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    PROPOSAL
    Maryland Register
    Issue Date:  December 23, 2016
    Volume 43 • Issue 26 • Pages 1458—1459
     
    Title 10
    DEPARTMENT OF HEALTH AND MENTAL HYGIENE
    Notice of Proposed Action
    [16-346-P]
    The Secretary of Health and Mental Hygiene proposes to:
    (1) Amend Regulations .01, .02, .17, and .18 under COMAR 10.06.01 Communicable Diseases and Related Conditions of Public Health Importance; and
    (2) Repeal in their entirety Regulations .01—.03 under COMAR 10.18.04 Disease Control.
    Statement of Purpose
    The purpose of this action is to:
    (1) Repeal the chapter on HIV/AIDS control in Subtitle 18 (COMAR 10.18.04);
    (2) Add HIV/AIDS control content to COMAR 10.06.01.17 which currently addresses syphilis control;
    (3) Update wording to use “individual” rather than “person” when referring to a human being and not an entity that could be a human being or a corporation and to use the phrase “sexually transmitted infection” rather than “sexually transmitted disease”;
    (4) Update the time frame in which a physician shall report to the health officer an individual receiving treatment for or under medical observation for syphilis in an infectious stage from “immediately” to “within 1 working day” to maintain consistency with the information in the table found in COMAR 10.06.01.03;
    (5) Add email addresses to the list of information that a physician shall endeavor to ascertain about those whom a patient with syphilis or HIV has potentially had infectious contact with;
    (6) Remove language detailing isolation of the reported person as an action to be taken to protect the public health against a person not examined by a physician for infection with HIV/AIDS or syphilis within one week after notification of their exposure to the disease; and
    (7) Remove “by a licensed physician” from the text stating that that a reported individual shall be examined to ascertain whether they have been infected with syphilis and HIV/AIDS.
    Comparison to Federal Standards
    There is no corresponding federal standard to this proposed action.
    Estimate of Economic Impact
    The proposed action has no economic impact.
    Economic Impact on Small Businesses
    The proposed action has minimal or no economic impact on small businesses.
    Impact on Individuals with Disabilities
    The proposed action has no impact on individuals with disabilities.
    Opportunity for Public Comment
    Comments may be sent to Michele Phinney, Director, Office of Regulation and Policy Coordination, Department of Health and Mental Hygiene, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to dhmh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through January 23, 2017. A public hearing has not been scheduled.
     
    Subtitle 06 DISEASES
    10.06.01 Communicable Diseases and Related Conditions of Public Health Importance
    Authority: Health-General Article, §§2-104(b), 18-102, 18-103, 18-105,
    18-201, 18.201.1, 18-20
    2, 18-205, 18-208, 18-214.1, 18-307, 18-337, and
    2
    4-101—24-110, Annotated Code of Maryland
    .01 Scope.
    A. This chapter does not apply to human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) surveillance, reporting, record maintenance, or confidentiality, which [is] are covered by COMAR [10.18] 10.18.02 and 10.18.03.
    B. This chapter applies to human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) control.
    [B.] C. This chapter provides regulations for [cooperative] coordinated control efforts for communicable [disease] diseases and related [condition control] conditions by the Department, local health officers, medical laboratory directors, physicians, veterinarians, and other Maryland governmental agencies, as guided by policy statements such as:
    (1)—(2) (text unchanged)
    .02 Definitions.
    A. (text unchanged)
    B. Terms Defined.
    (1) (text unchanged)
    (2) “Case” means an individual who has laboratory or clinical evidence of being infected by an infectious agent.
    [(2)] (3) (text unchanged)
    [(3) “Case” or “case of a disease” means an individual who has laboratory or clinical evidence of being infected by an infectious agent. A case may or may not have symptoms of the infection.]
    (4)—(25) (text unchanged)
    (26) “Sexually transmitted [disease or] infection” means an infection which may be spread by sexual intercourse [or other forms of sexual contact with an infected individual, including a disease or condition classified as a venereal disease], including oral, anal, or vaginal sexual contact with an infected individual.
    (27)—(29) (text unchanged)
    .17 [Sexually Transmitted Disease —] Syphilis and HIV.
