DHS 145.05 NoteNote: The official report of the American Public Health Association entitled Control of Communicable Diseases Manual, 20th edition (2015), edited by David L. Heymann, is available for purchase from the American Public Health Association, Publications Sales, PO Box 933019, Atlanta, GA 31193-3019. The official report of the American Academy of Pediatrics entitled Red Book: 2015 Report of the Committee on Infectious Diseases, 30th edition (2015), edited by David W. Kimberlin is available for purchase from the American Academy of Pediatrics, 141 Northwest Point Blvd, Elk Grove Village, IL 60007-1019. These reports are on file in the Department’s Division of Public Health and the Legislative Reference Bureau.
DHS 145.05 HistoryHistory: Cr. Register, April, 1984, No. 340, eff. 5-1-84; am. (2) and (3), Register, February, 1989, No. 398, eff. 3-1-89; am. (2) and (3), Register, March, 2000, No. 531, eff. 4-1-00; CR 03-033: am. (2) and (3) Register December 2003 No. 576, eff. 1-1-04; CR 07-090: am. (2) and (3) Register February 2008 No. 626, eff. 3-1-08; CR 17-014: am. (2), (3), Register June 2018 No. 750 eff. 7-1-18. DHS 145.06DHS 145.06 General statement of powers for control of communicable disease. DHS 145.06(1)(1) Applicability. The general powers under this section apply to all communicable diseases listed in Appendix A of this chapter and any other infectious disease which the chief medical officer deems poses a threat to the citizens of the state. DHS 145.06(2)(2) Persons whose substantiated condition poses a threat to others. A person may be considered to have a contagious medical condition which poses a threat to others if that person has been medically diagnosed as having any communicable disease and exhibits any of the following: DHS 145.06(2)(a)(a) A behavior which has been demonstrated epidemiologically to transmit the disease to others or which evidences a careless disregard for the transmission of the disease to others. DHS 145.06(2)(b)(b) Past behavior that evidences a substantial likelihood that the person will transmit the disease to others or statements of the person that are credible indicators of the person’s intent to transmit the disease to others. DHS 145.06(2)(c)(c) Refusal to complete a medically directed regimen of examination and treatment necessary to render the disease noncontagious. DHS 145.06(2)(d)(d) A demonstrated inability to complete a medically directed regimen of examination and treatment necessary to render the disease noncontagious, as evidenced by any of the following: DHS 145.06(2)(d)1.1. A diminished capacity by reason of use of mood-altering chemicals, including alcohol. DHS 145.06(2)(d)2.2. A diagnosis as having significantly below average intellectual functioning. DHS 145.06(2)(d)3.3. An organic disorder of the brain or a psychiatric disorder of thought, mood, perception, orientation or memory. DHS 145.06(2)(d)4.4. Being a minor, or having a guardian appointed under ch. 54, Stats., following documentation by a court that the person is incompetent. DHS 145.06(2)(e)(e) Misrepresentation by the person of substantial facts regarding the person’s medical history or behavior, which can be demonstrated epidemiologically to increase the threat of transmission of disease. DHS 145.06(2)(f)(f) Any other willful act or pattern of acts or omission or course of conduct by the person which can be demonstrated epidemiologically to increase the threat of transmission of disease to others. DHS 145.06(3)(3) Persons whose suspected condition poses a threat to others. A person may be suspected of harboring a contagious medical condition which poses a threat to others if that person exhibits any of the factors noted in sub. (2) and, in addition, demonstrates any of the following without medical evidence which refutes it: DHS 145.06(3)(a)(a) Has been linked epidemiologically to exposure to a known case of communicable disease. DHS 145.06(3)(b)(b) Has clinical laboratory findings indicative of a communicable disease. DHS 145.06(3)(c)(c) Exhibits symptoms that are medically consistent with the presence of a communicable disease. DHS 145.06(4)(4) Authority to control communicable diseases. When it comes to the attention of an official empowered under s. 250.02 (1), 250.04 (1) or 252.02 (4) and (6), Stats., or under s. 252.03 (1) and (2), Stats., that a person is known to have or is suspected of having a contagious medical condition which poses a threat to others, the official may direct that person to comply with any of the following, singly or in combination, as appropriate: DHS 145.06(4)(a)(a) Participate in a designated program of education or counseling. DHS 145.06(4)(b)(b) Participate in a