Chapter 90. Regulations for Disease Reporting and Control
Part I
Definitions
12VAC5-90-10. Definitions.
The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:
"Affected area" means any part or the whole of the Commonwealth that has been identified as where persons reside or may be located who are known to have been exposed to or infected with, or who are reasonably suspected to have been exposed to or infected with, a communicable disease of public health threat. "Affected area" includes cities, counties, towns, and subsections of such areas, public and private property, buildings, and other structures.
"Arboviral infection" means a viral illness that is transmitted by a mosquito, tick, or other arthropod. This includes chikungunya (CHIK), dengue, eastern equine encephalitis (EEE), LaCrosse encephalitis (LAC), also known as California encephalitis, St. Louis encephalitis (SLE), West Nile virus (WNV), and Zika virus (Zika) infection.
"Board" means the State Board of Health.
"Cancer" means all carcinomas, sarcomas, melanomas, leukemias, and lymphomas excluding localized basal and squamous cell carcinomas of the skin, except for lesions of the mucous membranes.
"CDC" means the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services.
"Child care center" means a child day center, child day program, family day home, family day system, or registered family day home as defined by § 63.2-100 of the Code of Virginia, or a similar place providing day care of children by such other name as may be applied.
"Clinic" means any facility, freestanding or associated with a hospital, that provides preventive, diagnostic, therapeutic, rehabilitative, or palliative care or services to outpatients.
"Commissioner" means the State Health Commissioner or the State Health Commissioner's duly designated officer or agent, unless stated in a provision of this chapter that it applies to the State Health Commissioner in the State Health Commissioner's sole discretion.
"Communicable disease" means an illness due to an infectious agent or its toxic products that is transmitted, directly or indirectly, to a susceptible host from an infected person, animal, or arthropod or through the agency of an intermediate host or a vector or through the inanimate environment.
"Communicable disease of public health significance" means an illness caused by a specific or suspected infectious agent that may be transmitted directly or indirectly from one individual to another. This includes infections caused by human immunodeficiency viruses, bloodborne pathogens, and tubercle bacillus. The State Health Commissioner may determine that diseases caused by other pathogens constitute communicable diseases of public health significance.
"Communicable disease of public health threat" means an illness of public health significance, as determined by the State Health Commissioner in accordance with this chapter, caused by a specific or suspected infectious agent that may be reasonably expected or is known to be readily transmitted directly or indirectly from one individual to another and has been found to create a risk of death or significant injury or impairment; this definition shall not, however, be construed to include human immunodeficiency viruses or the tubercle bacilli, unless used as a bioterrorism weapon.
"Companion animal" means, consistent with the provisions of § 3.2-6500 of the Code of Virginia, any domestic or feral dog, domestic or feral cat, nonhuman primate, guinea pig, hamster, rabbit not raised for human food or fiber, exotic or native animal, reptile, exotic or native bird, or any feral animal or any animal under the care, custody, or ownership of a person or any animal that is bought, sold, traded, or bartered by any person. Agricultural animals, game species, or any animals regulated under federal law as research animals are not considered companion animals for the purpose of this chapter.
"Condition" means any adverse health event, such as a disease, an infection, a syndrome, or as indicated by a procedure, including the results of a physical exam, laboratory test, or imaging interpretation, suggesting that an exposure of public health importance has occurred.
"Contact" means a person or animal known to have been in such association with an infected person or animal as to have had an opportunity of acquiring the infection.
"Contact services" means a broad array of services that are offered to persons with infectious diseases and their contacts. Contact services include contact tracing, providing information about current infections, developing risk reduction plans to reduce the chances of future infections, and connecting to appropriate medical care and other services.
"Contact tracing" means the process by which an infected person or health department employee notifies others that they may have been exposed to the infected person in a manner known to transmit the infectious agent in question.
"Coronavirus infection, severe" means suspected or confirmed infection with severe acute respiratory syndrome (SARS)-associated coronavirus (SARS-CoV), Middle East respiratory syndrome (MERS)-associated coronavirus (MERS-CoV), or another coronavirus causing a severe acute illness.
"Decontamination" means the use of physical or chemical means to remove, inactivate, or destroy hazardous substances or organisms from a person, surface, or item to the point that such substances or organisms are no longer capable of causing adverse health effects and the surface or item is rendered safe for handling, use, or disposal.
"Department" means the State Department of Health, also referred to as the Virginia Department of Health (VDH).
"Designee" or "designated officer or agent" means any person or group of persons designated by the State Health Commissioner to act on behalf of the commissioner or the board.
"Ehrlichiosis/Anaplasmosis" means human infections caused by Ehrlichia chaffeensis (formerly included in the category "human monocytic ehrlichiosis" or "HME"), Ehrlichia ewingii or Anaplasma phagocytophilum (formerly included in the category "human granulocytic ehrlichiosis" or "HGE").
"Epidemic" means the occurrence in a community or region of cases of an illness clearly in excess of normal expectancy.
"Essential needs" means basic human needs for sustenance, including food, water, clothing, and health care (e.g., medications, therapies, testing, and durable medical equipment).
"Exceptional circumstances" means the presence, as determined by the commissioner in the commissioner's sole discretion, of one or more factors that may affect the ability of the department to effectively control a communicable disease of public health threat. Factors to be considered include (i) characteristics or suspected characteristics of the disease-causing organism or suspected disease-causing organism such as virulence, routes of transmission, minimum infectious dose, rapidity of disease spread, the potential for extensive disease spread, and the existence and availability of demonstrated effective treatment; (ii) known or suspected risk factors for infection; (iii) the potential magnitude of the effect of the disease on the health and welfare of the public; and (iv) the extent of voluntary compliance with public health recommendations. The determination of exceptional circumstances by the commissioner may take into account the experience or results of investigation in Virginia, another state, or another country.
"Foodborne outbreak" means two or more cases of a similar illness acquired through the consumption of food contaminated with chemicals or an infectious agent or its toxic products. Such illnesses include heavy metal intoxication, staphylococcal food poisoning, botulism, salmonellosis, shigellosis, Clostridium perfringens food poisoning, hepatitis A, and Shiga toxin-producing Escherichia coli infection.
"Health care-associated infection" (also known as nosocomial infection) means a localized or systemic condition resulting from an adverse reaction to the presence of an infectious agent or its toxin that (i) occurs in a patient in a health care facility (e.g., a medical care facility or outpatient clinic), and (ii) was not found to be present or incubating at the time of admission unless the infection was related to a previous admission to the same setting.
"Immunization" means a procedure that increases the protective response of an individual's immune system to specified pathogens.
"Independent pathology laboratory" means a nonhospital or a hospital laboratory performing surgical pathology, including fine needle aspiration biopsy and bone marrow specimen examination services, that reports the results of such tests directly to physician offices, without reporting to a hospital or accessioning the information into a hospital tumor registry.
"Individual" means a person or companion animal. When the context requires it, "person " shall be deemed to include any individual.
"Infection" means the entry and multiplication or persistence of a disease-causing organism (prion, virus, bacteria, fungus, parasite, or ectoparasite) in the body of an individual. An infection may be inapparent (i.e., without recognizable signs or symptoms but identifiable by laboratory means) or manifest (clinically apparent).
"Influenza, laboratory-confirmed" means by culture, antigen detection by direct fluorescent antibody (DFA), or nucleic acid detection. Influenza rapid antigen tests are not reportable.
