LA County Department of Public Health - Tuberculosis Control Program

Title 17, California Code of Regulations (CCR), Section 2505 Reportable Conditions: Notification by Laboratories

California Code of Regulations, Title 17, Section 2505 requires laboratories to report laboratory testing results suggestive of the following diseases of public health importance to the local health department

Salmonella (Section 2612 – see below)

List (e)(1)		List (e)(2)
Anthrax		Chlamydial infections
Botulism		Cryptosporidiosis
Brucellosis		Diphtheria
Plague, animal or human		Encephalitis, arboviral
Smallpox (Variola)		Escherichia coli O157:H7 infection
Tularemia		Gonorrhea
Viral hemorrhagic fever agents (e.g., Crimean-Congo, Ebola, Lassa and Marburg viruses)		Hepatitis A, acute infection , by IgM antibody test or positive viral antigen test
		Hepatitis B, acute infection, by IgM anti-HBc antibody test
		Hepatitis B surface antigen positivity (specify gender of case)
		Listeriosis
		Malaria
		Measles (Rubeola), acute infection, by IgM antibody test or positive viral antigen test
		Rabies, animal or human
		Syphilis
		Tuberculosis
		Typhoid
		Vibrio species infections

WHEN TO REPORT
These laboratory findings are reportable to the local health officer of the health jurisdiction where the health care provider who first submitted the specimen is located within one (1) hour (List (e)(1) diseases) or within one (1) working day (List (e)(2) diseases) from the time that the laboratory notifies that health care provider or other person authorized to receive the report. If the laboratory that makes the positive finding received the specimen from another laboratory, the laboratory making the positive finding shall notify the local health officer of the jurisdiction in which the health care provider is located within the time specified above from the time the laboratory notifies the referring laboratory that submitted the specimen. If the laboratory is an out-of-state laboratory, the California laboratory that receives a report of such findings shall notify the local health officer in the same way as if the finding had been made by the California laboratory.

HOW TO REPORT
Laboratory reports must be made in writing and give the following information:

the date the specimen was obtained,
the patient identification number,
the specimen accession number or other unique specimen identifier,
the laboratory findings for the test performed,
the date that any positive laboratory findings were identified,
the name, gender, address, telephone number (if known), and age or date of birth of the patient,
the name, address, and telephone number of the health care provider who ordered the test.

The notification for List (e)(1) diseases shall be reported by telephone within one (1) hour, followed by a written report submitted by electronic facsimile transmission or electronic mail within one (1) working day, to the local health officer in the jurisdiction where the health care provider who submitted the specimen is located. The notification for List (e)(2) diseases shall be submitted by courier, mail, electronic facsimile transmission or electronic mail within one (1) working day to the local health officer in the jurisdiction where the health care provider who submitted the specimen is located. Whenever the specimen, or an isolate therefrom, is transferred between laboratories, a test requisition with the above patient and submitter information shall accompany the specimen. The laboratory that first receives a specimen shall be responsible for obtaining the patient and submitter information at the time the specimen is received by that laboratory.

ADDITIONAL REPORTING REQUIREMENTS

ANTHRAX, BOTULISM, BRUCELLOSIS, PLAGUE, SMALLPOX, TULAREMIA, and VIRAL HEMORRHAGIC FEVERS
Whenever a laboratory receives a specimen for the laboratory diagnosis of a suspected human case of one of these diseases, such laboratory shall communicate immediately by telephone with the Microbial Diseases Laboratory (or, for Smallpox or Viral Hemorrhagic Fevers, with the Viral and Rickettsial Disease Laboratory) of the Department of Health Services for instruction.

TUBERCULOSIS
Any clinical laboratory or approved public health laboratory that isolates Mycobacterium tuberculosis from a patient specimen must submit a culture to the local public health laboratory as soon as available from the primary isolate on which a diagnosis was established.

The following information must be submitted with the Culture:

the name, address, and the date of birth of the person from whom the specimen was obtained,
the patient identification number,
the specimen accession number or other unique specimen identifier,
the date the specimen was obtained from the patient,
the name, address, and telephone number of the health care provider who ordered the test.

Unless drug susceptibility testing has been performed by the clinical laboratory on a strain obtained from the same patient within the previous three months or the health care provider who submitted the specimen for laboratory examination informs the laboratory that such drug susceptibility testing has been performed by another laboratory on a culture obtained from that patient within the previous three months, the clinical laboratory must do the following:

perform or refer for drug susceptibility testing on at least one isolate from each patient from whom Mycobacterium tuberculosis was isolated,
report the results of drug susceptibility testing to the local health officer of the city or county where the submitting physician's office is located within one (1) working day from the time the health care provider or other authorized person who submitted the specimen is notified,
if the drug susceptibility testing determines the culture to be resistant to at least isoniazid and rifampin, in addition, submit one culture or subculture from each patient from whom multidrug-resistant Mycobacterium tuberculosis was isolated to the public health laboratory for the local health jurisdiction in which the health care provider’s office is located.

Whenever a clinical laboratory finds that a specimen from a patient with known or suspected tuberculosis tests positive for acid fast bacillus (AFB) staining and the patient has not had a culture which identifies that acid fast organism within the past 30 days, the clinical laboratory shall culture and identify the acid fast bacteria or refer a subculture to another laboratory for those purposes.

MALARIA
Any clinical laboratory that makes a finding of malaria parasites in the blood film of a patient shall immediately submit one or more such blood film slides for confirmation to the local public health laboratory for the local health jurisdiction where the health care provider is located. When requested, all blood films will be returned to the submitter.

SALMONELLA
California Code of Regulations, Title 17, Section 2612 requires that a culture of the organisms on which a diagnosis of salmonellosis is established must be submitted to the local public health laboratory and then to the State’s Microbial Diseases Laboratory for definitive identification.

All laboratory notifications are acquired in confidence. The confidentiality of patient information is always protected.