Code of Massachusetts Regulations › 105 CMR - DEPARTMENT OF PUBLIC HEALTH › Title 105 CMR 300.000 - Reportable Diseases, Surveillance, and Isolation and Quarantine Requirements › Section 300.200 - Isolation and Quarantine Requirements

Current through Register 1525, July 5, 2024
Upon the report of a case or suspected case of disease declared
				dangerous to the public health, the local board of health and the Department
				are authorized to implement and enforce the requirements outlined in 105 CMR
				300.200. Minimum requirements for the isolation and quarantine of diseases
				dangerous to the public health are set forth in 105 CMR 300.200(A). Depending
				on the specific circumstances related to the exposure, case and/or contact with
				respect to any disease or condition listed in 105 CMR 300.200(A) or (B),
				additional control measures may be required.
(A)
Diseases Reportable to Local
			 Boards of Health
.
Disease
Minimum Period of Isolation of
							 Patient
Minimum Period of Quarantine of
							 Contacts
Amebiasis
After diarrhea has resolved, food handlers may only
							 return to food handling duties after producing one negative stool specimen. If
							 a case has been treated with an antimicrobial, the stool specimen shall not be
							 collected until at least 48 hours after cessation of therapy. In outbreak
							 circumstances, two negative stool specimens produced at least 24 hours apart
							 will be required prior to returning to food handling duties.
Contacts with diarrhea, who are food handlers, shall
							 be considered the same as a case and handled in the same fashion. In outbreak
							 circumstances, asymptomatic contacts who are food handlers shall be required to
							 produce two negative stool specimens produced at least 24 hours apart prior to
							 returning to food handling duties. Otherwise, no restrictions.
Anaplasmosis
No restrictions
No restrictions
Anthrax
For cutaneous anthrax, place on contact precautions
							 until lesions are healed or free from anthrax bacilli.
No restrictions
Arbovirus infection
No restrictions
No restrictions
Babesiosis
No restrictions except for exclusion from blood
							 donation.
No restrictions
B. miyamotoi
No restrictions
No restrictions
Botulism
No restrictions
No restrictions
Brucellosis
No restrictions
No restrictions
Campylobacteriosis
After diarrhea has resolved, food handlers may only
							 return to food handling duties after producing one negative stool specimen. If
							 a case has been treated with an antimicrobial, the stool specimen shall not be
							 collected until at least 48 hours after cessation of therapy. In outbreak
							 circumstances, two negative stool specimens produced at least 24 hours apart
							 will be required prior to returning to food handling duties.
Contacts with diarrhea, who are food handlers, shall
							 be considered the same as a case and handled in the same fashion. In outbreak
							 circumstances, asymptomatic contacts who are food handlers shall be required to
							 produce two negative stool specimens produced at least 24 hours apart prior to
							 returning to food handling duties. Otherwise, no restrictions.
Cholera
After diarrhea has resolved, food handlers may only
							 return to food handling duties after producing two negative stool specimens
							 produced at least 24 hours apart. If a case has been treated with an
							 antimicrobial, the stool specimen shall not be collected until at least 48
							 hours after cessation of therapy.
Contacts with diarrhea, who are food handlers, shall
							 be considered the same as a case and handled in the same fashion. In outbreak
							 circumstances, asymptomatic contacts who are food handlers shall be required to
							 produce two negative stool specimens produced at least 24 hours apart prior to
							 returning to food handling duties. Otherwise, no restrictions.
Clostridium
							 difficile
No restrictions
No restrictions
Infection due to coronaviruses
Subject to recommendations based on the specific
							 coronavirus infection as determined by the Department based on the most current
							 recommendations by the Centers for Disease Control and
							 Prevention.
Subject to recommendations based on the specific
							 coronavirus exposure as determined by the Department.
Creutzfeldt-Jakob disease or variant
							 Creutzfeldt-Jakob disease
No restrictions
No restrictions
Cryptosporidiosis
After diarrhea has resolved, food handlers may only
							 return to food handling duties after producing one negative stool specimen. If
							 a case has been treated with an antimicrobial, the stool specimen shall not be
							 collected until at least 48 hours after cessation of therapy. In outbreak
							 circumstances, two negative stool specimens produced at least 24 hours apart
							 will be required prior to returning to food handling duties.