"Influenza A, novel virus" means infection of a human with an influenza A virus subtype that is different from currently circulating human influenza H1 and H3 viruses. Novel subtypes include H2, H5, H7, and H9 subtypes or influenza H1 and H3 subtypes originating from a nonhuman species or from genetic reassortment of human and animal influenza viruses.
"Invasive" means the organism is affecting a normally sterile site, including blood or cerebrospinal fluid.
"Investigation" means an inquiry into the incidence, prevalence, extent, source, mode of transmission, causation of, and other information pertinent to a disease occurrence.
"Isolation" means the physical separation, including confinement or restriction of movement, of an individual who is infected with, or is reasonably suspected to be infected with, a communicable disease in order to prevent or limit the transmission of the communicable disease to uninfected and unexposed individuals.
"Isolation, complete" means the full-time confinement or restriction of movement of an individual infected with, or reasonably suspected to be infected with, a communicable disease in order to prevent or limit the transmission of the communicable disease to uninfected and unexposed individuals.
"Isolation, modified" means a selective, partial limitation of freedom of movement or actions of an individual infected with, or reasonably suspected to be infected with, a communicable disease. Modified isolation is designed to meet particular situations and includes the exclusion of children from school, the prohibition or restriction from engaging in a particular occupation or using public or mass transportation, or requirements for the use of devices or procedures intended to limit disease transmission.
"Isolation, protective" means the physical separation of a susceptible individual not infected with, or not reasonably suspected to be infected with, a communicable disease from an environment where transmission is occurring, or is reasonably suspected to be occurring, in order to prevent the individual from acquiring the communicable disease.
"Laboratory" means a clinical laboratory that examines materials derived from the human body for the purpose of providing information on the diagnosis, prevention, or treatment of disease.
"Laboratory director" means any person in charge of supervising a laboratory conducting business in the Commonwealth of Virginia.
"Law-enforcement agency" means any sheriff's office, police department, adult or youth correctional officer, or other agency or department that employs persons who have law-enforcement authority that is under the direction and control of the Commonwealth or any local governing body. "Law-enforcement agency" shall include, by order of the Governor, the Virginia National Guard.
"Lead, reportable blood levels" means any detectable blood lead level in children 15 years of age and younger and levels greater than or equal to 5 μg/dL in a person older than 15 years of age.
"Least restrictive" means the minimal limitation of the freedom of movement and communication of an individual while under an order of isolation or an order of quarantine that also effectively protects unexposed and susceptible individuals from disease transmission.
"Medical care facility" means any hospital or nursing home licensed in the Commonwealth or any hospital operated by or contracted to operate by an entity of the United States government or the Commonwealth of Virginia.
"Midwife" means any person who is licensed as a nurse midwife by the Virginia Boards of Nursing and Medicine or who is licensed by the Board of Medicine as a certified professional midwife.
"National Healthcare Safety Network" or "NHSN" means a surveillance system created by the CDC for accumulating, exchanging, and integrating relevant information on infectious adverse events associated with health care delivery.
"Nucleic acid detection" means laboratory testing of a clinical specimen to determine the presence of deoxyribonucleic acid (DNA) or ribonucleic acid (RNA) specific for an infectious agent using any method, including hybridization, sequencing, or amplification such as polymerase chain reaction.
"Nurse" means any person licensed as a professional nurse or as a licensed practical nurse by the Virginia Board of Nursing.
"Occupational outbreak" means a cluster of illness or disease that is indicative of a work-related exposure. Such conditions include silicosis, asbestosis, byssinosis, pneumoconiosis, and tuberculosis.
"Outbreak" means the occurrence of more cases of a disease than expected.
"Period of communicability" means the time during which the etiologic agent may be transferred directly or indirectly from an infected person to another person or from an infected animal to a person.
"Physician" means any person licensed to practice medicine or osteopathy by the Virginia Board of Medicine.
"Quarantine" means the physical separation, including confinement or restriction of movement, of individuals who are present within an affected area or who are known to have been exposed, or may reasonably be suspected to have been exposed, to a communicable disease and who do not yet show signs or symptoms of infection with the communicable disease in order to prevent or limit the transmission of the communicable disease of public health threat to unexposed and uninfected individuals.
"Quarantine, complete" means the full-time confinement or restriction of movement of individuals who do not have signs or symptoms of infection but may have been exposed, or may reasonably be suspected to have been exposed, to a communicable disease of public health threat in order to prevent the transmission of the communicable disease of public health threat to uninfected individuals.
"Quarantine, modified" means a selective, partial limitation of freedom of movement or actions of individuals who do not have signs or symptoms of the infection but have been exposed to, or are reasonably suspected to have been exposed to, a communicable disease of public health threat. Modified quarantine may be designed to meet particular situations and includes limiting movement to the home, work, or one or more other locations, the prohibition or restriction from using public or mass transportation, or requirements for the use of devices or procedures intended to limit disease transmission.
"Reportable disease" means an illness due to a specific toxic substance, occupational exposure, or infectious agent that affects a susceptible individual, either directly, as from an infected animal or person, or indirectly through an intermediate host, vector, or the environment, as determined by the board.
"School" means (i) any public school from kindergarten through grade 12 operated under the authority of any locality within the Commonwealth; (ii) any private or religious school that offers instruction at any level or grade from kindergarten through grade 12; and (iii) any private or religious nursery school or preschool, or any private or religious child care center required to be licensed by the Commonwealth.
"Serology" means the testing of blood, serum, or other body fluids for the presence of antibodies or other markers of an infection or disease process.
"Surveillance" means the ongoing systematic collection, analysis, and interpretation of outcome-specific data for use in the planning, implementation, and evaluation of public health practice. A surveillance system includes the functional capacity for data analysis as well as the timely dissemination of these data to persons who can undertake effective prevention and control activities.
"Susceptible individual" means a person or animal who is vulnerable to or potentially able to contract a disease or condition. Factors that affect an individual's susceptibility include physical characteristics, genetics, previous or chronic exposures, chronic conditions or infections, immunization history, or use of medications.
"Toxic substance" means any substance, including any raw materials, intermediate products, catalysts, final products, or by-products of any manufacturing operation conducted in a commercial establishment, that has the capacity through its physical, chemical, or biological properties to pose a substantial risk of death or impairment either immediately or over time to the normal functions of humans, aquatic organisms, or any other animal but not including any pharmaceutical preparation, which deliberately or inadvertently is consumed in such a way as to result in a drug overdose.
"Tubercle bacilli" means disease-causing organisms belonging to the Mycobacterium tuberculosis complex and includes Mycobacterium tuberculosis, Mycobacterium africanum, Mycobacterium bovis, Mycobacterium canetti, Mycobacterium microti, Mycobacterium caprae, and other members as may be established by the commissioner.
"Tuberculosis, active disease" (also "active tuberculosis disease" and "active TB disease"), as defined by § 32.1-49.1 of the Code of Virginia, means a communicable disease caused by an airborne microorganism and characterized by the presence of either (i) a specimen of sputum or other bodily fluid or tissue that has been found to contain tubercle bacilli as evidenced by culture or nucleic acid amplification, including preliminary identification by rapid methodologies; (ii) a specimen of sputum or other bodily fluid or tissue that is suspected to contain tubercle bacilli as evidenced by smear, and where sufficient clinical and radiographic evidence of active tuberculosis disease is present as determined by a physician licensed to practice medicine in Virginia; or (iii) sufficient clinical and radiographic evidence of active tuberculosis disease as determined by the commissioner is present, but a specimen of sputum or other bodily fluid or tissue containing, or suspected of containing, tubercle bacilli is unobtainable.
