Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 156 - COMMUNICABLE DISEASES › Exhibit C - Hawaii Isolation and Control Requirements

Current through June, 2024
Any person informed by the department, a private
				  physician, or hospital that he or she has or is suspected of having a
				  communicable disease for which isolation is required, shall remain isolated in
				  the manner prescribed by the department of health. Isolation shall include
				  exclusion from school and workplace, and restriction from food handling and
				  direct care occupations. It is the responsibility of the principal or director
				  in charge of a school to prohibit any student diagnosed or suspected of having
				  a communicable disease for which isolation is required from attending school
				  until the expiration of the prescribed period of isolation. Parents, guardians,
				  custodians or any other person in loco parentis shall not permit any child
				  diagnosed or suspected of having a communicable disease for which isolation is
				  required to attend school or to be present at any public gatherings until the
				  expiration of the prescribed period of isolation. No person diagnosed or
				  suspected of having a communicable disease for which isolation is required
				  shall engage in any employment in which transmission of disease is likely to
				  occur until expiration of the prescribed period of isolation. Every health care
				  provider shall report immediately to the department any violation of such
				  isolation directive.
The diseases described below are declared by the Director of
				  Health to be a threat to the public health. Restrictions shall be imposed on
				  cases, suspected cases, and contacts of cases to the degree and for the
				  duration indicated below.
Medical management and disease intervention activities
				  described below are recommended for AIDS, Chlamydia, food and water borne
				  diseases, gonococcal disease, hepatitis B acute and chronic, hepatitis C acute
				  and chronic, HIV, pelvic inflammatory disease, syphilis and tuberculosis.
				  Health care providers are required to make these recommendations to cases,
				  suspected cases and contacts.
Note: See page 4 for definitions of key
				  terms
Disease
For Cases and Suspected
							 Cases
For Contacts
AIDS (Acquired Immunodeficiency Syndrome, CDC case
							 definition)
For Cases: Counseling, interview, standard
							 precautions. For Suspected Cases: Counseling, testing, interview.
Counseling, testing, and interview of sexual and
							 needle-sharing partners.
Amebiasis
Restrict from food handling and direct care
							 occupations until chemotherapy is completed.
None
Anthrax
None
None
Botulism, foodborne
None
None
Botulism, infant
None
None
Brucellosis
None
None
Campylobacteriosis
Restrict from food handling and direct care
							 occupations until asymptomatic.
None
Chickenpox (varicella)
Non-hospitalized persons: restrict from school, work,
							 or other public places including hotel lobbies, restaurants and airplanes until
							 vesicles become dry or crusted (usually
							 5-7 days).
							 Hospitalized persons: airborne and contact precautions until vesicles become
							 dry or crusted (usually
							 5-7 days).
None
Chlamydia
(Chlamydia trachomatis)
For Cases: Treatment, counseling and interview. For
							 Suspected Cases: Testing, counseling and interview. Hepatitis B immunization.
Surveillance, testing, and chemoprophylaxis of sexual
							 contacts.
Cholera
Restrict from foodhandling until asymptomatic.
None
Congenital Rubella Syndrome
None
None
Cryptosporidiosis
Restrict from food handling and direct care
							 occupations until asymptomatic.
None
Cyclosporiasis
Restrict from food handling and direct care
							 occupations until chemotherapy is completed.
None
Dengue
None
None
Diphtheria
Droplet precautions for pharyngeal diphtheria, contact
							 precautions for cutaneous diphtheria; Maintain isolation until two cultures
							 from both throat and nose (skin lesions in cutaneous diphtheria) taken 24 hours
							 apart, and not less than 24 hours after cessation of antimicrobial therapy,
							 fail to show diphtheria bacilli.
Exclude from occupations involving food handling or
							 close association with children until proven culture negative.
Encephalitis. Meningitis. Arboviral
							 (includes California Serogroup, Eastern eauine. Western Equine. St. Louis. West
							 Nile. Powassan)
None
None
Enterococcus, vancomycin-resistant
None
None
Escherichia coli
O157:H7 or other
E. coli
shigatoxin produced hemorrhagic colitis
Restrict from food handling, direct care occupations
							 and school until asymptomatic and stool culture negative.
