Utah Office of Administrative Rules

NOTICE OF SUBSTANTIVE CHANGE

TYPE OF FILING: Repeal and Reenact

Rule or section number:

R386-702

Filing ID: 57823

Agency Information

1. Title catchline:

Health and Human Services, Population Health, Environmental Epidemiology

Building:

Cannon Health Building

Street address:

288 N 1460 W

City, state:

Salt Lake City, UT

Mailing address:

PO Box 142100

City, state and zip:

Salt Lake City, UT 84116

Contact persons:

Name:

Phone:

Email:

Chris Smoot

385-566-9476

csmoot@utah.gov

Rachelle Boulton

385-228-5632

rboulton@utah.gov

Please address questions regarding information on this notice to the persons listed above.

General Information

2. Rule or section catchline:

R386-702. Communicable Disease Rule

4. Purpose of the new rule or reason for the change:

Because electronic reporting has become more widely adopted in Utah and is required for some federal programs, such as the Centers for Medicaid and Medicare Services Promoting Interoperability Programs, the Division of Population Health (division) determined it is appropriate to update this rule to improve reporting efficiency and quality.

Upon review of this rule, the Governance Committee also recommended adding the name of the bacterium that causes melioidosis to lists of reportable events to align with the formatting of other list items.

Additional changes to reportable conditions in this filing are based on an analysis from an epidemiologist affiliate group, including state and local health department officials.

Additionally, upon internal review of this rule, the division determined additional changes in this filing are appropriate to simplify wording and clarify intent throughout the rule to better comply with the Rulewriting Manual for Utah and align with other rules under the Department of Health and Human Services (department).

While the department anticipates additional substantive changes are needed for Sections R386-702-15 through R386-702-18, those will be made in a future filing.

The department is collecting public comment on a public form available at https://docs.google.com/forms/d/e/1FAIpQLSc8PC_rJY1c-EzeuZLtdYZIeDvISpffCI_SjNuuamVZT5i1aA/viewform.

5. Summary of the new rule or change:

This change removes non-emergency manual disease reporting methods, enhances electronic disease reporting methods, amends the list of reportable conditions, updates disease control measures, and clarifies language to improve interpretation of rule requirements.

Additionally, it makes style and formatting changes to comply with the Rulewriting Manual for Utah and align with other rules under the department.

As there are a significant amount of changes and line-by-line markups would be difficult to follow, the department determined this filing should be formatted as a repeal and reenact.

Fiscal Information

6. Provide an estimate and written explanation of the aggregate anticipated cost or savings to:

A. State budget:

As a result of this filing, there is an anticipated cost to the department of a one-time $50,000 expansion of the department's online reporting portal and an ongoing annual cost of an estimated $20,000 for the portal's maintenance.

Department IT systems already accept HL7 messages used in electronic laboratory reporting (ELR), electronic case reporting (eCR), and syndromic surveillance (SyS).

Staff is already appropriated for the upkeep of those data feeds and onboarding of new users, and there is no measurable additional cost from any increase in volume of reports received or savings as a result of time saved by using the online system for reporting.

The department already developed and used the online reporting portal for the COVID-19 pandemic response and, as a result of this filing, the reporting portal will expand its functionality to include all reportable conditions. Though expanding the reporting portal's functionality and maintenance is anticipated to result in the costs mentioned above, this expansion falls within the scope of normal operations, and it is anticipated that any additional work will be absorbed into the responsibilities of existing staff.

The University of Utah submits a significant number of communicable disease reports each month and is already using ELR, eCR, and SyS in a way that complies with these new requirements. Therefore, this rule change is not expected to have any fiscal impact to the University of Utah.

B. Local governments:

Although this filing updates the required format for a reporting entity to submit a report of a communicable disease to the department, this filing leaves the format of reports accepted by Utah's 13 local health departments (LHDs) to each LHD's discretion.

Due to the department no longer accepting non-emergency manual reports, this may increase the volume of manual reports that are submitted to LHDs, but there is no way to know how many manual reports will be submitted to LHDs or if the number of reports those LHDs already receive will change as a result of this filing.

Based on data available to the department in October 2025, any LHDs in the state that do reportable testing provide only CLIA-waived tests for reportable conditions and would be categorized as category two laboratories required to report to the department via the reporting portal. This is not anticipated to incur additional costs to these LHDs because the department's reporting portal is online and free to access, and the information required for the form within the department's reporting portal is the same information the LHDs already report.

C. Small businesses ("small business" means a business employing 1-49 persons):

There is no anticipated fiscal impact to the approximately 4,000 small businesses in Utah, including laboratories and small health care providers.

Small businesses that qualify as a category one laboratory were already required to report through ELR. This filing removes the option of reporting with an HL7 2.3.1 message structure, but reporting with the remaining required HL7 2.5.1 message structure is not anticipated to result in a cost to these small businesses. The HL7 2.5.1 message structure is already used by many of these small business category one laboratories, and, furthermore, updating message structures is an industry standard that is periodically anticipated by small businesses.

Small businesses that qualify as a category two laboratory are required to report to the department via ELR, unless ELR is unavailable to the small business category two laboratory. If ELR is unavailable, the small business category two laboratory may use the department's reporting portal. This is not anticipated to incur a cost to these small businesses because the department's reporting portal is online and free to access, and the information required for the form within the department's reporting portal is the same information the small business category two laboratories already report.

It is not anticipated that any small business would qualify as an "acute care hospital" and be required to report via eCR. It is also not anticipated that any small businesses operate an emergency department and therefore, be required to report via SyS.

While the changes to reportable conditions may result in a cost to small business reporters to update practices and processes, any such cost is inestimable because each small business has unique internal practices and processes.

Additionally, a small business may choose to comply with ELR requirements through a vendor. Vendors used to comply with ELR requirements do not usually charge a small business based on volume or variety of reports, but there is no way for the department to predict the funding structure of each vendor.

The time required for a small business to input reports into the online reporting portal may increase if they identify any case of the reportable conditions added by this filing, but there is no way to know if or how many such cases will arise for each small business.

D. Non-small businesses ("non-small business" means a business employing 50 or more persons):

There is no anticipated fiscal impact to the approximately 500 non-small businesses in Utah, including hospitals, laboratories, and non-small health care providers.

Non-small businesses that qualify as a category one laboratory were already required to report through ELR. This filing removes the option of reporting with an HL7 2.3.1 message structure, but reporting with the remaining required HL7 2.5.1 message structure is not anticipated to result in a cost to these non-small businesses. The HL7 2.5.1 message structure is

already used by many of these non-small business category one laboratories, and, furthermore, updating message structures is an industry standard that is periodically anticipated by non-small businesses.

Non-small businesses that qualify as a category two laboratory are required to report to the department via ELR, unless ELR is unavailable to the non-small business category two laboratory. If ELR is unavailable, the non-small business category two laboratory may use the department's reporting portal.

This is not anticipated to incur a cost to these non-small businesses because the department's reporting portal is online and free to access, and the information required for the form within the department's reporting portal is the same information the non-small business category two laboratories already report.

Non-small businesses that qualify as acute care hospitals are required to report via eCR as a result of this filing. This would require them to maintain an EHR or EMR that is capable of eCR, and none of the acute care hospital reporters in Utah are known to lack a system capable of eCR. eCR is already an industry standard and required for some federal funding programs, such as the Centers for Medicaid and Medicare Services Promoting Interoperability Program.

While all of the known acute care hospital reporters in Utah have access to an EHR or EMR that is capable of eCR, this filing requires these acute care hospital reporters to maintain these systems for future reports. Any cost of these systems varies by vendor and is therefore inestimable.

