PART II. COMMUNICABLE DISEASE

11.56.180 Conditions defined.

The word "conditions," when used in this part, shall mean any of those reportable pathological conditions or matters listed under the headings entitled: Category I Diseases, Conditions and Findings and Category II Diseases, Conditions and Findings. (Ord. 63633 § 4 (part), 1996.)

11.56.190 Reportable diseases and conditions.

The following diseases and conditions are hereby declared reportable:

A. Category I Diseases, Conditions and Findings. Category I diseases, conditions and findings must be reported to the Saint Louis City Health Commissioner within twenty-four (24) hours of suspected diagnosis by telephone, facsimile system or other rapid communication, followed by a written report within seven (7) days. Category I diseases, conditions and findings are:

1. Diseases, findings or agents that occur naturally or from accidental exposure:

Animal (mammal) bite, wound, humans

Diphtheria

Haemophilus influenza, invasive disease

Hantavirus pulmonary syndrome

Hepatitis A

Hyperthermia

Hypothermia

Influenza, suspected--nosocomial outbreaks and public or private school closures

Lead (blood) level greater than or equal to forty-five micrograms per deciliter (=45 :g/dl) in any person equal to or less than seventy-two (=72) months of age

Measles (rubeola)

Meningococcal disease, invasive

Outbreaks or epidemics of any illness, disease or condition that may be of public health concern

Pertussis

Poliomyelitis

Rabies, animal or human

Rubella, including congenital syndrome

Staphylococcus aureus, vancomycin resistant

Streptococcus pneumoniae, invasive in children less than five (5) years

Syphilis, including congenital syphilis

Tuberculosis disease

Typhoid fever

2. Diseases, findings or agents that occur naturally or that might result from a terrorist attack involving biological, radiological, or chemical weapons:

Adult respiratory distress syndrome (ARDS) in patients under 50 years of age (without a contributing medical history)

Anthrax

Botulism

Brucellosis

Cholera

Encephalitis/meningitis, Venezuelan equine

Glanders

Hemorrhagic fever (e.g., dengue, yellow fever)

Plague

Q fever

Ricin

Smallpox (variola)

Staphylococcal enterotoxin B

T-2 mycotoxins

Tularemia

3. Diseases, findings or adverse reactions that occur as a result of inoculation to prevent smallpox, including but not limited to the following:

Accidental administration

Accidental implantation (inadvertent autoinoculation)

Bacterial infection of site of inoculation

Congenital vaccinia

Contact vaccinia (i.e., vaccinia virus infection in a contact of a smallpox vaccinee)

Eczema vaccinatum

Erythema multiforme

Generalized vaccinia

Post-vaccinial encephalitis

Progressive vaccinia (vaccinia necrosum, vaccinia gangrenosa, disseminated vaccinia)

Vaccinia keratitis

B. Category II diseases or findings shall be reported to the local health authority or the Department of Health and Senior Services within three (3) days of first knowledge or suspicion. Category II diseases or findings are:

Acquired immunodeficiency syndrome (AIDS)

Arsenic poisoning

Blastomycosis

California serogroup viral encephalitis/meningitis

Campylobacter infections

Carbon monoxide poisoning

CD4+ T cell count

Chancroid

Chemical poisoning, acute, as defined in the most current ATSDR CERCLA Priority List of Hazardous Substances; if terrorism is suspected, refer to subsection (A)(2) of this section

Chlamydia trachomatis, infections

Coccidioidomycosis

Creutzfeldt-Jakob disease

Cryptosporidiosis

Cyclosporidiosis

Eastern equine viral encephalitis/meningitis

Ehrlichiosis, human granulocytic, monocytic, or other/unspecified agent

Escherichia coli O157:H7

Escherichia coli, shiga toxin positive, serogroup non-O157:H7

Giardiasis

Gonorrhea

Hansen disease (leprosy)

Heavy metal poisoning including, but not limited to, cadmium and mercury

Hemolytic uremic syndrome (HUS), postdiarrhea

Hepatitis B, acute

Hepatitis B surface antigen (prenatal HBsAg) in pregnant women

Hepatitis C

Hepatitis non-A, non-B, non-C

Human immunodeficiency virus (HIV)- exposed newborn infant (i.e., newborn infant whose mother is infected with HIV)

