacter species;

(B) Escherichia coli; or

(iii) Pseudomonas aeruginosa; or

(c) antiviral susceptibility test results, including nucleotide sequencing, genotyping, or phenotypic analysis, are reportable when performed on HIV.

(4) Unusual events reportable by each entity include at least one case or suspect case of a communicable disease, condition, or syndrome considered:

(a) rare, unusual, or new to Utah;

(b) previously controlled or eradicated;

(d) due to exposure or infection from a bioterrorism event with transmission to the public; or

(e) any other infection not explicitly identified in Subsection (1) that the department considers a public health hazard.

(5) Outbreaks, epidemics, or unusual occurrences of events reportable by an entity are as follows:

(a) the entity shall report two or more cases or suspect cases, with or without an identified organism, including:

(i) gastrointestinal illnesses;

(ii) respiratory illnesses;

(iii) meningitis or encephalitis;

(iv) infections caused by antimicrobial resistant organisms;

(v) illnesses with suspected foodborne or waterborne transmission;

(vi) illnesses with suspected ongoing transmission in any facility;

(vii) infections that may indicate a bioterrorism event; or

(viii) any other infections not explicitly identified in Subsection (1) that the department considers a public health hazard;

(b) the entity shall report any increase or shift in pharmaceutical sales that may indicate a change in disease trends.

(6)(a) In addition to laboratory results set forth in Subsections (1) through (5), each category one laboratory or category two laboratory shall include laboratory results for, or laboratory results that provide presumptive evidence of, the following communicable diseases:

(i) influenza virus;

(ii) norovirus infection;

(iii) respiratory syncytial virus (RSV);

(iv) Streptococcal disease, invasive due to any species; or

(v) toxoplasmosis.

(b) Each category one laboratory or category two laboratory shall include any laboratory results, including positive, negative, equivocal, or indeterminate, associated with the following tests or conditions:

(i) CD4+ T-Lymphocyte tests, regardless of known HIV status;

(ii) chlamydia;

(iii) Clostridioides difficile;

(iv) cytomegalovirus (CMV), congenital for a person up to 12 months old;

(v) gonorrhea;

(vi) hepatitis A;

(vii) hepatitis B, including viral loads;

(viii) hepatitis C, including viral loads;

(ix) HIV, including viral loads and confirmatory tests;

(x) liver function tests, including ALT, AST, and bilirubin associated with a viral hepatitis case;

(xi) measles (rubeola);

(xiii) syphilis; or

(xiv) tuberculosis.

(c) The department may identify additional reporting criteria when necessary for the management of an outbreak or identification of an exposure, in accordance with Title 26B, Chapter 7, Part 2, Detection and Management of Chronic and Communicable Diseases and Public Health Emergencies.

(d) Non-positive laboratory results reported for any event identified in Subsection (6)(b) will be used to:

(i) determine when a previously reported case becomes non-infectious;

(ii) identify any newly acquired infection through identification of a seroconversion window; or

(iii) provide information critical for assignment of a case status.

(e) The department keeps information associated with a non-positive laboratory result for 18 months.

(i) At the end of the 18-month period, if the result has not been appended to an existing case, any personal identifier is deleted from the result.

(ii) The de-identified result is added to a de-identified, aggregate data set.

(iii) The data set is kept for use by the department to:

(A) analyze trends associated with testing patterns and case distribution; and

(B) identify and establish prevention and intervention efforts for at-risk populations.

(7)(a) A university or hospital that conducts research studies exempt from reporting AIDS and HIV infection under Section 26B-7-203 must seek written approval of reporting exemption from the department institutional review board before the study commencement.

(b) The university or hospital shall submit the following to the department within 30 days of department institutional review board approval:

(i) a summary of the research protocol, including funding sources and justification for requiring anonymity; and

(ii) written approval from the department institutional review board.

(c) The university or hospital shall submit a report that includes each of the indicators specified in Subsection 26B-7-203(4)(a) to the department annually during an ongoing research study.

(d) The university or hospital shall submit a final report that includes each of the indicators specified in Subsection 26B-7-203(4)(a) to the department within 30 days of the conclusion of the research study.

(e) Any document pertaining to a reporting exemption in Subsection (7) may be submitted to the department by email to dhhs_irb@utah.gov or by mail to 288 N. 1460 West, Salt Lake City, Utah 84116.

R386-702-5. Entities Required to Report.

(1) The entities required to report each case or suspect case of a reportable event described in Section R386-702-4 include:

(a) each entity listed in Section 26B-7-206;

(b) any assisted living facility;

(d) any category one laboratory;

(e) any category two laboratory;

(f) any correctional facility;

(g) any dispensary;

(h) any health care facility, as defined in Section 78B-3-403;

(i) any mental health facility, as defined in Section 26B-5-301;

(j) any nursing care facility, as defined in Section 26B-2-201;

(k) any school; and

(l) any person with a knowledge of others who have a communicable disease.

(2) Each entity involved in processing a clinical specimen or in diagnosis, treatment, or care of a case or suspect case shall report the case or suspect case.

(a) Processing a clinical specimen includes receiving, forwarding, or analyzing the specimen.

(b) Even if more than one entity is involved with the specimen, case, or suspect case, each entity shall report the case or suspect case.

(3) Each entity shall designate an individual or group responsible for ensuring the entity complies with any requirement for reporting in this rule.

(a) A designated individual may include:

(i) an administrative officer;

(ii) a charge nurse;

(iii) a clinic manager;

(iv) a compliance officer;

(v) an infection preventionist;

(vi) a laboratory director; or

(vii) another comparable staff member, as appropriate.

(b) Each entity shall submit the name of the designated individual or group to the department upon request.

R386-702-6. Mandatory Submission of Clinical Material.

(1) Each laboratory shall submit clinical material from each case identified with any organism listed in Section R386-702-4 to UPHL within three working days of identification.

(2)(a) Submission of clinical material is mandatory for:

(i) any antibiotic-resistant organism, from any specimen, that:

(A) is resistant to vancomycin in Staphylococcus aureus (VRSA);

(B) is resistant to a carbapenem in:

(I) Acinetobacter species;

(II) any Enterobacterales organism;

(III) Pseudomonas aeruginosa that is not susceptible to:

(Aa) ceftolozane/tazobactam; or

(Bb) cefepime or ceftazidime when ceftolozane/tazobactam resistance is unknown;

(I) Acinetobacter species;

(II) any Enterobacterales organism; or

(III) Pseudomonas aeruginosa;

(ii) Campylobacter species;

(iii) Candida auris or Candida haemulonii from any body site;

(iv) Corynebacterium diphtheriae;

(v) Cronobacter sakazakii, from a normally sterile site in a person less than 12 months old;

(vi) Shiga toxin-producing Escherichia coli including enrichment or MacConkey broths that tested positive by any method for Shiga toxin;

(vii) Haemophilus influenzae from a normally sterile site;

(viii) influenza A virus, unsubtypeable;

(ix) influenza virus in a hospitalized case;

(x) Legionella species;

(xi) Listeria monocytogenes;

(xii) measles (rubeola);

(xiii) Mycobacterium tuberculosis complex;

(xiv) Neisseria meningitidis, from a normally sterile site;

(xv) Salmonella species;

(xvi) any SARS-CoV-2 NAAT-positive sample;

(xvii) Shigella species;

(xviii) Vibrio species;

(xix) West Nile virus;

(xx) Yersinia species;

(xxi) Zika disease;

(xxii) any organism implicated in an outbreak when instructed by authorized local or state health department personnel; or

(xxiii) any potential bioterrorism agent, including:

(A) Bacillus anthracis;

(B) Brucella species;

(D) Francisella tularensis; and

(E) Yersinia pestis.

