BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

 STATE OF MONTANA

 

In the matter of the amendment of ARM 37.114.101, 37.114.105, 37.114.201, 37.114.203, 37.114.204, 37.114.205, 37.114.301, 37.114.312, 37.114.313, 37.114.314, 37.114.315, 37.114.501, 37.114.503, 37.114.512, 37.114.515, 37.114.530, 37.114.531, 37.114.540, 37.114.542, 37.114.546, 37.114.552, 37.114.561, 37.114.563, 37.114.571, and 37.114.583, and the repeal of ARM 37.114.504, 37.114.506, 37.114.507, 37.114.509, 37.114.510, 37.114.514, 37.114.516, 37.114.518, 37.114.519, 37.114.521, 37.114.522, 37.114.524, 37.114.525, 37.114.528, 37.114.533, 37.114.534, 37.114.536, 37.114.537, 37.114.539, 37.114.544, 37.114.548, 37.114.549, 37.114.551, 37.114.554, 37.114.555, 37.114.557, 37.114.558, 37.114.560, 37.114.565, 37.114.566, 37.114.568, 37.114.570, 37.114.573, 37.114.574, 37.114.575, 37.114.577, 37.114.578, 37.114.579, 37.114.581, 37.114.582, 37.114.585, 37.114.588, 37.114.589, 37.114.591, 37.114.592, and 37.114.595, pertaining to communicable disease control

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NOTICE OF AMENDMENT AND REPEAL

 

TO: All Concerned Persons

 

1. On January 17, 2013, the Department of Public Health and Human Services published MAR Notice No. 37-624 pertaining to the public hearing on the proposed amendment and repeal of the above-stated rules at page 14 of the 2013 Montana Administrative Register, Issue Number 1. On April 11, 2013, the Department of Public Health and Human Services published an Amended Notice of Public Hearing on Proposed Amendment at page 518 of the 2013 Montana Administrative Register, Issue Number 7.

 

2. The department has amended ARM 37.114.101, 37.114.105, 37.114.201, 37.114.205, 37.114.301, 37.114.312, 37.114.313, 37.114.314, 37.114.315, 37.114.501, 37.114.503, 37.114.512, 37.114.515, 37.114.530, 37.114.531, 37.114.540, 37.114.542, 37.114.546, 37.114.552, 37.114.561, 37.114.571, and 37.114.583, as proposed.

 

3. The department has amended the following rules as proposed, but with the following changes from the original proposal, new matter underlined, deleted matter interlined:

 

            37.114.203 REPORTABLE DISEASES AND CONDITIONS (1) The following communicable diseases and conditions are reportable:

            (a) AIDS, as defined by the Centers for Disease Control and Prevention, and HIV infection, as determined by a positive result from a test approved by the Federal Food and Drug Administration for the detection of HIV, including, but not limited to, antibody, antigen, and all HIV nucleic acid tests irrespective of result, and CD4 and other tests used to monitor HIV disease;

            (b) through (bp) remain as proposed.

 

AUTH:    50-1-202, 50-17-103, 50-18-105, 50-18-106, MCA

IMP:      50-1-202, 50-2-118, 50-17-103, 50-18-102, 50-18-106, MCA

 

            37.114.204 REPORTS AND REPORT DEADLINES (1) remains as proposed.

            (2) A local health officer must transmit by telephone or secure electronic means to the department the information required by ARM 37.114.205(1) and (2) for each suspected or confirmed case of one of the following diseases, within the time limit noted for each:

            (a) Information about a case of one of the following diseases should be submitted within 24 hours by telephone by the local health officer:

            (i) through (iii) remain as proposed.

            (iv) Influenza-associated hospitalization and mortality, pediatric;

            (v) through (5) remain as proposed.

            (6) A laboratory that performs testing for respiratory syncytial virus (RSV) must submit to the department on a weekly basis, October 1 through June 1, a summary of the total number of RSV-specific antigen direct detection tests performed, the number of positive tests for each type, and the testing method (rapid or molecular testing) used for each specimen result on a form provided by the department.

