[30 Pa.B. 2715]
[Continued from previous Web Page] § 27.96. Diagnostic tests for [venereal] sexually transmitted diseases.
[Section 14 of the act (35 P. S. § 521.14) provides that a standard or approved test procedure for each of the venereal diseases]
(a) When testing for a sexually transmitted disease is required by the act or this chapter, the test used shall be a test approved by the [Department] Food and Drug Administration, and if a laboratory test is part of the approved procedure, it shall be [made] conducted in a clinical laboratory approved by the Department to [make] perform the [tests] test.
(b) The diagnostic tests that have been approved to test for each sexually transmitted disease may be ascertained by contacting the Division of Clinical Microbiology, Bureau of Laboratories.
§ 27.97. Treatment of minors.
[Section 14a of the act (35 P. S. § 521.14a) provides that a] A person under the age of 21 [infected with a venereal disease may be given appropriate treatment by a physician] may give consent for medical and other health services to determine the presence of or to treat a sexually transmitted disease and any other reportable disease, infection or condition. If the minor consents to undergo diagnosis or treatment, approval or consent of [his parents or persons in loco parentis may not be] another person is not necessary[, and the]. The physician may not be sued or held liable for [properly] implementing appropriate diagnostic measures or administering appropriate treatment to the minor if the minor has consented to the procedures or treatment.
§ 27.98. Prophylactic treatment of newborns.
Physicians and midwives attending women in childbirth shall instill in each eye of the newborn child, as soon as practicable after birth, either a 1% silver nitrate solution, [or tetracycline ophthalmic ointment or solution,] or erythromycin ophthalmic ointment or solution as a single application in both conjunctival sacs, or appropriate medication approved by the Department. If the parent or guardian of the newborn child objects on the ground that the prophylactic treatment conflicts with the parent's or guardian's religious beliefs or practices, prophylactic treatment shall be withheld[; and an] An entry in the child's hospital record indicating the reason for withholding treatment shall be made and signed by the attending physician and the parent or guardian.
§ 27.99. Prenatal examination for hepatitis B.
(a) A physician who attends, treats or examines a pregnant woman for conditions relating to pregnancy during the period of gestation or delivery, shall inform the woman that he intends to take or cause to be taken, unless the woman objects, a sample of her blood at the time of the first examination (including the initial visit when a pregnancy test is positive) or within 15 days thereafter, but no later than the time of delivery, and shall submit the sample to a clinical laboratory approved by the Department to conduct immunologic testing.
(b) When a pregnant woman tests positive for hepatitis B surface antigen, a physician shall provide the appropriate prophylaxis treatment to the newborn within 12 hours after birth. If the parent or guardian of the newborn child objects on the ground that the prophylactic treatment conflicts with the parent's or guardian's religious beliefs or practices, prophylactic treatment shall be withheld, and an entry in the child's hospital record indicating the reason for withholding treatment shall be made and signed by the attending physician and the parent or guardian.
Subchapter E. [PROCEDURE FOR TREATING EACH REPORTABLE DISEASE] SELECTED PROCEDURES FOR PREVENTING DISEASE TRANSMISSION (Editor's Note: The Department is proposing to delete §§ 27.101--27.146 as they currently appear in the Pennsylvania Code at pages 27-29--27-50 (serial pages (243681)--(243702)). The following sections are being printed in regular type to enhance readability.)
§ 27.151. Restrictions on the donation of blood, blood products, tissue, sperm and ova.
(a) A person known to be infected with the causative agent of a reportable disease is not allowed to donate blood, blood products, tissue, sperm or ova for use in other human beings.
(1) In addition, a person or entity may not accept any of these materials for donation without obtaining laboratory evidence showing the absence of hepatitis B, hepatitis C, HIV or other diseases and infections, which the Department may specify by placing a notice in the Pennsylvania Bulletin.
(2) The list of additional diseases and conditions will not remain in effect for more than 90 days after publication unless the Board acts to affirm it within that 90-day period.
