<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".08-2" citation="COMAR 10.06.01.08-2" title_num="10" subtitle_num="06" chapter_num="01" heading="Cholera (Vibrio cholera O1 or O139).">
  <paragraph num="A.">
    <text>Control of a Case.</text>
    <paragraph num="(1)">
      <text>For a case with diarrhea due to or presumed due to cholera, a health officer shall restrict or exclude a case from:</text>
      <paragraph num="(a)">
        <text>Attending a child care facility; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Participating in an occupation involving;</text>
        <paragraph num="(i)">
          <text>Food handling;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Patient care; or</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Care of young children or the elderly.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>For a case who has been without diarrhea for at least 48 hours, unless a health officer otherwise restricts or excludes the case based on Regulation .06D of this chapter, the case may:</text>
      <paragraph num="(a)">
        <text>Attend a child care facility; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Participate in an occupation involving:</text>
        <paragraph num="(i)">
          <text>Food handling;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Patient care; or</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Care of young children or the elderly.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>If a health officer has restricted or excluded a case under §A(1) of this regulation or Regulation .06D of this chapter, the health officer shall approve resumption of child care attendance or occupational duties when:</text>
      <paragraph num="(a)">
        <text>The case's fecal cultures are Vibrio-free on two consecutive specimens collected:</text>
        <paragraph num="(i)">
          <text>Not less than 24 hours apart; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>If antibiotics have been given, not sooner than 48 hours following discontinuation of antibiotics; or</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>The health officer determines that the likelihood of disease transmission is low.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Control of Contacts at Increased Risk of Transmitting Cholera.</text>
    <paragraph num="(1)">
      <text>A health officer shall restrict or exclude from child care or an occupational setting a contact who has diarrhea, until at least 48 hours after diarrhea ceases, if the contact is in the household of a case or is a close contact who:</text>
      <paragraph num="(a)">
        <text>Attends a child care facility; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Participates in an occupation involving:</text>
        <paragraph num="(i)">
          <text>Food handling;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Patient care; or</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Care of young children or the elderly.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>If an individual is a contact of a case as specified in §B(1) of this regulation, and that individual has diarrhea at the time of the health department's investigation of the case, then the contact shall submit for examination two fecal specimens taken at:</text>
      <paragraph num="(a)">
        <text>Not less than 24 hours apart; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>If antibiotics have been given, not sooner than 48 hours following discontinuation of antibiotics.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>If either of the specimens referred to in §B(2) of this regulation is positive for Vibrio cholera, a health officer shall consider the contact to be a case, and the control measures specified in §A of this regulation apply.</text>
    </paragraph>
  </paragraph>
</regulation>