(b) The department may suspend or modify mandatory submission requirements.

(3) If a laboratory identifies a case with an organism designated by UPHL as a potential bioterrorism agent, the laboratory shall immediately notify UPHL by phone before submitting clinical material from the case.

(a) During business hours, the phone number for UPHL is 801-965-2400.

(b) After hours, the phone number for UPHL is 801-560-6586.

(4) Submission of clinical material does not replace the requirement for laboratories to report the event to the department as specified in Sections R386-702-7 and R386-702-8.

(5) For additional information on the process described in this section, contact UPHL at 801-965-2400.

R386-702-7. Reporting Criteria.

(1) Each case report shall comply with criteria in this subsection.

(a)(i) An acute care hospital that identifies a case shall report to the department through eCR.

(ii) Any other entity listed as required to report in Section R386-702-5 that identifies a case shall report to:

(A) the department using eCR; or

(B) a local health department using a method approved by the local health department.

(iii) Any entity reporting via eCR may include in the submission any clinical information for an encounter that meets criteria for reporting.

(iv) Each entity shall report any preliminary positive result for an event specified in Subsection (3)(b) in accordance with Subsection (3).

(b) Each entity reporting an event that is not listed in Subsection (3) shall report the event:

(i) within 24 hours of diagnosis if reporting using eCR; or

(ii) within one working day of diagnosis if reporting using another method.

(iii) Each entity may report in real time as each report is released.

(2) Each laboratory report shall comply with criteria in this subsection.

(a) Each entity listed as required to report in Section R386-702-5 that identifies a case shall report laboratory results within 24 hours of finalization.

(i) Each entity may report in real time as each report is released.

(ii) Each entity shall report any preliminary positive result for an event specified in Subsection (3)(b) in accordance with Subsection (3).

(b)(i) A category one laboratory that identifies a case or suspect case shall report to the department through ELR.

(ii)(A) A category two laboratory, health care facility, or provider that identifies a case shall report to the department through ELR, unless the department determines that ELR is unavailable for that entity.

(B) If the department determines that ELR is unavailable for an entity required to report, that entity shall use electronic reporting through the reporting portal established by the department or an alternate electronic reporting method approved by the department.

(3) Any event that requires immediate reporting is described in this subsection.

(a) Each entity shall report any immediately reportable event by phone as soon as possible but no later than 24 hours after identification.

(b) The department designates an event as immediately reportable if there is a case or suspect case of:

(i) anthrax or anthrax-like illness;

(ii) botulism, excluding infant botulism;

(iii) cholera;

(iv) Cronobacter sakazakii, from a normally sterile site in a person less than 12 months old;

(v) novel coronavirus disease, including:

(A) Middle East Respiratory Syndrome (MERS); and

(B) severe acute respiratory syndrome (SARS);

(vi) diphtheria;

(vii) free-living amebae, from any human source;

(A) acanthamoeba spp.;

(B) Balamuthia mandrillaris (B. mandrillaris);

(viii) Haemophilus influenzae, invasive;

(ix) hepatitis A;

(x) influenza infection suspected or confirmed to be caused by a non-seasonal influenza strain;

(xi) measles (rubeola);

(xii) melioidosis (Burkholderia pseudomallei);

(xiii) meningococcal disease, invasive;

(xiv) plague;

(xv) poliovirus, paralytic and nonparalytic;

(xvi) rabies, human and animal;

(xvii) rubella, excluding congenital syndrome;

(xviii) smallpox;

(xix) Staphylococcus aureus from any specimen that is resistant to vancomycin (VRSA);

(xx) transmissible spongiform encephalopathies, or prion diseases, including Creutzfeldt-Jakob disease;

(xxi) tuberculosis;

(xxii) tularemia;

(xxiii) typhoid, cases and carriers;

(xxiv) viral hemorrhagic fevers;

(xxv) yellow fever; or

(xxvi) any event described in Subsection R386-702-4(5) or R386-702-4(6).

(c) Each entity reporting an immediately reportable condition shall report to a local health department or the department by phone.

(i) During business hours, the phone number to report to the department is 801-538-6191.

(ii) After business hours, the phone number to report to the department is 888-EPI-UTAH (888-374-8824).

(d) A confidential morbidity report form is available at https://epi.utah.gov/disease-reporting.

R386-702-8. Required Information.

When reporting an event specified in Subsections R386-702-4(2) through R386-702-4(6) to the department, each entity's report shall include:

(1) patient information, including the patient's:

(a) full name;

(b) date of birth;

(d) address, including the street address, city, state, and zip code; and

(e) phone number;

(2) diagnostic information, including the:

(a) name of the diagnostic facility;

(b) phone number of the diagnostic facility;

(d) phone number of the ordering or diagnosing health care provider; and

(e) diagnosis or condition being reported;

(3) reporter information, including the:

(a) name of the person or facility reporting; and

(b) phone number of the person or facility reporting; and

(4) for any report submitted through eCR or ELR, additional information and reporting specifications described in the:

(a) eCR Supplemental Document, incorporated by reference in Section R386-702-3; and

(b) ELRSupplemental Document, incorporated by reference in Section R386-702-3; and

(5) any additional required information as listed at https://epi.utah.gov/disease-reporting, including any technical document, reporting form, and protocol.

R386-702-9. Syndromic Surveillance.

(1) When transmitting syndromic surveillance data to the department, each entity shall use a version of HL7 determined and approved by the department.

(2) Sections 26B-1-202, 26B-7-202, and 26B-7-207 authorize reporting of encounter data, unless such reporting is made mandatory by a public health emergency declared under Section 26B-7-317 or 26A-1-11.

(3) Any hospital or other health care facility that treats patients in an emergency department shall report any emergency department encounter using a method approved by the department and in accordance with departmental standards and guidance described in the Syndromic Surveillance Reporting Requirement Supplemental Document, incorporated by reference in Section R386-702-3.