(b) The only exception to a person or entity accepting donations without obtaining laboratory evidence showing the absence of diseases and infections designated by the Department is when the delay that would be necessary to properly test the blood of the donor would threaten the recipient's survival.
§ 27.152. Investigation of cases and outbreaks.
(a) The Department or a local health authority may investigate any case or outbreak of disease judged by the Department or local health authority to be a potential threat to the public health.
(b) A person may not interfere with or obstruct a representative of the Department or a local health authority who seeks to enter a house, health care facility, building or other premises to carry out an investigation of a case or outbreak, if the representative presents documentation to establish that he is an authorized representative of the Department or the local health authority.
(c) In the course of conducting an investigation of a case or outbreak, the authorized representative of the Department or local health authority may conduct a confidential review of medical records. A person may not interfere with or obstruct this review.
§ 27.153. Restrictions on food handlers.
A person with the following diseases or conditions is not permitted to work as a food handler. See, also, 3 Pa.C.S. Chapter 65 (relating to the Food Employee Certification Act) and 7 Pa. Code §§ 78.41--78.43 (relating to health and disease control of employes)) except as follows:
(1) Amebiasis. Until the etiologic organism is eradicated as proven by two consecutive negative stool specimens, obtained at least 24 hours apart, as verified by a physician. If antiparasitic treatment has been given, the specimens may not be collected sooner than 48 hours after treatment was completed. See § 27.156 (relating to special requirements for amebiasis).
(2) Enterohemorrhagic E. coli. Until the etiologic organism is eradicated as proven by two consecutive negative stool specimens, obtained at least 24 hours apart, as verified by a physician. If antibacterial treatment has been given, the specimens may not be collected sooner than 48 hours after treatment was completed. See § 27.157 (relating to special requirements for enterohemorrhagic E. coli).
(3) Shigellosis. Until the etiologic organism is eradicated as proven by two consecutive negative stool specimens, obtained at least 24 hours apart, as verified by a physician. If antibacterial treatment has been given, the specimens may not be collected sooner than 48 hours after treatment was completed. See § 27.158 (relating to special requirements for shigellosis).
(4) Typhoid fever or paratyphoid fever. Until the etiologic organism has been eradicated as proven by three negative successive stool specimens collected at intervals of no less than 24 hours nor earlier than 48 hours after receiving the last dose of a chemotherapeutic drug effective against Salmonella typhi, and no earlier than 1 month after onset. See § 27.159 (relating to special requirements for typhoid and paratyphoid fever).
(5) Hepatitis A, viral hepatitis or jaundice of unspecified etiology. Until 1 week following the onset of jaundice, or 2 weeks following symptom onset or IgM antibody positivity if jaundice is not present, as verified by a physician.
(6) Diarrhea. Until resolved or judged to be noninfective by a physician.
§ 27.154. Restrictions on caregivers in a child care group setting.
A person with the following diseases or conditions is not permitted to work as a care giver in a child care group setting if the caregiver attends or works in a capacity which requires direct contact with children except as follows:
(1) Amebiasis. Until the etiologic organism is eradicated as proven by two consecutive negative stool specimens, obtained at least 24 hours apart, as verified by a physician. If antibacterial treatment has been given the specimens may not be collected sooner than 48 hours after treatment was completed. See § 27.156 (relating to special requirements for amebiasis).
(2) Enterohemorrhagic E. coli. Until the etiologic organism is eradicated as proven by two consecutive negative stool specimens, obtained at least 24 hours apart, as verified by a physician. If antibacterial treatment has been given, the specimens may not be collected sooner than 48 hours after treatment was completed. See § 27.157 (relating to special requirements for enterohemorrhagic E. coli).
(3) Shigellosis. Until the etiologic organism is eradicated as proven by two consecutive negative stool specimens, obtained at least 24 hours apart, as verified by a physician. If antibacterial treatment has been given the specimens may not be collected sooner than 48 hours after treatment was completed. See § 27.161 (relating to special requirements for shigellosis).
