The Americans with Disabilities Act, often described as the most sweeping nondiscrimination legislation since the Civil Rights Act of 1964, provides protections against discrimination for individuals with disabilities. Due to concern about the spread of highly contagious diseases such as the 2009 H1N1 pandemic influenza and extensively drug-resistant tuberculosis (XDR-TB), questions have been raised about the application of the ADA in such situations. The threshold issue when discussing the applicability of the ADA is whether the individual in question is a person with a disability. Generally, individuals with serious contagious diseases would most likely be considered individuals with disabilities. However, this does not mean that an individual with a serious contagious disease would have to be hired or given access to a place of public accommodation if such an action would place other individuals at a significant risk. Such determinations are highly fact specific and the differences between the contagious diseases discussed by the courts (e.g., HIV infection, tuberculosis, and hepatitis) and pandemic influenza may give rise to differing conclusions. Each contagious disease has specific patterns of transmission that affect the magnitude and duration of a potential threat to others. The starting point for an analysis of rights provided by the ADA is whether an individual is an individual with a disability. The term "disability," with respect to an individual, is defined as "(A) a physical or mental impairment that substantially limits one or more of the major life activities of such individual; (B) a record of such an impairment; or (C) being regarded as having such an impairment (as described in paragraph(3))." The ADA was amended by the ADA Amendments Act of 2008, P.L. 110-325 , to expand the interpretation of the definition of disability from that of several Supreme Court decisions. Although the statutory language is essentially the same as it was in the original ADA, P.L. 110-325 contains new rules of construction regarding the definition of disability, which provide that the definition of disability shall be construed in favor of broad coverage to the maximum extent permitted by the terms of the act; the term "substantially limits" shall be interpreted consistently with the findings and purposes of the ADA Amendments Act; an impairment that substantially limits one major life activity need not limit other major life activities to be considered a disability; an impairment that is episodic or in remission is a disability if it would have substantially limited a major life activity when active; the determination of whether an impairment substantially limits a major life activity shall be made without regard to the ameliorative effects of mitigating measures, except that the ameliorative effects of ordinary eyeglasses or contact lenses shall be considered. Generally, individuals with serious contagious diseases would most likely be considered individuals with disabilities. However, what is defined as a "serious" contagious disease is fact specific. For example, the Equal Employment Opportunity Commission (EEOC) has indicated that individuals infected with the 2009 H1N1 pandemic influenza virus would not be individuals with disabilities. However, if the disease were to become more severe, an infected individual might be considered to be an individual with a disability under the ADA. The EEOC guidance does not delineate when the illness would be serious enough to be encompassed by the ADA. Even if a contagious disease is serious and an infected individual is covered by the ADA, if that individual poses a direct threat to others, he or she would not necessarily have to be hired or given access to a place of public accommodation. Title I of the ADA, which prohibits employment discrimination against otherwise qualified individuals with disabilities, specifically states that "the term 'qualifications standards' may include a requirement that an individual shall not pose a direct threat to the health or safety of other individuals in the workplace." In addition, the Secretary of Health and Human Services (HHS) is required to publish, and update, a list of infectious and communicable diseases that may be transmitted through handling the food supply. Similarly, title III, which prohibits discrimination in public accommodations and services operated by private entities, states: "Nothing in this title shall require an entity to permit an individual to participate in or benefit from the goods, services, facilities, privileges, advantages and accommodations of such entity where such individual poses a direct threat to the health or safety of others. The term 'direct threat' means a significant risk to the health or safety of others that cannot be eliminated by a modification of policies, practices, or procedures or by the provision of auxiliary aids or services." Although title II, which prohibits discrimination by state and local government services, does not contain such specific language, it does require an individual to be "qualified" and this is defined in part as meeting "the essential eligibility requirements of the receipt of services or the participation in programs or activities...." Contagious diseases were discussed in the ADA's legislative history. The Senate report noted that the qualification standards permitted with regard to employment under title I may include a requirement that an individual with a currently contagious disease or