Non-small businesses that operate an emergency department would be required to report via SyS as a result of this filing. This would require them to maintain an EHR or EMR that is capable of eCR, and none of the acute care hospital reporters in Utah are known to lack a system capable of eCR. eCR is already an industry standard and required for some federal funding programs, such as the Centers for Medicaid and Medicare Services Promoting Interoperability Program.

While the changes to reportable conditions may result in a cost to non-small business reporters to update practices and processes, any such cost is inestimable because each non-small business has unique internal practices and processes.

Additionally, a non-small business may choose to comply with ELR requirements through a vendor. Vendors used to comply with ELR requirements do not usually charge a non-small business based on volume or variety of reports, but there is no way for the department to predict the funding structure of each vendor.

The time required for a non-small business to input reports into the online reporting portal may increase if they identify any case of the reportable conditions added by this filing, but there is no way to know if or how many such cases will arise for each non-small business.

Any non-small business medical software vendors of EHR, EMR, or LIMS software may choose to update software to become compatible with ELR, eCR, and SyS to satisfy customer needs as an indirect result of this filing. However, because this filing does not require vendors to update practices and the process for any such update would vary by vendor, any such cost is inestimable.

E. Persons other than small businesses, non-small businesses, state, or local government entities ("person" means any individual, partnership, corporation, association, governmental entity, or public or private organization of any character other than an agency):

There is no anticipated cost to other persons as a result of this filing because the process for reporting a communicable disease for any other person has not changed.

F. Compliance costs for affected persons:

The department estimates that the expansion of the online reporting portal will require approximately 500 total hours of work split between a contracted software developer and staff member with an estimated average hourly wage of $100, leading to a total anticipated cost of $50,000.

Additionally, the department estimates that maintenance for the online reporting portal will have an ongoing annual compliance cost of four hours weekly split between a contracted software developer and staff member at an estimated average hourly wage of $100, leading to a total anticipated annual cost of $20,000.

As the University of Utah is already using ELR, eCR, and SyS in a way that complies with new requirements in this filing, there is no anticipated compliance cost.

As LHDs are not anticipated to have to change current methods of reporting as a result of this filing, there is no anticipated compliance cost.

Small business laboratories and health care providers are not anticipated to have a compliance cost related to any updates in messaging structure or as a result of ELR requirements, and any compliance costs as a result of changes in this filing to reportable conditions are inestimable.

Non-small business hospitals, laboratories, and health care providers are not anticipated to have a compliance cost related to any updates in messaging structure or as a result of ELR requirements. Non-small business acute care hospitals may have an inestimable compliance cost to comply with eCR requirements. Non-small business that operate an emergency department may have an inestimable compliance cost to comply with SyS requirements. Any compliance costs as a result of changes in this filing to reportable conditions are also inestimable.

Additionally, non-small medical software vendors that choose to update software to become compatible with ELR, eCR, and SyS may have an inestimable compliance cost.

G. Regulatory Impact Summary Table (This table includes only fiscal impacts the agency was able to measure. If the agency could not estimate an impact, it is excluded from this table but described in boxes A through F.)

Regulatory Impact Summary Table

Fiscal Cost

FY2026

FY2027

FY2028

FY2029

FY2030

State Budget

$50,000

$20,000

Local Governments

Small Businesses

Non-Small Businesses

Other Persons

Total Fiscal Cost

Fiscal Benefits

FY2026

FY2027

FY2028

FY2029

FY2030

State Budget

Local Governments

Small Businesses

Non-Small Businesses

Other Persons

Total Fiscal Benefits

Net Fiscal Benefits

($50,000)

($20,000)

H. Department head comments on fiscal impact and approval of regulatory impact analysis:

The Executive Director of the Department of Health and Human Services, Tracy S. Gruber, has reviewed and approved this regulatory impact analysis.

Citation Information

7. Provide citations to the statutory authority for the rule. If there is also a federal requirement for the rule, provide a citation to that requirement:

Section 26B-1-202

Section 26B-7-202

Section 26B-7-207

Incorporation by Reference Information

8. Incorporation by Reference (if this rule incorporates more than two items by reference, please include additional tables):

A. This rule adds or updates the following title of material incorporated by reference (a copy of the material incorporated by reference must be submitted to the Office of Administrative Rules. If none, leave blank):

Official Title of Materials Incorporated (from title page)

HL7 CDA R2 Implementation Guide: Public Health Case Report, the Electronic Initial Case Report (eICR) Release 3.1.1 – US Realm

Publisher

Health Level Seven International

Issue Date

October 2024

Issue or Version

3.1.1

B. This rule adds or updates the following title of material incorporated by reference (a copy of the material incorporated by reference must be submitted to the Office of Administrative Rules. If none, leave blank):

Official Title of Materials Incorporated (from title page)

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

Publisher

Health Level Seven International

Issue Date

October 2022

Issue or Version

2.5.1

C. This rule adds or updates the following title of material incorporated by reference (a copy of the material incorporated by reference must be submitted to the Office of Administrative Rules. If none, leave blank):

Official Title of Materials Incorporated (from title page)

Electronic Case Reporting Supplemental Document

Publisher

Utah Department of Health and Human Services

Issue Date

August 14, 2025

Issue or Version

D. This rule adds or updates the following title of material incorporated by reference (a copy of the material incorporated by reference must be submitted to the Office of Administrative Rules. If none, leave blank):

Official Title of Materials Incorporated (from title page)

Electronic Laboratory Reporting Supplemental Document

Publisher

Utah Department of Health and Human Services

Issue Date

August 14, 2025

Issue or Version

E. This rule adds or updates the following title of material incorporated by reference (a copy of the material incorporated by reference must be submitted to the Office of Administrative Rules. If none, leave blank):

Official Title of Materials Incorporated (from title page)

Syndromic Surveillance Reporting Requirement Supplemental Document

Publisher

Utah Department of Health and Human Services

Issue Date

August 29, 2025

Issue or Version

F. This rule adds or updates the following title of material incorporated by reference (a copy of the material incorporated by reference must be submitted to the Office of Administrative Rules. If none, leave blank):

Official Title of Materials Incorporated (from title page)

HL7 Version 2.5.1 Implementation Guide: Syndromic Surveillance, Release 1 - US Realm

Publisher

Health Level Seven International

Issue Date

July 26, 2019

Issue or Version

2.5.1

Public Notice Information

9. The public may submit written or oral comments to the agency identified in box 1.

A. Comments will be accepted until:

04/14/2026

10. This rule change MAY become effective on:

04/21/2026

NOTE: The date above is the date the agency anticipates making the rule or its changes effective. It is NOT the effective date.

Agency Authorization Information

Agency head or

designee and title:

Tracy S. Gruber, Executive Director

Date:

02/25/2026

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

[R386-702. Communicable Disease Rule.

R386-702-1. Purpose Statement.

(1) Sections 26B-7-316 through 26B-7-324 provide authority for sections in this rule as noted, and Sections 26B-7-202, 26B-7-207, and

26B-1-202 authorize all other sections of this rule.

(2) This rule 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. Reporting requirements and

authorizations are specified for communicable and infectious diseases, outbreaks, and unusual occurrence of any disease. Each section has been

adopted with the intent of reducing disease morbidity and mortality through the rapid implementation of established practices and procedures.

(3) The successes of medicine and public health dramatically reduced the risk of epidemics and early loss of life due to infectious agents

during the twentieth century. However, the emergence of diseases such as Middle Eastern Respiratory Syndrome (MERS), and the rapid spread of

diseases such as West Nile virus to the United States from other parts of the world, made possible by advances in transportation, trade, food

production, and other factors, highlight the continuing threat to health from infectious diseases. Continual attention to these threats and cooperation

among all health care providers, government agencies, and other entities that are partners in protecting the public's health are crucial to maintaining

and improving the health of the citizens of Utah.

R386-702-2. Definitions.

