Mandatory Reporting of Infectious Diseases by Clinicians

NOTICE This issue of MMWR Recommendations and Reports (Volume 39, No. RR-9) is a reprint of two articles published in the December 1, 1989, edition of the Journal of the American Medical Association. The articles are reprinted, with permission, in the MMWR series of publications as a service to the readership. The tables of state and territorial disease requirements provide summary information and were current as of March 1, 1989. Readers should contact state health departments for current and complete information on reporting requirements in individual states. Mandatory Reporting of Infectious Diseases by Clinicians Terence L. Chorba, MD, MPH Ruth L. Berkelman, MD Susan K. Safford, MD Norma P. Gibbs Harry F. Hull, MD Reporting of cases of communicable disease is important in the planning and evaluation of disease prevention and control programs, in the assurance of appropriate medical therapy, and in the detection of common-source outbreaks. In the United States, the authority to require notification of cases of disease resides in the respective state legislatures. We examined the laws and regulations of health departments of all US jurisdictions to ascertain diseases and conditions currently required to be reported in each state or territory. We present herein the state reporting requirements for infectious diseases and infectious disease-related conditions. To obtain additional information regarding time frames for reporting, agencies to which reports are required, persons required to report, and specific conditions under which reports are required, the reader is referred to the statutes and health department regulations of the respective states. Reporting of cases of infectious diseases and related conditions has been and remains a vital step in controlling and preventing the spread of communicable disease. These reports are useful in many ways, including assurance of provision of appropriate medical therapy (eg, for tuberculosis), detection of common-source outbreaks (eg, in food-borne outbreaks), and planning and evaluating prevention and control programs (eg, for vaccine-preventable diseases). The epidemic of the acquired immunodeficiency syndrome, the recent increase in tuberculosis in young adults, the reemergence of malaria as a health threat to travelers, and the potential spread of dengue fever to the continental United States have all contributed to the renewed interest in the surveillance of infectious diseases.

BACKGROUND

The control and prevention of infectious disease has traditionally been a primary health mandate. Systematic reporting of various diseases in the United States began in 1874 when the State Board of Health of Massachusetts inaugurated a plan for the weekly voluntary reporting of prevalent diseases by physicians (1). A sample postcard was designed to "reduce to the minimum the expenditure of time and trouble incident to the service asked of busy medical men (2)." In 1883, Michigan became the first US jurisdiction to mandate the reporting of specific infectious diseases. By 1901, all states required notification of selected communicable diseases to local health authorities. However, the poliomyelitis epidemic in 1916 and the influenza pandemic of 1918 heightened interest in reporting requirements, resulting in the participation of all states in national morbidity reporting by 1925. Today, all states and territories of the United States participate in a national morbidity reporting system and regularly report aggregate or case-specific data for 49 infectious diseases and related conditions to the Centers for Disease Control (CDC) in Atlanta, Ga (3). In the United States, the authority to require notification of cases of disease resides in the respective state legislatures. In some states, authority is enumerated in statutory provisions; in other states, authority to require reporting has been given to state boards of health; still other states require reports both under statutes and under health department regulations. Variation among states also exists among conditions and diseases to be reported, time frames for reporting, agencies receiving reports, persons required to report, and conditions under which reports are required. In many states, local health departments provide epidemiologic services; as a consequence, health care providers in many states are encouraged to report diseases directly to local health departments rather than to the state health department. Compilations of disease-reporting requirements in the United States were last published by the US Public Health Service in 1933 (4) and 1944 (5). To ascertain diseases and conditions currently required to be reported in each state, we examined the laws and regulations of health departments of all the states, the District of Columbia, the Commonwealth of Puerto Rico, Guam, American Samoa, the Commonwealth of the Northern Mariana Islands, and the US Virgin Islands (hereafter referred to as states). This information was provided by the Council of State and Territorial Epidemiologists (CSTE) through the respective state epidemiologists. Among reportable diseases identified at the outset of this project were more than 160 infectious diseases or infectious disease-related conditions, 90 diseases caused by occupational exposures, 23 other environmental diseases, 29 congenital or noninfectious childhood conditions, and 6 diseases of unknown etiology. In addition, the laws relating to morbidity in some states specify that cases of certain classes of disease shall be notifiable, eg, "diseases which are known or suspected to be related to environmental exposure to toxic-hazardous material" (Alaska) or "the occurrence of any increase in incidence of disease of unknown or unusual etiology" (Hawaii). The Table summarizes the infectious diseases and infectious disease-related conditions reportable (or in process of being made reportable) in at least 10 states for physicians and other health care providers as of March 1, 1989. Diseases are presented in the nomenclature used by the majority of states or, where appropriate, in the nomenclature recommended by the American Public Health Association (6). Where appropriate, eponymic terms have been changed to internationally accepted format. Consequently, there is variation between the terms used in this Table and those used in some state statutes or regulations. Diseases reportable in fewer than 10 states are not included unless nomenclature used in some states could be interpreted to denote diseases or conditions for which different nomenclature was used in other states (see Table footnotes). A semicolon (;) is provided to demarcate separate reporting requirements for conditions described by the same nomenclature. For example, Ohio's reporting requirements for streptococcal disease, site unspecified, are presented as "NZ;n," denoting a reporting requirement for streptococcal B infections in newborns and a reporting requirement for total numbers of streptococcal infections. Many states also have infectious disease-reporting requirements for laboratories, but these are not presented herein. In addition, the National Childhood Vaccine Injury Act of 1986 requires that health care providers who administer certain vaccines and toxoids are required by law to record permanently certain information and to report to the US Department of Health and Human Services selected adverse events occurring after vaccination. Events occurring after receipt of publicly purchased vaccines are reported through local, county, and/or state health departments to the CDC on its Report of Adverse Events Following Immunization (CDC form 71.19). Events occurring after receipt of a privately purchased vaccine usually are reported directly to the Food and Drug Administration (FDA) on its Adverse Reaction Report (FDA form 1639) by the health care provider or the manufacturer; this form, which may be duplicated, can be obtained directly from the FDA and is also printed in the FDA Drug Bulletin, the physician's edition of the Physician's Desk