None
Filariasis
None
None
Fish poisoning (ciguatera, scombroid or
							 hallucinogenic)
None
None
Foodborne illness (2 or more ill persons eating either
							 a common food or at a place in common)
Restriction from food handling and direct care
							 occupations may be required; refer to specific agent.
Restriction from food handling and direct care
							 occupations may be required; Refer to specific agent.
Giardiasis
None
None
Gonococcal disease
(Neisseria
							 gonorrhoeae)
For Cases: Treatment, counseling, and interview. For
							 Suspected Cases: Testing, counseling and interview. Hepatitis B immunization.
Surveillance, testing and chemoprophylaxis of sexual
							 contacts.
Haemophilus influenzae
(meningitis,
							 bacteremia, epiglottitis, pneumonia, or isolation from a normally sterile site)
Report serotype
if available.
Droplet precautions until 24 hours after the start of
							 effective antibiotic therapy.
None
Hansen's disease
For Cases: Treatment, counseling and contact
							 investigation. For Suspected Cases: Periodic re-screenings.
None
Hantavirus Disease
None
None
Hepatitis A
Restrict from food handling and direct care
							 occupations for first two weeks of illness, but no more than 1 week after
							 jaundice. For preschool children restrict from daycare for 10 days after
							 diagnosis, {viral excretion up to 6 months among infants and children}
Restrict from food handling until laboratory tests
							 confirm contact is free of HAV infection.
Hepatitis B (acute)
For Cases: Counseling, standard precautions, and
							 hepatitis A immunization. For Suspected Cases with no immunity against
							 hepatitis B: Testing, post-exposure prophylaxis, counseling, standard
							 precautions, and hepatitis A immunization.
Surveillance, testing, counseling, and post-exposure
							 prophylaxis.
Hepatitis B (chronic)
For Cases: Counseling, standard precautions, referral
							 for care, and hepatitis A immunization. For Suspected Cases: Testing,
							 counseling, standard precautions, and hepatitis A immunization.
Surveillance, testing, counseling, and post-exposure
							 prophylaxis.
Hepatitis C (acute)
For Cases: Counseling, standard precautions, and
							 hepatitis B immunization series. For Suspected Cases: Testing, counseling,
							 standard precautions.
Surveillance, testing and counseling.
Hepatitis C (chronic)
For Cases: Counseling, standard precautions, referral
							 for care, and hepatitis A and B immunization series. For Suspected Cases:
							 Testing, counseling, and standard precautions.
Surveillance, testing and counseling.
Hepatitis E
Restrict from food handling and direct care
							 occupations for first two weeks of illness, but no more than 1 week after
							 jaundice. For preschool children restrict from daycare for 10 days after
							 diagnosis.
Restrict from food handling until laboratory tests
							 confirm contact is free of HAV infection.
Hemolytic uremic syndrome
Restriction may be required; refer to specific agent.
None
HIV
For Cases: Counseling, interview, standard
							 precautions, and referral for care. Hepatitis A & B vaccination. For
							 Suspected Cases: Counseling, testing, and interview.
Testing, counseling and interview of sexual and
							 needle-sharing partners.
Influenza, outbreak
Hospitalized persons: droplet precautions for 5 days.
							 Pandemic influenza: Incubation to be determined by current recommendations.
None
Legionellosis
None
None
Leptospirosis
None
None
Listeriosis
None
None
Malaria
None
None
Measles (rubeola)
Non-hospitalized persons: restrict from school, work,
							 or other public places including hotel lobbies, restaurants and airplanes for 4
							 full days after appearance of the rash. Hospitalized patients: airborne
							 precautions until 4 full days after appearance of the rash.
Exclude susceptible contacts from school, workplace
							 and other group settings from the 7th through the 18th day after exposure.
Meningococcal disease (meningitis, meningococcemia, or
							 isolation from a normally sterile from a normally sterile site.
Droplet precautions until 24 hours after the start of
							 effective antibiotic therapy.
None
Methicillin-Resistant
Staphylococcus
							 auerus
Hospitalized persons: contact precautions.
None
Mumps
Non-hospitalized persons: restrict from school, work,
							 or other public places including hotel lobbies, restaurants and airplanes for 9
							 days after onset of swelling or parotitis. Hospitalized patients: droplet
							 precautions until 9 days from onset of swelling or parotitis.