(4) Typhoid fever or paratyphoid fever. Until the etiologic organism is eradicated as proven by three negative successive stool specimens collected at intervals of no less than 24 hours nor earlier than 48 hours after receiving the last dose of a chemotherapeutic drug effective against Salmonella typhi, and no earlier than 1 month after onset. See § 27.159 (relating to special requirements for typhoid and paratyphoid fever).
(5) Hepatitis A, viral hepatitis or jaundice of unspecified etiology. Until 1 week following the onset of jaundice, or 2 weeks following symptom onset or IgM antibody positivity if jaundice is not present, as verified by a physician.
(6) Diarrhea. Until resolved or judged to be noninfective by a physician.
§ 27.155. Restrictions on health care practitioners.
Persons with the following diseases or conditions are not permitted to work as health care practitioners who provide direct patient care:
(1) Amebiasis. Until the etiologic organism is eradicated as proven by two consecutive negative stool specimens, obtained at least 24 hours apart, as verified by a physician. If antiparasitic treatment has been given, the specimens may not be collected sooner than 48 hours after treatment was completed. See § 27.156 (relating to special requirements for amebiasis).
(2) Enterohemorrhagic E. coli. Until the etiologic organism is eradicated as proven by two consecutive negative stool specimens, obtained at least 24 hours apart, as verified by a physician. If antibacterial treatment has been given, the specimens may not be collected sooner than 48 hours after treatment was completed. See § 27.157 (relating to special requirements for enterohemorrhagic E. coli).
(3) Shigellosis. Until the etiologic organism is eradicated as proven by two consecutive negative stool specimens, obtained at least 24 hours apart, as verified by a physician. If antibacterial treatment has been given, the specimens may not be collected sooner than 48 hours after treatment was completed. See § 27.158 (relating to special requirements for shigellosis).
(4) Typhoid fever or paratyphoid fever. Until the etiologic organism is eradicated as proven by three negative successive stool specimens collected at intervals of no less than 24 hours nor earlier than 48 hours after receiving the last dose of a chemotherapeutic drug effective against Salmonella typhi, and no earlier than 1 month after onset. See § 27.159 (relating to special requirements for typhoid or paratyphoid fever).
(5) Hepatitis A, viral hepatitis or jaundice of unspecified etiology. Until 1 week following the onset of jaundice, or 2 weeks following symptom onset or IgM antibody positivity if jaundice is not present, as verified by a physician.
(6) Diarrhea. Until resolved or judged to be noninfective by a physician.
§ 27.156. Special requirements for amebiasis.
A household contact of a case of amebiasis who prepares or serves food for public consumption, who attends or works in a child care group setting in a capacity which requires contact with children, or who provides direct patient care shall be required to cease work until the contact has submitted two consecutive stool specimens, taken at least 24 hours apart and at least 48 hours after the last dose of any antiparasitic therapy, to an appropriate clinical laboratory for bacteriologic examination and those specimens are determined by the laboratory to be negative for Entamoeba histolytica.
§ 27.157. Special requirements for enterohemorrhagic E. coli.
A household contact of a case of enterohemorrhagic E. coli, who prepares or serves food for public consumption, who attends or works in a child care group setting in a capacity which requires contact with children, or who provides direct patient care shall be required to cease work until the contact has submitted two consecutive stool specimens, taken at least 24 hours apart and at least 48 hours after the last dose of any antimicrobial therapy, to an appropriate clinical laboratory for bacteriologic examination and those specimens are determined by the laboratory to be negative for enterohemorrhagic E. coli.
§ 27.158. Special requirements for shigellosis.
A household contact of a case of shigellosis, who prepares or serves food for public consumption, who attends or works in a child care group setting in a capacity which requires contact with children, or who provides direct patient care shall be required to cease work until the contact has submitted two consecutive stool specimens, taken at least 24 hours apart and at least 48 hours after the last dose of any antimicrobial therapy, to an appropriate clinical laboratory for bacteriologic examination and the specimens are determined by the laboratory to be negative for shigella.