(4) Any hospital or other health care facility may report any non-emergency department encounter using a method approved by the department and in accordance with departmental standards and guidance described in the Syndromic Surveillance Reporting Requirement Supplemental Document, incorporated by reference in Section R386-702-3.

(5) Each entity reporting syndromic surveillance data identified in accordance with the Syndromic Surveillance Reporting Requirement Supplemental Document, incorporated by reference in Section R386-702-3, shall report within 24 hours of each triggering event, as described in the document, within a reportable encounter using a method approved by the department.

R386-702-10. Confidentiality of Reports.

(1)(a) Any report required by this rule is confidential. Information collected pursuant to this rule may not be:

(i) released or made public; or

(ii) disclosed in response to a subpoena, search warrant, discovery proceeding, or otherwise, except as provided by Sections 26B-7-217, 26B-7-218, and 26B-7-220.

(b) The penalty for a violation of confidentiality is prescribed in Section 26B-7-219.

(2) Nothing in this rule precludes the discussion of case information with an attending clinician or public health worker.

(3) When a Good Samaritan aids a person in grave physical distress, the Good Samaritan's health care provider may submit a request to the department or local health department to disclose communicable disease-related information regarding the person who the Good Samaritan aided.

(a) The department or local health department shall disclose communicable disease-related information if the health care provider's request includes:

(i) information regarding the occurrence of the accident, fire, or other life-threatening emergency;

(ii) a description of the exposure risk to the Good Samaritan; and

(iii) contact information for the Good Samaritan and the Good Samaritan's health care provider.

(b) The department or local health department shall ensure that the disclosed information:

(i) includes enough detail to allow for appropriate education and follow-up to the Good Samaritan; and

(ii) ensures confidentiality is maintained for the person who was aided.

(c)(i) Identifying information regarding the person who was aided may not be shared with the Good Samaritan or the Good Samaritan's health care provider.

(ii) The department or local health department shall inform any Good Samaritan through written notice that information regarding the person who was aided is protected by state law.

R386-702-11. Enforcement and Penalties.

(1) Any person who violates this rule may be subject to a penalty or sanction as provided in Sections 26B-7-219 and 26B-7-316.

(2) Willful non-compliance may result in the department working with another agency to incur a penalty that may include loss of accreditation or licensure.

(3) Records maintained by each reporting entity are subject to review by the department to assure complete and accurate reporting.

(4) If the department conducts a surveillance project, such as assessing whether a case finding is complete or for another measure of data quality, and finds a case that was not originally reported, the department may waive any penalty for the participating entity at the department's discretion.

R386-702-12. Information Necessary for Public Health Investigation and Surveillance.

(1) Each reporting entity shall provide the department or local health department with any records or other material requested by the department and necessary to conduct a thorough investigation, including:

(a) medical records;

(b) additional laboratory testing results;

(d) clinical material; or

(e) contact information for any case, suspect case, or person potentially exposed.

(2) Any individual or entity shall grant the department or local health department on-site access to a facility when the department or local health department decides such access is critical to a public health investigation.

R386-702-13. General Measures for the Control of Communicable Diseases.

(1) Each local health department shall maintain reportable disease records:

(a) as needed to enforce Title 26B, Chapter 7 Public Health and Prevention and this rule; and

(b) as requested by the department.

(2) Each local health department shall follow the general control measures for reportable diseases described in this subsection.

(a) When an unusual or rare disease occurs in any part of the state or when any disease becomes so prevalent as to endanger the state as a whole, a local health department shall contact the office for assistance and cooperate with any representative of the department.

(b) The local health department shall:

(i) investigate and control any cause of an epidemic, infectious, communicable, or other disease affecting the public health; and

(ii) provide for the detection, reporting, prevention, and control of any communicable, infectious, or acute disease that is determined by the department or local health department to be dangerous or important or that may affect the public health.

(c) The local health department may require physical examination or other measures as necessary to protect the health of others.

(d) If the local health officer determines it is necessary or advisable that any person must be kept from contact with the public to protect the public's health, the local health officer shall establish, maintain, and enforce involuntary treatment, isolation, and quarantine as provided by Sections 26B-7-303 through 26B-7-315.

(i) Any control measure shall be specific to the known or suspected disease agent.

(ii) The local health officer may consult with the office or use any applicable incorporation by reference document, listed in Section R386-702-3, to determine any appropriate control measure.

(e) The local health department shall take any necessary action or measure described in Sections 26B-7-303 through 26B-7-315 and this rule to prevent the spread of any communicable disease, infectious agent, or other condition that poses a public health hazard. The local health department shall initiate action upon discovery of a case or receipt of notification or a report of a disease.

(3) Upon request of a public health authority, any case, suspected case, carrier, contact, other person, or entity, including a facility, hotel, or other organization, shall promptly cooperate when the department or local health department is:

(a) conducting an investigation of the circumstances or cause of a case, suspected case, outbreak, or suspected outbreak is happening; or

(b) carrying out measures for prevention, suppression, or control of a public health hazard, including procedures of restriction, isolation, and quarantine.

(4) Any public food handler or place that handles or processes a food or drink product shall comply with control measures in this section.

(a) A person known to be infected with a communicable disease that can be transmitted by a food or drink product, or who is suspected of being infected with such a disease, may not engage in the commercial handling of any food or drink products or be employed on any premise that handles that type of product, unless:

(i) the product is packaged off-site and remains in a closed container until purchased for consumption; or

(ii) the person is determined by the local health department to be free of communicable disease or incapable of transmitting the infection.

(b)(i) If any case, carrier, or suspected case of a disease that can be transmitted by a food or drink product is found any place that handles or sells a food or drink product or if a disease is found or suspected to have been transmitted by a food or drink product, the local health department may immediately prohibit the sale or removal of the food or drink product from the premise.

(ii) Handling or sale of the food or drink product from the premise may resume when measures have been taken to eliminate the threat to health from the product and the product's processing.

(c) If a local health department cannot comply with this rule without assistance, the local health officer or a representative shall request assistance from the department.

(i) In such circumstances, the local health department shall provide required information to the office.

(ii) If the local health officer fails to comply with this rule, the department shall take action necessary to enforce this rule.

(d) A physician or other health care provider who orders a laboratory analysis necessary to identify any causative agent of a reportable disease or determine the adequacy of treatment of any patient with the disease shall order that the analysis be performed in or referred to a laboratory that holds a valid certificate under the Clinical Laboratory Improvement Amendments of 1988, 42 U.S.C. Sec. 263a.

R386-702-14. Special Measures for the Control of Rabies.

(1) Terms used in this section are defined as:

(a) "Animal control officer" means the same as defined in Section 11-46-102.

(b) "Animal housemate" means a pet that has been a permanent resident of a household since before a rabies exposure.

(d) "Lagomorph" means a hare, pika, or rabbit.

(e) "Livestock" means a cow, horse, pig, or sheep.