(1) "Carrier" means the same as that term is defined in Section 26B-7-201.

(2) "Communicable disease" means the same as that term is defined in Section 26B-7-201.

(3) "Contact" means the same as that term is defined in Section 26B-7-201.

(4) "Epidemic" means the same as that term is defined in Section 26B-7-201.

(5) "Infection" means the same as that term is defined in Section 26B-7-201.

(6) "Schools" means the same as that term is defined in Section 26B-7-201.

(7) "Health care provider" means the same as that term is defined in Section 26B-7-206.

(8) "Assisted living facilities" means the same as that term is defined in Section 26B-2-201.

(9) "Nursing care facilities" means the same as that term is defined in Section 26B-2-201.

(10) "Bioterrorism" means the same as that term is defined in Section 26B-7-301.

(11) "Childcare programs" means the same as that term is defined in Section 26B-2-401.

(12) "Health care facilities" means the same as that term is defined in Section 78B-3-403.

(13) "Mental health facilities" means the same as that term is defined in Section 26B-5-301.

(14) "Local health department" means the same as that term is defined in Section R386-80-2.

(15) In addition, for purposes of this rule:

(a) "Blood and plasma center" is defined as a blood bank, blood storage facility, plasma center, hospital, any facility where blood or blood

products are collected, or any facility where blood services are provided.

(b) "Care facilities licensed through the Department of Health and Human Services" is described as any facility licensed through the

Department of Health and Human Services, and includes adult day care facilities, adult foster care facilities, crisis respite facilities, domestic violence

shelters and treatment programs, foster care homes, mental health treatment programs, residential treatment and day treatment facilities for persons

with disabilities, substance abuse treatment programs, and youth treatment programs.

(c) "Case" is defined as 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.

(d) "Clinic" is defined as any facility where a health care provider practices.

(e) "Condition" is defined as an abnormal state of health that may interfere with a person's regular feelings of wellbeing.

(f) "Correctional facility" is defined as a facility that forcibly confines an individual under the authority of the government, including

prisons, detention centers, jails, juvenile detention centers.

(g) "Department" is defined as the Utah Department of Health and Human Services.

(h) "Diagnostic facility" is defined as the facility where the case or suspect case was seen and evaluated by a healthcare provider.

(i) "Dispensary" is defined as an office in a school, hospital, industrial plant, or other organization that dispenses medications or medical

supplies.

(j) "Electronic case reporting" is defined as the transmission of clinical, diagnostic, laboratory, and treatment related data from reporting

entities to the Department in a structured, computer-readable format that reflects comparable content to HL7 CDA R2 Implementation Guide: Public

Health Case Report, Release 2 - US Realm - the Electronic Initial Case Report (eICR). Electronic Initial Case Reporting is a form of electronic

reporting.

(k) "Electronic laboratory reporting" is defined as the transmission of laboratory or health related data from reporting entities to the

Department using HL7 ORU-R01 2.3.1 or 2.5.1, LOINC, and SNOMED standard message structure and vocabulary. Electronic laboratory reporting

is a form of electronic reporting.

(l) "Electronic reporting" is defined as the transmission of laboratory or health related data from reporting entities to the Department in a

structured, computer-readable format that reflects comparable content to HL7 messaging.

(m) "Encounter" is defined as an instance of an individual presenting to a health care facility.

(n) "Event" is defined as any communicable disease, condition, laboratory result, syndrome, outbreak, epidemic, or other public health

hazard that meets criteria for being reportable under this rule.

(o) "Good Samaritan" is defined as a person who gives reasonable aid to strangers in grave physical distress.

(p) "Invasive disease" is defined as infection occurring in parts of the body where organisms are not normally present, such as the

bloodstream, organs, or the meninges.

(q) "Laboratory" is defined as any facility that receives, refers, or analyzes clinical specimens.

(r) "Manual reporting" is defined as the transmission of laboratory or health related data from reporting entities to the Department using

processes that require hand keying for data to be incorporated into Department databases.

(s) "Normally sterile site" is defined as a part of the body where organisms are not normally present, such as the bloodstream, organs, or

the meninges.

(t) "Outbreak" is defined as the increased occurrence of any communicable disease, health condition, or syndrome in a community,

institution, or region; or two or more cases of a communicable disease, health condition, or syndrome in persons with a common exposure.

(u) "Public health hazard" is defined as the presence of an infectious organism or condition in the environment that endangers the health of

a specified population.

(v) "Suspect case" is defined as any person, living or deceased, who a reporting entity, local health department, or the Department believes

might be a case, but for whom it has not been established that the criteria necessary to become a case have been met.

(w) "SARS-CoV-2 NAAT" is any SARS-CoV-2 Nucleic Acid Amplification Test (NAAT) conducted in a facility certified under CLIA to

perform moderate- or high-complexity tests.

(x) "Syndrome" is defined as a set of signs or symptoms that often occur together.

R386-702-3. Reportable Events.

(1) The Department declares the following events to be of concern to public health and reporting of all instances is required or authorized

by Sections 26B-7-202, 26B-7-207, and 26B-1-202.

(2) Events reportable by each entity are as follows:

(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 Bacillus cereus strains that express anthrax toxin genes;

(e) antibiotic resistant organisms from any clinical specimen that meet the following criteria:

(i) resistant to a carbapenem in:

(A) Acinetobacter species;

(B) Enterobacter species;

(D) Klebsiella species; or

(ii) Resistant to vancomycin in Staphylococcus aureus (VRSA); or

(iii) demonstrated carbapenemase production in:

(A) Acinetobacter species;

(B) Enterobacter species;

(D) Klebsiella species; or

(E) any other Enterobacteriaceae species;

(f) arbovirus infection, including:

(i) chikungunya virus infection;

(ii) West Nile virus infection; and

(iii) Zika virus infection; 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, VZV, human herpesvirus 3, 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) cryptosporidiosis (Cryptosporidium spp.);

(u) cyclosporiasis (Cyclospora spp., including Cyclospora cayetanensis);

(v) dengue fever (dengue virus);

(w) diphtheria (Corynebacterium diphtheriae);

(x) ehrlichiosis (Ehrlichia spp.);

(y) encephalitis (bacterial, fungal, parasitic, protozoan, and viral);

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

(aa) giardiasis (Giardia lamblia), also known as beaver fever;

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

(cc) Haemophilus influenzae, invasive disease;

(dd) hantavirus infection (Sin Nombre virus);

(ee) hemolytic uremic syndrome, postdiarrheal;

(ff) 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;

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

(hh) 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;

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

(jj) leptospirosis (Leptospira spp.);

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

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

(mm) malaria (Plasmodium spp.);

(nn) measles (measles virus), also known as rubeola;

(oo) meningitis (bacterial, fungal, parasitic, protozoan, and viral);

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

(qq) mumps (mumps virus);

(rr) 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.);

(ss) pertussis (Bordetella pertussis);

(tt) plague (Yersinia pestis);

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

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

(ww) Q fever (Coxiella burnetii);

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

(yy) relapsing fever (Borrelia spp.), tick-borne and louse-borne;

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

(aaa) salmonellosis (Salmonella spp.);

(bbb) shigellosis (Shigella spp.);

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

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

(eee) streptococcal disease, invasive, due to:

(i) Streptococcus pneumoniae;

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

(iii) group B streptococcus (Streptococcus agalactiae);

(fff) Syphilis (Treponema pallidum), including:

(i) any stage;

(ii) congenital; and

(iii) syphilitic stillbirths;

(ggg) tetanus (Clostridium tetani);

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

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

(jjj) trichinellosis (Trichinella spp.);

(kkk) tularemia (Francisella tularensis);

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

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

(nnn) viral hemorrhagic fevers including:

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

(ii) Lassa fever (Lassa virus); and

(iii) Marburg fever (Marburg virus);

(ooo) yellow fever (yellow fever virus).