"Tuberculosis infection " means a positive result from a test for tuberculosis infection without clinical or other evidence of active tuberculosis disease.
"Vaccinia, disease or adverse event" means vaccinia infection or serious or unexpected events in persons who received the smallpox vaccine or their contacts, including bacterial infections, eczema vaccinatum, erythema multiforme, generalized vaccinia, progressive vaccinia, inadvertent inoculation, post-vaccinial encephalopathy or encephalomyelitis, ocular vaccinia, and fetal vaccinia.
"Waterborne outbreak" means two or more cases of a similar illness acquired through the ingestion of or other exposure to water contaminated with chemicals or an infectious agent or its toxic products. Such illnesses include giardiasis, viral gastroenteritis, cryptosporidiosis, hepatitis A, cholera, and shigellosis. A single case of laboratory-confirmed primary amebic meningoencephalitis or of waterborne chemical poisoning is considered an outbreak.
Statutory Authority
§§ 32.1-12, 32.1-35, and 32.1-42 of the Code of Virginia.
Historical Notes
Derived from VR355-28-100 § 1.1, eff. July 1, 1993; amended, Virginia Register Volume 15, Issue 6, eff. January 6, 1999; Errata, 15:8 VA.R. 1099 January 4, 1999; amended, Virginia Register Volume 20, Issue 21, eff. July 28, 2004; Volume 23, Issue 15, eff. May 2, 2007; Volume 27, Issue 13, eff. March 28, 2011; Volume 33, Issue 2, eff. October 20, 2016; Volume 36, Issue 6, eff. December 26, 2019; Volume 41, Issue 26, eff. September 10, 2025.
Part II
General Information
12VAC5-90-20. Authority.
Chapter 2 of Title 32.1 of the Code of Virginia deals with the reporting and control of diseases. Specifically, § 32.1-35 directs the Board of Health to promulgate regulations specifying which diseases occurring in the Commonwealth are to be reportable and the method by which they are to be reported. Further, § 32.1-42 of the Code of Virginia authorizes the board to promulgate regulations and orders to prevent a potential emergency caused by a disease dangerous to the public health. Section 32.1-12 of the Code of Virginia empowers the Board of Health to adopt such regulations as are necessary to carry out provisions of laws of the Commonwealth administered by the Commissioner of the Department of Health.
Statutory Authority
§§ 32.1-12 and 32.1-35 of the Code of Virginia.
Historical Notes
Derived from VR355-28-100 § 2.1, eff. July 1, 1993.
12VAC5-90-30. Purpose.
This chapter is designed to provide for the uniform reporting of diseases of public health importance occurring within the Commonwealth in order that appropriate control measures may be instituted to reduce the occurrence of disease.
Statutory Authority
§ 32.1-35 of the Code of Virginia.
Historical Notes
Derived from VR355-28-100 § 2.2, eff. July 1, 1993; amended, Virginia Register Volume 27, Issue 13, eff. March 28, 2011.
12VAC5-90-40. Administration.
A. The State Board of Health ("board") has the responsibility for promulgating regulations pertaining to the reporting and control of diseases of public health importance and to meet any emergency or to prevent a potential emergency caused by a disease dangerous to the public health including but not limited to specific procedures for responding to any disease listed pursuant to § 32.1-35 of the Code of Virginia that is determined to be caused by an agent or substance used as a weapon or any communicable disease of public health threat that is involved in an order of quarantine or an order of isolation pursuant to Article 3.02 (§ 32.1-48.05 et seq.) of the Code of Virginia.
B. The State Health Commissioner ("commissioner") is the executive officer for the State Board of Health with the authority of the board when it is not in session, subject to the rules and regulations of and review by the board. The commissioner has the authority to require quarantine, isolation, immunization, decontamination, or treatment of any individual or group of individuals when he determines any such measure to be necessary to control the spread of any disease of public health importance and has the authority to issue orders of isolation pursuant to Article 3.01 (§ 32.1-48.01 et seq.) of the Code of Virginia and orders of quarantine and orders of isolation under exceptional circumstances involving any communicable disease of public health threat pursuant to Article 3.02 (§ 32.1-48.05 et seq.) of the Code of Virginia.
C. The local health director is responsible for the surveillance and investigation of those diseases specified by this chapter which occur in his jurisdiction. He is further responsible for reporting all such surveillance and investigations to the Office of Epidemiology. In cooperation with the commissioner, he is responsible for instituting measures for disease control, which may include implementing the quarantine and isolation orders of the commissioner.
D. The Office of Epidemiology, an organizational part of the department, is responsible for the statewide surveillance of those diseases specified by this chapter, for defining and disseminating appropriate disease control protocols for an outbreak situation, for coordinating the investigation of those diseases with the local health director, and for providing direct assistance where necessary. The Director of the Office of Epidemiology acts as the commissioner's designee in reviewing reports and investigations of diseases and recommendations by local health directors for quarantine or isolation. However, authority to order quarantine or isolation resides solely with the commissioner.
E. All persons responsible for the administration of this chapter shall ensure that the anonymity of patients and practitioners is preserved, according to state and federal law including the provisions of §§ 32.1-38, 32.1-41, and 32.1-71 of the Code of Virginia.
Statutory Authority
§§ 32.1-12 and 32.1-35 of the Code of Virginia.
Historical Notes
Derived from VR355-28-100 § 2.3, eff. July 1, 1993; amended, Virginia Register Volume 15, Issue 6, eff. January 6, 1999; Volume 20, Issue 21, eff. July 28, 2004; Volume 23, Issue 15, eff. May 2, 2007.
12VAC5-90-50. (Repealed.)
Historical Notes
Derived from VR355-28-100 § 2.4, eff. July 1, 1993; amended, Virginia Register Volume 15, Issue 6, eff. January 6, 1999; repealed, Virginia Register Volume 33, Issue 2, eff. October 20, 2016.
12VAC5-90-60. (Repealed.)
Historical Notes
Derived from VR355-28-100 § 2.5, eff. July 1, 1993; repealed, Virginia Register Volume 15, Issue 6, eff. January 6, 1999.
12VAC5-90-70. Powers and procedures of chapter not exclusive.
The board reserves the right to authorize a procedure for enforcement of this chapter which is not inconsistent with the provisions set forth herein and the provisions of Chapter 2 (§ 32.1-35 et seq.) of Title 32.1 of the Code of Virginia.
Statutory Authority
§§ 32.1-12 and 32.1-35 of the Code of Virginia.
Historical Notes
Derived from VR355-28-100 § 2.6, eff. July 1, 1993; amended, Virginia Register Volume 15, Issue 6, eff. January 6, 1999.
Part III
Reporting of Disease
12VAC5-90-80. Lists of diseases that shall be reported.
A. The persons enumerated in 12VAC5-90-90 shall report the following named diseases, toxic effects, and conditions pursuant to this chapter. A condition identified by an asterisk (*) requires immediate communication to the local health department by the most rapid means available upon suspicion or confirmation, as defined in subsection C of this section. Other conditions shall be reported within three days of suspected or confirmed diagnosis, unless otherwise specified in this section. Neonatal Abstinence Syndrome shall be reported as specified in subsection E of this section. Coronavirus disease 2019 (SARS-CoV-2) shall be reported as specified in subsection I of the section.