defined program of treatment for the known or suspected condition. DHS 145.06(4)(c)(c) Undergo examination and tests necessary to identify a disease, monitor its status or evaluate the effects of treatment on it. DHS 145.06(4)(d)(d) Notify or appear before designated health officials for verification of status, testing or direct observation of treatment. DHS 145.06(4)(e)(e) Cease and desist in conduct or employment which constitutes a threat to others. DHS 145.06(4)(f)(f) Reside part-time or full-time in an isolated or segregated setting which decreases the danger of transmission of the communicable disease. DHS 145.06(4)(g)(g) Be placed in an appropriate institutional treatment facility until the person has become noninfectious. DHS 145.06(5)(5) Failure to comply with directive. When a person fails to comply with a directive under sub. (4), the official who issued the directive may petition a court of record to order the person to comply. In petitioning a court under this subsection, the petitioner shall ensure all of the following: DHS 145.06(5)(a)(a) That the petition is supported by clear and convincing evidence of the allegation. DHS 145.06(5)(b)(b) That the respondent has been given the directive in writing, including the evidence that supports the allegation, and has been afforded the opportunity to seek counsel. DHS 145.06(5)(c)(c) That the remedy proposed is the least restrictive on the respondent which would serve to correct the situation and to protect the public’s health. DHS 145.06(6)(6) Hazards to health. Officials empowered under ss. 250.02 (1), 250.04 (1) and 252.02 (4) and (6), Stats., or under s. 252.03 (1) and (2), Stats., may direct persons who own or supervise real or physical property or animals and their environs, which present a threat of transmission of any communicable disease under sub. (1), to do what is reasonable and necessary to abate the threat of transmission. Persons failing or refusing to comply with a directive shall come under the provisions of sub. (5) and this subsection. DHS 145.06 HistoryHistory: Cr. Register, March, 2000, No. 531, eff. 4-1-00; correction in (2) (d) 4. made under s. 13.92 (4) (b) 7., Stats., Register February 2008 No. 626. DHS 145.07DHS 145.07 Special disease control measures. DHS 145.07(1)(1) Schools and day care centers. Any teacher, principal, director or nurse serving a school or day care center may send home, for the purpose of diagnosis and treatment, any pupil suspected of having a communicable disease or of having any other disease or condition having the potential to affect the health of other students and staff including but not limited to pediculosis and scabies. The teacher, principal, director or nurse authorizing the action shall ensure that the parent, guardian or other person legally responsible for the child or other adult with whom the child resides and the nurse serving the child’s school or day care center are immediately informed of the action. A teacher who sends a pupil home shall also notify the principal or director of the action. DHS 145.07(2)(2) Personal care. Home health agency personnel providing personal care in the home and persons providing personal care in health care facilities, day care centers and other comparable facilities shall refrain from providing care while they are able to transmit a communicable disease through the provision of that care, in accord with the methods of communicable disease control contained in official guidance of the Centers for Disease Control and Prevention, unless specified otherwise by the state epidemiologist. DHS 145.07 NoteNote: The official guidance of the Centers for Disease Control and Prevention entitled, “Guideline for Infection Control in Health Care Personnel, 1998,” is on file in the Department’s Division of Public Health and the Legislative Reference Bureau, and may be found in the American Journal of Infection Control, vol. 26, 1998, pp. 289-354.
DHS 145.07(3)(3) Food handlers. Food handlers shall refrain from handling food while they have a disease in a form that is communicable by food handling, in accord with the methods of communicable disease control contained in the official report of the American Public Health Association, unless specified otherwise by the state epidemiologist. DHS 145.07 NoteNote: The official report of the American Public Health Association entitled Control of Communicable Disease Manual, 20th edition (2015), edited by David L. Heymann, is on file in the Department’s Division of Public Health and the Legislative Reference Bureau, and is available for purchase from the American Public Health Association, Publication Sales, PO Box 933019, Atlanta, GA 31193-3019.