(3) Pregnancy is a reportable event for a subset of communicable diseases, and reporting is required even if the communicable disease was

reported to public health before the pregnancy. Perinatally transmissible conditions reportable by each entity are as follows:

(i) hepatitis B infection;

(ii) hepatitis C infection;

(iii) HIV infection;

(iv) listeriosis;

(v) rubella;

(vi) syphilis infection; and

(vii) Zika virus infection.

(4) Antimicrobial susceptibility tests reportable by each 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; and

(vi) Streptococcus pneumoniae;

(vii) organisms resistant to a carbapenem in:

(A) Acinetobacter species;

(B) Enterobacter species;

(D) Klebsiella species;

(viii) organisms resistant to VRSA.

(b) Individual carbapenemase test results including positive, negative, equivocal, indeterminate and the method used, are reportable when

performed on organisms resistant to a carbapenem, or with demonstrated carbapenemase, in:

(i) Acinetobacter species;

(ii) Enterobacter species;

(iii) Escherichia coli; and

(iv) Klebsiella species.

(c) Antiviral susceptibility test results, including nucleotide sequencing, genotyping, or phenotypic analysis, are reportable when

performed on: human immunodeficiency virus (HIV).

(5) Unusual events reportable by each entity include one or more cases or suspect cases 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 that may indicate a bioterrorism event with potential transmission to the public; or

(e) any other infection not explicitly identified in Subsection R386-702-3(2) that public health considers a public health hazard.

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

(a) Entities 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 R386-702-3(2) that public health considers a public health hazard.

(b) Entities shall report increases or shifts in pharmaceutical sales that may indicate changes in disease trends.

(7) Laboratory results reportable by electronic reporters are as follows:

(a) In addition to laboratory results set forth in Subsections R386-702-3(2) through R386-702-3(6), entities reporting electronically shall

include the following laboratory results or laboratory results that provide presumptive evidence of the following communicable diseases:

(i) influenza virus;

(ii) norovirus infection;

(iii) Pseudomonas aeruginosa, resistant to a carbapenem, or with demonstrated carbapenemase production;

(iv) Staphylococcus aureus from a normally sterile site with methicillin testing performed, reported as either methicillin-susceptible

Staphylococcus aureus (MSSA) or methicillin-resistant Staphylococcus aureus (MRSA); and

(v) Streptococcal disease, invasive due to all species.

(b) Entities reporting electronically shall include any laboratory results including positive, negative, equivocal, indeterminate, associated

with the following tests or conditions:

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

(ii) chlamydia;

(iii) Clostridium difficile;

(iv) novel coronavirus COVID-19 (SARS-CoV-2), detected by a SARS-CoV-2 NAAT;

(v) cytomegalovirus (CMV), congenital (infants less than or equal to 12 months of age);

(vi) gonorrhea;

(vii) hepatitis A;

(viii) hepatitis B, including viral loads;

(ix) hepatitis C, including viral loads;

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

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

(xii) Lyme disease;

(xiii) respiratory syncytial virus (RSV);

(xiv) syphilis;

(xv) tuberculosis; and

(xvi) Zika virus.

(c) Entities reporting electronically shall report full panel antibiotic susceptibility test results, including minimum inhibitory concentration

and results suppressed to the ordering clinician, are reportable when performed on Pseudomonas aeruginosa, resistant to a carbapenem, or with

demonstrated carbapenemase.

(d) The Department may, by authority granted through Title 26B, Chapter 7, Part 2, Detection and Management of Chronic and

Communicable Diseases and Public Health Emergencies, identify additional reporting criteria when deemed necessary for the management of

outbreaks or identification of exposures.

(e) Non-positive laboratory results reported for the events identified in Subsection R386-702-3(7)(b) will be used for the following

purposes:

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

(ii) to identify newly acquired infections through identification of a seroconversion window; or

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

(f) Information associated with a non-positive laboratory result will be kept by the Department for a period of 18 months.

(i) At the end of the 18 month period, if the result has not been appended to an existing case, personal identifiers will be stripped and

expunged from the result.

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

(iii) The data set will be kept for use by public health to analyze trends associated with testing patterns and case distribution, and identify

and establish prevention and intervention efforts for at-risk populations.

(8) Authorized reporting of syndromes and conditions are as follows:

(a) Reporting of encounters for the following syndromes and conditions is authorized by Sections 26B-7-202, 26B-7-206, and 26B-7-207,

unless made mandatory by the declaration of a public health emergency:

(i) respiratory illness, including:

(A) upper or lower respiratory tract infections;

(B) difficulty breathing; or

(ii) gastrointestinal illness, including:

(A) vomiting;

(B) diarrhea; or

(iii) influenza-like constitutional symptoms or signs;

(iv) neurologic symptoms or signs indicating the possibility of meningitis, encephalitis, or unexplained acute encephalopathy or delirium;

(v) rash illness;

(vi) hemorrhagic illness;

(vii) botulism-like syndrome;

(viii) lymphadenitis;

(ix) sepsis or unexplained shock;

(x) febrile illness (illness with fever, chills or rigors);

(xi) nontraumatic coma or sudden death; and

(xii) other criteria specified by the Department as indicative of disease outbreaks or injurious exposures of uncertain origin.

(b) Reporting of encounters for syndromes and conditions not specified in Subsection R386-702-3(8)(a) is also authorized by Sections

26B-7-316 through 26B-7-324, unless made mandatory by the declaration of a public health emergency.

(c) Information included in the reporting of the events identified in Subsections R386-702-3(8)(a) and R386-702-3(8)(b) will be used for

the following purposes:

(i) to support early identification and ruling out of public health threats, disasters, outbreaks, suspected incidents, and acts of bioterrorism;

(ii) to assist in characterizing population groups at greatest risk for disease or injury;

(iii) to support assessment of the severity and magnitude of possible threats; or

(iv) to satisfy syndromic surveillance objectives of the Federal Centers for Medicaid and Medicare Meaningful Use incentive program.

(9) Reporting exceptions:

(a) A university or hospital that conducts research studies exempt from reporting AIDS and HIV infection under Section 26B-7-203 shall

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 HIV Epidemiologist 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 HIV

Epidemiologist 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

HIV Epidemiologist within 30 days of the conclusion of the research study.

(e) Documents can be submitted to the HIV Epidemiologist by fax at (801) 538-9923 or by mail to 288 North 1460 West Salt Lake City,

Utah 84116.

R386-702-4. Entities Required to Report.

(1) Section 26B-7-206 lists those entities required to report cases or suspect cases of the reportable events set forth in Section R386-702-3.

This includes:

(a) health care providers, as defined in Section 78B-3-403;

(b) health care facilities, as defined in Section 78B-3-403;

(d) mental health facilities, as defined in Section 26B-5-301;

(e) care facilities licensed through the Department of Health and Human Services;

(f) nursing care facilities and assisted living facilities, as defined in Section 26B-2-201;

(g) dispensaries;

(h) clinics;

(i) laboratories;

(j) schools, as defined in Section 26B-7-201;

(k) childcare programs, as defined in Section 26B-2-401; and

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

(2) In addition, the following entities are required to report cases or suspect cases of the reportable events set forth in Section R386-702-3:

(a) blood and plasma donation centers; and

(b) correctional facilities.

(3) When more than one entity is involved in the processing of a clinical specimen; or the diagnosis, treatment, or care of a case or suspect

case, each entity involved shall report, even when diagnosis or testing is done outside of Utah.

(4) Health care entities may designate a single person or group of persons to report the events identified in Section R386-702-3 to public

health on behalf of their health care providers or medical laboratories, as long as reporting complies with requirements in this rule.

R386-702-5. Mandatory Submission of Clinical Material.