Exclude susceptible contacts from school, workplace
							 and other group settings from the 12th through the 25th day after exposure.
Norovirus
Restrict from food handling and direct care
							 occupations until asymptomatic.
None
Pelvic Inflammatory Disease (PID)
For Cases: Treatment, counseling, and interview. For
							 Suspected Cases: Medical examination and testing, treatment, counseling, and
							 interview. Hepatitis B immunization.
Surveillance, testing, counseling, and interview,
							 chemoprophylaxis of sexual contacts.
Pertussis
Non-hospitalized persons: restrict from school, work,
							 or other public places including hotel lobbies, restaurants and airplanes until
							 5 days of a minimum 14-day course of antibiotics has been completed or until 3
							 weeks after the onset of paroxysmal cough. Hospitalized persons: droplet
							 precautions until 5 days of a minimum 14-day course of antibiotics has been
							 completed or until 3 weeks after the onset of paroxysmal cough.
Exclude household and other close contacts from
							 school, workplace and other group settings until completion of 5 days of a
							 minimum 14-day course of antibiotics or for 14 days from last exposure.
Plague
Droplet precautions for pneumonic plague until
							 completion of 3 full days of appropriate antibiotic therapy with a favorable
							 clinical response.
None
Pneumococcal pneumonia
None
None
Poliomyelitis
None
None
Psittacosis
None
None
Rabies
Contact precautions for respiratory secretions for
							 duration of illness.
None
Rubella
Non-hospitalized persons: restrict from school, work,
							 or other public places including hotel lobbies, restaurants and airplanes for 7
							 days after appearance of the rash. Hospitalized patients: droplet precautions
							 until 7 days after appearance of rash.
Exclude susceptible contacts from school, workplace
							 and other group settings from the 14th through the 23rd day after exposure.
Salmonellosis (other than typhoid)
Restrict from food handling and direct care
							 occupations until 2 consecutive stool cultures, collected greater than or equal
							 to 24 hours apart, and not less than 48 hours after cessation of antimicrobial
							 therapy, are negative for
Salmonella.
Restrict from foodhandling and direct care occupations
							 until stool is known to be culture negative.
Severe Acute Respiratory Syndrome (SARS)
Non-hospitalized persons: Limit activities outside the
							 home except as necessary for medical care. For example, do not go to work,
							 school, or public areas. If patient must leave the home, wear a mask, if
							 tolerated. Do not use public transportation. Ensure appropriate follow-up and
							 care of exposed close contacts of SARS patients in home isolation. Hospitalized
							 patients: instructing patient and the persons who accompany them to: 1) inform
							 healthcare personnel of symptoms of a respiratory infection when they first
							 register for care, and 2) practice
respiratory hygiene/cough
							 etiquette
Healthcare workers should practice droplet precautions.
							 Hospitalized patients: Contact the Department of Health for additional
							 guidance.
Contact the Department of Health for
							 additional guidance.
Shigellosis
Restrict from food handling and direct care
							 occupations until 2 consecutive stool samples or rectal swabs collected greater
							 than or equal to 24 hours apart, and not less than 48 hours after cessation of
							 antimicrobial therapy are negative for
Shigella.
Restrict from foodhandling and direct care occupations
							 until stool is known to be culture negative.
Smallpox (variola virus)
Identify and isolate cases
Contact the Department of Health for additional
							 guidance.
Streptococcal disease, Group A (beta hemolytic,
							 invasive disease not including pharyngitis)
Exclude from foodhandling until 48 hours after the
							 start of effective antibiotic therapy.
None
Syphilis
For Cases: Treatment, counseling, and interview. For
							 Suspected Cases: Medical examination and other STD & HIV testing, hepatitis
							 B immunization, testing, treatment, counseling, and interview.
Surveillance, testing, counseling, interview, and
							 treatment of sexual contacts.