Contacts with diarrhea, who are food handlers, shall
							 be considered the same as a case and handled in the same fashion. In outbreak
							 circumstances, asymptomatic contacts who are food handlers shall be required to
							 produce two negative stool specimens produced at least 24 hours apart prior to
							 returning to food handling duties. Otherwise, no restrictions.
Cyclosporiasis
Food handlers may return to food handling duties
							 after diarrhea has resolved. In certain situations however, food handlers may
							 be required to produce one or two negative stool specimens before returning to
							 food handling duties. If a case has been treated with an antimicrobial, the
							 stool specimen shall not be collected until at least 48 hours after cessation
							 of therapy.
Contacts with diarrhea, who are food handlers, shall
							 be considered the same as a case and handled in the same fashion. In certain
							 outbreak situations, asymptomatic contacts who are food handlers may be
							 required to produce one or two negative stool specimens prior to returning to
							 food handling duties. Otherwise, no restrictions.
Diphtheria
Maintain isolation until two successive pairs of nose
							 and throat cultures (and cultures of skin lesions in cutaneous diphtheria)
							 obtained greater than 24 hours apart and at least 24 hours after completion of
							 antimicrobial therapy are negative. If there was no antimicrobial therapy,
							 these two sequential pairs of cultures shall be taken after symptoms resolve
							 and greater than two weeks after their onset. If an avirulent (nontoxigenic)
							 strain is documented, isolation is not necessary.
All contacts (both symptomatic and asymptomatic) who
							 are food handlers must be excluded from work until two successive pairs of nose
							 and throat cultures obtained greater than two weeks after completion of
							 antimicrobial prophylaxis (if any) and greater than 24 hours apart are
							 negative. Symptomatic contacts who are not food handlers shall be considered
							 the same as a case until their culture results are negative and they are
							 cleared by the appropriate public health authority. Asymptomatic contacts who
							 are not foodhandlers must be on appropriate antibiotics and personal
							 surveillance.
Ehrlichiosis
No restrictions
No restrictions
Encephalitis, any case
No restrictions
No restrictions
Food poisoning and toxicity
No restrictions
No restrictions
Giardiasis
After diarrhea has resolved, food handlers may only
							 return to food handling duties after producing one negative stool specimen. If
							 a case has been treated with an antimicrobial, the stool specimen shall not be
							 collected until at least 48 hours after cessation of therapy. In outbreak
							 circumstances, two negative stool specimens produced at least 24 hours apart
							 will be required prior to returning to food handling duties.
Contacts with diarrhea, who are food handlers, shall
							 be considered the same as a case and handled in the same fashion. In outbreak
							 circumstances, asymptomatic contacts who are food handlers shall be required to
							 produce two negative stool specimens produced at least 24 hours apart prior to
							 returning to food handling duties. Otherwise, no restrictions.
Glanders
No restrictions
No restrictions
Group A streptococcus, invasive
							 infection
Persons with streptococcal pharyngitis or skin
							 infections, with or without invasive disease, shall not return to school or
							 child care until at least 24 hours after initiating antimicrobial
							 treatment.
Personal surveillance and prophylaxis with an
							 antimicrobial when appropriate. Otherwise, no restrictions.
Group B streptococcus, invasive
							 infection
No restrictions
No restrictions
Haemophilus influenzae
, invasive
							 infection
a) type B
b) non type B
Until 24 hours after initiating antimicrobial
							 treatment.
No restrictions
Personal surveillance and prophylaxis with an
							 appropriate antimicrobial when indicated by clinical situation of the contact
							 or by potential for transmission. Otherwise, no restrictions.
No restrictions
Hansen's disease
No restrictions if under medical
							 care.
No restrictions
Hantavirus infection
No restrictions
No restrictions
Hemolytic uremic syndrome
After diarrhea has resolved, food handlers may only
							 return to food handling duties after producing two negative stool specimens,
							 produced at least 24 hours apart. If a case was treated with an antimicrobial,
							 the stool specimen shall not be collected until at least 48 hours after
							 cessation of therapy.