(1) Laboratories shall submit clinical material from cases identified with organisms listed in Subsection R386-702-5(3) to the Utah

Department of Health and Human Services, Utah Public Health Laboratory (UPHL) within three working days of identification.

(a) Clinical material is defined as:

(i) A clinical isolate containing the organism for which submission of material is required; or

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

preference:

(A) a patient specimen;

(B) nucleic acid; or

(2) Laboratories submitting clinical material from cases identified with organisms designated by UPHL as potential bioterrorism agents

shall first notify UPHL via telephone immediately during business hours at (801) 965-2400, or after hours at (801) 560-6586.

(3) Organisms mandated for standard clinical submission include:

(a) antibiotic resistant organisms from any clinical specimen that meet the following criteria:

(i) resistant to a carbapenem in:

(A) Acinetobacter species;

(B) Enterobacter species;

(D) Klebsiella species; or

(E) Pseudomonas aeruginosa;

(ii) resistant to vancomycin in Staphylococcus aureus (VRSA);

(iii) demonstrated carbapenemase production in:

(A) Acinetobacter species;

(B) Enterobacter species;

(D) Klebsiella species;

(E) any other Enterobacteriaceae species; or

(F) Pseudomonas aeruginosa;

(b) Campylobacter species;

(d) Corynebacterium diphtheriae;

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

Shiga toxin;

(f) Haemophilus influenzae, from normally sterile sites;

(g) influenza A virus, unsubtypeable;

(h) influenza virus, only hospitalized cases;

(i) Legionella species;

(j) Listeria monocytogenes;

(k) measles (rubeola) virus;

(l) Mycobacterium tuberculosis complex;

(m) Neisseria meningitidis, from normally sterile sites;

(n) Salmonella species;

(o) SARS-CoV-2 NAAT-positive samples;

(p) Shigella species;

(q) Vibrio species;

(r) West Nile virus;

(s) Yersinia species;

(t) Zika virus; and

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

(v) mandatory submission requirements may be temporarily suspended or modified by the Department.

(4) Organisms mandated for bioterrorism clinical submission include:

(a) Bacillus anthracis;

(b) Brucella species;

(d) Francisella tularensis; and

(e) Yersinia pestis.

(5) Submission of clinical material does not replace the requirement for laboratories to report the event to public health as defined in

Sections R386-702-6 and R386-702-7.

(6) For additional information on this process, contact UPHL at (801) 965-2400.

R386-702-6. Reporting Criteria.

(1) Manual reporting criteria is as follows:

(a) Reporting timeframes are as follows:

(i) Entities shall report immediately reportable events by telephone as soon as possible, but no later than 24 hours after identification.

Events designated as immediately reportable by the Department include cases and suspect cases of:

(A) anthrax or anthrax-like illness;

(B) botulism, excluding infant botulism;

(D) novel coronavirus disease including: Middle East Respiratory Syndrome (MERS), and severe acute respiratory syndrome (SARS);

(E) diphtheria;

(F) Haemophilus influenzae, invasive disease;

(G) hepatitis A;

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

(I) measles;

(J) meningococcal disease, invasive;

(K) plague;

(L) poliovirus, paralytic and nonparalytic;

(M) rabies, human and animal;

(N) rubella, excluding congenital syndrome;

(O) smallpox;

(P) Staphylococcus aureus from any clinical specimen that is resistant to vancomycin;

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

(R) tuberculosis;

(S) tularemia;

(T) typhoid, cases and carriers;

(U) viral hemorrhagic fevers;

(V) yellow fever; or

(W) any event described in Subsection R386-702-3(5) or R386-702-3(6).

(ii) Entities shall report events in Subsections R386-702-3(2) through R386-702-3(6) not required to be reported immediately within three

working days from the time of identification.

(b) Methods for reporting are as follows:

(i) Entities reporting manually shall send reports to either a local health department or the Department by phone, secured fax, secured

email, or mail.

(ii) Contact information for the Department is as follows:

(A) phone: (801) 538-6191 during business hours, or 888-EPI-UTAH (888-374-8824) after hours;

(B) secured fax: (801) 538-9923;

(D) mail: 288 North 1460 West Salt Lake City, Utah 84116.

(iii) A confidential morbidity report form is available at: http://health.utah.gov/epi/reporting/.

(iv) The Department incorporates by reference version 2.2 of the Utah Reporting Specifications for Communicable Diseases, that identifies

individual laboratory tests that shall be reported to the Department by manual reporting entities.

(2) Electronic reporting criteria is as follows:

(a) Reporting timeframes are as follows:

(i) Entities that report electronically shall report laboratory results within 24 hours of finalization.

(A) Entities can choose to report in real-time, as each report is released, or batch reports.

(B) Entities reporting electronically shall report preliminary positive results for the immediately reportable events specified in Subsection

R386-702-6(1)(a)(i).

(b) Methods for reporting are as follows:

(i) Laboratories that identify cases or suspect cases shall report to the Department through electronic laboratory reporting, in a manner

approved by the Department. Reportable events shall be identified by automated computer algorithms.

(A) Laboratories may substitute electronic reporting if electronic laboratory reporting is not available, with permission from the

Department, and in a manner approved by the Department.

(B) Hospitals reporting electronically shall use HL7 2.5.1 message structure, and standard LOINC and SNOMED terminology in

accordance with Meaningful Use regulations.

(C) Laboratories reporting electronically shall use HL7 2.3.1 or 2.5.1 message structure, and appropriate LOINC codes designating the test

performed.

(D) Entities reporting electronically shall submit local vocabulary codes with translations to the Division of Population Health Informatics

Program, if applicable.

(E) The Department incorporates by reference version 1.3 of the Utah Electronic Laboratory Reporting Specifications for Communicable

Diseases, that identifies individual laboratory tests that shall be reported to the Department by electronic reporting entities.

(F) For additional information on this process, refer to https://health.utah.gov/phaccess/public/elr/ or contact the Division of Population

Health Informatics Program by phone (801-538-6191) or email (edx@utah.gov).

(ii) Electronic case reporting is an authorized method of reporting to the Department. For additional information on this process, contact

the Division of Population Health Informatics Program by phone (801-538-6191) or email (edx@utah.gov).

(A) Entities reporting via electronic case reporting may send any clinical information for an encounter that meets criteria for reporting to

public health.

(3) Syndromic reporting criteria is as follows:

Entities reporting syndromes or conditions identified in Subsection R386-702-3(8) shall report as soon as practicable using a schedule

approved by the Department.

For information on reporting syndromic data, refer to https://health.utah.gov/phaccess/public/SS/ or contact the Division of Population

Health Informatics Program by phone (801-538-6191) or email (edx@utah.gov).

R386-702-7. Required Information.

(1) Entities shall include the following information when reporting events specified in Subsections R386-702-3(2) through R386-702-3(6)

to public health:

(a) Patient information:

(i) full name;

(ii) date of birth;

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

(iv) telephone number;

(v) gender;

(vi) race and ethnicity;

(vii) date of onset;

(viii) hospitalization status and date of admission; and

(ix) pregnancy status and estimated due date.

(b) Diagnostic information:

(i) name of the diagnostic facility;

(ii) address, including street address, city, state, and zip code; of the diagnostic facility;

(iii) telephone number of the diagnostic facility;

(iv) full name of the ordering or diagnosing health care provider;

(v) address, including street address, city, state, and zip code; of the ordering or diagnosing health care provider; and

(vi) telephone number of the ordering or diagnosing health care provider.

(i) full name of the person reporting;

(ii) name of the facility reporting; and

(iii) telephone number of the person or facility reporting.