    A. Control of a Case.
    (1) [A] For an individual who appears to have or who has syphilis in a stage which is or may become communicable, or HIV, a physician [in attendance upon an individual who appears to have, or who has, syphilis in a stage which is or may become communicable,] shall instruct the individual in the use of any measure[,] and render any treatment which may be necessary to prevent the spread of the disease.
    (2) An individual under medical observation for diagnosis [or under treatment for] of syphilis or HIV shall remain under medical supervision until the:
    (a) (text unchanged)
    (b) Syphilis or HIV, if present, has been reported to the health officer; [and]
    (c) [Person] Individual with syphilis has had the treatment that is necessary for the protection of the public health[.]; and
    (d) Individual with HIV has entered into HIV medical care.
    (3) A physician [in attendance] shall report to the health officer [immediately] within 1 working day and in writing the name and address of an individual who is:
    (a) (text unchanged)
    (b) Under medical observation for diagnosis or treatment of syphilis in an infectious or potentially infectious stage, who fails to return for observation or treatment within 1 week of the date of a missed appointment, and is not known to the attending physician to be under medical observation or treatment elsewhere for this [disease] infection.
    (4) A health officer shall:
    (a) Investigate [a person] an individual reported to the health officer under the provisions of [§A(3)(b)] §A(3) of this regulation or Health-General Article, §18-201.1, Annotated Code of Maryland, who is within the health officer’s territorial jurisdiction;
    (b) Take such measures [, which may include isolation at home or in a hospital or other institution,] as may be deemed necessary for the protection of the public health; and
    (c) Forward to the Secretary immediately a report of [a person] an individual reported under the provisions of [§A(3)(b)] §A of this regulation or Health-General Article, §18-201.1, Annotated Code of Maryland, who is outside the health officer’s territorial jurisdiction for referral to the health officer of the proper jurisdiction.
    B. Control of Contacts.
    (1) A physician in attendance upon a patient having syphilis [shall] or HIV:
    (a) [Endeavor] Shall endeavor to bring an individual with whom the patient has had potentially infectious contact to examination and [epidemiologic treatment], as appropriate, prophylaxis by:
    (i) Requesting the health officer to conduct a contact investigation of any case of syphilis[,] or HIV; or
    (ii) Interviewing the patient in order to ascertain the names, descriptions, addresses, [and] telephone numbers, and email addresses of those with whom the patient has had potentially infectious contact; [and]
    (b) [Report] Shall report immediately to the health officer [any untreated] an individual identified as having had potentially infectious contact with [an individual] a patient having syphilis reported under the provisions of §A(3) of this regulation; and
    (c) May report to the health officer an individual identified as having had potentially infectious contact with a patient having HIV reported under Health-General Article, §18-201.1, Annotated Code of Maryland, if a patient that has been informed of the patient’s HIV positive status refuses to notify the patient’s sexual and needle-sharing partners.
    (2) A health officer shall:
    (a) Investigate and notify immediately an individual reported under the provisions of §B(1)(b) of this regulation, who is within the health officer’s jurisdiction, [to submit to] of the individual’s exposure and advise the individual to undergo a medical examination to ascertain whether the individual is infected with syphilis or HIV; and
    (b) Forward immediately to the Secretary all reports of [persons] individuals who are outside the health officer’s territorial jurisdiction for referral to the health officer of the proper jurisdiction[; and.
    (c) Take action to protect the public health against a person who is not examined by a licensed physician for infection with this disease within 1 week after notification. This action may include isolation of the reported person at home or in a hospital or other institution].
    (3) A reported individual shall:
    (a) Within 1 week of notification, be examined [by a licensed physician] to ascertain whether the individual has been infected with syphilis or HIV; and
    (b) (text unchanged)
    C.—D. (text unchanged)
    .18 Other Sexually Transmitted [Diseases] Infections.
    A. (text unchanged)
    B. Control of Contacts.
    (1) (text unchanged)
    (2) A physician in attendance upon [a person] an individual who is a sexual contact of a case of a sexually transmitted [disease] infection shall perform a medical examination and render indicated treatment.
    C. (text unchanged)
    VAN T. MITCHELL
    Secretary of Health and Mental Hygiene