Contacts with diarrhea, who are food handlers, shall
							 be considered the same as a case and handled in the same fashion. In outbreak
							 circumstances, asymptomatic contacts who are food handlers shall be required to
							 produce two negative stool specimens produced at least 24 hours apart prior to
							 returning to food handling duties. Otherwise, no restrictions.
Hepatitis A
Isolation until one week after onset of symptoms or
							 for cases where the onset date is not known, one week past the date the
							 specimen positive for IgM antibody to HAV was provided.
No restrictions except for susceptible food handlers,
							 who shall be excluded from their occupations for 28 days unless they receive a
							 prophylactic dose of immune globulin (IG) and/or hepatitis A vaccine within 14
							 days of exposure, or in accordance with the latest recommendations from the
							 Department.
Hepatitis B
No restrictions except for exclusion from organ and
							 blood donation. Case shall receive counseling to modify activities in order to
							 prevent transmission.
Personal surveillance for high-risk contacts who
							 should receive hepatitis B immune globulin (HBIG) and vaccine. Infants born to
							 infected women should also receive HBIG and vaccine. Otherwise, no
							 restrictions.
Hepatitis C
No restrictions except for exclusion from organ and
							 blood donation. Case shall receive counseling to modify activities in order to
							 prevent transmission.
Personal surveillance for high-risk contacts.
Otherwise, no restrictions.
Hepatitis D
Same as co-infecting hepatitis B
Same as co-infecting hepatitis B
Hepatitis E
Isolation until one week after onset of symptoms, or
							 for cases where the onset date is not known, one week past the date of the
							 specimen positive for evidence of acute hepatitis E was
							 provided.
No restrictions, except for susceptible food
							 handlers, who shall be excluded from their occupations for 28 days.
Influenza
No restrictions
No restrictions
Legionellosis
No restrictions
No restrictions
Listeriosis
No restrictions
No restrictions
Lyme disease
No restrictions
No restrictions
Lymphocytic choriomeningitis virus
							 infection
No restrictions, except for exclusion from organ and
							 blood donation
No restrictions
Malaria
No restrictions except for exclusion from blood
							 donation.
No restrictions
Measles
Through four days after onset of rash (counting the
							 day of rash onset as day zero).
Contacts born in or after 1957, who are not
							 appropriately immunized or do not have laboratory evidence of immunity, will be
							 excluded from work, classes or other public activities from the fifth through
							 the 21 
							 st day after their exposure
							 even if they receive immune globulin. If exposure was continuous and/or if
							 multiple cases occur, susceptibles will be excluded through the
							 21st day after rash onset in the last case. Health
							 care workers and inpatients, regardless of year of birth, who are not
							 appropriately immunized or do not have laboratory evidence of immunity, will be
							 excluded from work (health care workers) or isolated with airborne precautions
							 (inpatients) from the fifth day after their first exposure through the 21 
							 st day after their last
							 exposure. These restrictions for health care workers and inpatients remain even
							 if the contact received IG or was vaccinated post-exposure.
Melioidosis
No restrictions
No restrictions
Meningitis
a) bacterial, community-acquired
b) viral (aseptic), and other
							 non-bacterial
If infected with
H. influenzae
or
N. meningitidis
, droplet precautions until 24 hours after
							 initiation of appropriate antibiotic therapy. Otherwise, no
							 restrictions.
No restrictions
Personal surveillance and antibiotic prophylaxis,
							 where appropriate, if case has
H. influenzae
or
N.
							 meningitidis
. Otherwise, no restrictions.
No restrictions
Meningococcal disease, invasive
							 infection
Droplet precautions until 24 hours after initiation
							 of appropriate antibiotic therapy. Otherwise, no restrictions.
Personal surveillance and antibiotic prophylaxis,
							 where appropriate. Otherwise no restrictions.
Monkeypox
Until lesions have dried and crusts have separated.
							 If no lesions, until seven days after onset of fever.
