Town of Stoneham, Massachusetts

Sec. 20_24. Reporting.

(a) Physicians shall report diseases which are deemed “dangerous to the public health.” The list of such reportable diseases shall be as defined by the Department of Public Health of the Commonwealth according to Chapter 111, Section~6, of the General Laws.

Physicians shall report such diseases to the Board of Health of the town where the patient is being attended by him. The Board of Health receiving such report shall send a copy to the Board of Health

1. Of the town where patient resides;

2. Of the town in which patient is known to have contracted the disease;

3. Of the town in which patient is known to have exposed any person to the disease.

(b) The Board of Health receiving notice of any case “dangerous to the public health” shall, within twenty_four hours, notify the Massachusetts Department of Public Health.

1. Name and location (of infected persons);

3. Name of person reporting;

5. Other information required by the Massachusetts Department of Health.

Every Board of Health shall promptly give information to the School Committee regarding “diseases dangerous to the public health.”

Every Board of Health shall appoint some person who shall be responsible for sending notices to the Massachusetts Department of Health regarding diseases dangerous to the public health. To assure continuity of such reporting, an alternate person shall be appointed to make reports during disability or absence of primary appointee.

Sec. 20_25. Definitions and Notes.

Adult. Any person who has reached his eighteenth birthday.

Carrier. A carrier is an infected person who harbors a specific infectious agent in the absence of discernible clinical disease and serves as a potential source of infection for man. The carrier state may occur with infections inapparent throughout their course, commonly known as healthy carriers, and also as a feature of incubation period, convalescence and post-convalescence of a clinically recognizable disease, commonly known as incubatory and convalescent carriers. Under either circumstance the carrier state may be short or long, temporary or chronic carriers. The same applies to vertebrate animals.

Cleaning. The removal from surfaces, by scrubbing and washing, as with hot water, soap or suitable detergent, of infectious agents and of organic matter on which and in which infectious agents may find favorable conditions for prolonging life virulence.

Communicable disease. An illness due to a specific infectious agent or its toxic products, which arises through transmission of that agent or its products from a reservoir to a susceptible host, either directly as from an infected person or animal, or indirectly through the agency of an intermediate plant or animal host, a vector or the inanimate environment.

Communicable period. The time or times during which the infectious agent may be transferred directly or indirectly from an infected person to another person, from an infected animal to man or from an infected man to animal. In diseases such as diphtheria and scarlet fever, in which mucous membranes are involved from the first entry of the pathogen, the period of communicability is from the date of first exposure to a source of infection, until the infecting microorganism is no longer disseminated from the involved mucous membranes. In diseases such as tuberculosis, syphilis and gonorrhea, the communicable state may be at any time over a long and sometimes intermittent period when unhealed lesions of the disease permit the discharge of infectious agents from the surface of the skin or through any of the body orifices. In certain diseases, communicability does not occur during the early incubation period or after full recovery; e.g., measles and chicken pox. In diseases transmitted by arthropods, such as malaria and yellow fever, the periods of communicability are those during which the infectious agent occurs in the blood or other tissues of the infected person in infective form and in sufficient numbers for vector infection. A period of communicability is also to be distinguished for the arthropod vector, namely that time during which the agent is present in the tissues of the arthropod in such form as to be capable of transmitting infection.

Contamination. The presence of an infectious agent on a body surface, also on or in clothes, bedding, toys, surgical instruments or dressings or other inanimate articles or substances including water, milk, and food. Contamination is distinct from pollution which implies the presence of offensive but noninfectious matter in the environment.

Contact. A contact is a person or animal that has been in such association with an infected person or animal or with a contaminated environment as to have had opportunity to acquire the infection. Exposure may be direct and involve physical touching as in kissing, shaking hands, or in sexual intercourse. Persons thus exposed are variously characterized as direct, immediate or intimate contacts. Exposure may be indirect, with no established physical touching, through living in the same household, being in the same room or through remote or close association at school, work, or play. Exposure may be long or short; single, continued or repetitive; and either casual or close. Such indirectly exposed persons are often denoted as either familial, school, or work contacts; or as close, casual or remote contacts, in expression of varying degrees of risk or a developing infection.

Disinfection. Killing of infectious agents outside the body by chemical or physical means directly applied. Concurrent disinfection is the application of a disinfectant as soon as possible after the discharge of infectious material from the body of an infected person, or after the soiling of articles with such infectious discharges, all personal contact with such discharges or articles being prevented prior to such disinfection.

Disinfestation. Any physical or chemical process serving to destroy undesired small animal forms, particularly arthropods or rodents, present upon the person, the clothing, or in the environment of an individual, or on domestic animals. This includes delousing as applied to infestation with pediculus humanus, the body louse.

Food service establishment.

(a) Food. All articles, whether simple, mixed or compound, used or intended to be used for food, drink, confectionery or condiment, by human beings.