Tetanus
None
None
Toxoplasmosis
None
None
Trichinosis
None
None
Tuberculosis
Restrict patients from: School, workplace, and other
							 congregate settings (e.g., nursing homes, homeless shelters, correctional
							 facilities, etc.). Hospitalized patients: Follow airborne precautions and place
							 in respiratory isolation. Discontinue restrictions, precautions, and
							 respiratory isolation
only
when the TB patient meets
all
of the following criteria: * Patient has demonstrated
							 negative AFB smear results from 3 consecutive sputum specimens. Sputum
							 specimens may be collected either over 3 consecutive mornings or Q8 hours x 3
							 (at least 1 early morning sputum sample is recommended). * Patient is taking
							 effective and adequate therapy per 2003 ATS/CDC/IDSA Treatment of Tuberculosis
							 guidelines, preferably by directly observed therapy (DOT). * Patient has
							 demonstrated clinical improvement to therapy.
None
Typhoid Fever
Restrict from food handling and direct care
							 occupations until 3 consecutive negative stool cultures are obtained from
							 stools collected greater than or equal to 24 hours apart, and not less than 48
							 hours after cessation of antimicrobial therapy, and not earlier than 1 month
							 after onset.
Restrict from food handling and direct care
							 occupations until 2 consecutive negative stool cultures are obtained from
							 stools collected greater than or equal to 24 hours apart.
Typhus (louse, flea, mite-borne)
None
None
Vibriosis (other than
cholerae)
Restrict from food handling until asymptomatic.
None
Viral hemorrhagic fevers (filoviruses [e.g., Ebola,
							 Marburg] and arenaviruses [e.g., Lassa Machupo])
Strict isolation during the acute febrile period.
							 Respiratory protection desirable along with other barrier methods.
None
West Nile Virus
None
None
Yellow fever
None
None
Yersiniosis (other than plague)
Restrict from food handling and direct care
							 occupations until asymptomatic.
None
DEFINITIONS:
Contact
- a person who has been in such an
				  association with an infected person or animal or a contaminated environment as
				  to have had an opportunity to acquire the infection.
Airborne precautions
- measures intended to
				  prevent transmission of infection by airborne droplet particles containing
				  microorganisms that remain suspended in the air and that can be widely
				  dispersed by air currents. In addition to standard precautions, a private,
				  negative air pressure isolation room is indicated; however, patients infected
				  with the same organism may share the same isolation room. Respiratory
				  protection should be worn by all susceptible persons entering the isolation
				  room. Patient transport should be minimized.
Contact precautions
- measures intended to
				  prevent infection by microorganisms transmitted via direct contact with a
				  patient or by indirect contact with environmental surfaces or patient-care
				  items in the patient's environment. In addition to standard precautions, a
				  private room is indicated, but patients infected with the same organism may
				  share a room. Masks are indicated for those in close contact with the patient;
				  gowns should be worn if soiling is likely; gloves are indicated if touching
				  potentially infectious surfaces.
Direct care occupations
- any occupational
				  activity that has the potential to result in the transmission of infectious
				  microorganisms from a care-giver to persons receiving care. Direct care
				  occupations include persons engaged in providing care to children, patients,
				  the elderly, or infirm.
Droplet precautions
- measures intended to
				  prevent infection by microorganisms transmitted via relatively large droplets
				  that can be generated by a patient while coughing, sneezing, and talking. In
				  addition to standard precautions, a private room is indicated, but patients
				  infected with the same organism may share a room. Masks are indicated for those
				  in contact with the patient. Gowns and gloves are not required.
Foodhandling
- any contact with food,
				  beverages, or materials and/or items used in their preparation that has the
				  potential to result in the transmission of infectious microorganisms via
				  ingestion of the food and/or beverage. Examples of foodhandling include (but
				  are not limited to) transporting food or food containers, preparation or
				  service of food, and contact with utensils or food associated equipment.
Standard precautions
- measures intended to
				  prevent transmission of infectious microorganisms that should be employed with
				  all patients receiving care, regardless of their diagnosis or presumed
				  infection status. In general terms these measures include handwashing with
				  appropriate soap after each contact with potentially infectious materials,
				  between patients and when indicated, between different sites on the same
				  patient; wearing gloves when touching blood, body fluids, secretions,
				  excretions, and contaminated items; wearing masks and eye protection for
				  patient care activities likely to generate splashes; wearing gowns for patient
				  care activities that are likely to generate splashes or sprays in order to
				  protect skin, clothing and mucous membranes; appropriate handling and
				  disinfection of patient care equipment; and routine implementation of
				  environmental cleaning and disinfection procedures.