§ 27.159. Special requirements for typhoid and paratyphoid fever.
(a) An asymptomatic household contact of a case of typhoid fever or paratyphoid fever who prepares or serves food for public consumption, who attends or works in a child care group setting in a capacity which requires contact with children, or who provides direct patient care shall be required to cease work until the contact has submitted two stool specimens, taken at least 24 hours apart, to an appropriate clinical laboratory for bacteriologic examination and those specimens are determined by the laboratory to be negative for Salmonella typhi or Salmonella paratyphi.
(b) A symptomatic household contact of a case of typhoid or paratyphoid fever who prepares or serves food for public consumption, who attends or works in a child care group setting in a capacity which involves contact with children, or who provides direct patient care shall be required to cease work until bacteriologic examination of three consecutive stool specimens, taken at least 24 hours apart and no sooner than 48 hours after any microbial therapy, and no earlier than 1 month after onset, are reported as negative.
(c) A chronic carrier of typhoid or paratyphoid fever shall be excluded from preparing or serving food for public consumption, attending or working in a child care group setting in a capacity which involves contact with children, and providing direct patient care, until three consecutive negative fecal cultures are obtained from specimens taken at least 1 month apart and at least 48 hours after antibiotic therapy has stopped.
§ 27.160. Special requirements for measles.
(a) Isolation. An infected person shall be restricted to the premises for 4 days after the appearance of the rash.
(b) Quarantine. Whenever measles is determined to be present in a school or child care group setting population, the Department or a local health department may do the following:
(1) Ascertain which children and staff persons are presumed susceptibles. A presumed susceptible is a person who fits into all of the following categories:
(i) Presents no history of two doses of measles vaccination, separated by at least 1 month, while 12 months of age or older.
(ii) Does not demonstrate serological evidence of measles immunity. The serological evidence is the presence of antibody to measles determined by the hemagglutination inhibition test or a comparable test.
(iii) Was born after December 31, 1956.
(2) Order exclusion from the school or child care group setting of presumed susceptible children and staff persons who do not present evidence of having received measles vaccination within 30 days prior to the outbreak. Exclusion shall continue until the excluded persons prove they do not meet the exclusion criteria specified in subsection (b)(1), they receive a measles vaccination, or no case of measles has occurred for a 14-day period.
§ 27.161. Special requirements for tuberculosis.
(a) Isolation. A person suspected of having tuberculosis in its communicable stage shall be isolated in the following manner:
(1) Isolation for tuberculosis shall be established at the usual residence of the person suffering from tuberculosis whenever facilities for adequate isolation of the infectious person are available at the residence, if the person will accept the isolation. Isolation of a person treated at a residence shall include instruction in the need to cover the mouth and nose when coughing and sneezing, and careful handling and disposal of sputum.
(2) If isolation for tuberculosis cannot be accomplished or maintained at the usual residence of the person and whenever, in the opinion of the Department or local health authority, the person is a health threat to others, by reason of the person's habits, neglect of treatment or noncompliance with the measures designed to protect others from infection, the isolation shall be enforced by following the procedures in § 27.87 (relating to refusal to submit to treatment for communicable disease).
(i) Isolation of a person treated in an appropriate institution shall be in accordance with CDC Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health-Care Facilities and any updates thereto as approved by the Board.
(ii) The Department will publish notice in the Pennsylvania Bulletin of updates of this publication within 30 days after Board approval is obtained.
(b) Handling of contacts. A human household contact or other close human contact shall be required to have a Mantoux tuberculin test or chest X-ray, or both. A close human contact means a person who spends a substantial amount of time with a person who has infectious tuberculosis. If the person refuses, enforcement shall be accomplished as designated in §§ 27.82 and 27.83 (relating to refusal to submit to examination; and court ordered examinations). If evidence of tuberculosis in contacts is found on chest X-rays or by symptoms, laboratory studies shall be conducted to determine if the contacts represent a public health threat.