Amebiasis (Entamoeba histolytica)
*Anthrax (Bacillus anthracis)
Arboviral infections (e.g., CHIK, dengue, EEE, LAC, SLE, WNV, Zika)
Babesiosis (Babesia spp.)
*Botulism (Clostridium botulinum)
*Brucellosis (Brucella spp.)
Campylobacteriosis (Campylobacter spp.)
Candida auris, infection or colonization
Carbapenemase-producing organism, infection, or colonization
Chancroid (Haemophilus ducreyi)
Chickenpox (Varicella virus)
Chlamydia trachomatis infection
*Cholera (Vibrio cholerae O1 or O139)
*Coronavirus infection, severe (e.g., SARS-CoV, MERS-CoV)
Coronavirus disease 2019 (COVID-19 or SARS-CoV-2)
Cryptosporidiosis (Cryptosporidium spp.)
Cyclosporiasis (Cyclospora spp.)
*Diphtheria (Corynebacterium diphtheriae)
*Disease caused by an agent that may have been used as a weapon
Ehrlichiosis/Anaplasmosis (Ehrlichia spp., Anaplasma phagocytophilum)
Giardiasis (Giardia spp.)
Gonorrhea (Neisseria gonorrhoeae)
Granuloma inguinale (Calymmatobacterium granulomatis)
*Haemophilus influenzae infection, invasive
Hantavirus pulmonary syndrome
Hemolytic uremic syndrome (HUS)
*Hepatitis A
Hepatitis B (acute and chronic)
Hepatitis C (acute and chronic)
Hepatitis, other acute viral
Human immunodeficiency virus (HIV) infection
Influenza, laboratory-confirmed
*Influenza-associated deaths if younger than 18 years of age
Lead, reportable blood levels
Legionellosis (Legionella spp.)
Leprosy (Hansen's disease) (Mycobacterium leprae)
Leptospirosis (Leptospira interrogans)
Listeriosis (Listeria monocytogenes)
Lyme disease (Borrelia spp.)
Lymphogranuloma venereum (Chlamydia trachomatis)
Malaria (Plasmodium spp.)
*Measles (Rubeola)
*Meningococcal disease (Neisseria meningitidis)
Mumps
Neonatal abstinence syndrome (NAS)
Ophthalmia neonatorum
*Orthopoxviruses (e.g., Monkeypox virus, Variola virus, Vaccinia disease or adverse event)
*Outbreaks, all (including foodborne, health care-associated, occupational, toxic substance-related, waterborne, and any other outbreak)
*Pertussis (Bordetella pertussis)
*Plague (Yersinia pestis)
*Poliovirus infection, including poliomyelitis
*Psittacosis (Chlamydophila psittaci)
*Q fever (Coxiella burnetii)
*Rabies, human and animal
Rabies treatment, post-exposure
*Rubella, including congenital rubella syndrome
Salmonellosis (Salmonella spp.)
Shiga toxin-producing Escherichia coli infection
Shigellosis (Shigella spp.)
Spotted fever rickettsiosis (Rickettsia spp.)
Streptococcal disease, Group A, invasive or toxic shock
Streptococcus pneumoniae infection, invasive if younger than five years of age
Syphilis (Treponema pallidum) report *congenital, *primary, *secondary, and other
Tetanus (Clostridium tetani)
Toxic substance-related illness
Trichinosis (Trichinellosis) (Trichinella spiralis)
*Tuberculosis, active disease (Mycobacterium tuberculosis complex)
Tuberculosis infection
*Tularemia (Francisella tularensis)
*Typhoid/Paratyphoid infection (Salmonella Typhi, Salmonella Paratyphi)
*Unusual occurrence of disease of public health concern
Vancomycin-intermediate or vancomycin-resistant Staphylococcus aureus infection
*Vibriosis (Vibrio spp.)
*Viral hemorrhagic fever
*Yellow fever
Yersiniosis (Yersinia spp.)
B. A laboratory director shall report test results indicative of and specific for the diseases, infections, microorganisms, conditions, and toxic effects specified in this subsection for humans. Tests include microbiological culture, isolation, or identification; assays for specific antibodies; and identification of specific antigens, toxins, or nucleic acid sequences. Additional condition-specific requirements are noted in this subsection and subsection D of this section. A condition identified by an asterisk (*) requires immediate communication to the local health department by the most rapid means available upon suspicion or confirmation, as defined in subsection C of this section. Other conditions shall be reported within three days of suspected or confirmed diagnosis.
Amebiasis (Entamoeba histolytica)
*Anthrax (Bacillus anthracis)
Arboviral infection, for example, CHIK, dengue, EEE, LAC, SLE, WNV, or Zika
Babesiosis (Babesia spp.)
*Botulism (Clostridium botulinum)
*Brucellosis (Brucella spp.)
Campylobacteriosis (Campylobacter spp.)
Candida auris - Include available antimicrobial susceptibility findings in report.
Carbapenemase-producing organism - Include available antimicrobial susceptibility findings in report.
Chancroid (Haemophilus ducreyi)
Chickenpox (Varicella virus)
Chlamydia trachomatis infection
*Cholera (Vibrio cholerae O1 or O139)
*Coronavirus infection, severe (e.g., SARS-CoV, MERS-CoV)
Coronavirus disease 2019 (COVID-19 or SARS-CoV-2)
Cryptosporidiosis (Cryptosporidium spp.)
Cyclosporiasis (Cyclospora spp.)
*Diphtheria (Corynebacterium diphtheriae)
Ehrlichiosis/Anaplasmosis (Ehrlichia spp., Anaplasma phagocytophilum)
Giardiasis (Giardia spp.)
Gonorrhea (Neisseria gonorrhoeae) - Include available antimicrobial susceptibility findings in report.
*Haemophilus influenzae infection, invasive
Hantavirus pulmonary syndrome
*Hepatitis A
Hepatitis B (acute and chronic) - For all hepatitis B patients, also report available results of serum alanine aminotransferase (ALT) and all available results from the hepatitis panel.
Hepatitis C (acute and chronic) - For all patients with any positive HCV test, also report all results of HCV viral load tests, including undetectable viral loads and report available results of serum alanine aminotransferase (ALT) and all available results from the hepatitis panel.
Hepatitis, other acute viral - Any finding indicative of acute infection with hepatitis D, E, or other cause of viral hepatitis. For any reportable hepatitis finding, submit all available results from the hepatitis panel.
Human immunodeficiency virus (HIV) infection - For HIV-infected patients, report all results of CD4 and HIV viral load tests, including undetectable viral loads. For HIV-infected patients, report all HIV genetic nucleotide sequence data associated with HIV drug resistance tests by electronic submission. For children younger than three years of age, report all tests regardless of the test findings (e.g., negative or positive).
Influenza, laboratory-confirmed - By culture, antigen detection by direct fluorescent antibody (DFA), or nucleic acid detection.
Lead, reportable blood levels - All lead results from tests of venous or capillary blood performed by a laboratory certified by the Centers for Medicare and Medicaid Services in accordance with 42 USC § 263a, the Clinical Laboratory Improvement Amendment of 1988 (CLIA-certified).
Legionellosis (Legionella spp.)
Leptospirosis (Leptospira interrogans)
Listeriosis (Listeria monocytogenes), invasive or if associated with miscarriage or stillbirth from placental or fetal tissue
Lyme disease (Borrelia spp.)
