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<regulation prefix="Regulation" num=".21" citation="COMAR 10.06.01.21" title_num="10" subtitle_num="06" chapter_num="01" heading="Typhoid Fever (Salmonella Typhi) and Paratyphoid Fever (Salmonella Paratyphi A, Salmonella Paratyphi B tartrate negative, and Salmonella Paratyphi C).">
  <paragraph num="A.">
    <text>Control of a Case.</text>
    <paragraph num="(1)">
      <text>A case may not attend a child care facility until fecal specimens are Salmonella-free on three consecutive specimens collected not less than 24 hours apart and not sooner than 48 hours following discontinuation of antibiotics, or until a health officer approves readmission based on the low likelihood of transmission.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A case may not participate in occupations involving food handling, patient care, or care of young children or the elderly until fecal specimens are Salmonella-free on three consecutive specimens collected not less than 24 hours apart, and not sooner than 48 hours after discontinuation of antibiotics.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>A health officer shall supervise a case and release a case from supervision only after fecal specimens are culture negative for Salmonella Typhi or Paratyphi on three consecutive specimens collected not:</text>
      <paragraph num="(a)">
        <text>Less than 24 hours apart;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Sooner than 48 hours following discontinuation of antibiotics; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Earlier than 1 month after onset or date of first positive culture if asymptomatic.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>If any one of the specimens required in §A(3) of this regulation is positive, at least three consecutive negative cultures of feces at intervals of 1 month within the 12 months following onset shall be required for release from supervision.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>If a person continues to excrete Salmonella Typhi or Paratyphi at 12 months, the requirements of §D of this regulation apply.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Control of Contacts of a Case. Household, sexual, and other close contacts of a case may not attend a child care facility or participate in occupations involving food handling, patient care, or care of young children or the elderly until two consecutive cultures of feces taken at least 24 hours apart are negative for Salmonella Typhi or Paratyphi.</text>
  </paragraph>
  <paragraph num="C.">
    <text>Infection Control. A health care provider shall practice standard precautions.</text>
  </paragraph>
  <paragraph num="D.">
    <text>Control of Carriers.</text>
    <paragraph num="(1)">
      <text>A health officer shall:</text>
      <paragraph num="(a)">
        <text>Monitor the location, occupation, and bacteriological status of a carrier of Salmonella Typhi or Paratyphi;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Keep a complete file of all pertinent data on the carrier;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Issue written instructions to the carrier concerning the restrictions upon and responsibilities of the carrier;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Notify the carrier of the availability of treatments that may eliminate carriage;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Contact each carrier in the health officer's jurisdiction at intervals of not more than 1 year to check on the carrier's occupation and address and to determine if all instructions are being followed;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Release a carrier from supervision only after there have been three consecutive negative cultures of feces, taken 1 month apart at least 48 hours after antibiotic treatment; and</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Forward immediately to the Secretary a report of a carrier who has relocated outside the health officer's territorial jurisdiction for referral to the health officer of the proper jurisdiction.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>A case or a case's physician shall submit the fecal specimens to the State Laboratory for the release of a carrier.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>A carrier:</text>
      <paragraph num="(a)">
        <text>May not participate in occupations 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 num="(b)">
        <text>Shall abide by Regulation .06D and E; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Shall keep a health officer informed at all times of the carrier's address and occupation, and shall notify the health officer at once of any change in address or occupation.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Control of Contacts of a Carrier.</text>
    <paragraph num="(1)">
      <text>A health officer shall require culture of feces of those household and close contacts:</text>
      <paragraph num="(a)">
        <text>Who attend a child care facility; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Whose occupations involve:</text>
        <paragraph num="(i)">
          <text>Food handling; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Care of patients, 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 required in §E(2) of this regulation is positive for Salmonella Typhi or Paratyphi, then the 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>