Personal surveillance. Otherwise no
							 restrictions.
Mumps
Through five days after onset of gland swelling
							 (counting the initial day of gland swelling as day zero).
Contacts born in or after 1957, who are not
							 appropriately immunized or do not have laboratory evidence of immunity, will be
							 excluded from work, classes or other public activities from the
							 12th through the 25th day
							 after their exposure. When multiple cases occur, susceptibles need to be
							 excluded through 25 days after the onset of the last case. Health care workers,
							 and inpatients, regardless of year of birth, who are not appropriately
							 immunized or do not have laboratory evidence of immunity will be excluded from
							 work (health care workers) or isolated with droplet precautions (inpatients)
							 from the 12th through the
							 25th date after their exposure.
Noroviruses
Food handlers must be excluded from food handing
							 duties for either 72 hours past the resolution of symptoms or 72 hours past the
							 date the specimen positive for norovirus was produced, which ever occurs
							 last.
Contacts with diarrhea or vomiting who are food
							 handlers shall be excluded from food handling duties for 72 hours past the
							 resolution of symptoms.
Pertussis
Until 21 days from onset of cough or five days after
							 initiation of appropriate antibiotic therapy.
If the contact is symptomatic, use same restrictions
							 as for cases. If the contact is an asymptomatic healthcare worker not receiving
							 antibiotic prophylaxis, exclude from the workplace for 21 days after last
							 exposure or, if unknown, for 21 days after the onset of the last case in the
							 setting. If the contact is asymptomatic, not a healthcare worker, and exposed
							 within the last 21 days, s/he should receive antibiotic prophylaxis but no
							 exclusion is generally required. In certain situations deemed to be high-risk,
							 the public health authority may require exclusion of asymptomatic contacts not
							 receiving antibiotic prophylaxis and/or other contacts, and/or may extend the
							 exclusion period beyond 21 days up to a maximum of 42 days.
Plague
For pneumonic plague, droplet precautions until 72
							 hours after initiation of appropriate antibiotic therapy. For bubonic plague,
							 case shall be placed on contact precautions until 48 hours after initiation of
							 effective therapy.
Contacts of cases of pneumonic plague should be
							 provided prophylaxis and placed under personal surveillance for seven days;
							 those who refuse prophylaxis shall be placed in quarantine and under personal
							 surveillance for seven days.
Poliomyelitis
Place case on enteric precautions for six weeks after
							 onset of symptoms or until poliovirus can no longer be recovered from feces
							 (the number of negative specimens required will be determined by the Department
							 on a case-by-case basis).
According to applicable Department guidelines,
							 administer an appropriate preparation of polio virus vaccine if the immune
							 status is unknown or incomplete. Otherwise, no restrictions.
Powassan
No restrictions
No restrictions
Psittacosis
No restrictions
No restrictions
Q Fever
No restrictions
No restrictions
Rabies- human
For duration of illness
Post-exposure prophylaxis of contacts when
							 appropriate, using recommendations of the Department. Otherwise, no
							 restrictions.
Reye Syndrome
No restrictions
No restrictions
Rickettsialpox
No restrictions
No restrictions
Rocky Mountain spotted fever
No restrictions
No restrictions
Rubella
a) Congenital
Isolation from susceptible persons for the first year
							 of life or until two cultures of clinical specimens (nasopharyngeal secretions
							 or urine) obtained one month apart after age three months are negative for
							 rubella virus.
No restrictions except for susceptibles, then same as
							 for non-congenital rubella.
b) Non-Congenital
Until seven days after onset of rash (counting the
							 day of rash onset as day zero).
Contacts born in or after 1957, who are not
							 appropriately immunized or do not have laboratory evidence of immunity, will be
							 excluded from work, classes or other public activities from the seventh through
							 the 23rd day after their last exposure. When
							 multiple cases occur, susceptibles need to be excluded until 23 days after the
							 onset of the last case.Health care workers inpatients, regardless of year of
							 birth, who are not appropriately immunized or do not have laboratory evidence
							 of immunity, will be excluded from work (health care workers) or isolated with
							 droplet precautions (inpatients) from the seventh day after first exposure
							 through the 23rd day after their last
							 exposure.