(f) "Post-exposure prophylaxis" or "PEP" means a single dose of human rabies immune globulin (HRIG) followed by a series of rabies vaccinations that are given to prevent rabies after exposure to the rabies virus.

(g) "Professional quarantine facility" means a municipal or county animal shelter or other facility under the supervision of a licensed veterinarian.

(h) "Rabies exposure" means:

(i) a bite, scratch, or any contact with the saliva or brain tissue of a rabid animal through a mucous membrane or an open cut in the skin, with the exception of a scratch from a cat, dog, or ferret; or

(ii) any potential contact with a bat.

(A) A potential contact with a bat includes any instance when a bat is present with an unattended child or a person who is asleep, intoxicated, or mentally impaired.

(B) A bite or scratch from a bat may be too small to see or feel.

(i) "Small rodent" means a chinchilla, chipmunk, gopher, guinea pig, hamster, mouse, rat, squirrel, or any similar animal.

(j) "Unprovoked bite" means when an animal bites a human who was not trying to feed, pick up, pet, chase, or otherwise interact with the animal.

(k) "Up-to-date" means an animal has received at least one rabies vaccine licensed in the US for that animal's species and the most recent rabies vaccine's labeled duration of immunity has not expired.

(l) "Wild animal" means any mammal, excluding a cat, dog, ferret, lagomorph, livestock, or small rodent.

(i) A wild animal includes:

(A) a bat, bear, bobcat, coyote, fox, mountain lion, raccoon, and skunk; and

(B) any offspring of a wild animal crossbred with a domestic cat or dog.

(ii) "High-risk wild animal" means a bat, coyote, fox, raccoon, or skunk.

(iii) "Rare, valuable, captive wild animal" means a wild animal kept in a captive, controlled environment, including a research institution, wildlife sanctuary, or zoological park.

(2)(a) This section is made in accordance with the National Association of State Public Health Veterinarians Compendium of Animal Rabies Prevention and Control, 2016.

(b) For any matter not specified in this section, each person or entity involved in or responding to a potential rabies exposure shall comply with the guidelines in the referenced documents.

(3) A physician treating an individual for rabies shall:

(a) evaluate individually each exposure to possible rabies infection; and

(b) consult with local or state public health officials if any question arises about the need for rabies post-exposure prophylaxis.

(4) Any person or entity responding to a potential rabies exposure shall comply with this section.

(a) If a veterinarian decides an animal that was exposed to rabies displays signs or symptoms of rabies, the veterinarian shall euthanize the animal and submit the animal to UPHL for rabies testing, as described in Subsection R386-702-14(5).

(i) If the euthanized animal tests positive for rabies, any human who may have been exposed to the animal during quarantine shall immediately receive PEP.

(ii) If the euthanized animal tests positive for rabies, any other animal that may have been exposed during the quarantine period shall be quarantined and monitored for signs or symptoms of rabies as appropriate, based on the animal's species and vaccination status.

(iii) If the euthanized animal tests negative for rabies, any exposed person does not need PEP.

(b) If an owned cat, dog or ferret bites another owned cat, dog or ferret, neither the biting animal nor the bitten animal is required to be quarantined.

(c) If an owned cat, dog, or ferret bites a human, the biting animal shall be quarantined for ten days, regardless of the biting animal's rabies vaccination status.

(i) When a bite occurs, the owner of the biting animal or the local health department shall notify an animal control officer.

(ii) A biting animal's owner may perform the ten-day quarantine at the owner's home if the owner complies with the quarantine procedures in this section. During the quarantine period:

(A) the biting animal may not leave the owner's property;

(B) a biting animal that is a cat or ferret shall remain indoors;

(C) a biting animal that is a dog shall remain indoors as much as possible and may only go outdoors for a limited time, while leashed and supervised, for bathroom breaks;

(D) the biting animal may interact with any owner as usual but may not have contact with any other person;

(E) the biting animal may have contact with any normal animal housemate but may not have contact with any other animal; and

(F) the owner shall monitor the biting animal closely for signs or symptoms of rabies.

(iii) An animal control officer or employee shall check on the animal's status at minimum on days five and ten.

(iv) A biting animal may not receive a rabies vaccine during the ten-day quarantine period.

(v) At the end of the ten-day quarantine, if the animal is free of signs or symptoms of rabies:

(A) the human bite victim does not need PEP; and

(B) if the animal is not up-to-date on rabies vaccination, the animal's owner shall ensure that the animal is given a booster rabies vaccination under the supervision of a veterinarian as soon as possible.

(vi) If a biting animal shows signs or symptoms of rabies:

(A) the biting animal's owner shall report immediately to an animal control officer;

(B) a veterinarian shall evaluate the biting animal; and

(C) an animal control officer or the veterinarian shall immediately report signs or symptoms of rabies in the biting animal to the local health department.

(d) If a vaccinated cat, dog or ferret experiences a rabies exposure, the exposed animal shall be quarantined for 45 days.

(i) A wild animal that cannot be tested is assumed to be rabid.

(ii) After a rabies exposure, the exposed animal's owner shall:

(A) immediately notify an animal control officer;

(B) immediately clean the animal's wound; and

(iii)(A) To qualify for a 45-day quarantine, there must be proof that the exposed animal had been administered at least one rabies vaccine before the rabies exposure.

(B) If the exposed animal is not up-to-date on rabies vaccination and the booster is not administered as soon as possible, it may be necessary to extend the quarantine beyond 45 days.

(iv) The exposed animal's owner may perform the 45-day quarantine at the owner's home if the owner complies with quarantine procedures in this section. During the quarantine period:

(A) the exposed animal may not leave the owner's property;

(B) the exposed animal that is a cat or ferret shall remain indoors;

(C) the exposed animal that is a dog shall remain indoors as much as possible and may only go outdoors for a limited time, while leashed supervised, for bathroom breaks;

(D) the exposed animal may interact with any owner as usual but may not have contact with any other person;

(E) the exposed animal may have contact with any normal animal housemate but may not have contact with any other animal; and

(F) the owner shall monitor the exposed animal closely for signs or symptoms of rabies.

(v)(A) An animal control officer or employee shall verify that before a 45-day quarantine in a home begins, any cat, dog or ferret in the household that is not the exposed animal is up-to-date on rabies vaccination.

(B) If any cat, dog or ferret in the household that is not the exposed animal is not up-to-date on rabies vaccination, the owner shall ensure the animal is given a booster rabies vaccination under the supervision of a veterinarian.

(vi) An animal control officer or employee shall check on the status of the exposed animal at minimum:

(A) during the first week of quarantine; and

(B) at the end of the 45 days.

(vii) If the exposed animal does not develop signs or symptoms of rabies during the 45-day quarantine, the animal may be released after quarantine with no additional action required.

(vii) If the exposed animal shows signs or symptoms of rabies:

(A) the owner shall report immediately to an animal control officer;

(B) a veterinarian shall evaluate the exposed animal; and

(C) an animal control officer or the veterinarian shall immediately report signs or symptoms of rabies in the exposed animal to the local health department.

