§ 11.19 Typhoid and Paratyphoid Fever; Exclusion.
RCNY § 11.19
(a)A case of typhoid or paratyphoid fever who is a food handler; an enrollee or attendee under the age of five or staff member who has contact with children under the age of five in a school, day care facility, camp or other congregate care setting with children under the age of five; a health care practitioner in a hospital or medical facility who provides oral care; a resident of a congregate homeless facility or shelter or any other congregate residential setting; or any other person who in the opinion of the Department represents a risk to the health of the public, shall be excluded until the end of the febrile period and until four stool specimens are submitted to the Department, found to be free of typhoid and paratyphoid bacteria, and until released from exclusion by the Department. Stool specimens shall be submitted as specified herein. The initial two specimens shall be taken no less than 48 hours after the cessation of antibiotic therapy and 24 hours apart. A second set of two specimens shall be taken thirty (30) days later, and no less than 24 hours apart. The case shall be instructed not to prepare food for other members of the household or others, nurse the sick, or care for children until it is determined that the patient is non-infectious and a non-carrier as per subdivision (c) of this section. Members of the household shall be advised by the physician in attendance of precautions to be taken to prevent further spread of the disease and shall be informed as to the appropriate specific preventive measures.
(b)A household contact who is a food handler; an enrollee or attendee under the age of five or staff member of a school, day care facility or other congregate care setting with children under the age of five; a health care practitioner in a hospital or medical facility who provides oral care; or any other person who in the opinion of the Department represents a risk to the health of the public, shall be excluded until two successive stool specimens, taken no less than 24 hours apart are examined by the Department and found free of typhoid and paratyphoid bacilli.
(c)If the initial four stool specimens obtained pursuant to subdivision (a) of this section are negative for typhoid and paratyphoid bacteria, no further stool specimens shall be required, and the case shall be released from exclusion. If any of the four stool specimens obtained pursuant to subdivision (a) of this section are positive for typhoid or paratyphoid bacteria, then the case shall be recommended for further treatment which may include a longer course of an antibiotic to which the bacterial isolate is sensitive or surgery to remove the nidus of infection (e.g., the gallbladder). After completion of this treatment, such a case of typhoid or paratyphoid fever shall continue to submit to the Department two stool specimens taken no less than 48 hours after repeat antibiotic treatment or gallbladder removal and then one specimen taken no less than 30 days apart for three successive months. If all five stools are free of typhoid and paratyphoid bacilli, he or she shall be considered non-infectious and a non-carrier. If any of the stool specimens submitted contains typhoid or paratyphoid bacilli, he or she shall be considered to be a typhoid or paratyphoid carrier and, the convalescent typhoid or paratyphoid carrier shall comply with paragraphs (d)(1) through (6) of this section.
(d)A chronic typhoid or paratyphoid carrier is a person who has not shown clinical evidence of typhoid or paratyphoid fever within a period of 12 months, or who has never shown clinical evidence of typhoid or paratyphoid fever, but who continues to harbor typhoid bacilli, as determined by examination by the Department pursuant to subdivision (c) of this section. A household contact who tests positive for typhoid or paratyphoid bacilli, however, shall not be considered a chronic typhoid or paratyphoid carrier if the household contact no longer lives in the same household as the case or carrier and if, after two months of ceasing to live in the same household, the contact tests negative for typhoid and paratyphoid bacilli on two successive stool specimens taken no less than 48 hours after completion of an appropriate course of therapy with an antibiotic to which the bacterial isolate was sensitive and no less than 24 hours apart. A chronic typhoid carrier shall: (1) Submit specimens of his or her stool or urine whenever the Department requires; (2) Report his or her address, occupation and place of employment, in person or in writing, whenever the Department requires; (3) Promptly notify the Department of any temporary or permanent change of address or place of employment; (4) Refrain from cooking or handling any food, drink or eating utensils to be eaten or used by others, and refrain from nursing the sick or from caring for children; (5) Clean toilet seats used by him or her immediately after use; and (6) Thoroughly wash his or her hands with soap and water after using the toilet.
(e)Supervision by the Department of a chronic typhoid or paratyphoid carrier shall end: (1) In the instance of a chronic carrier who underwent surgery to remove a nidus of typhoid or paratyphoid infection, or who has completed an appropriate course of therapy to eradicate the carrier state with an antibiotic to which the bacterial isolate was sensitive, when two successive stool specimens, taken no less than 48 hours after surgery or completion of antibiotic treatment, followed by three successive stool specimens taken no less than 30 days apart, are examined by the Department and found free of typhoid and paratyphoid bacilli; or (2) In the instance of a chronic carrier who has not undergone surgery to remove a nidus of typhoid or paratyphoid infection, or who has not completed an appropriate course of therapy to eradicate the carrier state with an antibiotic to which the bacterial isolate was sensitive, when six successive stool specimens, taken no less than 30 days apart, are examined by the Department and found free of typhoid and paratyphoid bacilli; or (3) In the instance of a carrier other than the fecal type, when evidence is furnished which satisfies the Department that he or she is no longer a carrier.