(b) Food service establishment. Any fixed or mobile place, structure, or vehicle whether permanent, transient or temporary, including any restaurant, coffee shop, cafeteria, luncheonette, short_order café, grille, tearoom, sandwich shop, soda fountain, tavern, bar, cocktail lounge, night club, roadside stand, industrial feeding establishment, private, public or nonprofit organization or institution routinely serving the public, catering kitchen, commissary or any other similar eating and drinking establishment or place in which food or drink is prepared for sale or for service on the premises or elsewhere or where food is served or provided for the public with or without charge.

(c) Employee of food service establishment. Any person working in a food service establishment who transports food or food containers, who engages in food preparation or service or who comes in contact with any utensils or equipment used in the preparation, storage and serving of food.

Fumigation. Any process by which the killing of animal forms, especially arthropods and rodents, is accomplished by the employment of gaseous agents.

Health education. Health education is the process by which individuals and groups learn to promote, maintain or restore health. It aims at developing in them a sense of responsibility for health conditions as they affect them as individuals, and as members of families and communities. In communicable disease control, it commonly requires assessment of existing habits, attitudes and knowledge of a disease in a population as they relate to spread and frequency of the disease, with implementation of specific means to remedy observed deficiencies.

Infected person. Infected persons include both individuals with manifest disease and those with inapparent infection.

Infection. The entry and development or multiplication of an infectious agent in the body of man or animal. Infection is not synonymous with infectious disease; the result may be inapparent. The presence of living infectious agents on exterior surfaces of the body or upon articles of apparel or soiled articles is not infection but contamination of such articles and surfaces. The term “infection” should not be used to describe conditions of inanimate matter such as soil, water, sewage, milk or food; the term “contamination” applies.

Infectious agent. An organism, mainly microorganisms (bacterium, protozoan, spirochete, fungus, virus, rickettsia, bedsonia or other) but including helminths, capable of producing infection and under favorable circumstances of host and environment having the capacity to produce infectious disease.

Infectious disease. A disease of man or animal resulting from an infection.

Infestation. By infestation of persons and animals is meant the lodgment, development and reproduction of arthropods on the surface of the body or in the clothing. Infested articles or premises are such as harbor or give shelter to animal forms, especially arthropods and rodents.

Insecticide. Any chemical substance used for the destruction of arthropods, whether applied as powder, liquid, atomized liquid, aerosol, or as a paint spray; residual action is usual. The term larvicide is generally used to designate insecticides applied specifically for destruction of immature stages of arthropods; imagocide and adulticide, to designate those applied to destroy mature and adult forms.

Isolation. The separation for the period of communicability of infected persons from other persons, in such places and under such conditions as will prevent the direct or indirect conveyance of the infectious agent from infected persons to persons who are susceptible or who may spread the agent to others. This applies also to animals.

Patient or sick person. A person who is ill; here limited to a person suffering from a recognizable attack of a communicable disease.

Personal hygiene. Those protective measures primarily within the responsibility of the individual, by which to promote health and to limit the spread of infections, mainly those transmitted by direct contact. They include (a)~keeping the body clean by sufficiently frequent soap and water baths; (b)~washing hands in soap and water immediately after voiding bowels or bladder and always before eating; (c)~keeping hands and unclean articles, or articles that have been used for toilet purposes by others, away from the mouth, nose, eyes, ears, genitalia, and wounds; (d)~avoiding the use of common or unclean eating, drinking, or toilet articles of any kind, such as cutlery and crockery, drinking cups, towels, handkerchiefs, combs, hairbrushes, and pipes; (e)~avoiding exposure of other persons to spray from the nose and mouth as in coughing, sneezing, laughing or talking; (f)~washing hands thoroughly after handling the patient or his belongings and wearing a protective overall apron while in the sickroom.

(a) Complete quarantine. The limitation of freedom of movement of such well persons or domestic animals as have been exposed to a communicable disease, for a period of time equal to the longest usual incubation period of the disease, in such manner as to prevent effective contact with those not so exposed.

(b) Modified quarantine. A selective, partial limitation of freedom of movement of persons or domestic animals, commonly on the basis of known or presumed differences in susceptibility, but sometimes because of danger of disease transmission. It may be designed to meet particular situations; examples are exclusion of children from school or exemption of immune persons from provisions required of susceptible persons, such as contacts acting as employees of food serving establishments, or restriction of military populations to the post or to quarters.

Report of disease. Official report is notification to appropriate authority of the occurrence of specified communicable or other disease in man or animals. Diseases in man, except sexually transmitted diseases, are reported to the local Health Department; those in animals to the Division of Livestock Disease Control of the Massachusetts Department of Agriculture. Some few diseases in animals, also transmittable to man, are reportable to both authorities. The sexually transmitted diseases, gonorrhea, syphilis, chancroid, pymphogranuloma venereum, AIDS and granuloma inguinale, should be reported directly to the Massachusetts Department of Public Health on special forms provided on request.