Malaria (Plasmodium spp.)
*Measles (Rubeola)
*Meningococcal disease (Neisseria meningitidis), invasive - Include identification of gram-negative diplococci.
Mumps
*Mycobacterial diseases - (See 12VAC5-90-225 ) Report any of the following:
1. Acid fast bacilli;
2. M. tuberculosis complex or any other mycobacteria; or
3. Antimicrobial susceptibility results for M. tuberculosis complex.
*Orthopoxviruses (e.g., Monkeypox virus, Variola virus, Vaccinia disease or adverse event)
*Pertussis (Bordetella pertussis)
*Plague (Yersinia pestis)
*Poliovirus infection
*Psittacosis (Chlamydophila psittaci)
*Q fever (Coxiella burnetii)
*Rabies, human and animal
*Rubella
Salmonellosis (Salmonella spp.)
Shiga toxin-producing Escherichia coli infection
Shigellosis (Shigella spp.)
Spotted fever rickettsiosis (Rickettsia spp.)
Streptococcal disease, Group A, invasive or toxic shock
Streptococcus pneumoniae infection, invasive if younger than five years of age
*Syphilis (Treponema pallidum)
Toxic substance-related illness - By blood or urine laboratory findings above the normal range, including heavy metals, pesticides, and industrial-type solvents and gases. When applicable and available, report speciation of metals when blood or urine levels are elevated in order to differentiate the chemical species (elemental, organic, or inorganic).
Trichinosis (Trichinellosis) (Trichinella spiralis)
Tuberculosis infection
*Tularemia (Francisella tularensis)
*Typhoid/Paratyphoid infection (Salmonella Typhi, Salmonella Paratyphi A, Salmonella Paratyphi B, Salmonella Paratyphi C)
Vancomycin-intermediate or vancomycin-resistant Staphylococcus aureus infection - Include available antimicrobial susceptibility findings in report.
*Vibriosis (Vibrio spp., Photobacterium damselae, Grimontia hollisae), other than toxigenic Vibrio cholera O1 or O139, which are reportable as cholera
*Viral hemorrhagic fever
*Yellow fever
Yersiniosis (Yersinia spp.)
C. Certain of the diseases in the list of reportable diseases because of their extremely contagious nature, potential for greater harm, or availability of a specific intervention that must be administered in a timely manner require immediate identification and control. Reporting of persons confirmed or suspected of having these diseases, listed in this subsection, shall be made immediately by the most rapid means available, preferably by telephone to the local health department. (These same diseases are also identified by an asterisk (*) in subsections A and B, where applicable, of this section.)
Anthrax (Bacillus anthracis)
Botulism (Clostridium botulinum)
Brucellosis (Brucella spp.)
Cholera (Vibrio cholerae O1 or O139)
Coronavirus infection, severe (e.g., SARS-CoV, MERS-CoV)
Diphtheria (Corynebacterium diphtheriae)
Disease caused by an agent that may have been used as a weapon
Haemophilus influenzae infection, invasive
Hepatitis A
Influenza-associated deaths if younger than 18 years of age
Influenza A, novel virus
Measles (Rubeola virus)
Meningococcal disease (Neisseria meningitidis)
Outbreaks, all
Orthopoxviruses (e.g., Monkeypox virus, Variola virus, Vaccinia disease or adverse event)
Pertussis (Bordetella pertussis)
Plague (Yersinia pestis)
Poliovirus infection, including poliomyelitis
Psittacosis (Chlamydophila psittaci)
Q fever (Coxiella burnetii)
Rabies, human and animal
Rubella, including congenital rubella syndrome
Syphilis, congenital, primary, and secondary (Treponema pallidum)
Tuberculosis, active disease (Mycobacterium tuberculosis complex)
Tularemia (Francisella tularensis)
Typhoid/Paratyphoid infection (Salmonella Typhi, Salmonella Paratyphi (all types))
Unusual occurrence of disease of public health concern
Vibriosis (Vibrio spp., Photobacterium damselae, Grimontia hollisae), other than toxigenic Vibrio cholerae O1 or O139, which are reportable as cholera
Viral hemorrhagic fever
Yellow fever
D. A laboratory identifying evidence of any of the conditions in this subsection shall notify the local health department of the positive culture or other positive test result within the timeframes specified in subsection B of this section and submit the initial isolate (preferred) within five days or the clinical specimen within two days of a positive result to the Division of Consolidated Laboratory Services or other public health laboratory where specified in this subsection. A specimen or isolate must be identified with the patient and physician information required in 12VAC5-90-90 C.
Anthrax (Bacillus anthracis)
Botulism (Clostridium botulinum)
Brucellosis (Brucella sp.)
Candida auris
Candida haemulonii
Carbapenem-resistant Enterobacterales
Carbapenem-resistant Pseudomonas aeruginosa
Cholera (Vibrio cholerae O1 or O139)
Coronavirus infection, severe (e.g., SARS-CoV, MERS-CoV)
Diphtheria (Corynebacterium diphtheriae)
Haemophilus influenzae infection, invasive
Influenza, unsubtypeable
Listeriosis (Listeria monocytogenes)
Meningococcal disease (Neisseria meningitidis)
Pertussis (Bordetella pertussis)
Plague (Yersinia pestis)
Poliovirus infection
Q fever (Coxiella burnetii)
Salmonellosis (Salmonella spp.)
Shiga toxin-producing E. coli infection. A laboratory that identifies a Shiga toxin but does not perform simultaneous culture for Shiga toxin-producing E. coli should forward all positive stool specimens or positive enrichment broths to the Division of Consolidated Laboratory Services for confirmation and further characterization.
Shigellosis (Shigella spp.)
Streptococcal disease, Group A, invasive
Tuberculosis. A laboratory identifying Mycobacterium tuberculosis complex (see 12VAC5-90-225) shall submit a representative and viable sample of the initial culture to the Division of Consolidated Laboratory Services or other laboratory designated by the board to receive the specimen.
Tularemia (Francisella tularensis)
Typhoid/Paratyphoid infection (Salmonella Typhi, Salmonella Paratyphi (all types))
Vancomycin-intermediate or vancomycin-resistant Staphylococcus aureus infection
Vibriosis (Vibrio spp., Photobacterium damselae, Grimontia hollisae)
Yersiniosis (Yersinia spp.)
Other diseases as may be requested by the health department.
E. A physician or director of a medical care facility shall report neonatal abstinence syndrome if a newborn has been diagnosed with neonatal abstinence syndrome, a condition characterized by clinical signs of withdrawal from exposure to prescribed or illicit drugs. A report shall be submitted within one month of diagnosis by entering the information into the Department of Health's online Confidential Morbidity Report portal (https://www.vdh.virginia.gov/clinicians/disease-reporting-and-control-regulations/).
F. The occurrence of an outbreak or cluster of any illness that may represent a group expression of an illness that may be of public health concern shall be reported to the local health department immediately by the most rapid means available, preferably by telephone.
G. Toxic substance-related illnesses, including pesticide and heavy metal poisoning or illness resulting from exposure to an occupational dust or fiber or radioactive substance, shall be reported.
If the illness is verified or suspected and presents an emergency or a serious threat to public health or safety, the report of such illness shall be made immediately by the most rapid means available, preferably by telephone.