            (7) A laboratory that performs testing associated with HIV infection must report all test results that confirm HIV infection, all CD4 T-lymphocyte test results with or without confirmed HIV infection unless it is known that the test was performed in association with a disease other than HIV infection, positive p24 antigen assays, HIV nucleic acid viral load tests irrespective of results, positive results for qualitative nucleic acid tests for the detection of HIV infection and all test results for assays designed to assess HIV infection resistance to antiretroviral drugs.

 

AUTH: 50-1-202, 50-17-103, 50-18-105, MCA

IMP:    50-1-202, 50-17-103, 50-18-102, 50-18-106, MCA

 

            37.114.563 PERTUSSIS  (1) remains as proposed.

            (2) An individual identified by the local health officer as a close contact household contact or individual at high risk of severe illness or an individual who has close contact with a person at high risk of severe illness must be referred by the officer to a physician for chemoprophylaxis. Persons at high risk for severe illness include infants under 12 months, pregnant women, or individuals with preexisting health conditions that may be exacerbated by a pertussis infection. Other individuals identified as close contacts may be referred for chemoprophylaxis depending on the circumstances of the case or cases.

            (3) A person An individual identified by the local health officer as a close contact must be monitored by the local health officer for respiratory symptoms for 21 days after the person's last contact with the case.

            (4) If a an individual identified as a close contact shows respiratory symptoms consistent with pertussis, the health officer must order the contact individual to avoid contact with anyone outside of the contact's individual's immediate family until a medical evaluation indicates that the contact individual is not developing pertussis.

            (5) Surveillance for susceptible close contacts must be initiated immediately by the local health officer and immediate immunizations recommended by the officer must be administered to identified susceptible close contacts.

 

AUTH:   50-1-202, 50-2-118, MCA

IMP:      50-1-202, 50-2-118, MCA

 

4. The department has repealed ARM 37.114.504, 37.114.506, 37.114.507, 37.114.509, 37.114.510, 37.114.514, 37.114.516, 37.114.518, 37.114.519, 37.114.521, 37.114.522, 37.114.524, 37.114.525, 37.114.528, 37.114.533, 37.114.534, 37.114.536, 37.114.537, 37.114.539, 37.114.544, 37.114.548, 37.114.549, 37.114.551, 37.114.554, 37.114.555, 37.114.557, 37.114.558, 37.114.560, 37.114.565, 37.114.566, 37.114.568, 37.114.570, 37.114.573, 37.114.574, 37.114.575, 37.114.577, 37.114.578, 37.114.579, 37.114.581, 37.114.582, 37.114.585, 37.114.588, 37.114.589, 37.114.591, 37.114.592, and 37.114.595 as proposed.

 

5. The department has thoroughly considered the comments and testimony received. A summary of the comments received and the department's responses are as follows:

 

COMMENT #1: One commenter recommended that the department add all positive and negative respiratory syncytial virus (RSV) results throughout the year so as to identify the beginning and end of active RSV season.

 

RESPONSE #1: The department agrees with the recommendation and has changed the language in ARM 37.114.204 to incorporate laboratory reporting of RSV.

 

COMMENT #2: A commenter wrote of concerns about the reporting of all CD4 (T-cells) tests as those tests pertain to HIV infection due to the fact that this test is sometimes performed in association with other conditions. The commenter suggested language to address tests utilized in conjunction with HIV infection.

 

RESPONSE #2: The department researched the issue of CD4 and laboratory reporting and addressed the issue by removing the text under ARM 37.114.203(1)(a) and added more specific language under ARM 37.114.204.   This added language allows tests not associated with HIV infection to not be reported and the incorporation of more specific language regarding laboratory reporting as it relates to HIV infection.

 

COMMENT #3: A comment was received regarding the clarity of the use of the words "individual" and "close contact" in the amended language for pertussis control measures.

 

RESPONSE #3: The department agrees with the recommendation and the language under ARM 37.114.563 is being changed to clarify this issue.

 

 

 

/s/ Shannon L. McDonald                          /s/ Richard H. Opper                                   

Shannon L. McDonald                               Richard H. Opper, Director

Rule Reviewer                                             Public Health and Human Services

           

Certified to the Secretary of State May 28, 2013