Reservoir of infectious agents. Reservoirs are man, animals, plants, soil or inanimate organic matter, in which an infectious agent lives and multiplies and depends primarily for survival, reproducing itself in such manner that it can be transmitted to a susceptible host. Man himself is the most frequent reservoir of infectious agents pathogenic for man.

School. The Board of Health or school physician may delegate to the school nurse, principal, and/or teacher the responsibility for readmission to school of a child who has been ill with a communicable disease after the designated period of isolation. (Based on Chapter~7, Section 55, of the General Laws of the Commonwealth of Massachusetts.)

Source of infection. The thing, person, object or substance from which an infectious agent passes immediately to a host. Transfer is often direct from reservoir to host in which case the reservoir is also the source of infection (measles). The source may be at any point in the chain of transmission as a vehicle, vector, intermediate animal host, or contaminated article; thus contaminated water (typhoid), an infective mosquito (yellow fever), beef (tapeworm infection) or a toy (diphtheria). In each instance cited, the reservoir is an infected person. Source of infection should be clearly distinguished from source of contamination such as overflow of a septic tank contaminating a water supply or an infected cook contaminating a salad.

Transmission of infectious agents. Modes of transmission of infection are the mechanisms by which an infectious agent is transported from reservoir to susceptible human host. They are:

(1) Direct contact. Actual touching of the infected person or animal or other reservoir of infection.

(2) Indirect contact. Touching of contaminated objects such as toys, handkerchiefs, soiled clothing, bedding, etc.

(3) Droplet spread. The projection onto the eyes and the face or into the nose or mouth of the spray emanating from an infected person during sneezing, coughing, singing or talking. Such droplets usually travel no more than three feet from the source.

(b) Vehicle. Water, food, milk or any substance serving as an intermediate means by which an infectious agent is transported from a reservoir and introduced into a susceptible host through ingestion, through inoculation or by deposit on skin or mucous membrane.

(c) Vector. Arthropods or other invertebrates which transmit infection by inoculation into or through the skin or mucous membrane by biting, or by deposit of infective materials on the skin or on food or other objects.

I. DISEASES REPORTABLE TO LOCAL BOARDS OF HEALTH

Campylobactor Enteritis

Chickenpox (varicella)

Encephalitis (specify type if known)

Foodborne Poisonings

(b) Paralytic shellfish poisoning

Haemophilis influenzae systemic infection (without meningitis)

Hemolytic Uremic Syndrome

(b) Type B (infection,

acute disease or carriage)

.Meningococcal Infection (without meningitis)

Pertussis (Whooping Cough)

Rabies (Human or Animal)

Rocky Mountain Spotted Fever

Salmonellosis (including Typhoid and Paratyphoid Fevers)

Toxic Shock Syndrome

II. DISEASES REPORTABLE DIRECTLY TO THE DEPARTMENT

ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)

SEXUALLY TRANSMITTED DISEASES

Chlamydial Infections (Genital)

Herpes, Neonatal (onset within 30 days after birth)

Lymphogranuloma Venereum

Ophthalmia Neonatorum

Pelvic Inflammatory Disease

Rabies postexposure prophylaxis

III. WORK-RELATED DISEASES AND INJURIES REPORTABLE DIRECTLY TO THE DEPARTMENT

Occupational Lung Disease

(d) Chemical Pneumonitis

(e) Asthma caused by or aggravated by workplace exposures

Work-related Heavy Metal Absorption

(a) Mercury (blood >15ug/1:urine>35 ug/grams creatinine)

(b) cadmium (blood .5 ug/1:urine >5 ug/grams creatinine)

Work-related acute Chemical Poisoning

(a) Carbon Monoxide Poisoning

(b) Pesticide Poisoning

Work-related Carpal Tunnel Syndrome

Work-related Traumatic Injury to a Person less than 18 years of Age

Sec. 20_26. Isolation Regulations.

The Department of Public Health of Massachusetts, acting under the authority of Section 6, Chapter 111 of the General Laws, prescribes and establishes isolation requirements of diseases declared to be dangerous to public health as set out in Appendix A at the end of these Board of Health Regulations.

Any Cases of Illness believed to be due to food consumption shall be immediately reported by telephone to the local Board of Health (105 CMR 300.120).

Any instance of a food handling facility employee who has contracted or become a carrier of a disease transmissible through food shall be immediately reported by telephone to the local Board of Health (105 CMR 300.121).

Any cluster or outbreak of illness shall be reported immediately by telephone to the local Board of Health (105 CMR 300.122). The local Board of Health shall report any cluster or outbreak of illness to the Massachusetts Department of Public Health (105 CMR 300.130).

Any Cluster of Work-related conditions, regardless of whether or not they are on the reportable list, shall be immediately reported by telephone or other electronic means to the MDPH, Occupational Health Surveillance Program (105 CMR 300.141).

*Diseases declared by the Department of Public Health to be dangerous to the Public Health and reportable under authority of G.L. c. 111, sec. 6.