A. The Department will routinely make current
information available to practicing Health Care Providers regarding the
occurrence, prevention, and control of Notifiable Diseases and Conditions. In
addition, the Department will use all reasonable means to:
1. Confirm, in a timely manner, any case or
suspected case of a Notifiable Disease or Condition;
2. Ascertain, so far as possible, all sources
of infection and exposures to the infection;
3. Identify exposures to environmental
hazards;
4. Institute control
measures for Notifiable Diseases and Conditions consistent with the currently
accepted standards as found in the Control of Communicable Diseases
Manual 20th Edition, published in 2015, or
any subsequent edition, which is the official report of the American Public
Health Association, unless specified otherwise by the State Epidemiologist.
Copies of the manual may be obtained from the American Public Health
Association, 800 I Street NW, Washington, DC 20001-3710; and
5. Determine whether isolation and/or
quarantine measures may be necessary.
B.
Scope
The scope and extent of the duties for disease investigation
and intervention may vary depending upon the circumstances of the cases,
falling into one of four broad categories:
1. Routine cases;
2. Non-Compliant Persons;
3. Outbreaks or epidemics; or
4. Extreme Public Health
Emergencies.
C.
Routine Case Investigation and Intervention
1. Providers and Public Health
Health Care Providers must instruct their patients diagnosed
with Notifiable Diseases or Conditions, or who have recently been exposed to
such conditions or diseases, regarding precautions to be taken to prevent
spread of the disease or condition. The Department will make current
information available to practicing health care providers regarding the
prevention and control of Notifiable Conditions or Diseases. The Department
will be available to consult with healthcare providers regarding appropriate
treatment and notification.
2. Interviews
In order to assure rapid and timely implementation of
control measures, including contact notification and referral services, the
Department may interview all persons either treated for or recently exposed to
Notifiable Conditions or Diseases, their health providers, and such other
persons as the Department determines may have relevant information relating to
the onset or contraction of such conditions or diseases. Cases of Notifiable
Diseases or Conditions may require further interview under the following
conditions:
a. Specific public health
disease intervention strategies are required;
b. The case is part of an ongoing cluster or
outbreak of disease or exposure to toxic agents or environmental hazards
investigation; or
c. The
epidemiology of the disease or condition is not clearly understood or defined.
When practical, the Department will contact and inform the
healthcare provider of plans to interview the case in order to foster
communication and collaboration in disease control
efforts.
3.
Interventions
Public health workers will recommend or take actions that
they deem necessary to implement interventions with each case and that are
consistent with currently accepted standards as found for the notifiable
condition or disease in the 20th Edition published
in 2015 of Control of Communicable Diseases Manual, or any
subsequent edition, published by the American Public Health Association, unless
specified otherwise by the State Epidemiologist. Copies of the manual may be
obtained from the American Public Health Association, 800 I Street NW,
Washington, DC 20001-3710.
D.
Non-Compliant Persons and Public
Health Threats
1. Background
Nothing in this rule will be construed to deny persons the
right to rely solely upon exercise of their philosophical, religious or other
personal beliefs, if that reliance is based upon sincere religious or
conscientious objection to standard treatment and/or public health
interventions and if alternative public health measures, even if more
restrictive, are available to address the public health threat posed by the
infectiousness. If such persons endanger the public through their
infectiousness or through their behaviors while infected, the Department may
use public health disease control methods, up to and including involuntary
confinement, isolation and medical treatment, as necessary to protect the
public, as authorized by 22 MRS Ch. 250 and this rule.
2. Investigation
a. The Department begins investigating a
complaint when a complaint is made by any person with sufficient reason and
evidence to believe that another person has either contracted or been exposed
to Notifiable Diseases or Conditions and is engaged in behavior that may
transmit that condition. During such an investigation, the Department will
determine whether it needs to impose any public health control measures.
Anonymous complaints or complaints based only on second-hand information will
be investigated at the Department's discretion. A report made by a Health Care
Provider or other reporter of a Non-Compliant Person or a Public Health Threat
may be considered a complaint.
b.
Upon the initiation of an investigation of a valid complaint, the Department
will document the following reported information in the investigative record:
i. Contact information for the individual
making the complaint, as provided by the reporter;
ii. Name, contact and locating information
for the alleged Non-Compliant Person against whom the complaint is made;
and
iii. Specific allegations of
the non-compliant behavior.
c. Investigations will be conducted in a
systematic fashion utilizing appropriate public health workers with expertise
in the Notifiable Disease or Condition. Investigations will be conducted under
the direction of the Department and concluded within 15 business days of the
complaint being received.
d. Each
investigation will establish and document whether the alleged non-compliant
person is infected with the Notifiable Disease or Condition and whether the
alleged Non-Compliant Person is engaging in behavior that exposes others to
infection with the Notifiable Disease or Condition. If the public health worker
is unable to establish that the person is infected or that the alleged behavior
exposing others to infection is occurring, the investigation must cease
immediately.
e. If there is
credible evidence to substantiate the allegation of non-compliance, the
Department must make all reasonable attempts to locate the subject of the
complaint to conduct a personal interview to assess the individual's current
understanding of the exposure to infection with the Notifiable Disease or
Condition, its treatment, and the behaviors that are placing others at risk of
infection. The interview must establish and document whether the person:
i. Knows that (s)he is infected or has been
exposed;
ii. Has received
appropriate education and counseling about the infection or exposure;
iii. Understands the modes of transmission of
the Notifiable Disease or Condition and methods to prevent transmission; and
iv. Is engaging in non-compliant
behavior or is a Public Health Threat.
The complete documentation of the investigation, findings and
recommendations will be submitted electronically to the
Department.