Human immunodeficiency virus (HIV) infection, as indicated by HIV antibody testing (reactive screening test followed by a positive confirmatory test), HIV antigen testing (reactive screening test followed by a positive confirmatory test), detection of HIV nucleic acid (RNA or DNA), HIV viral culture, or other testing that indicates HIV infection Human immunodeficiency virus (HIV) test results (including both positive and negative results) for children less than two (2) years of age whose mothers are infected with HIV Human immunodeficiency virus (HIV) viral load measurement (including nondetectable results)

Influenza, laboratory-confirmed

Lead (blood) level less than forty-five micrograms per deciliter (<45 :g/dl) in any person equal to or less than seventy two (=72) months of age and any lead (blood) level in persons older than seventy-two (>72) months of age

Legionellosis

Leptospirosis

Listeria monocytogenes

Lyme disease

Malaria

Methemoglobinemia

Mumps

Mycobacterial disease other than tuberculosis (MOTT)

Nosocomial outbreaks

Occupational lung diseases including silicosis, asbestosis, byssinosis, farmer’s lung and toxic organic dust syndrome

Pesticide poisoning

Powassan viral encephalitis/meningitis

Psittacosis

Respiratory diseases triggered by environmental contaminants including environmentally or occupationally induced asthma and bronchitis

Rocky Mountain spotted fever

Saint Louis viral encephalitis/meningitis

Salmonellosis

Shigellosis

Streptococcal disease, invasive, Group A

Streptococcus pneumoniae, drug resistant invasive disease

Tetanus

Toxic shock syndrome, staphylococcal or streptococcal

Trichinosis

Tuberculosis infection

Varicella deaths

West Nile fever

West Nile viral encephalitis/meningitis

Western equine viral encephalitis/meningitis

Yersinia enterocolitica

C. The occurrence of an outbreak or epidemic of any illness, disease or condition which may be of public health concern, including any illness in a food handler that is potentially transmissible through food. This also includes public health threats than could result from terrorist activities such as clusters of unusual diseases or manifestations of illness and clusters of unexplained deaths. Such incidents shall be reported to the Health Commissioner by telephone, facsimile, or other rapid communication within twenty-four (24) hours of first knowledge or suspicion.

(Ord. 66374 § 1, 2004: prior: Ord. 63633 § 4 (part), 1996.)

11.56.200 Report--Blanks.

The Health Commissioner shall, upon application, furnish the proper blank forms on which reports, as required by this chapter, shall be made. (Ord. 63633 § 4 (part), 1996.)

11.56.210 Report--Physicians and laboratories.

Every laboratory that tests or examines a specimen and every physician in the City who shall prescribe for or attend any person having a reportable disease or condition as declared in this chapter, shall within the times provided in this chapter, after first discovering the existence of such disease or condition, make a report, within the time limit provided, to the Health Commissioner, which report shall give the name, age, birth date, residence (street number), race and sex of the person having such disease or condition. (Ord. 63633 § 4 (part), 1996.)

11.56.250 Placarding premises--Determination of necessity.

The Health Commissioner, when he deems it necessary, shall have the power to cause to be placed on the inside or outside of any building or other premises or door of any room occupied, or which has been occupied, by a person having a communicable disease, excepting tuberculosis, tetanus and diseases of the eye, a printed placard giving notice of such disease. No person shall remove, deface or in any manner whatsoever obstruct such placard from public view. Every person having control of a house or premises upon any portion of which a printed placard was caused to be placed by the Health Commissioner, shall be held responsible for the removal, defacement or obstruction of such placard. (Ord. 63633 § 4 (part), 1996.)

11.56.270 Notice to Health Commissioner when sick patient leaves physician’s care.

It shall be the duty of the attending physician on any case of a communicable disease to give written notice to the Health Commissioner if the patient so afflicted passes out of his professional care previous to the termination of the disease. (Ord. 63633 § 4 (part), 1996.)

11.56.290 Termination--Order.

Whenever a physician has reported to the Health Commissioner that a case of communicable disease has recovered and is ready for termination, the Health Commissioner, if he deems it necessary, may cause the examination to be made of such patient by a physician of the Division of Health. If the Health Commissioner orders such an examination and if, in the opinion of such physician, the case is ready for termination, the Health Commissioner shall order the case to be terminated and the premises disinfected, cleaned or renovated. (Ord. 63633 § 4 (part), 1996.)

V.A.M.S.:

334.140 St. Louis health commissioner

11.56.300 Termination--Typhoid fever.

No case of typhoid fever shall be considered terminated and no longer communicable until two bacteriological examinations of the urine and feces of the typhoid fever patient shall show an absence of typhoid fever bacilli. These examinations shall be made by the Chief Bacteriologist of the Division of Health at an interval of one week. (Ord. 63633 § 4 (part), 1996.)