§ 27.162. Special requirements for animal bites.
Except as may be otherwise required by the Dog Law (3 P. S. §§ 459-101--459-1205) and regulations promulgated by the Department of Agriculture thereunder, quarantine of a biting animal shall conform to the following:
(1) When an animal bites or otherwise potentially exposes a human to rabies, the Department or local health authority shall, after the case of an animal bite is reported, determine whether the animal shall be immediately destroyed and its head submitted to one of the State or county diagnostic laboratories for a rabies examination or whether some other action shall be pursued.
(2) Notwithstanding paragraph (1), when a healthy dog or cat bites or otherwise potentially exposes a human to rabies, the dog or cat shall be quarantined in a place and manner approved by the Department or the local health officer for 10 days after the date of the bite, unless the Department or local health officer directs otherwise.
(3) If a quarantine is imposed, the Department or the local health officer may order the owner or custodian of a biting animal to have the animal examined for symptoms of rabies during the quarantine period by a veterinarian licensed by the State Board of Veterinary Medicine. The cost of the examinations and other associated costs shall be borne by the owner or custodian of the biting animal.
§ 27.163. Special requirements for psittacosis.
A quarantine is not required for household contacts of a bird that is a carrier of psittacosis. However, parts of any buildings that housed birds infected with psittacosis may not be used by human beings until thoroughly cleaned and disinfected.
§ 27.164. Special requirements for close contacts of cases of plague, pharyngitis or pneumonia.
A close contact of any person or animal that is diagnosed as having plague (Yersinia pestis) pharyngitis, or pneumonia shall be provided chemoprophylaxis and placed under surveillance for 7 days.
Subchapter F. MISCELLANEOUS PROVISIONS
PSITTACOSIS § 27.181. Records of the sale, purchase or exchange of psittacine birds.
[Dealers] A dealer who [purchase, sell, exchange or give] purchases, sells, exchanges or gives away a bird of the psittacine family shall keep a record for a period of 2 years of each transaction. This record shall include the number of birds purchased, sold, exchanged or given away, the date of the transaction, and the name and address of the person from whom purchased, to whom sold or given away, or with whom exchanged. Records shall be available for official inspection.
§ 27.183. Occurrence of psittacosis.
(a) The occurrence of a case of psittacosis in the human or avian family shall be cause for the [health authorities of competent jurisdiction] LMRO to make an epidemiologic investigation to determine the source of infection.
(b) Psittacine birds or other birds found on the same premises with a case of human or avian psittacosis shall be quarantined and treated, or destroyed, as prescribed by the [health authorities] Department or localhealth authority. Aviaries, pet shops or other sources from which the birds were procured shall be quarantined until [it can be determined that psittacosis does not exist] the quarantine is terminated by the Department or local health authority. If quarantine is not maintained, the [health authorities] Department or local health authority may seize and destroy the [bird or] birds for which quarantine was ordered. [Bodies] The Department or local health authority shall destroy the bodies of the birds [so destroyed shall be disposed of] in a manner which will preclude, insofar as possible, the dissemination of the suspected infecting organism.
§ 27.184. [Violation of regulations] (Reserved).
[The act provides that inspection and prosecution for violation of §§ 27.181--27.183 (relating to psittacosis) may be made or brought by an agent of the health authorities or agent of an agency authorized by the Department to investigate and prosecute the violations. The investigation or prosecution shall be under of the act.]
IMPORTATION OF [LIVE WILD RABBITS, HARES OR RODENTS, AND IMPORTATION AND SALE OF LIVE TURTLES] ANIMALS AND ANIMAL PRODUCTS § 27.191. Importation of [live wild rabbits, hares or rodents] animals and animal products during a public health emergency.
In the event of a public health emergency, the [Secretary] Department may direct the following procedures for the importation of [wild rabbits, hares or rodents] animals or animal products:
(1) Permit required. [No person, organization or corporation may bring, cause to] The Department may designate a specific type of animal or animal product which may not be brought or [transport a live wild rabbit, hare or rodent] transported into this Commonwealth unless [the] that animal or animal product is accompanied by a permit issued by the Department or other agency authorized by the Department to issue permits.
