Rule-Making Notices (Hearing Notices)

NOTICE IS HEREBY GIVEN that pursuant to ss. 227.11, 252.02 (4) and (7), 254.51 (3), and 900.01 (5g), Stats., and interpreting Ch. 252 and ss. 254.04 and 254.51, Stats., the Wisconsin Department of Health and Family Services proposes to revise ch. HFS 145, relating to communicable disease list revisions and reporting communicable diseases, and affecting small businesses.

Hearing Information

Date and Time	Location
November 12, 2007 3:00 to 5:00 PM	Dept. of Health and Family Services 1 W. Wilson St., Rm B155 Madison, WI
November 13, 2007 2:00 to 4:00 PM	Lakeview Professional Plaza 1200 Lake View Drive First Floor Dining Room Wausau, WI

The hearing site is fully accessible to people with disabilities. If you are hearing impaired, do not speak English or have circumstances that might make communication at a hearing difficult; you require an interpreter or a non-English large print or taped version of the proposed rules, contact the person at the address or telephone number given below at least 10 days before the hearing. With less than 10 days notice, an interpreter may not be available.

Submission of Written Comments

Written comments may be submitted at the public hearing or submitted to the contact person listed below. Comments may also be made using the Wisconsin Administrative Rule Website at http://adminrules.wisconsin.gov. The deadline for submitting comments to the Department is 4:30 p.m. on November 20, 2007.

Copies of Rules and Fiscal Estimate

A copy of the full text of the rules and the fiscal estimate can be obtained at no charge from the Wisconsin Administrative Rules Website at http://adminrules. wisconsin.gov or by contacting the person listed below.

Contact Person

Marjorie Hurie

Department of Health and Family Services

Division of Public Health

Bureau of Communicable Diseases and Preparedness

1 W. Wilson St., RM 318

PO Box 2659

Madison, WI 53701-2659

[e-mail]

608-264-9892

1-888-701-1253 (TTY)

Analysis Prepared by the Department of Health and Family Services

The Department is authorized by s. 990.01 (5g), Stats., to define communicable diseases by rule and by s. 252.02 (1), Stats., to establish surveillance systems for communicable diseases. The Department's surveillance system requires medical providers, health care facilities and laboratories to report the communicable diseases listed in ch. HFS 145 Appendix A to the local health officer or the state epidemiologist. At the national level, the Council of State and Territorial Epidemiologists (CSTE) recommends reportable diseases by adding them to the list of Nationally Notifiable Infectious Diseases (NNID). The diseases CSTE places under surveillance are typically novel pathogens or those with severe manifestations whose transmission is amenable to control by public health measures. States are encouraged to establish parallel reporting requirements. Accordingly, the Department proposes to add the following six NNID listed diseases to ch. HFS 145 Appendix A:

1.   Influenza-associated pediatric deaths

2.   Influenza A virus infection, novel subtypes

3.   Poliovirus infection, nonparalytic

4.   Severe Acute Respiratory Syndrome-associated Coronavirus (SARS-CoV)

5.   Vancomycin-intermediate Staphylococcus aureus (VISA) infections and Vancomycin-resistant Staphylococcus aureus (VRSA) infections

6.   Vibriosis

Additionally, the Department proposes to add the following three diseases which are not on the NNID list to ch. HFS 145 Appendix A:

1.   Any illness caused by an agent that is foreign, exotic or unusual to Wisconsin, and that has public health implications. Section 250.02, Stats., authorizes the Department to take action to ascertain the presence of any communicable disease. This generic reporting requirement is in lieu of a long listing of individual exotic diseases that are rare but have major public ramifications. It also takes into account the possible emergence of important diseases that are as yet unknown. Each state adjacent to Wisconsin requires that unusual illnesses be reported.

2.   Lymphocytic Choriomeningitis Virus (LCMV) infections. In 2003, LCMV was transmitted in organs from an infected Wisconsin donor to four organ recipients. Implementation of public health measures upon identification of a case could potentially limit further exposures.

3.   Transmissible spongiform encephalitis (TSE, human). Approximately 50% of states currently mandate reporting of human TSEs and the Division of Public Health already maintains surveillance for human TSEs. Mandatory reporting will simplify the process of obtaining clinical information, especially from out-of-state providers, and will permit the Department to describe more accurately the burden of endemic TSEs of humans.

Additionally, the Department proposes to delete eight diseases, none of which are on the NNID list, from ch. HFS 145 Appendix A. The Department does not anticipate that there will be any adverse impact on the public from deletion of the eight diseases from mandatory reporting:

1.   Amebiasis

2.   Cat scratch disease (infection caused by Bartonella species)

3.   Encephalitis, viral (other than arboviral)

4.   Genital herpes infection (first episode identified by health care provider)

5.   Hepatitis non-A, non-B, (acute)

6.   Meningitis, viral (other than arboviral)

7.   Reye syndrome

8.   Typhus fever

Additionally, the Department proposes to change the way the following five diseases are listed in ch. HFS 145 Appendix A:

1.   Change Arboviral infection (encephalitis/meningitis) to Arboviral Disease. The proposed change in terminology makes reporting requirements consistent with current Wisconsin public health practice. This group of diseases is currently on the NNID list.