Salmonellosis
a) Not including typhoid fever
After diarrhea has resolved, food handlers may only
							 return to food handling duties after producing one negative stool specimen. If
							 a case was treated with an antimicrobial, the stool specimen shall not be
							 collected until at least 48 hours after cessation of therapy. In outbreak
							 circumstances, two negative stool specimens produced at least 24 hours apart
							 will be required prior to returning to food handling duties.
Contacts with diarrhea, who are food handlers, shall
							 be considered the same as a case and handled in the same fashion. In outbreak
							 circumstances, asymptomatic contacts who are food handlers shall be required to
							 produce two negative stool specimens produced at least 24 hours apart prior to
							 returning to food handling duties. Otherwise, no restrictions.
b) S. typhi (typhoid fever)
Food handlers may only return to food handling duties
							 after producing three consecutive negative stool specimens each produced no
							 less than 48 hours apart and one month after onset of first symptoms. If one
							 culture is positive, repeat cultures shall be collected at one month intervals
							 until three consecutive negative cultures are obtained. If the case has been
							 treated with an antimicrobial, the first stool specimen shall not be collected
							 until 48 hours after cessation of therapy.
All food handlers, symptomatic or asymptomatic, who
							 are contacts of a typhoid case shall be considered the same as a case and
							 handled in the same fashion.
Shiga toxin-producing organisms, including
E.
							 coli
O157:H7
After diarrhea has resolved, food handlers may only
							 return to food handling duties after producing two negative stool specimens,
							 produced at least 24 hours apart. If a case was treated with an antimicrobial,
							 the stool specimen shall not be collected until at least 48 hours after
							 cessation of therapy.
Contacts with diarrhea, who are food handlers, shall
							 be considered the same as a case and handled in the same fashion. In outbreak
							 circumstances, asymptomatic contacts who are food handlers shall be required to
							 produce two negative stool specimens produced at least 24 hours apart prior to
							 returning to food handling duties. Otherwise, no restrictions.
Shigellosis
After diarrhea has resolved, food handlers may only
							 return to food handling duties after producing two negative stool specimens
							 produced at least 24 hours apart. If a case was treated with an antimicrobial,
							 the stool specimen shall not be collected until at least 48 hours after
							 cessation of therapy.
Contacts with diarrhea, who are food handlers, shall
							 be considered the same as a case and handled in the same fashion. In outbreak
							 circumstances, asymptomatic contacts who are food handlers shall be required to
							 produce two negative stool specimens produced at least 24 hours apart prior to
							 returning to food handling duties. Otherwise, no restrictions.
Smallpox
In conjunction with public health authorities, place
							 case(s) on highest level of isolation to prevent direct contact, droplet
							 contact and airborne exposure until lesions have dried and crusts have
							 separated.
Afebrile contacts shall be placed under fever
							 surveillance (quarantine) for 18 days from the last contact or 14 days from
							 successful vaccination (which ever comes first), with monitoring and recording
							 of temperature twice daily (morning and evening). Febrile contacts with or
							 without rash shall be considered the same as a case and handled in the same
							 fashion (isolation). If no rash develops after five days and the fever is
							 diagnosed as being caused by recent vaccination or some other non-smallpox
							 etiology, contact may be released from isolation to home to continue fever
							 surveillance for 18 days following their last contact with a case or 14 days
							 following successful vaccination (whichever comes first).
Streptococcus pneumoniae
, invasive
							 infection
No restrictions
No restrictions
Tetanus
No restrictions
No restrictions
Toxic shock syndrome
No restrictions
No restrictions
Trichinosis
No restrictions
No restrictions
Tularemia
No restrictions
No restrictions
Typhus
No restrictions
No restrictions
Varicella (chickenpox)
If vesicles are present, until lesions have dried and
							 crusted, or until no new lesions appear, usually by the fifth day (counting the
							 day of rash onset as day zero). If no vesicles are present, until the lesions
							 have faded (i.e. the skin lesions are in the process of resolving; lesions do
							 not need to be completely resolved) or no new lesions appear within a 24-hour
							 period, whichever is later.