H. An unusual or emerging condition of public health concern shall be reported to the local health department immediately by the most rapid means available, preferably by telephone. In addition, the commissioner or the commissioner's designee may establish surveillance systems for diseases or conditions that are not on the list of reportable diseases to identify cases (delineate the magnitude of the situation), to identify the mode of transmission and risk factors for the disease, and to identify and implement appropriate action to protect public health. A person reporting information at the request of the department for special surveillance or other epidemiological studies shall be immune from liability as provided by § 32.1-38 of the Code of Virginia.
I. A physician or medical care facility director shall report coronavirus disease 2019, also known as COVID-19, if a person who is infected with SARS-CoV-2 or who is suspected of having COVID-19 is treated or examined, hospitalized, or admitted into the intensive care unit. A physician or medical care facility director shall report the person's name, telephone number, address, age, date of birth, race, ethnicity, sex, and pregnancy status; name of disease diagnosed or suspected; the medical record number (if applicable); the date of onset of illness; available laboratory tests and results; and the name, address, and telephone number of the physician and medical facility where the examination was made. A case report shall be submitted within three days of the suspicion or confirmation of disease by entering the information into the Department of Health online Confidential Morbidity Report portal at https://www.vdh.virginia.gov/clinicians/disease-reporting-and-control-regulations/ or via electronic case reporting (https://www.vdh.virginia.gov/meaningful-use/meaningful-use-submissions-of-electronic-case-reports/).
J. A laboratory director, including a director of another entity that holds Clinical Laboratory Improvement Amendments Certificates of Waiver, shall report a positive SARS-CoV-2 test within three days of identification of evidence of disease. The report shall include the source of the specimen and the laboratory method and result; the name, telephone number, email address, address, age, date of birth, race, ethnicity, sex, and pregnancy status (if known) of the person from whom the specimen was obtained; and the name, address, and telephone number of the physician at whose request and medical facility at which the examination was made. A report shall be made by entering information into the department's available portal for laboratory reporting at https://www.vdh.virginia.gov/clinicians/disease-reporting-and-control-regulations/ or via electronic laboratory reporting at http://www.vdh.virginia.gov/meaningful-use/submissionofreportablelabresults.
Statutory Authority
§§ 32.1-12, 32.1-35, and 32.1-42 of the Code of Virginia.
Historical Notes
Derived from VR355-28-100 § 3.1, eff. July 1, 1993; amended, Virginia Register Volume 15, Issue 6, eff. January 6, 1999; Volume 18, Issue 9, eff. December 18, 2001; Volume 20, Issue 21, eff. July 28, 2004; Volume 23, Issue 15, eff. May 2, 2007; Volume 25, Issue 11, eff. March 4, 2009; Errata, 25:12 VA.R. 2293 February 16, 2009; amended, Virginia Register Volume 27, Issue 13, eff. March 28, 2011; Volume 33, Issue 2, eff. October 20, 2016; Volume 34, Issue 7, eff. December 27, 2017; Errata, 34:8 VA.R. 831 December 11, 2017; Volume 35, Issue 4, eff. November 14, 2018; Volume 36, Issue 6, eff. December 26, 2019; Volume 39, Issue 9, eff. January 18, 2023; Volume 41, Issue 26, eff. September 10, 2025.
12VAC5-90-90. Those required to report.
A. A physician who treats or examines any person who is suffering from or who is suspected of having a reportable disease or condition shall report, at a minimum, that person's name, telephone number, address, age, date of birth, race, ethnicity, sex, and pregnancy status for females; name of disease diagnosed or suspected; the date of onset of illness; available laboratory tests and results; and the name, address, and telephone number of the physician and medical facility where the examination was made. A physician may designate someone to report on the physician's behalf, but the physician shall ensure that the appropriate report is made. A physician, designee, or organization making a report as authorized in this section shall be immune from liability as provided by § 32.1-38 of the Code of Virginia. The physician shall send the report within the timeframes specified in 12VAC5-90-80 to the local health department serving the jurisdiction in which the facility is located via the Virginia Department of Health's online Confidential Morbidity Report portal at https://www.vdh.virginia.gov/clinicians/disease-reporting-and-control-regulations/ or a CDC or VDH disease-specific surveillance form.
B. A laboratory director shall report a laboratory examination of a clinical specimen that yields evidence of a disease listed in 12VAC5-90-80 B. A laboratory director shall report results that are performed in-house or referred to a reference laboratory, with the following exception: if the laboratory director ascertains that the reference laboratory that tests a specimen reports to the department electronically, then the reference laboratory findings do not need to be reported by the laboratory of origin.
C. A report from a laboratory director shall give the source of the specimen and the laboratory method and result; the name, address, age, date of birth, race, ethnicity, sex, and pregnancy status for females (if known) of the person from whom the specimen was obtained; and the name, address, and telephone number of the physician at whose request and medical facility at which the examination was made. If the influenza virus is isolated, the type shall be reported, if available. A laboratory director shall make the report within the timeframes specified in 12VAC5-90-80 to the local health department serving the jurisdiction in which the laboratory is located via the department's online Confidential Morbidity Report portal or on the laboratory's own form, including a computer-generated report if it includes the required information. A laboratory director may make the required reports by means of secure electronic transmission upon agreement of the laboratory director and the department. A laboratory director shall submit a report of HIV genetic nucleotide sequence data associated with HIV drug resistance tests electronically. A person making a report as authorized in this section shall be immune from liability as provided by § 32.1-38 of the Code of Virginia.
D. If a clinical specimen yields evidence indicating the presence of a select agent or toxin as defined in 42 CFR Part 73, the laboratory director shall contact the Division of Consolidated Laboratory Services and arrange to forward an isolate for confirmation. If a select agent or toxin has been confirmed in a clinical specimen, the laboratory director shall consult with Division of Consolidated Laboratory Services or CDC regarding isolate transport or destruction.
E. A laboratory operating within a medical care facility shall be considered to be in compliance with the requirement to notify the local health department if the director of the medical care facility assumes the reporting responsibility; however, the laboratory director shall still submit isolates to the Division of Consolidated Laboratory Services or other designated laboratory as noted in 12VAC5-90-80 D unless the laboratory has submitted an exemption request that has been approved by the department.
F. A person in charge of a medical care facility shall make a report to the local health department serving the jurisdiction where the facility is located of the occurrence in or admission to the facility of a patient with a reportable disease listed in 12VAC5-90-80 A unless the person in charge of a medical care facility has evidence that the occurrence has been reported by a physician. A person making a report as authorized in this section shall be immune from liability as provided by § 32.1-38 of the Code of Virginia. The requirement to report shall include all inpatient, outpatient, and emergency care departments within the medical care facility. A report shall contain the patient's name, address, age, date of birth, race, ethnicity, sex, and, if the patient is female, pregnancy status; name of disease being reported; available laboratory tests and results; the date of admission; medical record number; date expired (if applicable); and attending physician. A report shall be made within the timeframes specified in 12VAC5-90-80 to the local health department serving the jurisdiction in which the facility is located via the Virginia Department of Health's online Confidential Morbidity Report portal at https://www.vdh.virginia.gov/clinicians/disease-reporting-and-control-regulations/ or a CDC or VDH disease-specific surveillance form. The person in charge of the medical facility may make the reports by means of secure electronic transmission upon agreement of the medical care facility and the department.
G. A person in charge of a medical care facility may assume the reporting responsibility on behalf of the director of the laboratory operating within the facility.