2.   Change E. coli 0157:H7, and other enterohemorrhagic E. coli, enteropathogenic E. coli, enteroinvasive E. coli, enterotoxigenic E. coli to E. coli 0157:H7 and other Shiga toxin-producing E. coli (STEC), enteropathogenic E. coli, enteroinvasive E. coli, and enterotoxigenic E. coli. In 2005, CSTE recommended that the enterohemorrhagic Escherichia coli (EHEC) condition name be revised to Shiga toxin-producing Escherichia coli (STEC) to more accurately describe the condition under surveillance.

3.   Change Hepatitis E from a category I disease to a category II disease because this disease does not occur often in the United States and person-to-person transmission is uncommon.

4.   Change Suspected Outbreaks of Other Acute or Occupational-related diseases from category II to category I because a possible outbreak requires immediate attention.

5.   Change Varicella (chickenpox) – report by number of cases only to Varicella (chickenpox). In 2003, CDC encouraged all states to establish individual case reporting systems to monitor the impact of the varicella vaccination program on varicella morbidity. This level of surveillance is now operationally feasible because the number of cases is far fewer than in the pre-vaccination era. Varicella is on the NNID list.

Lastly, the Department proposes to:

1) Alphabetize the diseases in ch. HFS 145 Appendix A to make the list easier for persons reporting communicable diseases to use.

2) Allow reports of communicable diseases to be submitted electronically. Electronic transmission of reports currently occurs and is expected to increase.

3) Cite the most recent editions of the Sexually Transmitted Diseases Treatment Guidelines and the Control of Communicable Diseases Manual to make the references current.

4) Require laboratories to forward specimens to the State Laboratory of Hygiene for confirmatory or investigation purposes if requested by the State Epidemiologist.

5) Require laboratories and health care facilities to report a negative test result on a case or a suspected case to justify release from isolation or quarantine if requested by the State Epidemiologist or Local Health Officer.

6) Remove language requiring a person, laboratory or health care facility to report the total number of cases of other communicable diseases listed in ch. HFS 145 Appendix A to the local health officer on a weekly basis because varicella, the only disease reported in this manner, will now be reported as individual cases.

The intended goals of the proposed rulemaking are to make communicable disease reporting requirements in Wisconsin current, consistent with CSTE recommendations and supportive of Wisconsin public health practice. Instead of regulatory action, medical providers, health care facilities and laboratories could be asked to submit reports voluntarily. However, such reporting would be incomplete and more staff time would be required to solicit the reports. Without this proposed rulemaking, disease reporters would continue to complete and submit reports of some communicable diseases unnecessarily, national communicable disease data would not reflect diseases occurring in Wisconsin, and the rule language would be outdated.

Members of the public who may be affected by the proposed rulemaking are those who acquire one of the communicable diseases the proposed rulemaking adds. Other members of the public who may be affected are the individual's family members or other contacts who were spared infection because public health measures were applied.

Initial Regulatory Flexibility Analysis

Chapter HFS 145 requires medical providers, health care facilities and laboratories to report communicable diseases listed in Appendix A to the Local Health Officer or the State Epidemiologist. This rulemaking proposes adding 9 diseases to, and subtracting 8 diseases from, ch. HFS 145 Appendix A. The rulemaking includes no fees and failure to comply with the rulemaking carries no penalties. Costs to the private sector include completing and mailing communicable disease case report forms, or keying-in and transmitting data electronically, to local health departments or the Department. Communicable disease reporting is frequently performed by the infection control practitioner or clerical staff.

This rulemaking is unlikely to have a significant economic impact on the private sector generally, and any health care facilities or laboratories that may meet the definition of small business in 227.114 (1), Stats., in particular. It includes no fees, failure to comply with the rulemaking carries no penalties and communicable disease reporting mechanisms are already in place. Usual costs to the private sector include completing and mailing communicable disease case reports forms, or keying-in and transmitting data electronically, to local health departments or the Department. These tasks are frequently performed by the infection control practitioner or clerical staff. Since the largest laboratories will be reporting automatically through electronic laboratory reporting, there will be minimal impact on these laboratories. Requests from the State Epidemiologist or the Local Health Officer for negative test results to justify release from isolation or quarantine are anticipated to be infrequent, as are requests from the State Epidemiologist that specimens to be forwarded to a public health laboratory for confirmatory or investigation purposes.