(e)(i) If an unvaccinated cat, dog, or ferret, experiences a rabies exposure:

(A) the unvaccinated, exposed cat or dog shall be quarantined for four months;

(B) the unvaccinated, exposed ferret shall be quarantined for six months; or

(ii) A wild animal that cannot be tested is assumed to be rabid.

(iii) After an exposure, the unvaccinated, exposed animal's owner shall:

(A) immediately notify an animal control officer;

(B) immediately clean the animal's wound; and

(C)(I) ensure the animal is given a rabies vaccination under the supervision of a veterinarian as soon as possible and no later than 96 hours after exposure.

(II) If the vaccination is not administered within 96 hours of the exposure, it may be necessary to extend the quarantine beyond four or six months.

(iv)(A) An animal control officer shall ensure that any quarantine for a previously unvaccinated, exposed animal is performed in a professional quarantine facility at the expense of the animal's owner.

(B) If a professional quarantine facility is not available or the animal's owner chooses not to have the animal to undergo the quarantine, the owner shall ensure that the animal is euthanized.

(v) The previously unvaccinated, exposed animal does not need to be tested for rabies unless:

(A) a person has been exposed to the animal; or

(B) the animal shows signs or symptoms of rabies.

(vi) During the four- or six-month quarantine:

(A) the professional quarantine facility shall ensure that the animal does not have contact with any person, including the owner, or any other animal; and

(B) the facility shall monitor the animal for signs or symptoms of rabies.

(C) If the animal does not develop signs or symptoms of rabies, the animal may be released after quarantine with no additional action required.

(D) If the animal shows signs or symptoms of rabies, the facility shall:

(I) report immediately to an animal control officer; and

(II) ensure a veterinarian evaluates the animal.

(III) An animal control officer or veterinarian shall immediately report signs or symptoms of rabies in the animal to the local health department.

(f)(i) If a person experiences a potential rabies exposure from a stray cat, dog, or ferret, a professional quarantine facility shall:

(A) quarantine the stray cat, dog, or ferret for ten days; or

(B) immediately euthanize the stray cat, dog, or ferret.

(ii)(A) If the stray cat, dog, or ferret is euthanized, a veterinarian or animal control officer shall submit the animal's head to UPHL for rabies testing, as described in Subsection R386-702-14(5).

(B) If the euthanized animal tests negative for rabies, any exposed person does not need PEP.

(g)(i) If a person has a potential rabies exposure from a wild animal, the exposed person or an attending medical professional shall notify an animal control officer immediately.

(ii) A wild animal that causes a rabies exposure is not required to quarantine, as any interpretation of rabies symptoms in a wild animal is unreliable and information about the incubation period is unknown.

(iii) If the exposing wild animal can be located, an animal control officer or Division of Wildlife Resources (DWR) employee shall:

(A) immediately euthanize the animal; and

(B) submit the animal's head or intact brain to the UPHL for rabies testing, as described in Subsection R386-702-14(5).

(h)(i) There is not a rabies vaccine licensed for use on a rare, valuable, captive wild animal, and any use of a rabies vaccine on one of these animals is considered extralabel use.

(ii) A zoo or research institution may establish a vaccination program in an attempt to protect a rare, valuable, captive wild animal, but any such program may not conflict with appropriate public health activity that protects humans.

(iii) When a rare, valuable, captive wild animal maintained in a zoological park, approved by the USDA, or a research institution, as defined by Subsection 26B-1-236(2)(a), bites or scratches a human, the zoological park or research institution shall notify the department.

(iv) The department may waive requirements in Subsection R386-702-14(4)(g) if a zoological park operator or research institution manager can demonstrate rabies control measures, including that:

(A) any each employee who works with the exposing animal has received pre-exposure rabies immunization; and

(B) any each person bitten by the animal voluntarily agrees to receive PEP.

(i)(i) The department does not recommend testing a small rodent or lagomorph for rabies unless:

(A) a small rodent or lagomorph bites a human unprovoked; or

(B) a small rodent or lagomorph displays neurologic signs or symptoms of rabies.

(ii) A small rodent or lagomorph infected with rabies or known to transmit rabies to humans is extremely rare, and rabies response is almost never indicated for an exposure from a small rodent or lagomorph.

(j) If vaccinated livestock is up-to-date on rabies vaccination and experiences a rabies exposure, the animal's owner shall:

(i) immediately notify an animal control officer;

(ii) ensure that the livestock is given a booster rabies vaccination immediately; and

(iii) ensure that the livestock is observed for 45 days.

(k)(i) If unvaccinated livestock experiences a rabies exposure, the owner shall immediately notify an animal control officer.

(ii) The exposed livestock shall be:

(A) quarantined by the Utah state veterinarian for six months; or

(B) euthanized.

(l)(i) If livestock that is overdue for a booster rabies vaccination experiences a rabies exposure, a veterinarian shall evaluate each case based on at least:

(A) the severity of the exposure;

(B) the amount of time since the animal's last vaccination;

(D) the animal's current health status; and

(E) local rabies epidemiology.

(ii) Based on the conclusion of the evaluation in Subsection (4)(k)(i), the veterinarian shall determine whether the exposed animal shall be:

(A) immediately administered a booster rabies vaccination followed by:

(I) observation; or

(II) a strict quarantine; or

(B) euthanized.

(5) Any person or entity involved with specimen submission or rabies testing shall comply with this subsection.

(a) A person or entity responsible for an animal that meets the testing criteria shall submit the animal to the UPHL for rabies testing.

(i) An animal meets testing criteria if that animal is:

(A) a bat that has exposed, or may have exposed, a human, cat, dog, or ferret;

(B) a bat, dead or alive, that has been chewed by or been in the mouth of a cat, dog, or ferret;

(C) a cat, dog, or ferret that shows signs or symptoms of rabies and has exposed a human, regardless of the animal's rabies vaccination status;

(D) a cat, dog, or ferret that dies or is euthanized before a required ten-day quarantine is complete;

(E) a stray animal that has exposed a human;

(F) a wild animal that has exposed a human, cat, dog, ferret, or livestock; or

(G) livestock with signs or symptoms of rabies.

(ii)(A) An animal does not meet testing criteria if the animal is:

(I) a bat that is believed to have been dead when a potential rabies exposure occurred, as long as any exposed human or animal did not have contact with the bat's teeth, claws, wet saliva, or nervous or brain tissue;

(II) an animal that has signs of advanced decomposition, including desiccation, the presence of maggots, or a necrotic smell;

(III) a wild animal, including a bat, that has not exposed a human, cat, dog, ferret, or livestock;

(IV) a bird, fish, or reptile; or

(V) a small rodent or lagomorph, unless prior approval from an animal control officer or a local or state health department epidemiologist is obtained for submission, as described in Subsection R386-702-14(4)(i).