H. The person in charge of a residential or day program, service, or facility licensed or operated by any agency of the Commonwealth or a school, child care center, or summer camp as defined in § 35.1-1 of the Code of Virginia shall report immediately to the local health department the presence or suspected presence in the person in charge's program, service, facility, school, child care center, or summer camp of persons who have common symptoms suggesting an outbreak situation. The person in charge shall report additional information, including identifying and contact information for individuals with communicable diseases of public health concern or individuals who are involved in outbreaks that occur in the person in charge's facilities, as necessary to facilitate public health investigation and disease control. Identifying and contact information, at minimum, shall include a name and telephone number. A person making a report pursuant to this section shall be immune from liability as provided by § 32.1-38 of the Code of Virginia.
I. The local health director shall forward a report of a disease or report of evidence of a disease that has been made on a resident of the local health director's jurisdiction to the Office of Epidemiology within three days of receipt. The report shall be submitted immediately by the most rapid means available if the disease is one requiring rapid communication, as required in 12VAC5-90-80 C. Rapid reporting shall be confirmed in writing and submitted to the Office of Epidemiology, by either a paper report or entry into a shared secure electronic disease surveillance system, within three days. A local health director shall immediately forward to the appropriate local health director a disease report on an individual residing in the appropriate local health director's jurisdiction or to the Office of Epidemiology if the individual resides outside Virginia. The Office of Epidemiology shall notify other state health departments of reported illnesses in residents of the other state and shall notify CDC as necessary and appropriate.
J. In accordance with § 32.1-37.1 of the Code of Virginia, a person in charge of a hospital, nursing facility or nursing home, assisted living facility, or correctional facility shall, at the time of transferring custody of a dead body to a person practicing funeral services, notify the person practicing funeral services or the person practicing funeral services's agent if the dead person was known to have had, immediately prior to death, an infectious disease which may be transmitted through exposure to any bodily fluids. These include any of the following infectious diseases:
Coronavirus, severe (e.g., SARS-CoV, MERS-CoV)
Creutzfeldt-Jakob disease
Human immunodeficiency virus (HIV) infection
Hepatitis B (acute and chronic)
Hepatitis C (acute and chronic)
Rabies
Smallpox (Variola virus)
Syphilis, infectious (Treponema pallidum)
Tuberculosis, active disease (Mycobacterium tuberculosis complex)
Vaccinia, disease or adverse event
Viral hemorrhagic fever
K. Pursuant to 12VAC5-421-80, a food employee or conditional employee shall notify the person in charge of the food establishment when diagnosed with certain diseases that are transmissible through food, and the person in charge of the food establishment shall notify the department.
Statutory Authority
§§ 32.1-12, 32.1-35, and 32.1-42 of the Code of Virginia.
Historical Notes
Derived from VR355-28-100 § 3.2, eff. July 1, 1993; amended, Virginia Register Volume 15, Issue 6, eff. January 6, 1999; Errata, 15:8 VA.R. 1099 January 4, 1999; amended, Virginia Register Volume 20, Issue 21, eff. July 28, 2004; Volume 23, Issue 15, eff. May 2, 2007; Volume 27, Issue 13, eff. March 28, 2011; Volume 33, Issue 2, eff. October 20, 2016; Volume 36, Issue 6, eff. December 26, 2019; Volume 39, Issue 9, eff. January 18, 2023; Volume 41, Issue 26, eff. September 10, 2025.
Part IV
Control of Disease
12VAC5-90-100. Methods.
The board and commissioner shall use appropriate disease control measures to manage the diseases listed in 12VAC5-90-80 A, including but not limited to those described in the "Methods of Control" sections of the 20th Edition of the Control of Communicable Diseases Manual (2015) published by the American Public Health Association. The board and commissioner reserve the right to use any legal means to control any disease which is a threat to the public health.
When notified about a disease specified in 12VAC5-90-80, the local health director or his designee shall have the authority and responsibility to perform contact tracing/contact services for HIV infection, infectious syphilis, and active tuberculosis disease and may perform contact services for the other diseases if deemed necessary to protect the public health. All contacts of HIV infection shall be afforded the opportunity for appropriate counseling, testing, and individual face-to-face disclosure of their test results. In no case shall names of informants or infected individuals be revealed to contacts by the health department. All information obtained shall be kept strictly confidential.
The local health director or his designee shall review reports of diseases received from his jurisdiction and follow up such reports, when indicated, with an appropriate investigation in order to evaluate the severity of the problem. The local health director or his designee may recommend to any individual or group of individuals appropriate public health control measures, including but not limited to quarantine, isolation, immunization, decontamination, or treatment. He shall determine in consultation with the Office of Epidemiology and the commissioner if further investigation is required and if one or more forms of quarantine, isolation, or both will be necessary.
Complete isolation shall apply to situations where an individual is infected with a communicable disease of public health significance (including but not limited to active tuberculosis disease or HIV infection) and is engaging in behavior that places others at risk for infection with the communicable disease of public health significance, in accordance with the provisions of Article 3.01 (§ 32.1-48.01 et seq.) of Chapter 2 of Title 32.1 of the Code of Virginia.
Modified isolation shall apply to situations in which the local health director determines that modifications of activity are necessary to prevent disease transmission. Such situations shall include but are not limited to the temporary exclusion of a child with a communicable disease from school, the temporary exclusion of an individual with a communicable disease from food handling or patient care, the temporary prohibition or restriction of an individual with a communicable disease from using public transportation, the requirement that a person with a communicable disease use certain personal protective equipment, or restrictions of other activities that may pose a risk to the health of others.
Protective isolation shall apply to situations such as the exclusion, under § 32.1-47 of the Code of Virginia, of any unimmunized child from a school in which an outbreak, potential epidemic, or epidemic of a vaccine preventable disease has been identified.
To the extent permitted by the Code of Virginia, the local health director may be authorized as the commissioner's designee to implement the forms of isolation described in this section. When these forms of isolation are deemed to be insufficient, the local health director may use the provisions of Article 3.01 (§ 32.1-48.01 et seq.) of Chapter 2 of Title 32.1 of the Code of Virginia for the control of communicable diseases of public health significance or, in consultation with the Office of Epidemiology, shall provide sufficient information to enable the commissioner to prepare an order or orders of isolation, quarantine, or both under Article 3.02 (§ 32.1-48.05 et seq.) of Chapter 2 of Title 32.1 of the Code of Virginia for the control of communicable diseases of public health threat.
Statutory Authority
§ 32.1-35 of the Code of Virginia.
Historical Notes
Derived from VR355-28-100 § 4.1, eff. July 1, 1993; amended, Virginia Register Volume 15, Issue 6, eff. January 6, 1999; Volume 20, Issue 21, eff. July 28, 2004; Volume 23, Issue 15, eff. May 2, 2007; Volume 27, Issue 13, eff. March 28, 2011; Volume 33, Issue 2, eff. October 20, 2016.
12VAC5-90-103. Isolation for communicable disease of public health threat.
A. The commissioner, in the commissioner's sole discretion, may invoke the provisions of Article 3.02 (§ 32.1-48.05 et seq.) of Chapter 2 of Title 32.1 of the Code of Virginia and may declare the isolation of any individual upon a determination that:
1. The individual is known to have been infected with or is reasonably suspected to have been infected with a communicable disease of public health threat;
2. Exceptional circumstances render the procedures of Article 3.01 (§ 32.1-48.01 et seq.) of Chapter 2 of Title 32.1 of the Code of Virginia to be insufficient, or the individual has failed or refused to comply voluntarily with the control measures directed by the commissioner in response to a communicable disease of public health threat; and
3. Isolation is the necessary means to contain a communicable disease of public health threat, to ensure that the isolated individual receives appropriate medical treatment subject to the provisions of § 32.1-44 of the Code of Virginia, or to protect health care providers and others who may come into contact with the infected individual.