3. Treatment
a. Temporary custody and treatment of those
persons who have either contracted or been exposed to a Notifiable Disease or
Condition and who pose an immediate Public Health Threat may be imposed by a
court on an involuntary basis pursuant to
22
MRS§§810 -
812, in the event such persons
refuse appropriate countermeasures or public health interventions, as indicated
above in Section 9(C), paragraph 3 or conduct themselves in a manner which
constitutes a Public Health Threat. For the purpose of this subsection, persons
who have either contracted or been exposed to Notifiable Diseases and
Conditions who knowingly expose others to the danger thereof, pose a Public
Health Threat and are considered to be non-compliant.
b. The Commissioner or the Commissioner's
designee may initiate judicial proceedings to seek an order that a
Non-Compliant Person submit to involuntary medical treatment and other control
measures to protect the public health, in accordance with 22 MRS chapter 250,
subchapter 2.
c. Treatment must be
in accord with the most current treatment recommendations and standards of care
for the Notifiable Disease or Condition, as advised by U.S. CDC and infectious
disease providers. In imposing treatment and related public health disease
control measures on an individual, the least restrictive measures will be
utilized to ensure effective medical treatment of the disease or condition and
to limit the spread of the Notifiable Disease or Condition or other infectious
disease, which pose a threat to public health. The Department will adopt
medical treatment and public health disease control strategies, as described in
Section 9(D) of this rule whenever practical and as long as doing so does not
unreasonably increase the threat to the public health.
4. Other Interventions
a. For each investigation that substantiates
a case of non-compliance, or a Public Health Threat, and where recommendations
approved by the Department do not resolve the case or threat, the Department
will establish a Standing Committee that is chaired by the Department's
designee for the coordination of public health control measures responsive to
the situation. The Standing Committee will include as many as possible of the
following professionals:
i. The person's
health care provider;
ii.
Professional staff from other health or social service agencies serving the
Non-Compliant Person;
iii. The
Director of the Maine CDC or designee;
iv. The appropriate Maine CDC Associate
Division Director;
v. The public
health worker investigating the case;
vi. The State Epidemiologist or designee; and
vii. The Department program manager
with expertise in the particular Notifiable Disease or Condition.
The Standing Committee will be represented by and may seek
legal advice from a representative of the Office of the Attorney
General.
b. These
interventions which may be imposed include, but are not limited to:
i. Face-to-face counseling by a public health
educator, epidemiologist, public health nurse, disease intervention specialist
or other public health professional regarding the infected individual's
notifiable disease or condition, its cause and treatment and the necessity for
disease control measures.
ii.
Recommended measures individualized into a documented plan for the infected
individual, including such supported services as:
* Direct observation of the individual taking required
medications on a daily basis;
* Transportation to treatment facilities;
* Individual or group supportive counseling or therapy;
and
* Financial support for shelter and food for the duration of
medical treatment.
iii. A
Cease and Desist Order, signed by the Commissioner, directing the infected
individual to comply with medical treatment and specifying public health
disease control measures to be followed.
* Upon receipt of information that the Department's Cease and
Desist Order has been violated, the Department may contact the Office of the
Attorney General to pursue a civil fine and/or injunctive relief pursuant to
22 MRS
§804(2), or civil
commitment or other relief under
22 MRS,
§§810 or
812, to enforce the Cease and
Desist Order being violated.
iv. The Standing Committee may, at its
discretion, not issue a Department Cease and Desist Order and instead directly
request the Office of the Attorney General to pursue a court order pursuant to
22 MRS Ch 250.
In taking the step of seeking court-ordered confinement,
isolation, quarantine and treatment, the Standing Committee should minimally
base its actions on one or both of the following factors:
* Whether, based on laboratory tests or clinical signs and
symptoms, the individual has a great likelihood of active disease that is
extremely contagious; or
* The risk of infecting others, taking into consideration the
individual's housing and employment
situation.
E.
Investigation and Intervention of
Outbreaks or Epidemics
1. Control
Measures In the event of an outbreak or epidemic of a notifiable disease or
condition or of a potential epidemic, the Department will institute public
health disease control measures consistent with national standards as published
in the 20th Edition published in 2015
Control of Communicable Diseases Manual, or any subsequent
edition, published by the American Public Health Association. Copies of the
manual may be obtained from the American Public Health Association, 800 I
Street NW, Washington, DC 20001-3710.
2. Common Source of an Outbreak or Epidemic
In accordance with
22 MRS
§2159 and the Maine Food Code at 10-144
CMR Ch. 200, §8-702, any public or private enterprise, utility, lodging
area, food market, or other entity which provides food or water which has been
determined by either laboratory or epidemiological methods to be a source or
likely source of outbreak or epidemic may be ordered by the Department to end
the use or distribution of said food or water until the source of contamination
is found and corrected and the food or water has been proven safe for
consumption.
3. Vaccine-Preventable
Outbreaks or Epidemics
a. The Department may
offer immunization, including mass immunization clinics, to the public for
protection in case of an Epidemic or threatened Epidemic, as ordered by the
Commissioner, pursuant to
22 MRS
§§1061 -
1063.
b. In the event of an Outbreak, an Epidemic,
or a single case of, and potential, Epidemic, due to a vaccine-preventable
disease in a child care facility or a school, the Department may recommend that
the superintendent of that district or the administrator of the child care
facility exclude all children from school or the center who have not already
experienced the illness or who are not immunized against the epidemic disease.
If an Epidemic of a vaccine-preventable disease in a child-care center or
school district continues in spite of exclusion of unimmunized children, or if
such exclusion is not possible, the Department has the discretion to exclude
any susceptible pupils, as authorized in
22 MRS
§806.