Contacts in non-health care settings, who are not
							 appropriately immunized or are without laboratory evidence of immunity or a
							 reliable history of chickenpox, shall be excluded from school, work or other
							 public activities from the eighth through the 21st
							 days after their exposure to the case during the case's infectious period. If
							 the exposure was continuous, contacts shall be excluded from the eighth through
							 the 21st days after the case's rash onset. Neonates
							 born to mothers with active varicella shall be isolated from susceptibles until
							 21 days of age. Health care workers who are not appropriately immunized or are
							 without laboratory evidence of immunity shall be excluded from work (health
							 care workers) or isolated with airborne precautions (inpatients) from the
							 eighth day after their first exposure through the 21 
							 st day after the last
							 exposure. In all settings, anyone receiving varicella zoster immune globulin
							 (VZIG) or intravenous immune globulin (IVIG) shall extend their exclusion to 28
							 days post-exposure.
Vibriosis (non- Cholera)
Food handlers with diarrhea may return to work after
							 diarrhea has resolved.
No restrictions
Viral hemorrhagic fevers
Place on hemorrhagic fever specific barrier
							 precautions with airborne, contact, and droplet precautions, and double
							 gloving, with strict hand hygiene, impermeable gowns, face shields, eye
							 protection, and leg and shoe coverings until clinical illness has
							 resolved.
Personal surveillance
Yersiniosis
After diarrhea has resolved, food handlers may only
							 return to food handling duties after producing one negative stool specimen. If
							 a case was treated with an antimicrobial, the stool specimen shall not be
							 collected until at least 48 hours after cessation of therapy. In outbreak
							 circumstances, two negative stool specimens produced at least 24 hours apart
							 will be required prior to returning to food handling duties.
Contacts with diarrhea, who are food handlers, shall
							 be considered the same as a case and handled in the same fashion. In outbreak
							 circumstances, asymptomatic contacts who are food handlers shall be required to
							 produce two negative stool specimens produced at least 24 hours apart prior to
							 returning to food handling duties. Otherwise, no restrictions.
(B)
Diseases Reportable Directly to the Department of Public
			 Health
.
Disease
Minimum Period of Isolation of
							 Patient
Minimum Period of Quarantine of
							 Contacts
Tuberculosis
a) Active tuberculosis: Pulmonary (also includes
							 mediastinal, laryngeal, pleural, or miliary)
b) Active tuberculosis: Extra-pulmonary c) Latent TB
							 infection
Clearance from isolation in the community requires
							 one or more of the following: three appropriately collected and processed
							 sputum smears that are collected in eight - 24 hour intervals (one of which
							 should be an early morning specimen); or other FDA cleared/approved or
							 generally accepted laboratory tests indicating tuberculosis is unlikely or
							 infectiousness is unlikely, as per guidelines such as those of the CDC, the
							 Advisory Council of the Elimination of Tuberculosis (ACET) or the American
							 Thoracic Society (ATS); or until the patient has undergone a period of
							 effective chemotherapy in accordance with current treatment standards, such as
							 those of CDC, ACET or ATS, and there is demonstration of clinical improvement
							 (
i.e
. decreasing cough, reduced fever, resolving lung
							 infiltrates).
No restrictions except for appropriate handling of
							 infected fluids.
No restrictions
No restrictions of asymptomatic contacts
							 required.
No restrictions No restrictions
(C)
Standard Precautions
. In addition to the specific
			 practices set out in
			 105 CMR 300.000, standard
			 precautions should be followed when treating all patients and contacts. The
			 Department adopts, by reference, as standard practice for infection control,
			 the most current version of the guidelines on the prevention of transmission of
			 infection published by the U.S. Centers for Disease Control and Prevention and
			 its Healthcare Infection Control Practices Advisory Committee.
(D)
Work-related Diseases and
			 Injuries Reportable Directlyto the Department of Public Health
. As
			 these diseases are not communicable, each case should be evaluated individually
			 regarding a return to work.