DHS 145.07(4)(4) Prevention of ophthalmia neonatorum. The attending physician or midwife shall ensure placement of 2 drops of a one percent solution of silver nitrate, or a 1-2 centimeter ribbon of an ophthalmic ointment containing 0.5% erythromycin or one percent tetracycline, in each eye of a newborn child as soon as possible after delivery but not later than one hour after delivery. No more than one newborn child may be treated from an individual container. DHS 145.07 HistoryHistory: Cr. Register, April, 1984, No. 340, eff. 5-1-84; r. and recr. (4), Register, November, 1984, No. 347, eff. 12-1-84; am. (1) to (3), Register, February, 1989, No. 398, eff. 3-1-89; renum. from HFS 145.06 and am., Register, March, 2000, No. 531, eff. 4-1-00; CR 17-014: am. (2), (3), Register June 2018 No. 750 eff. 7-1-18; correction in (3) made under s. 35.17, Stats., Register June 2018 No. 750. DHS 145.08DHS 145.08 Definitions. In this subchapter: DHS 145.08(1)(1) “Case management” means the creation and implementation of an individualized treatment plan for a person with tuberculosis infection or disease that ensures that the person receives appropriate treatment and support services in a timely, effective, and coordinated manner. DHS 145.08(2)(2) “Confinement” means the restriction of a person with tuberculosis to a specified place in order to prevent the transmission of the disease to others, to prevent the development of drug-resistant organisms or to ensure that the person receives a complete course of treatment. DHS 145.08(3)(3) “Contact” means a person who shares air with a person who has infectious tuberculosis. DHS 145.08(4)(4) “Contact investigation” means the process of identifying, examining, evaluating and treating a person at risk of infection with Mycobacterium tuberculosis due to recent exposure to infectious tuberculosis or suspected tuberculosis. DHS 145.08(5)(5) “Directly observed therapy” means the ingestion of prescribed anti-tuberculosis medication that is observed by a health care worker or other responsible person acting under the authority of the local health department. DHS 145.08(6)(6) “Infectious tuberculosis” means tuberculosis disease of the respiratory tract capable of producing infection or disease in others, as demonstrated by the presence of acid–fast bacilli in the sputum or bronchial secretions, or by radiographic and clinical findings. DHS 145.08(7)(7) “Isolate” means a population of Mycobacterium tuberculosis bacteria that has been obtained in pure culture medium. DHS 145.08(8)(8) “Isolation” means the separation of persons with infectious tuberculosis from other persons, in a place and under conditions that will prevent transmission of the infection. DHS 145.08(9)(9) “Licensed prescriber” means an advanced practice nurse prescriber, a physician assistant, or other person licensed to prescribe medication under Wisconsin law. DHS 145.08(10)(10) “Public health dispensary” means a program of a local health department or group of local health departments to prevent and control tuberculosis disease and infection by the identification, medical evaluation, treatment and management of persons at risk for tuberculosis infection or disease. DHS 145.08(11)(11) “Repository” means a central location at the Wisconsin State Laboratory of Hygiene for receipt and storage of patient isolates of Mycobacterium tuberculosis. DHS 145.08(12)(12) “Sputum conversion” means the conversion of serial sputum cultures for Mycobacterium tuberculosis from positive to negative, in response to effective treatment. DHS 145.08(13)(13) “Suspected tuberculosis” means an illness marked by symptoms, signs, or laboratory tests that may be indicative of infectious tuberculosis such as prolonged cough, prolonged fever, hemoptysis, compatible radiographic findings or other appropriate medical imaging findings. DHS 145.08(14)(14) “Tuberculosis disease” means an illness determined by clinical or laboratory criteria or both to be caused by Mycobacterium tuberculosis. DHS 145.08(15)(15) “Tuberculosis infection” means an infection with Mycobacterium tuberculosis in a person who has no symptoms of tuberculosis disease and is not infectious. DHS 145.08 HistoryHistory: Cr. Register, April, 1984, No. 340, eff. 5-1-84; r. and recr. Register, March, 2000, No. 531, eff. 4-1-00; CR 01-105: r. and recr. Register March 2002 No. 555, eff. 4-1-02. DHS 145.09(1)(1) Any laboratory that receives a specimen for tuberculosis testing shall report all positive results as specified in s. DHS 145.04, including those obtained by an out-of-state laboratory, to the local health officer and to the department. The laboratory shall also submit an isolate from a patient with a positive culture to the state repository. DHS 145.09 NoteNote: Isolates for the state repository should be sent to: Mycobacteriology Laboratory, Wisconsin State Laboratory of Hygiene, 2601 Agriculture Dr., Room 254, Madison, WI 53718.