(d) Laboratory testing information:

(i) name of the laboratory performing the test;

(ii) the laboratory's name for, or description of, the test;

(iii) specimen source;

(iv) specimen collection date;

(v) testing results;

(vi) laboratory test date;

(vii) test reference range; and

(viii) test status including preliminary, final, amended, or corrected.

(2) Entities shall submit reports that are clearly legible and do not contain any internal codes or abbreviations to the Department.

(3) Entities submitting or forwarding a specimen for testing using a laboratory test identified in the Utah Electronic Laboratory Reporting

Specifications for Communicable Diseases shall include the patient's full name, date of birth, gender, race, ethnicity, address, and telephone number,

so that the performing laboratory can report results to the appropriate public health agency.

(a) If the patient's address is not known by the submitting or forwarding entity, the submitting or forwarding entity shall provide the

performing laboratory with the name and address of the facility where the specimen originated.

(4) Entities shall reference http://health.utah.gov/epi/reporting, or contact the Department at (801) 538-6191, for additional reporting

specifications, including technical documents, reporting forms, and protocols.

(5) Full reporting of relevant patient information is authorized when reporting events listed in Subsection R386-702-3(8) to public health.

(a) Entities shall include in reports at least the following information, if known:

(i) name of the facility;

(ii) a patient identifier;

(iii) date of visit;

(iv) time of visit;

(v) patient's age;

(vi) patient's gender;

(vii) zip code of patient's residence;

(viii) chief complaint, reason for visit, or diagnosis; and

(ix) whether the patient was admitted to the hospital.

R386-702-8. Confidentiality of Reports.

(1) Reports required by this rule are confidential and are not open to public inspection. Information collected pursuant to this rule shall not

be released or made public, except as provided by Sections 26B-7-217 and 26B-7-220. Penalties for violation of confidentiality are prescribed in

Section 26B-7-219.

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

(3) The Department or local health department shall disclose communicable disease-related information regarding the person who was

assisted to the medical provider of a Good Samaritan when that medical provider submits a request to the Department or local health department.

(a) The request must include:

(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 their medical provider.

(b) The Department or local health department will 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) No identifying information will be shared with the Good Samaritan or their medical provider regarding the person who was assisted.

The Good Samaritan shall receive written information warning them that information regarding the person who was assisted is protected by state law.

R386-702-9. Non-Compliance with Reporting Regulations.

(1) Any person who violates Rule R386-702 may be subject to 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 other agencies to incur penalties that may include loss of

accreditation or licensure.

(3) Records maintained by reporting entities are subject to review by Department personnel to assure the completeness and accuracy of

reporting.

(4) If public health conducts a surveillance project, such as assessing the completeness of case finding or assessing another measure of data

quality, the Department may, at its discretion, waive any penalties for participating entities if cases are found that were not originally reported for

whatever reason.

R386-702-10. Information Necessary for Public Health Investigation and Surveillance.

(1) Reporting entities shall provide the Department or local health department with any records or other materials requested by public

health that are necessary to conduct a thorough investigation.

(a) Subsection (1) includes medical records, additional laboratory testing results, treatment and vaccination history, clinical material, or

contact information for cases, suspect cases, or persons potentially exposed.

(b) The Department or local health department shall be granted on-site access to a facility, when such access is critical to a public health

investigation.

R386-702-11. General Measures for the Control of Communicable Diseases.

(1) The local health department shall maintain reportable disease records as needed to enforce Chapter 7 of the Health and Human Services

Code and this rule, or as requested by the Utah Department of Health and Human Services.

(2) General control measures for reportable diseases are as follows:

(a) The local health department shall, 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, contact the Office of Communicable Diseases, Utah Department of Health and Human Services for

assistance, and shall cooperate with the representatives of the Utah Department of Health and Human Services.

(b) The local health department shall investigate and control the causes of epidemic, infectious, communicable, and other disease affecting

the public health. The local health department shall also provide for the detection, reporting, prevention, and control of communicable, infectious,

and acute diseases that are dangerous or important or that may affect the public health. The local health department may require physical examination

and measures to be performed as necessary to protect the health of others.

(c) If, in the opinion of the local health officer it is necessary or advisable to protect the public's health that any person shall be kept from

contact with the public, 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. Control measures shall be specific to the known or suspected disease agent. Guidance is available from the

Office of Communicable Diseases, Utah Department of Health and Human Services, or official reference listed in Section R386-702-18.

(d) The local health department shall take action and measures as may be necessary within Sections 26B-7-303 through 26B-7-315, and

this rule, to prevent the spread of any communicable disease, infectious agent, or any other condition that pose a public health hazard. Action shall be

initiated upon discovery of a case or upon receipt of notification or report of any disease.

(e) A case; suspected case; carrier; contact; other person; or entity, including a facility, hotel, or other organization, shall, upon request of a

public health authority, promptly cooperate during:

(i) an investigation of the circumstances or cause of a case, suspected case, outbreak, or suspected outbreak.

(ii) the carrying out of measures for prevention, suppression, and control of a public health hazard, including procedures of restriction,

isolation, and quarantine.

(3) Control measures for public food handlers and places where food or drink products are handled or processed are as follows:

(a) A person known to be infected with a communicable disease that can be transmitted by food or drink products, or who is suspected of

being infected with such a disease, may not engage in the commercial handling of food or drink products, or be employed on any premises handling

those types of products, unless those products are packaged off-site and remain in a closed container until purchased for consumption, until the

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

(b) If a case, carrier, or suspected case of a disease that can be conveyed by food or drink products is found at any place where food or

drink products are handled or offered for sale, or if a disease is found or suspected to have been transmitted by these food or drink products, the local

health department may immediately prohibit the sale, or removal of drink and other food products from the premises. Sale or distribution of food or

drink products from the premises may be resumed when measures have been taken to eliminate the threat to health from the product and its

processing.

(c) If a local health department finds it is not able to completely comply with this rule, the local health officer or their representative shall

request the assistance of the Utah Department of Health and Human Services. In such circumstances, the local health department shall provide

required information to the Office of Communicable Diseases. If the local health officer fails to comply with this rule, the Utah Department of Health

and Human Services shall take action necessary to enforce this rule.

(d) Laboratory analyses that are necessary to identify the causative agents of reportable diseases or to determine adequacy of treatment of

patients with a disease shall be ordered by the physician or other health care provider to be performed in or referred to a laboratory holding a valid

certificate under the Clinical Laboratory Improvement Amendments of 1988.

R386-702-12. Special Measures for Control of Rabies.

(1) Rationale of treatment is as follows:

A physician must evaluate individually each exposure to possible rabies infection. The physician shall also consult with local or state

public health officials if questions arise about the need for rabies prophylaxis.

(2) Management of biting animals is as follows:

(a) A healthy dog, cat, or ferret that bites a person shall be confined and observed at least daily for ten days from the date of bite,

regardless of vaccination status, as specified by local animal control ordinances. It is recommended that rabies vaccine not be administered during the

observation period. Such animals shall be evaluated by a veterinarian at the first sign of illness during confinement. A veterinarian or animal control

officer shall immediately report any illness in the animal to the local health department. If signs suggestive of rabies develop, a veterinarian or animal

control officer shall direct that the animal be euthanized, its head removed, and the head shipped under refrigeration, not frozen, for examination of

the brain by a laboratory approved by the Utah Department of Health and Human Services.

(b) If the dog, cat, or ferret shows no signs of rabies or illness during the ten day period, the veterinarian or animal control officer shall

direct that the unvaccinated animal be vaccinated against rabies at the owner's expense before release to the owner. If a veterinarian is not available,

the animal may be released, but the owner shall have the animal vaccinated within 72 hours of release. If the dog, cat, or ferret was appropriately

vaccinated against rabies before the incident, the animal may be released from confinement after the 10-day observation period with no further

restrictions.