11.56.310 Termination--Required before removal of placard or household goods.

Excepting under special written permission of the Health Commissioner, no person shall remove, or aid in removing, from any placarded building or other premises, in which a person having a communicable disease shall have been reported, any household goods, bedding, clothing or any other articles, until such case has been terminated by the Health Commissioner. (Ord. 63633 § 4 (part), 1996.)

V.A.M.S.:

210.090 Eye inflation to be reported

11.56.320 Removal of persons to hospital--Communicable disease.

Whenever the Health Commissioner shall become appraised or informed that any person residing in the City has a communicable disease which, in his opinion, may endanger the lives of the citizens of the City, it shall be his duty to make, or cause to be made, an examination of such person by a physician of the Division of Health, and an inspection of the building or premises in which he resides by an inspector of the Division of Health.

If such person is found to have a communicable disease, the Health Commissioner may, if he deems necessary, cause the person to be removed from such building or premises to an appropriate facility provided by the City for the treatment of such diseases.

If force be found necessary to make such an examination or to remove any person having a communicable disease, the Health Commissioner shall have the power and authority to use force, if he deems it necessary or judicious. (Ord. 63633 § 4 (part), 1996.)

City Counselor Ops.: 8429

McQuillin:

24.236 Segregation and removal of persons

11.56.330 Removal of persons to hospital--Filthy conditions.

Whenever the Health Commissioner becomes appraised or informed that any person, by reason of disease or filth, or the filth of the quarters occupied by such person, is a menace to public health, it shall be his duty to make, or cause to be made, an examination of the person by a physician of the Division of Health, and an inspection of the building or other premises by an inspector of the Division of Health.

If such person shall be, by reason of personal filth, or if the quarters occupied by such person are, by reason of filth, a menace to public health, the Health Commissioner may, if he deems it necessary, cause such person to be removed to an appropriate facility until such time as the person may be cleansed and the quarters and clothing shall be disinfected.

If force be found necessary to make such an examination of the person or buildings or other premises, or to remove the person by reason of personal filth of the person or of the quarters occupied by him, the Health Commissioner shall have the power and authority to use force, if he deems it necessary or judicious. (Ord. 63633 § 4 (part), 1996.)

McQuillin:

24.236 Segregation and removal of persons

11.56.340 School attendance.

No parent or guardian, or person having the care, custody or control of any minor and knowing him to have a communicable disease, shall permit such minor to attend any public, private or parochial school in the City, or to mingle with any person in a public place or public conveyance, until such minor shall be declared free from contagion by a licensed physician. No adult person knowing himself to be afflicted with or to have been reported as having any communicable disease shall attend any public, private or parochial school in the City, or shall mingle with any person in a public place or public conveyance in the City until he shall have been declared free from contagion or infection by a licensed physician. (Ord. 63633 § 4 (part), 1996.)

McQuillin:

24.236 Segregation and removal of persons

11.56.360 Reporting of exposure to communicable disease by school official.

Every principal of any public, private or parochial school in the City, who has reasonable cause to suspect that a teacher or pupil attending such school has been exposed to any communicable disease or is infected with any communicable disease shall have the duty to inform the St. Louis City Health Commissioner of such exposure or infection immediately. (Ord. 63633 § 4 (part), 1996.)

11.56.370 Premises--Vacation and disinfection--Travel restrictions.

Whenever a building or other premises or one or more City blocks or squares of ground shall have been infected with any communicable disease, the Health Commissioner shall have the power to cause such area to be vacated by the inhabitants for the purpose of disinfecting, cleansing or renovating.

If this action is not deemed expedient or judicious by the Commissioner, he shall have the power and authority to close up the streets in front of and surrounding such area and to prohibit the inhabitants thereof, or any other persons, from passing in or out, or to and from such area, except under such rules and regulations as he may prescribe, until the area has been disinfected, the infection or contagion ceased or the Commissioner orders the restrictions removed. (Ord. 63633 § 4 (part), 1996.)

McQuillin:

24.236 Segregation and removal of persons

11.56.380 Premises--Disinfection order.

The Health Commissioner shall order the disinfection, cleansing or renovating of all premises found occupied, or which have been occupied, by any person removed from such premises, as prescribed in Section 11.56.370, by reason of contagious or infectious disease or filth, if he deems it necessary. (Ord. 63633 § 4 (part), 1996.)