DHS 145.09(2)(2) Any laboratory that performs primary culture for mycobacteria shall perform organism identification using an approved rapid testing procedure specified in the official statement of the Association of Public Health Laboratories, unless specified otherwise by the state epidemiologist. The laboratory shall ensure at least 80% of culture-positive specimens are reported as either Mycobacterium tuberculosis complex or not Mycobacterium tuberculosis complex within 21 calendar days of the laboratory’s receipt of the specimens. DHS 145.09 NoteNote: The official statement of the Association of Public Health Laboratory entitled “Mycobacterium tuberculosis: assessing your laboratory”, 2013 is on file in the Legislative Reference Bureau, and is available from the Department’s Division of Public Health, P.O. Box 2659, Madison, WI 53701–2659..
DHS 145.09(3)(3) Any laboratory that identifies Mycobacterium tuberculosis shall ensure that antimicrobial drug susceptibility tests are performed on all initial isolates. The laboratory shall report the results of these tests to the local health officer or the department. DHS 145.09 NoteNote: Reports may be submitted to the Department’s Division of Public Health, P.O. Box 2659, Madison, WI 53701-2659.
DHS 145.09 HistoryHistory: Cr. Register, April, 1984, No. 340, eff. 5-1-84; am. (1), Register, February, 1989, No. 398, eff. 3-1-89; r. and recr. Register, March, 2000, No. 531, eff. 4-1-00; CR 01-105: r. and recr. Register March 2002 No. 555, eff. 4-1-02. DHS 145.10DHS 145.10 Restriction and management of patients and contacts. DHS 145.10(1)(1) All persons with infectious tuberculosis or suspected tuberculosis, and their contacts, shall exercise all reasonable precautions to prevent the infection of others, using the applicable methods of control set out in the official report of the American Public Health Association, unless specified otherwise by the state epidemiologist. DHS 145.10 NoteNote: The official report of the American Public Health Association entitled Control of Communicable Diseases Manual, 20th edition (2015), edited by David L. Heymann, is on file in the Department’s Division of Public Health and the Legislative Reference Bureau, and is available for purchase from the American Public Health Association, Publications Sales, PO Box 933019, Atlanta, GA 31193-3019.
DHS 145.10(2)(2) All persons with infectious tuberculosis or suspected tuberculosis shall be excluded from work, school and other premises that cannot be maintained in a manner adequate to protect others from being exposed to tuberculosis, as determined by the local health officer. DHS 145.10(3)(3) Official statements of the American Thoracic Society shall be considered in the treatment of tuberculosis, unless specified otherwise by the state epidemiologist. Specific medical treatment shall be prescribed by a physician or other licensed prescriber. DHS 145.10 NoteNote: The official statements of the American Thoracic Society may be found in the Centers for Disease Control and Prevention’s recommendations and report “Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection.” The report may be found in the Morbidity and Mortality Weekly Report, June 9, 2000, Vol. 49, No. RR-6. The official statements of the American Thoracic Society, entitled “Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis” may be found in Clinical Infectious Diseases, vol. 63, 2016, pp. e147-e195. These reports are on file in the Legislative Reference Bureau, and are available from the Department’s Division of Public Health, P.O. Box 2659, Madison, WI 53701-2659.
DHS 145.10(4)(a)(a) Any physician or licensed prescriber who treats a person with tuberculosis disease shall report all of the following to the local health officer: DHS 145.10(4)(a)2.2. The date of the person’s completion of the tuberculosis treatment regimen. DHS 145.10(4)(b)(b) The physician or his or her designee shall immediately report to the local health officer when a person with tuberculosis disease does any of the following: DHS 145.10(5)(5) Upon receiving a report under sub. (4) (b), the local health officer shall immediately investigate and transmit the report to the department. DHS 145.10(6)(6) The local health officer or the department may do any of the following: DHS 145.10(6)(d)(d) Order the confinement of a person if the local health officer or the department decides that confinement is necessary and all of the following conditions are met: DHS 145.10(6)(d)1.1. The department or local health officer notifies a court in writing of the confinement.
