<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".19" citation="COMAR 10.06.01.19" title_num="10" subtitle_num="06" chapter_num="01" heading="Shigellosis.">
  <paragraph num="A.">
    <text>Control of a Case.</text>
    <paragraph num="(1)">
      <text>A case may not attend a child care facility until:</text>
      <paragraph num="(a)">
        <text>The case's fecal cultures are Shigella-free on two consecutive specimens collected not less than 24 hours apart and not sooner than 48 hours following discontinuation of antibiotics, if antibiotics have been given; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A health officer approves readmission based on the low likelihood of disease transmission.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>A case, with or without diarrhea, may not participate in occupations involving food handling, patient care, or care of young children or the elderly until:</text>
      <paragraph num="(a)">
        <text>The case's fecal cultures are Shigella-free on two consecutive specimens collected not less than 24 hours apart and not sooner than 48 hours following discontinuation of antibiotics, if antibiotics have been given; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A health officer approves resumption of occupational duties based on the low likelihood of disease transmission.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Control of Contacts.</text>
    <paragraph num="(1)">
      <text>A health officer shall require a culture of feces only from a household member or close contact who:</text>
      <paragraph num="(a)">
        <text>Attends a child care facility; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Whose occupation involves:</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>A contact shall submit for examination two fecal specimens taken at an interval of not less than 24 hours apart.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>If either of the specimens collected under §B(2) of this regulation is positive for Shigella, the health officer shall consider the contact to be a case, and the control measures specified in §A of this regulation shall apply.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Infection Control. A health care provider shall practice standard precautions.</text>
  </paragraph>
</regulation>