11.56.400 Public not to be endangered by persons sick with communicable disease.

No person shall place others in danger of contacting any communicable disease from any person sick with such disease or from the body of a person who died of such disease by the exposure of the sick individual or dead body, by any connected negligent act, with respect to the care and custody of such person or by any needless exposure of himself. (Ord. 63633 § 4 (part), 1996.)

City Counselor Ops.: 8429

11.56.410 When Health Commissioner may close business places.

Whenever a person who resides in the City in any building or other premises in which there is conducted any grocery, bakery, dairy, confectionery, fruit store, restaurant, barbershop, tobacco store, dry goods or clothing store or any business where any article of food, drink, tobacco, dry goods, or clothing is manufactured, repaired, stored or sold has any communicable disease, the Health Commissioner may, if he deems it necessary, prohibit the sale or removal of any such article from the business described. He shall have the power to close such business in the building or other premises until the disease is terminated or the person sick with such disease has been removed from the building or other premises. He may direct that the building or other premises be disinfected or cleaned if he thinks such action is necessary. (Ord. 63633 § 4 (part), 1996.)

11.56.420 Duties of police.

It shall be the duty of the Police Department to notify the Health Commissioner whenever it considers or believes any communicable disease to exist. It shall assist the Health Commissioner, his officers or employees in the discharge of their duties whenever called upon to do so. (Ord. 63633 § 4 (part), 1996.)

11.56.470 Diphtheria--Termination cultures.

No case of diphtheria shall be terminated until the Chief Bacteriologist of the Division of Health shall report two negative cultures, taken on successive days from the nose or throat, or both, of such patient. (Ord. 63633 § 4 (part), 1996.)

11.56.480 Tuberculosis--Rules.

The Health Commissioner shall prepare rules prescribing measures essential for preventing the spread of tuberculosis, promoting its arrest and the recovery of the person suffering therefrom. He shall cause a printed copy of such rules to be distributed to all persons connected with every case of tuberculosis within the City of which he may have information. (Ord. 63633 § 4 (part), 1996.)

V.A.M.S.:

199.170 et seq. Commitment and hospitalization of tuberculosis patients

11.56.490 Tuberculosis--Examination by City Physician.

When a case of tuberculosis is reported to the Health Commissioner and no physician is in charge of the case, the Health Commissioner may designate a City Physician to examine and report such case. If the clinical evidence or a microscopical examination of the sputum of the patient in such case demonstrates the presence of tuberculosis, the Health Commissioner shall furnish the patient or his nurse, relative, friend or caretaker a printed copy of directions as to the best means of preventing the spread of the disease and promoting recovery of the patient. He shall instruct the inspectors of the Division of Health to report whether such directions and instructions of the Division of Health are obeyed. (Ord. 63633 § 4 (part), 1996.)

11.56.500 Tuberculosis--Sputa exam--Health Commissioner duties.

The Health Commissioner shall have the power to cause a microscopical examination to be made of the sputa of persons having symptoms of tuberculosis whenever it be requested by the attending physician or by a City Physician detailed to examine the case. He shall have the power to order the examination to be made by any competent person in the employ of the Division of Health, and any person so employed shall promptly make the examination and a report thereon free of charge. The result of the examination shall be reported in duplicate, one copy to be forwarded to the physician upon whose application the examination was made, and the other to the Health Commissioner. (Ord. 63633 § 4 (part), 1996.)

11.56.510 Tuberculosis--Sputa exam--Report and record.

It shall be the duty of every physician in the City, when called to attend any patient residing in the City who has symptoms of tuberculosis, to promptly submit specimens of sputum to the Health Division Laboratory for examination. If this examination or the clinical evidence demonstrates tuberculosis, the physician shall at once report the case to the Health Commissioner. This report shall contain the name of the patient, occupation, residence, place of employment, age, sex, nationality and social condition. A record shall be kept of such reports, which shall be accessible only on order of the Health Commissioner. (Ord. 63633 § 4 (part), 1996.)

11.56.520 Tuberculosis--Premises examination.

Whenever the Health Commissioner shall have information from the attending physician of the existence of a case of tuberculosis in the City, he shall cause the premises to be examined. Notes shall be taken of the sanitary condition of the premises, the number of persons living in the house, and whether the patient occupies a room alone or with others. (Ord. 63633 § 4 (part), 1996.)

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