Reference,

USP Drug Information for Health Care Providers, and AMA Drug Evaluations. Readers are referred elsewhere (7) for details of this surveillance system and requirements for recording and reporting. The accompanying article details state reporting requirements for occupational diseases (8). To obtain additional information regarding time frames for reporting, agencies to which reports are required, persons required to report, specific conditions under which reports are required, and reporting requirements for laboratories, the reader is referred to the statutes and health department regulations of the respective states.

COMMENT

References

  1. Trask JW. Vital statistics: a discussion of what they are and their uses in public health administration. Public Health Rep. 1915;30(suppl 12):1-51.
  2. Bowditch HI, Webster DL, Hoadley JC, et al. Letter from Massachusetts State Board of Health to physicians. Public Health Rep. 1915;30(suppl 12):31.
  3. Manual of Procedures for National Morbidity Reporting and Public Health Surveillance Activities. Atlanta, Ga: Centers for Disease Control;1985.
  4. Fowler W. Laws and regulations relating to morbidity reporting. Public Health Rep. 1933;48(suppl 100):1-29.
  5. Fowler W. The reportable diseases: diseases and conditions required to be reported in the several states. Public Health Rep. 1944;59:317-340.
  6. Benenson AS, ed. Control of Communicable Diseases in Man. 14th ed. Washington, DC:American Public Health Association;1985.
  7. Centers for Disease Control. National Childhood Vaccine Injury Act: requirements for permanent vaccination records and for reporting of selected events after vaccination. MMWR. 1988;37:197-200.
  8. Freund E, Seligman PJ, Chorba TL, Safford SK, Drachman JG, Hull HF. Mandatory reporting of occupational diseases by clinicians. JAMA. 1989;262:3041-3044.
  9. Valleron A-J, Bouvet E, Garnerin P, et al. A computer network for the surveillance of communicable diseases: the French experiment. Am J Public Health. 1986;76:1289-1292.
  10. Thacker SB, Choi K, Brachman PS. The surveillance of infectious diseases. JAMA. 1983;249:1181-1185.
  11. Moro ML, McCormick A. Surveillance of communicable disease. In: Eylenbosch WJ, Noah ND, eds. Surveillance in Health and Disease. New York, NY: Oxford University Press, Inc; 1988:166-182.
  12. Carter AO. Notifiable diseases in Canada. Can Med Assoc J. 1988;139:645-648.
  13. Centers for Disease Control. Guidelines for evaluating surveillance systems. MMWR. 1988;37(suppl S-5):1-18.
  14. Sacks JJ. Utilization of case definitions and laboratory reporting in the surveillance of notifiable communicable diseases in the United States. Am J Public Health. 1985;75:1420-1422.
  15. Centers for Disease Control and Council of State and Territorial Epidemiologists. Case definitions for surveillance of notifiable diseases - administrative report. MMWR. In press.
  16. Thacker SB, Berkelman RL. Public health surveillance in the United States. Epidemiol Rev. 1988;10:164-190.
  17. Lowry PW, Levine R, Stroup DF, Gunn RA, Wilder MH, Konigsberger C. Hepatitis A outbreak on a floating restaurant in Florida, 1986. Am J Epidemiol. 1989;129:155-164.
  18. Centers for Disease Control. Hepatitis B associated with jet gun injection - California. MMWR. 1986;35:373-376.
  19. Reingold AL, Kane MA, Murphy BL, Checko P, Francis DP, Maynard JE. Transmission of hepatitis B by an oral surgeon. J Infect Dis. 1982;145:262-268.
  20. Centers for Disease Control. Non-A, non-B hepatitis - Illinois. MMWR. 1989;38:529-562.
  21. Davis JP, Vergeront JM. The effect of publicity on the reporting of toxic-shock in Wisconsin. J Infect Dis. 1982;145:449-457.
  22. Todd JK, Wiesenthal AM, Ressman M, Caston SA, Hopkins RS. Toxic shock syndrome, II: estimated occurrence in Colorado as influenced by case ascertainment methods. Am J Epidemiol. 1985;122:857-867.