(B) If a person has picked up a dead bat, that instance would not generally qualify as an exposure. If a person is unsure whether a dead bat should be submitted for testing, that person may contact the department at onehealth@utah.gov or 801-538-6191 for further clarification.

(b) A person who has been exposed to an animal that meets criteria for testing, as described in Subsection (5)(a), shall cooperate with an animal control officer, a local health department, a wildlife official, or a veterinarian to submit:

(i) the animal's head if the animal is a bear, bobcat, cat, cougar, dog, ferret, fox, raccoon, skunk, or other similarly sized wild animal;

(ii) the animal's intact brain if the animal is livestock; or

(iii) the whole animal if the animal is less than 12 inches long, not including the tail.

(c) A trained professional, including a veterinarian, animal control officer, or wildlife official, shall euthanize each animal humanely.

(i) Any person euthanizing or decapitating an animal for testing shall perform the euthanasia or decapitation in a manner that does not destroy the cerebellum, hippocampus, or brainstem, which make up the brain structure required for testing.

(ii) If possible, a person euthanizing an animal should not shoot or club the animal in the head.

(d)(i) A person submitting an animal for testing shall:

(A) refrigerate the animal's specimen as soon as possible after the animal's death; and

(B) ship the specimen to UPHL within 24 hours.

(ii) If possible, the person should avoid freezing the specimen, especially for larger animals, as a frozen specimen may delay results.

(iii) If the person cannot keep the specimen refrigerated and ship the specimen within 24 hours, including during a holiday weekend, the person may freeze the specimen.

(iv) A person may call the rabies virology line at 801-965-2400 for guidance about specimen storage if there is a possibility of shipment delay.

(h)(i) A person may submit a live bat to UPHL if there is not a safe way to euthanize the bat.

(ii) The person submitting the live bat shall label the submission container clearly to state the presence of a live bat.

(iii) A person may not submit any other live animal to UPHL for rabies testing.

(i) A department-designated qualified laboratory shall perform a test for rabies diagnosis in accordance with the established Centers for Disease Control and Prevention (CDC) standardized protocol, preferably the direct fluorescent antibody test.

(j) The department's rabies website includes information on proper packaging and shipping of a specimen and the fee for rabies testing.

(i) The fee for rabies testing applies when:

(A) the submitted specimen is for a cat, dog, or ferret without signs or symptoms of rabies that exposed a person and did not complete a ten-day quarantine;

(B) the submitted specimen is for a healthy cat, dog, or ferret that did not expose a person;

(C) the submitted specimen is for a small rodent or lagomorph that has not received prior approval for testing as described in Subsection (5)(a)(ii)(A)(V);

(D) paperwork is incomplete, including when:

(I) no paperwork is submitted; and

(II) submitted paperwork is missing information in a required field or a thorough description of the situation that should be attached to the test request form; or

(E) a specimen is improperly transported, including when:

(I) a live bat is not labeled appropriately;

(II) a live bat is not securely packaged;

(III) a sample is submitted without absorbent pads; or

(IV) a sample arrives after business hours.

(ii)(A) The fee for rabies testing shall be waived when the submitted specimen is:

(I) from a bat that exposed a human, cat, dog, ferret, or livestock;

(II) from a cat, dog, or ferret with signs or symptoms of rabies that exposed a person, regardless of the animal's vaccination status;

(III) from an exposed cat, dog, or ferret that was without any signs or symptom of rabies but did not complete the ten-day quarantine due to severe injury or illness that required euthanasia; and

(IV) from any stray animal that exposed a person;

(V) from any wild animal that exposed a person, dog, cat, ferret, or livestock;

(VI) from livestock with signs or symptoms of rabies; or

(VII) otherwise approved by the department for a waived fee.

(B) The person submitting the specimen shall document the reason for a waived fee on the test request form.

(iii) A person submitting a specimen may contact the department at onehealth@utah.gov or 801-538-6191 to discuss the possibility of waiving a fee on a case-by-case basis.

(iv) If a person submitting a specimen believes the department has charged an inappropriate fee for rabies testing, within 30 days of the date on the testing invoice, that person may send the department a written description of the situation and request that the department retroactively waive the fee.

(A) Any mailed request for a retroactive fee waiver shall be sent to:

Attention: One Health Epidemiologist

Utah Department of Health and Human Services, Office of Communicable Diseases

PO Box 142104

Salt Lake City, UT 84114

(B) Any emailed request for a retroactive fee waiver shall be sent to epi@utah.gov and include "Attention: One Health Epidemiologist" in the subject line.

(6) Any person or entity involved in rabies prevention or control shall follow applicable measures in this subsection.

(a) A physician or other health care provider that administers a rabies vaccine to a human shall immediately report any serious systemic neuroparalytic or anaphylactic reaction to a rabies vaccine through the Vaccine Adverse Event Reporting System (VAERS).

(b) An animal's rabies vaccination is valid only if administered by or under the direction of a licensed veterinarian, in accordance with the Compendium of Animal Rabies Prevention and Control, incorporated by reference in Section R386-702-3.

(c) Any county, city, town, or other political subdivision that requires licensure of an animal shall require rabies vaccination of the animal as a prerequisite to obtaining a license.

(d)(i) Each agency or veterinarian administering a vaccine shall document each vaccination on the National Association of State Public Health Veterinarians (NASPHV) form number 51, Rabies Vaccination Certificate, which can be obtained from the vaccine's manufacturer.

(ii) The agency or veterinarian shall provide a paper or digital copy of the information recorded in the form to the animal's owner.

(e) An entity may not sell or otherwise provide an animal rabies vaccine to anyone other than a licensed veterinarian or a veterinary biologic supply firm.

(7) Any cat, dog or ferret in Utah shall be immunized against rabies.

(a) Any cat, dog, or ferret's owner shall ensure the animal receives appropriate rabies vaccination as described in Subsection R386-702-14(6)(b).

(b) The department recommends that each local government establish a program to:

(i) ensure the vaccination of any dog, cat, or ferret in the local government's jurisdiction; and

(ii) remove any stray or unwanted animal.

(8) If the department determines that a rabies outbreak is present in an area of the state, the department may require that:

(a) any cat, dog, or ferret in that area or an adjacent area be vaccinated or receive a booster rabies vaccination as appropriate for each animal's age;

(b) any cat, dog, or ferret's owner who does not ensure that the animal is vaccinated or receives a booster vaccination surrender the animal to the department for confinement and possible euthanasia;

(c) each cat, dog, or ferret's owner maintain control of the animal's behavior and environment until the department declares the outbreak to be resolved; or

(d) any cat, dog, or ferret that is not under an owner's control and is not vaccinated or has not received a booster vaccination be confined and possibly euthanized.

R386-702-15. Special Measures for the Control of Typhoid.