infection shall not pose a direct threat to the health or safety of other individuals in the workplace and cited to School Board of Nassau County v. Arline , a Supreme Court decision concerning contagious diseases and Section 504 of the Rehabilitation Act of 1973. Similarly, the House report of the Committee on Education and Labor reiterated the reference to Arline and added "[t]hus the term 'direct threat' is meant to connote the full standard set forth in the Arline decision." The Department of Justice issued amended regulations for titles II and III of the ADA which were published in the Federal Register on September 15, 2010. Although these regulations did not directly address contagious diseases, they did contain some revised language concerning the direct threat exception. Both the title II and title III regulations provide that public entities or places of public accommodations are not required to permit an individual to participate in services or activities when that individual poses a direct threat to the health or safety of others. In determining whether an individual poses a direct threat, both titles require "an individualized assessment, based on reasonable judgment that relies on current medical knowledge or on the best available objective evidence, to ascertain: The nature, duration, and severity of the risk; the probability that the potential injury will actually occur; and whether reasonable modifications of policies, practices, or procedures or the provision of auxiliary aids or services will mitigate the risk." Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. §794, in part prohibits discrimination against an otherwise qualified individual with a disability in any program or activity that receives federal financial assistance. Many of the concepts used in the ADA originated in Section 504, its regulations, and judicial interpretations. The legislative history of the ADA, as discussed above, specifically cited to the Supreme Court's interpretation of Section 504 in Arline which held that a person with active tuberculosis was an individual with a disability but may not be otherwise qualified to teach elementary school. Footnote 16, which was referenced in the ADA's legislative history, states in relevant part that "a person who poses a significant risk of communicating an infectious disease to others in the workplace will not be otherwise qualified for his or her job if reasonable accommodation will not eliminate that risk." The Court in Arline examined the standards to be used to determine if an individual with a contagious disease is otherwise qualified. In most cases, the Court observed, an individualized inquiry is necessary in order to protect individuals with disabilities from "deprivation based on prejudice, stereotypes, or unfounded fear, while giving appropriate weight to such legitimate concerns of grantees as avoiding exposing others to significant health and safety risks." The Court adopted the test enunciated by the American Medical Association (AMA) amicus brief and held that the factors which must be considered include "findings of facts, based on reasonable medical judgments given the state of medical knowledge, about (a) the nature of the risk (how the disease is transmitted), (b) the duration of the risk (how long is the carrier infectious), (c) the severity of the risk (what is the potential harm to third parties) and (d) the probabilities the disease will be transmitted and will cause varying degrees of harm." The Court also emphasized that courts "normally should defer to the reasonable medical judgments of public health officials" and that courts must consider whether the employer could reasonably accommodate the employee. Arline was remanded for consideration of the facts using this standard and the district court held that since the teacher had had negative cultures and the possibility of infection was "extremely rare," the school board must reinstate her or pay her salary until retirement eligibility. The Supreme Court in Bragdon v. Abbott , addressed the ADA definition of individual with a disability and held that the respondent's asymptomatic HIV infection was a physical impairment impacting on the major life activity of reproduction thus rendering the HIV infection a disability under the ADA. The Court also addressed the question of what is a direct threat, finding that the ADA's direct threat language codified the Court's decision in Arline. In Bragdon the plaintiff, an individual with asymptomatic HIV infection, sought dental treatment from the defendant and was told that she would be treated only in a hospital, not in the office. The plaintiff, Ms. Abbott, filed an ADA complaint and prevailed at the district court, court of appeals and the Supreme Court on the issue of whether she was an individual with a disability but the case was remanded for further consideration regarding the issue of direct threat. The Supreme Court provided some guidance regarding the direct threat issue in Bragdon stating that "the existence, or nonexistence, of a significant risk must be determined from the standpoint of the person who refuses the treatment or accommodation, and the risk assessment must be based on medical or other objective evidence." Dr. Bragdon had the duty to assess the risk of infection "based on the objective, scientific information available to him and others in his profession. His belief that a significant risk existed, even if maintained in good faith, would not relieve him from liability."