Small business regulatory coordinator

Rosie Greer

[e-mail]

608-266-1279

Fiscal Estimate

Anticipated costs to the Department include layout and printing costs associated with revising and reprinting the Division of Public Health's Communicable Disease Case Report form (DPH 4151); staff time to inform the mandated reporting agencies of the rule revisions through educational forums, e.g., Communicable Disease Spring Seminars, and scheduled meetings, e.g., regional Association of Practitioners of Infection Control chapter meetings and the State Laboratory of Hygiene's Laboratory Reporting Network; and staff time to prepare notices of the rule revisions for publication in the Wisconsin State Medical Journal, on the Department's web site and the Health Alert Network. These costs are insignificant and will be absorbed within the Bureau of Communicable Diseases and Preparedness budget and staff responsibilities.

The rule changes will not affect the expenditures or revenues of Local Health Departments. Local Health Officers are responsible under s. 252.03 (1), Stats., for investigating, preventing and controlling communicable diseases. Most of the diseases being added to Appendix A have been balanced by deletions from it and, with the exception of varicella (chickenpox), occur so rarely that few if any cases are expected annually. The addition of varicella reporting by individual case report to Appendix A (summary data on approximately 1,000 cases were reported in 2006) has been more than balanced by the deletion of genital herpes (more than 3,000 cases were reported in 2005).

Notice of Hearings

Natural Resources

(Environmental Protection—
Water Management, Chs. NR 300—)
[CR 07-094]

NOTICE IS HEREBY GIVEN THAT pursuant to ss. 30.12 (1g) and (3), 30.123 (6) and (7), 30.19 (1m) and (3r), 30.20 (1r) and (1t) and 30.206, Stats., interpreting ss. 30.12 (1g) and (3), 30.123 (6) and (7), 30.19 (1m) and (3r), 30.20 (1r) and (1t) and 30.206, Stats., the Department of Natural Resources will hold public hearings on revisions to chs. NR 320, 323, 328, 329, 341, 343 and 345, Wis. Adm. Code, relating to general permit criteria requiring decontamination of equipment for invasive species and viruses. This rule will modify the existing rules to establish a new exemption and general permit criteria requiring decontamination of equipment for invasive species and viruses (including but not limited to Viral Hemorrhagic Septicemia(VHS)). The new exemption and general permit standard require any person conducting an exempt or general permit activity to:

1. Inspect and remove aquatic plants, animals and mud from equipment.

2. Drain all water from equipment, including but not limited to tracked vehicles, barges, boats, silt or turbidity curtain, hoses, sheet pile and pumps.

3. Dispose of aquatic plants and animals in the trash. Never release or transfer aquatic plants, animals or water from one waterbody to another.

4. Wash equipment with hot (>140° F) or high pressure water or allow equipment to dry thoroughly for 5 days.

Hearing Information

NOTICE IS HEREBY FURTHER GIVEN that the hearings will be held on:

November 12, 2007 Monday at 2:00 p.m.	DNR Northeast Region Hdqrs. 2984 Shawano Avenue Green Bay
November 16, 2007 Friday at 2:00 p.m.	Room G09 GEF #2 Building 101 S. Webster Street Madison

NOTICE IS HEREBY FURTHER GIVEN that pursuant to the Americans with Disabilities Act, reasonable accommodations, including the provision of informational material in an alternative format, will be provided for qualified individuals with disabilities upon request. Please call Martin Griffin at [phone] with specific information on your request at least 10 days before the date of the scheduled hearing.

Copy of Rule and Submission of Written Comments

The proposed rule and fiscal estimate may be reviewed and comments electronically submitted at the following Internet site: http://adminrules.wisconsin.gov. Written comments on the proposed rule may be submitted via U.S. mail to Mr. Martin Griffin, Bureau of Watershed Management, P.O. Box 7921, Madison, WI 53707. Comments may be submitted until November 19, 2007. Written comments whether submitted electronically or by U.S. mail will have the same weight and effect as oral statements presented at the public hearings. A personal copy of the proposed rule and fiscal estimate may be obtained from Mr. Griffin.

Environmental Analysis

NOTICE IS HEREBY FURTHER GIVEN that the Department has made a preliminary determination that this action does not involve significant adverse environmental effects and does not need an environmental analysis under ch. NR 150, Wis. Adm. Code. However, based on the comments received, the Department may prepare an environmental analysis before proceeding with the proposal. This environmental review document would summarize the Department's consideration of the impacts of the proposal and reasonable alternatives.

Initial Regulatory Flexibility Analysis

NOTICE IS HEREBY FURTHER GIVEN that pursuant to s. 227.114, Stats., it is not anticipated that the proposed rule will have an economic impact on small businesses. The Department's Small Business Regulatory Coordinator may be contacted at [e-mail] or by calling [phone].

Fiscal Estimate

This rule package will increase operational costs for the state or for counties and municipalities to the extent that these precautionary practices are not already being implemented by these entities or by contractors acting on their behalf. However, since insufficient information is available to accurately estimate these costs, the Department is characterizing the state and local fiscal impact as “indeterminate" until more detailed cost information becomes available.