Because typhoid control measures depend largely on sanitary precautions and other health measures designed to protect the public, the local health department shall investigate each case of typhoid and strictly manage the infected individual according to this section.

(1) Standard precautions are required for cases during hospitalization. Use contact precautions for diapered or incontinent patients during illness. Hospital care is desirable during acute illness. Release of the patient from supervision by the local health department shall be based on three or more negative cultures of feces, and of urine in patients with schistosomiasis, taken at least 24 hours apart. Cultures must have been taken at least 48 hours after antibiotic therapy has ended and not earlier than one month after onset of illness as specified in Subsection R386-702-15(6). If any of these cultures is positive, repeat cultures at intervals of one month during the 12-month period following onset until at least three consecutive negative cultures are obtained as specified in Subsection R386-702-15(6). The patient shall be restricted from food handling, child care, and from providing patient care during the period of supervision by the local health department.

(2) Administration of typhoid vaccine is recommended for household members of known typhoid carriers. Household and close contacts of a carrier shall be restricted from food handling, child care, and patient care until two consecutive negative stool specimens, taken at least 24 hours apart, are submitted, or when approval is granted by the local health officer according to local jurisdiction.

(3) If a laboratory or physician identifies a carrier of typhoid, the attending physician shall immediately report the details of the case by telephone to the local health department or the office using the process described in Section R386-702-7.

Each infected individual shall submit to the supervision of the local health department. Carriers are prohibited from food handling, child care, and patient care until released in accordance with Subsection R386-702-15(4)(a) or R386-702-15(4)(b). Reports and orders of supervision shall be kept confidential and may be released only as allowed by Subsection 26B-7-217(2)(c).

(a) Any person who harbors typhoid bacilli for three but less than 12 months after onset is defined as a convalescent carrier. Release from occupational and food handling restrictions may be granted at any time from three to 12 months after onset, as specified in Subsection R386-702-15(6).

(b) Any person who continues to excrete typhoid bacilli for more than 12 months after onset of typhoid is a chronic carrier. Any person who gives no history of having had typhoid or who had the disease more than one year previously, and whose feces or urine are found to contain typhoid bacilli is also a chronic carrier.

(c) If typhoid bacilli are isolated from surgically removed tissues, organs, including the gallbladder or kidney, or from draining lesions such as osteomyelitis, the attending physician shall report the case to the local health department or the office. If the person continues to excrete typhoid bacilli for more than 12 months, the person is a chronic carrier and may be released after satisfying the criteria for chronic carriers in Subsection R386-702-15(6).

(4) The local health department shall report typhoid carriers to the office, and shall:

(a) require the necessary laboratory tests for release;

(b) issue written instructions to the carrier; and

(5) Requirements for Release of Convalescent and Chronic Carriers: The local health officer or their a representative may release a convalescent or chronic carrier from occupational and food handling restrictions only if at least one of the following conditions is satisfied:

(a) for carriers without schistosomiasis, three consecutive negative cultures obtained from fecal specimens authenticated by the attending physician, hospital personnel, laboratory personnel, or local health department staff taken at least one month apart and at least 48 hours after antibiotic therapy has stopped;

(b) for carriers with schistosomiasis, three consecutive negative cultures obtained from both fecal and urine specimens authenticated by the attending physician, hospital personnel, laboratory personnel, or local health department staff taken at least one month apart and at least 48 hours after antibiotic therapy has stopped;

(c) the local health officer or a representative determines that additional treatment such as cholecystectomy or nephrectomy has terminated the carrier state; or

(d) the local health officer or a representative determines the carrier no longer presents a risk to public health according to the evaluation of other factors.

R386-702-16. Special Measures for the Control of Ophthalmia Neonatorum.

(1) Every physician or midwife practicing obstetrics or midwifery shall, within three hours of the birth of a child, instill or cause to be instilled in each eye of such newborn 0.5% ophthalmic erythromycin ointment to prevent the development of ophthalmia neonatorum.

(2) If this ointment is not available due to a disruption in distribution or manufacturing, a physician or midwife shall apply or cause to be administered an alternative treatment to newborns at risk for exposure to Neisseria gonorrhoeae included in the Sexually Transmitted Infections Treatment Guidelines, 2021, incorporated by reference in Section R386-702-3.

R386-702-17. Special Measures for the Control of HIV or AIDS.

If an individual is tested and found to have an HIV infection, the department or local health department shall provide partner services, linkage to care activities, and promote retention to HIV care.

(1) Terms used in this section are defined as:

(a) "Partner" means any individual, including a spouse, who has shared needles, syringes, or drug paraphernalia or who has had sexual contact with an HIV infected individual.

(b) "Spouse" means any individual who is the marriage partner of that person at any time within the ten-year period before the diagnosis of HIV infection.

(c) "Linkage to care" means there was a reported CD4+ T-Lymphocyte test or HIV viral load determination within three months of HIV positive diagnosis.

(d) "Retention to care" means there was a reported CD4+ T-Lymphocyte test or HIV viral load determination once within a 12-month period.

(2) Partner services include:

(a) confidential partner notification within 30 days of receiving a positive HIV result or when relevant additional information is found to aide in an investigation or case management;

(b) prevention counseling;

(d) providing recommendations for testing for other sexually transmitted diseases;

(e) providing recommendations for hepatitis screening and vaccination;

(f) treatment or linkage to medical care on an ongoing basis, as needed; and

(g) linkage or referral to other prevention services and support.

(3) Re-engagement to care includes:

(a) linkage to medical care, on an ongoing basis, as needed;

(b) linkage or referral to other prevention services and support;

(d) prevention counseling;

(e) providing recommendations for testing for other sexually transmitted diseases;

(f) providing recommendations for hepatitis screening and vaccination;

(g) medication adherence counseling; and

(h) risk reduction counseling.

R386-702-18. Special Measures for the Control of Perinatal and Person-to-Person Transmission of Hepatitis B.

(1) A licensed health care provider who provides prenatal care shall routinely test each pregnant woman for hepatitis B surface antigen (HBsAg) at an early prenatal care visit. This section does not apply if the pregnant woman, after being informed of the possible consequences, objects to the test on the basis of religious or personal beliefs.

(2) The licensed health care provider who provides prenatal care shall repeat the HBsAg test during late pregnancy for those women who tested negative for HBsAg during early pregnancy, but who are at high risk based on:

(a) evidence of clinical hepatitis during pregnancy;

(b) injection drug use;

(d) occurrence of hepatitis B in a household or close family contact; or

(e) the judgment of the health care provider.

(3) In addition to other reporting required by this rule, each positive HBsAg result detected in a pregnant woman shall be reported to the local health department or the department, as specified in Section 26B-7-206. That report shall state that the woman was pregnant at time of testing if that information is available to the reporting entity.

(4) A licensed health care provider who provides prenatal care shall document a woman's HBsAg test results, or the basis of the objection to the test, in the medical record for that patient.