  23. Francis DP, Hadler SC, Prendergast TJ, et al. Occurrence of hepatitis A, B, and non-A/non-B in the United States: CDC Sentinel County Hepatitis Study I. Am J Med. 1984;76:69-74.
  24. Eisenberg MS, Wiesner PJ. Reporting and treating gonorrhea: results of a statewide survey in Alaska. J Am Venereal Dis Assoc. 1976;3:79-83.
  25. Centers for Disease Control. National surveillance for Reye syndrome, 1981: update - Reye syndrome and salicylate usage. MMWR. 1982;31:53-56,61.
  26. Guillain-Barre Syndrome Surveillance Report, January l978-March l979. Atlanta, Ga: Centers for Disease Control; 1980.
  27. Vogt RL, LaRue D, Klaucke DN, Jillson DA. Comparison of an active and passive surveillance system of primary care providers for hepatitis, measles, rubella, and salmonellosis in Vermont. Am J Public Health. 1983:73;795-797.
  28. Vogt RL, Clark SW, Kappel S. Evaluation of the state surveillance system using hospital discharge diagnoses, 1982-1983. Am J Epidemiol. 1986;123:197-198.
  29. Reichelderfer PS, Kappus KD, Kendal AP. Economical laboratory support system for influenza virus surveillance. J Clin Microbiol. 1987;25:947-948.
  30. Godes JR, Hall WN, Dean AG, Morse CD. Laboratory-based disease surveillance: a survey of state laboratory directors. Minn Med. 1982;65:762-764.
  31. Davis JP, Bohn MJ. The extent of underreporting of meningococcal disease in Wisconsin, 1980-1982. Wis Med J. 1984;83:11-14.
  32. Choi K, Thacker SB. An evaluation of influenza mortality surveillance, 1962-79, I. time series forecasts of expected pneumonia and inflenza deaths. Am J Epidemiol. 1981;113:215-226.
  33. Graitcer PL, Burton AH. The epidemiologic surveillance project: a computer-based system for disease surveillance. Am J Prev Med. 1987;3:123-127.
  34. Stroup DF, Williamson GD, Herndon JL, Karon JM. Detection of aberrations in the occurrence of notifiable diseases surveillance data. Stat Med. 1989;8:323-329.
  35. International Health Regulations (1969). 3rd annotated ed. Geneva, Switzerland: World Health Organization; 1983.
  36. Konowitz PM, Petrossian GA, Rose DN. The underreporting of disease and physicians' knowledge of reporting requirements. Public Health Rep. 1984;99:31-35.
  37. Disease Surveillance: Who Reports? Burlington: Vermont Dept of Health; 1988. Vermont Dept of Health Disease Control Bulletin.
  38. Alter MJ, Mares A, Hadler SC, Maynard JE. The effect of underreporting on the apparent incidence and epidemiology of acute viral hepatitis. Am J Epidemiol. 1987;125:133-139.
  39. Kimball AM, Thacker SB, Levy ME. Shigella surveillance in a large metropolitan area: assessment of a passive reporting system. Am J Public Health. 1980;70:164-166.
  40. Chalker RB, Blaser MJ. A review of human salmonellosis, III: magnitude of Salmonella infection in the United States. Rev Infect Dis. 1988;10:111-124.
  41. Hepatitis A cluster: a need to report disease occurrence. Del Monthly Surveill Rep. 1989;89:1-2.
  42. Hinman AR, Eddins DL, Kirby CD, et al. Progress in measles elimination. JAMA. 1982;247:1592-1595.

From the Epidemiology Program Office, Centers for Disease Control, Atlanta, GA (Drs Chorba, Berkelman, and Safford and Ms Gibbs); and the New Mexico Health and Environment Department, Santa Fe (Dr Hull). Reprint requests to the Centers for Disease Control, 1600 Clifton Rd NE, Mailstop F36, Atlanta, GA 30333 (Dr Chorba).

Disclaimer All MMWR HTML documents published before January 1993 are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.

**Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.

Morbidity and Mortality Weekly Report
Centers for Disease Control and Prevention
1600 Clifton Rd, MailStop E-90, Atlanta, GA 30333, U.S.A