Division of Disease Control and Health Protection

A synopsis of the more significant changes is given below.

Congenital Anomalies – added as a result of the 1997 Florida Legislature's mandate to establish a birth defects registry; included are major structural congenital defects, genetic disorders, and other congenital disorders.

Hepatitis B, perinatal – although covered under the reporting requirements for hepatitis B in the past, this category was added to place emphasis on identifying these cases; it has also been added to the national case definitions.

Hepatitis B, positive HbsAg in a pregnant woman – added in response to the need to identify cases of perinatal hepatitis B.

Hepatitis C – added as a current category of its own due to the public health significance of the disease and improvements in available testing technology. There will be cases classified as NANB because additional procedures in lab technology to identify hepatitis C are still needed.

Listeriosis – although not on the national notifiable list, this disease was added in response to increasing public health significance due to recent outbreaks

Neurotoxic Shellfish Poisoning – replaces paralytic shellfish poisoning, a form seen in other parts of the US.

Pesticide Related Illness or Injury – replaces "pesticide poisoning" and incorporates a more detailed and comprehensive case definition

Smallpox – removed from the list in 1996, smallpox was re-entered in response to the threat of its use in bioterrorism; reinstating this as a reportable disease is essential for early notification and intervention in the event of a bioterrorist incident.

Staphylococcus aureus, glycopeptide intermediate and resistant – in response to the CDC’s request that states conduct surveillance for vancomycin resistance in Staphylococcus aureus, GISA/VISA and GRSA/VRSA were added to the list.

Streptococcus pneumoniae, Invasive Disease – replaces "drug-resistant S. pneumoniae" that was added to the list in 1996 due to the urging of the CDC and in response to the nationwide increase in drug resistance in this organism; however, it has not been possible to track the incidence of drug resistance without a denominator, which making all invasive S. pneumoniae will now accomplish.

Tularemia – a nationally notifiable disease removed from the list in 1996 in both Florida and the US because of decreasing incidence; F. tularensis has been identified as a potential bioterrorist weapon, so reinstating tularemia as a notifiable disease is essential for early notification and intervention in the event of a bioterrorist incident.

Histoplasmosis – the incidence and public health significance of this disease in Florida validates deleting it from our list; it is not on the national notifiable list.

Kawasaki – although Florida has reported an average of 46 cases over the past 5 years, the lack of prevention strategies supports deleting this disease from Florida’s list.

Paralytic Shellfish Poisoning – this has been changed to Neurotoxic Shellfish Poisoning, the form most often seen in this part of the country.

Reye Syndrome – the dramatic decline and continued low incidence of this syndrome in the US validates its removal from the list; the near elimination of this disease should be recognized as the success it is.

Typhus – the incidence and public health significance of this disease in Florida do not justify keeping it on the list at this time; it is not on the national notifiable list.

Race and Ethnicity. Race and ethnicity (if available) are now a requirement for case report content.

Time Frame for Reporting. Reports now have a 72 hours time frame (not 48 hours as previously used). This new time frame aligns more closely with requirements for STDs (3 working days) and TB (72 hours).

List of Laboratory Tests. This section now requires the state health office to publish a list of laboratory test results that are reportable by the labs. The list is to be issued at least annually and is available from the Bureau of Epidemiology. The list, entitled "Reportable Laboratory Findings," will be sent to the licensed labs in Florida which conduct testing for diseases and conditions that meet criteria for reporting.

Required Patient & Provider Identifiers. Laboratories will now be required to have the following certain patient identifiers on reports sent to the state:

The physician who first authorizes or submits a specimen in behalf of a patient is the responsible party for obtaining and providing the information required above.

Time Frame for Reporting. Laboratories have 72 hours in which to make a report, and any telephone communication must be followed up by a written report. In cases where a laboratory has received a specimen from another lab, each laboratory that makes the positive finding is the responsible reporting party.

Special Requirements. Laboratories that identify Escherichia coli O157:H7, Neisseria meningitidis, or Haemophilus influenzae from sterile sites are now required to retain the culture for at least six months. In lieu of retaining these cultures they may send them to the State Central Laboratory in Jacksonville. This will allow for typing of these organisms in the event of an outbreak or need for specific information of epidemiologic or public health significance. In addition, all malaria and cyclospora slides must be retained for six months, or they may be sent to the state lab by the identifying laboratory.

The rule also contains a requirement for labs to make available its records concerning reportable diseases and conditions for on-site inspection by the Department of Health. While this type of activity is not planned on a regular basis, there is a need for authority to retrieve and review records beyond what is received electronically or by mail.

Documents Incorporated by Reference. Several documents were incorporated by reference under this section. These are: 1) Compendium of Psittacosis Control; 2) Recommendations of the Immunization Practices Advisory Committee; and 3) 1999 Rabies Prevention and Control in Florida. Where these documents may be obtained is now included in the rule language.

Hepatitis B. Added to the Perinatal Hepatitis B section was a requirement for all HbsAg-positive pregnant women and HbsAg-positive infants under the age of 25 months to be reported to the local county health department. These were also added to the list of reportable conditions as well as the case definitions.

Hepatitis B was added to the list of diseases considered to be sexually transmissible. This was done to enable the counties to give vaccine to minors and does not mean a change in reporting requirements or how the counties handle reporting of this disease. For example, if the county health department epidemiology unit has handled case reporting and investigation this will remain the same. Providers will not be required to report hepatitis B on the STD form as is done with other STDs.