(c) Any stray or unwanted dog, cat, or ferret that bites a person may be euthanized immediately by a veterinarian or animal control officer,

if permitted by local ordinance, and the head submitted, as described in Subsection R386-702-12(2)(a), for rabies examination. If the brain is

negative by fluorescent-antibody examination for rabies, one can assume that the saliva contained no virus, and the person bitten need not be treated.

(d) Wild animals include raccoons, skunks, coyotes, foxes, bats, the offspring of wild animals crossbred to domestic dogs and cats, and any

carnivorous animal other than a domestic dog, cat, or ferret.

(e) Signs of rabies in wild animals cannot be interpreted reliably. If a wild animal bites or scratches a person, the person or attending

medical personnel shall notify an animal control or law enforcement officer. A veterinarian, animal control officer or representative of the Division

of Wildlife Resources shall kill the animal at once, without unnecessary damage to the head, and submit the brain, as described in Subsection R386-

702-12(2)(a), for examination for evidence of rabies. If the brain is negative by fluorescent-antibody examination for rabies, one can assume that the

saliva contained no virus, and the person bitten need not be treated.

(f) Rabbits, opossums, squirrels, chipmunks, rats, and mice are rarely infected and their bites rarely, if ever, call for rabies prophylaxis or

testing. Unusual exposures to any animal should be reported to the local health department or the Office of Communicable Diseases, Utah

Department of Health and Human Services.

(g) When rare, valuable, captive wild animals maintained in zoological parks approved by the United States Department of Agriculture or

research institutions, as defined by Section 26B-1-236, bite or scratch a human, the Office of Communicable Diseases, Utah Department of Health

and Human Services shall be notified. Subsection R386-702-12(2)(e) may be waived by the Office of Communicable Diseases, Utah Department of

Health and Human Services if zoological park operators or research institution managers can demonstrate that the following rabies control measures

are established:

(i) Employees who work with the animal have received preexposure rabies immunization.

(ii) The person bitten by the animal voluntarily agrees to accept post-exposure rabies immunization provided by the zoological park or

research facility.

(iii) The director of the zoological park or research facility shall direct that the biting animal be held in complete quarantine for a minimum

of four months for dogs and cats, and six months for ferrets. Quarantine requires that the animal be prohibited from direct contact with other animals

or humans.

(h) Any animal bitten or scratched by a wild, carnivorous animal or a bat that is not available for testing shall be regarded as having been

exposed to rabies. The animal shall be placed in a strict quarantine for four months for dogs and cats, or six months for ferrets.

(i) For maximum protection of the public health, unvaccinated dogs, cats, and ferrets bitten or scratched by a confirmed or suspected rabid

animal shall be euthanized immediately by a veterinarian or animal control officer. If the owner is unwilling to have the animal euthanized, the local

health officer shall order that the animal be held in strict isolation in a municipal or county animal shelter or a veterinary medical facility approved by

the local health department, at the owner's expense, for at least four months for dogs and cats, and six months for ferrets. The animal shall be

vaccinated one month before being released. If any illness suggestive of rabies develops in the animal, the veterinarian or animal control officer shall

immediately report the illness to the local health department and the veterinarian or animal control officer shall direct that the animal be euthanized

and the head shall be handled as described in Subsection R386-702-12(2)(a).

(j) Dogs, cats, and ferrets that are currently vaccinated and are bitten by rabid animals, shall be revaccinated immediately by a veterinarian

and confined and observed by the animal's owner for 45 days. If any illness suggestive of rabies develops in the animal, the owner shall report

immediately to the local health department and the animal shall be euthanized by a veterinarian or animal control officer and the head shall be

handled as described in Subsection R386-702-12(2)(a).

(k) Livestock exposed to a rabid animal and currently vaccinated with a vaccine approved by the United States Department of Agriculture

for that species shall be revaccinated immediately by a veterinarian and observed by the owner for 45 days. Unvaccinated livestock shall be

slaughtered immediately. If the owner is unwilling to have the animal slaughtered, the animal shall be kept under close observation by the owner for

six months.

(l) Unvaccinated animals other than dogs, cats, ferrets, and livestock bitten by a confirmed or suspected rabid animal shall be euthanized

immediately by a veterinarian or animal control officer.

(3) Testing fees at the UPHL are as follows:

(a) Animals being submitted to UPHL for rabies testing must follow criteria defined in The Compendium of Animal Rabies Prevention

and Control to be eligible for testing without a fee. Testing of animals that fit this criteria will be eligible for a waived fee for testing. Testing of

animals that do not meet this criteria will incur a testing fee as set forth by UPHL.

(b) The following situations will not incur a rabies testing fee if testing is ordered for them through UPHL:

(i) Any bat in an instance where a person or animal has had an exposure, or reasonable probability of exposure, including known bat bites,

exposure to bat saliva, a bat found in a room with a sleeping person or unattended child, or a bat found near a child or mentally impaired or

intoxicated person.

(ii) Dogs, cats, or ferrets, regardless of rabies vaccination status, if signs suggestive of rabies are documented in them.

(iii) Wild mammals and hybrids that expose persons, pets, or livestock, including skunks, foxes, coyotes, and raccoons, may be tested.

(iv) Livestock may be tested if signs suggestive of rabies are documented.

(v) DHHS Office of Communicable Diseases staff are available to discuss additional situations that may warrant testing at (801) 538-6191.

(i) Any dog, cat, or ferret, with unknown or undocumented vaccination history that exposes a person, if signs suggestive of rabies are not

documented, or if the animal has not been confined and observed for at least 10 days.

(ii) Dogs, cats, and ferrets: currently vaccinated animals that expose a person, if signs suggestive of rabies are not documented, or animals

have not been confined and observed for at least 10 days.

(iii) Regardless of rabies vaccination status, a healthy dog, cat, or ferret that has not exposed a person.

(iv) Small rodents including rats, mice, squirrels, chipmunks, voles, or moles; and lagomorphs including rabbits and hares.

(v) Incomplete paperwork accompanying the sample will also result in a fee for testing; a thorough description of the situation must be

included with each sample submission.

(vi) DHHS Office of Communicable Diseases staff are available to discuss additional situations that may not warrant testing at (801) 538-

6191.

(d) If the specimen submitter feels they are charged inappropriately for rabies testing, they may send a letter describing the situation and

requesting a waiver for fees to the: Utah Department of Health and Human Services, Office of Communicable Diseases, P.O. Box 142104, Salt Lake

City, UT 84114, attention: Zoonotic Diseases Epidemiologist. Information may be submitted electronically via email to: epi@utah.gov, with a note in

the subject line "Attention: Zoonotic Diseases Epidemiologist."

(i) The specimen submitter has 30 days from receipt of the testing fee invoice to file an appeal. The letter must include copies of the

original paperwork that was submitted, and a copy of the invoice received, for a waiver to be considered.

(ii) DHHS and UPHL have 30 days to review information after receipt of an appeal request to make an official decision and notify the

submitter.

(iii) DHHS Office of Communicable Diseases staff are available to discuss questions about testing fees and the appeal process at (801)

538-6191.

(4) Measures for standardized rabies control practices are as follows:

(a) Humans requiring either pre- or post-exposure rabies prophylaxis shall be treated in accordance with the recommendations of the U.S.

Public Health Service Immunization Practices Advisory Committee, as incorporated by reference in Subsection R386-702-18(2). A copy of the

recommendations shall be made available to licensed medical personnel, upon request to the Office of Communicable Diseases, Utah Department of

Health and Human Services.

(b) A physician or other health care provider that administers rabies vaccine shall immediately report serious systemic neuroparalytic or

anaphylactic reactions to rabies vaccine through the Vaccine Adverse Event Reporting System (VAERS).

(c) The Compendium of Animal Rabies Prevention and Control, as incorporated by reference in Subsection R386-702-18(5), is the

reference document for animal vaccine use.