(5) Every hospital and birthing facility shall develop a policy to assure that:

(a) when a pregnant woman is admitted for delivery, or for monitoring of pregnancy status, the result from a test for HBsAg performed on that woman during that pregnancy is available for review and documented in the hospital record;

(b) when a pregnant woman is admitted for delivery, if the woman's test result is not available to the hospital or birthing facility, the mother is tested for HBsAg as soon as possible, but before discharge from the hospital or birthing facility;

(c) if a pregnant woman who has not had prenatal care during that pregnancy is admitted for monitoring of pregnancy status only, and if the woman's test result is not available to the hospital or birthing facility, the mother is tested for HBsAg status before discharge from the hospital or birthing facility;

(d) positive HBsAg results identified by testing performed or documented during the hospital stay are reported as specified in this rule;

(e) infants born to HBsAg positive mothers receive hepatitis B immune globulin (HBIG) and hepatitis B vaccine, administered at separate injection sites, within 12 hours of birth;

(f) infants born to mothers whose HBsAg status is unknown receive hepatitis B vaccine within 12 hours of birth, and if the infant is born preterm with birth weight less than 2,000 grams, that infant also receives HBIG within 12 hours;

(g) if, at the time of birth, the mother's HBsAg status is unknown and the HBsAg test result is later determined to be positive, that infant receives HBIG as soon as possible but within 7 days of birth; and

(h) HBIG administration and birth dose hepatitis B vaccine status of infants born to mothers who are HBsAg positive are reported within 24 hours of delivery to a local health department and the department Immunization Program at 801-538-9450.

(6) Local health departments shall perform the following activities or ensure that the following activities are performed:

(a) Females between the ages of 12 and 50 years when an HBsAg positive test result is reported will be screened for pregnancy status within one week of receipt of that lab result.

(b) Infants born to HBsAg positive mothers complete the hepatitis B vaccine series as specified in the Red Book: 2021-2024 Report of the Committee on Infectious Diseases, incorporated by reference in Section R386-702-3.

(c) Children born to HBsAg positive mothers are tested for HBsAg and antibody against hepatitis B surface antigen (anti-HBs) at 9 to 12 months of age to monitor the success of therapy and identify cases of perinatal hepatitis B infection. Testing is done at least one month after the final dose of hepatitis B vaccine series is administered, and no earlier than 9 months of age. Children who test negative for HBsAg and do not demonstrate serological evidence of immunity against hepatitis B when tested as described in this subsection receive three additional vaccine doses and are retested as specified in the Red Book: 2021-2024 Report of the Committee on Infectious Diseases, incorporated by reference in Section R386-702-3.

(d) HBsAg positive mothers are advised regarding how to reduce the risk of transmitting hepatitis B to others.

(e) Household members and sex partners of HBsAg positive mothers are evaluated to determine susceptibility to hepatitis B infection and if determined to be susceptible, are offered or advised to obtain vaccination against hepatitis B. Identified acute hepatitis B cases shall be investigated by the local health department, and identified household and sexual contacts shall be advised to obtain vaccination against hepatitis B.

(7) Subsections (5) and (6) do not apply if the pregnant woman or the child's guardian, after being informed of the possible consequences, objects to any of the required procedures on the basis of religious or moral beliefs. The hospital or birthing facility shall document the basis of the objection.

(8) Prevention of transmission by individuals with chronic hepatitis B infection.

(a) The department defines a chronic hepatitis B case as a person that is HBsAg positive, total antibody against hepatitis B core antigen (anti-HBc) positive, if performed, and IgM anti-HBc negative.

(b) An individual with chronic hepatitis B infection shall be advised regarding how to reduce the risk that the individual will transmit hepatitis B to others.

(c) Household members and sex partners of individuals with chronic hepatitis B infection shall be evaluated to determine susceptibility to hepatitis B infection, and if determined to be susceptible, shall be offered or advised to obtain vaccination against Hepatitis B.

R386-702-19. Public Health Emergency.

(1) Terms used in this section and for an order issued under this section and during the public health emergency are defined as:

(a) "Emergency center" means:

(i) a health care facility that operates an emergency department and is licensed under Title 26B, Chapter 2, Licensing and Certifications; or

(ii) a clinic that provides emergency or urgent health care to an average of at least 20 individuals daily.

(b) "Encounter information" means an emergency center's records of an encounter and includes the:

(i) reason for the visit;

(ii) chief complaint;

(iii) results of any diagnostic test;

(iv) presenting diagnosis; and

(v) final diagnosis, including any applicable diagnostic code.

(2) The department or a local health department may declare a public health emergency by issuing an order that mandates reporting an emergency illness or health condition specified in Section R386-702-4, in accordance with:

(a) Title 26B, Chapter 7, Part 3, Treatment, Isolation, and Quarantine Procedures for Communicable Diseases; or

(b) Title 26A, Chapter 1, Part 1, Local Health Department Act.

(3) The department may designate an emergency center as a specialized emergency center, which expands that emergency center's reporting requirements.

(a) The department shall designate the fewest number of specialized emergency centers as is practicable to obtain the necessary data to respond to the emergency.

(b) Each specialized emergency center shall report an encounter to the department by using a method described in Section R386-702-7 and reporting each encounter by 9 a.m. the day after the encounter. The department may accept an alternate reporting method, including:

(i) the specialized emergency center to allow a representative or agent of the department or a local health department to review the encounter information to identify any encounter during the previous day; or

(ii) any other department-approved arrangement.

(4)(a) For purposes of epidemiological and statistical analysis, each emergency center shall use the process described in Section R386-702-7 to report an encounter during the public health emergency that does not meet the definition for an immediately reportable condition as described in Subsection R386-702-7(3).

(b) The report for each encounter described in Subsection (4)(a) shall include the:

(i) facility name;

(ii) date of visit;

(iii) time of visit;

(iv) patient's age;

(v) patient's sex; and

(vi) zip code of the patient's residence.

(5)(a) If the department or a local health department collects identifying health information on an individual who is the subject of a report required under this section, the department or local health department shall destroy that identifying information upon the sooner of:

(i) the determination of the department or a local health department that the information is no longer necessary to carry out an investigation under this section; or

(ii) 180 days after the information was collected.

(b) The department or local health department may retain identifying information gathered under another section of this rule or other legal authority, in accordance with those provisions.

(6) Reporting an encounter during a public health emergency does not relieve a reporting entity of the responsibility to report the encounter under another section of this rule or other legal authority.

KEY: communicable diseases, quarantines, rabies, rules and procedures

Date of Last Change: June 1, 2026

Notice of Continuation: March 2, 2026

Authorizing, and Implemented or Interpreted Law: 26B-1-202; 26B-7-202; 26B-7-207; 26B-7-303 through 26B-7-315; 26B-7-316 through 26B-7-324