(2) Issuance of permits. A permit will be issued upon request if the source of the animal or animal product is [submitted] established to the satisfaction of the Department or its agent and that source is known to be free of infection.
(3) Destruction of animals and animal products. If the animal or animal product is not accompanied by a permit or if the source [of the animal] is not the same as that set forth in the permit, the animal or animal product shall be immediately seized and destroyed and the means of conveyance disinfected at the expense of the owner.
[(4) Violations. The act provides that prosecutions may be initiated by the Department, by alocal board or department of health or by a person having knowledge of a violation the act or this chapter.]
§ 27.192. Importation and sale of live turtles.
[No] A live [turtles] turtle may not be sold or distributed or offered for sale or distribution within this Commonwealth [on or after July 1, 1972,] except [where] when the seller or distributor of the turtles shall warrant to the satisfaction of the Department that the shipment of turtles is free from salmonella [and Arizona] contamination. The Department [in its discretion,] may waive the requirements of this section for live turtles sold or distributed within this Commonwealth for the purposes of research, other zoological purposes or for food.
DISPOSITION OF EFFECTS AND REMAINS OF INFECTED PERSONS § 27.201. Disposition of articles exposed to contamination.
[No] A person may not give, lend, sell, transmit or expose, without previous cleaning and a certificate from the [health authorities] Department or local health authority attesting to the cleaning of bedding, clothing, rags or other articles which have been exposed to contamination from bubonic plague, [smallpox (variola, varioloid)] or anthrax, except [where] when the transmission of the articles is made with proper precaution and with the permission of the [health authorities] Department or local health authority for the purpose of having them cleaned.
§ 27.202. Lease of premises occupied by a person with a communicable disease.
[No] A person may not rent a room, house or part of a house in which there has been a person suffering from a communicable disease to another person without having the room, house or part of a house and articles therein[, previously] cleaned [to the satisfaction of the health authorities] prior to occupancy. The keeping of a hotel, boarding house or an apartment house shall be deemed as renting part of a house to a person who shall be admitted as a guest into the hotel, boarding house or apartment house.
§ 27.203. Preparation for burial or transportation of deceased human bodies.
[In the preparation for burial of a body of a person who had died of amebiasis, anthrax, cholera, diphtheria, plague, poliomyelitis, scarlet fever, shigellosis, smallpox, typhoid fever, paratyphoid fever, salmonellosis or other known or suspected communicable diseases, it shall be the duty of the undertaker or person acting as such to disinfect thoroughly by arterial and cavity injection with approved disinfectant fluid and to wash the surface of the body with an efficient germicidal solution and to effectually plug the body orifices.] When handling deceased human bodies, appropriate precautions shall be taken to prevent the spread of communicable diseases.
§ 27.204. Funeral services.
Services held in connection with the funeral of a person who has died with a disease for which isolation or quarantine is required, [or from measles or whooping cough, may be public but] shall be private when so ordered by the [health authorities of the jurisdiction] Department or local health authority having jurisdiction in the area in which the services shall be held. When the local health authority is not an LMRO, the local health authority shall consult with and receive the approval of the Department prior to making the order. The attendance at private funerals shall include only the immediate relatives of the deceased and the necessary number of pallbearers.
§ 27.205. [Private transportation of human bodies] (Reserved).
[The body of a person who has died of amebiasis, anthrax, cholera, diphtheria, plague, shigellosis, smallpox, hemolytic streptococcal sore throat, typhoid fever, paratyphoid fever or other salmonella infections may be transported by private conveyance if the body is placed in a leak-proof container or is embalmed and the surface of the body washed with an efficient germicidal solution and the body orifices effectually plugged.]
[Pa.B. Doc. No. 00-930. Filed for public inspection May 26, 2000, 9:00 a.m.]
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