(d) A county, city, town, or other political subdivision that requires licensure of animals shall also require rabies vaccination as a

prerequisite to obtaining a license.

(e) Animal rabies vaccinations are valid only if performed by or under the direction of a licensed veterinarian in accordance with The

Compendium of Animal Rabies Prevention and Control.

(f) Agencies and veterinarians administering vaccine shall document each vaccination on the National Association of State Public Health

Veterinarians (NASPHV) form number 51, Rabies Vaccination Certificate, that can be obtained from vaccine manufacturers. The agency or

veterinarian shall provide a copy of the report to the animal's owner. Computer-generated forms containing the same information are also acceptable.

(g) Animal rabies vaccines may be sold or otherwise provided only to licensed veterinarians or veterinary biologic supply firms. Animal

rabies vaccine may be purchased by the Utah Department of Health and Human Services and the Utah Department of Agriculture and Food.

(5) Measures to prevent or control rabies outbreaks are as follows:

(a) The most important single factor in preventing human rabies is the maintenance of high levels of immunity in the pet dog, cat, and

ferret populations through vaccination. Vaccination requirements include:

(i) any dog, cat, and ferret in Utah should be immunized against rabies by a licensed veterinarian; and

(ii) local governments should establish effective programs to ensure vaccination of any dogs, cats, and ferrets and to remove strays and

unwanted animals.

(b) If the Utah Department of Health and Human Services determines that a rabies outbreak is present in an area of the state, the Utah

Department of Health and Human Services may require that:

(i) any dog, cat, and ferret in that area and adjacent areas be vaccinated or revaccinated against rabies as appropriate for each animal's age;

(ii) any such animal be kept under the control of its owner at all times until the Utah Department of Health and Human Services declares

the outbreak to be resolved;

(iii) an owner who does not have an animal vaccinated or revaccinated surrender the animal for confinement and possible destruction; and

(iv) such animals found at-large be confined and possibly destroyed.

R386-702-13. Special Measures for 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 the following:

(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 R386-702-13(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 R386-702-13(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 of Communicable Diseases, Utah Department of Health and Human Services using the process

described in Section R386-702-6. 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 R386-702-13(4)(a) or R386-702-13(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-

13(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 of Communicable Diseases, Utah

Department of Health and Human Services. 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 R386-702-13(6).

(4) The local health department shall report typhoid carriers to the Office of Communicable Diseases, 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 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 their representative determine that additional treatment such as cholecystectomy or nephrectomy has

terminated the carrier state; or

(d) the local health officer or their representative determines the carrier no longer presents a risk to public health according to the

evaluation of other factors.

R386-702-14. 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 infants at risk for exposure to N. gonorrhoeae included in the Centers for Disease Control and Prevention

Sexually Transmitted Infections Treatment Guidelines, 2021, incorporated by reference within this rule.

R386-702-15. Special Measures for the Control of HIV/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) Definitions:

(a) "Partner" is defined as 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" is defined as 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" is defined by a reported CD4+ T-Lymphocyte test or HIV viral load determination within three months of HIV

positive diagnosis.

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

(3) 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.

(4) 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.

R386-702-16. Special Measures to Prevent Perinatal and Person-to-Person Transmission of Hepatitis B Infection.

(1) A licensed healthcare 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 healthcare 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 healthcare 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 healthcare 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 the local health department and Utah Department of Health and Human Services Immunization Program at (801) 538-9450.

(6) Local health departments shall perform the following activities or assure that they 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" 32nd Edition. Elk Grove Village, IL, American Academy of Pediatrics; 2021.

(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" 32nd Edition. Elk Grove Village, IL, American

Academy of Pediatrics; 2021.

(d) HBsAg positive mothers are advised regarding how to reduce their 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.

R386-702-17. Public Health Emergency.

(1) Declaration of Emergency: With the Governor's and Executive Director's, or in the absence of the Executive Director, the Executive

Director's designee, concurrence, the Department or a local health department may declare a public health emergency by issuing an order mandating

reporting emergency illnesses or health conditions specified in Section R386-702-3 for a reasonable time.

(2) For purposes of an order issued under this section and during the public health emergency, the following definitions apply.

(a) "Emergency center" means:

(i) a health care facility licensed under Title 26B, Chapter 2, Health Care Facility Licensing and Inspection, that operates an emergency

department; or

(ii) a clinic that provides emergency or urgent health care to an average of 20 or more persons daily.

(b) "Encounter" means an instance of an individual presenting at the emergency center who satisfies the criteria in Subsection R386-702-

3(2).

(c) "Diagnostic information" means an emergency center's records of individuals who present for emergency or urgent treatment, including

the reason for the visit, chief complaint, results of diagnostic tests, presenting diagnosis, and final diagnosis, including diagnostic codes.

(3) The Department shall designate the fewest number of emergency centers as is practicable to obtain the necessary data to respond to the

emergency.

(a) Designated emergency centers shall report using the process described in Section R386-702-6.

(b) An emergency center designated by the Department shall report the encounters to the Department by:

(i) allowing Department representatives or agents, including local health department representatives, to review its diagnostic information

to identify encounters during the previous day;

(ii) reviewing its diagnostic information on encounters during the previous day and reporting all encounters by 9 a.m. the following day;

(iii) identifying encounters and submitting that information electronically to the Department, using a computerized analysis method, and

reporting mechanism and schedule approved by the Department; or

(iv) by other arrangement approved by the Department.

(4) For purposes of epidemiological and statistical analysis, the emergency center shall report on encounters during the public health

emergency that do not meet the definition for a reportable emergency illness or health condition. The report shall be made using the process

described in Section R386-702-6 and shall include the following information for each such encounter:

(a) facility name;

(b) date of visit;

(d) patient's age;

(e) patient's sex; and

(f) patient's zip code for patient's residence.

(5) If either the Department or a local health department collects identifying health information on an individual who is the subject of a

report made mandatory under this section, it shall destroy that identifying information upon the earlier of its determination that the information is no

longer necessary to carry out an investigation under this section or 180 days after the information was collected. However, the Department and local

health departments shall retain identifiable information gathered under other sections of this rule or other legal authority.

(6) Reporting on encounters during the public health emergency does not relieve a reporting entity of its responsibility to report under

other sections of this rule or other legal authority.

R386-702-18. Official References.

Treatment and management of individuals and animals who have or are suspected of having a communicable or infectious disease that

must be reported pursuant to this rule shall comply with the following documents, that are incorporated by reference:

(1) American Public Health Association. "Control of Communicable Diseases Manual." 21st ed., Heymann, David L., editor, 2022;

(2) Centers for Disease Control and Prevention. "Human Rabies Prevention---United States, 2008: Recommendations of the Advisory

Committee on Immunization Practices." Morbidity and Mortality Weekly Report. 57 (RR03) (2008):1-26, 28;

(3) National Association of State Public Health Veterinarians Committee. "Compendium of Animal Rabies Prevention and Control, 2016."

Nasphv.org. National Association of State Public Health Veterinarians, 18 October 2016. Web.

http://nasphv.org/Documents/NASPHVRabiesCompendium.pdf;

(4) American Academy of Pediatrics. "Red Book: 2021-2024 Report of the Committee on Infectious Diseases" 32nd Edition. Elk Grove

Village, IL, American Academy of Pediatrics; 2021; and

(5) National Association of State Public Health Veterinarians Animal Contact Compendium Committee 2017. "Compendium of Measures

to Prevent Disease Associated with Animals in Public Settings, 2017." Journal of the American Veterinary Medicine Association 243 (2017): 1269-

292.]

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: 2026[November 8, 2024]

Notice of Continuation: March 10, 2021

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

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Rule 702: Communicable Disease Rule