The commissioner, in the commissioner's sole discretion, may also order the isolation of an affected area if, in addition to the provisions of this subsection, the Governor has declared a state of emergency for such affected area of the Commonwealth.
B. For isolation for a communicable disease of public health threat, the local health department shall record information about the infection or suspected infection, the individual or affected area, and the nature or suspected nature of the exposure in consultation with the Office of Epidemiology. This information shall be sufficient to enable documenting a record of findings and to enable the commissioner to prepare the order of isolation, including the information required in § 32.1-48.12 of the Code of Virginia. In addition, the local health department shall maintain sufficient information on individuals to enable appropriate follow-up of individuals for health status evaluation and treatment as well as compliance with the order of isolation. The commissioner shall ensure that the protected health information of an individual subject to the order of isolation is disclosed only in compliance with state and federal law.
C. The local health department shall assess the situation, and in consultation with the Office of Epidemiology, identify the least restrictive means of isolation that effectively protects unexposed and susceptible individuals. The place of isolation selected shall allow the most freedom of movement and communication with family members and other contacts without allowing disease transmission to other individuals and shall allow the appropriate level of medical care needed by isolated individuals to the extent practicable. The commissioner, in the commissioner's sole discretion, may order an isolated individual to remain in the individual's residence, to remain in another place where the individual is present, or to report to a place designated by the commissioner for the duration of the isolation.
D. The commissioner's order of isolation shall be for a duration consistent with the known period of communicability of the communicable disease of public health threat or, if the course of the disease is unknown or uncertain, for a period anticipated as being consistent with the period of communicability of other similar infectious agents. In the situation where an area is under isolation, the duration of isolation shall take into account the transmission characteristics and known or suspected period of communicability.
E. The local health department shall deliver the order of isolation or ensure its delivery by an appropriate party, such as a law-enforcement officer or health department employee, to the affected individual in person to the extent practicable. If, in the opinion of the commissioner, the scope of the notification would exceed the capacity of the local health department to ensure individual notification in a timely manner, then print, radio, television, Internet, or other available means shall be used to inform those affected.
F. For an individual identified as, or for whom probable cause exists that the individual may be, in violation of an order of isolation, or for whom probable cause exists that the individual may fail or refuse to comply with the order, the enforcement authority directed by the commissioner to law-enforcement agencies shall include the power to detain or arrest.
An individual so detained shall be held in the least restrictive environment that can provide any required health care or other services for such individual. The commissioner shall ensure that law-enforcement personnel responsible for enforcing an order of isolation are informed of appropriate measures to take to protect themselves from contracting the disease of public health threat.
G. The local health department shall monitor the health of those under isolation either by regular telephone calls, visits, self-reports, or by reports of caregivers or health care providers or by other means.
H. Upon issuance of an order of isolation to an individual by the commissioner, the local health department shall manage the isolation, in conjunction with local emergency management resources, such that the individual's essential needs can be met to the extent practicable. Upon issuance of an order of isolation by the commissioner for an affected area, existing emergency protocols pursuant to Chapter 3.2 (§ 44-146.13 et seq.) of Title 44 of the Code of Virginia shall be utilized for mobilizing appropriate resources to ensure essential needs are met.
I. An individual subject to an order of isolation or a court-ordered confirmation or extension of the order may file an appeal of the order of isolation in accordance with the provisions of § 32.1-48.13 of the Code of Virginia. An appeal shall not stay any order of isolation.
J. Once the commissioner determines that individuals no longer pose a threat to the public health, the order of isolation has expired, or the order of isolation has been vacated by the court, the individuals under the order of isolation shall be released immediately. If the risk of an infected individual transmitting the communicable disease of public health threat to other individuals continues to exist, an order of isolation may be developed to extend the restriction prior to release from isolation.
K. If the criteria in subsection A of this section are met and an area is known or suspected to have been affected, then the commissioner shall notify the Governor of the situation and the need to order isolation for the affected area during the known or suspected time of exposure. In order for an affected area to be isolated, the Governor must declare a state of emergency for the affected area.
L. If an order of isolation is issued for an affected area during the known or suspected time of exposure, the commissioner shall cause the order of isolation to be communicated to the individuals residing or located in the affected area. The use of multiple forms of communication, including radio, television, Internet, or other available means, may be required in order to reach the individuals who were in the affected area during the known or suspected time of exposure.
M. The provisions for documentation, means of isolation, enforcement, health status monitoring, essential needs, and release from isolation as described in this section apply to the isolation of affected areas. Appropriate management of a disease of public health threat for an affected area may require the coordinated use of local, regional, state, and national resources. In specifying one or more affected areas to be placed under isolation, the commissioner shall maintain the objective to protect as many people as possible using the least restrictive means. As a result, defining the precise boundaries and timeframe of the exposure may not be possible or may change as additional information becomes available. If this occurs, the commissioner shall ensure that the description of the affected area is in congruence with the Governor's declaration of emergency and shall ensure that the latest information is communicated to those in or exposed to the affected area.
Statutory Authority
§§ 32.1-12, 32.1-35, and 32.1-42 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 23, Issue 15, eff. May 2, 2007; amended, Virginia Register Volume 27, Issue 13, eff. March 28, 2011; Volume 36, Issue 6, eff. December 26, 2019; Volume 41, Issue 26, eff. September 10, 2025.
12VAC5-90-107. Quarantine.
A. The commissioner, in the commissioner's sole discretion, may invoke the provisions of Article 3.02 (§ 32.1-48.05 et seq.) of Chapter 2 of Title 32.1 of the Code of Virginia and may order a complete or modified quarantine of an individual upon a determination that:
1. The individual is known to have been exposed to or is reasonably suspected to have been exposed to a communicable disease of public health threat;
2. Exceptional circumstances render the procedures of Article 3.01 (§ 32.1-48.01 et seq.) of Chapter 2 of Title 32.1 of the Code of Virginia to be insufficient, or the individual has failed or refused to comply voluntarily with the control measures directed by the commissioner in response to a communicable disease of public health threat; and
3. Quarantine is the necessary means to contain a communicable disease of public health threat to which an individual has been or may have been exposed and thus may become infected.
The commissioner, in the commissioner's sole discretion, may also order the quarantine of an affected area if, in addition to the provisions of this subsection, the Governor has declared a state of emergency for such affected area of the Commonwealth.
B. For quarantine for a communicable disease of public health threat, the local health department shall record information about the infection or suspected infection; the individual or affected area; and the nature or suspected nature of the exposure in consultation with the Office of Epidemiology. This information shall be sufficient to enable documenting a record of findings and enable the commissioner to prepare a written order of quarantine, including the information required in § 32.1-48.09 of the Code of Virginia. In addition, the local health department shall maintain sufficient information on individuals to enable appropriate follow-up of individuals for health status evaluation and treatment as well as compliance with the order of quarantine. The commissioner shall ensure that the protected health information of any individual subject to the order of quarantine is disclosed only in compliance with state and federal law.
C. The local health department shall assess the situation and, in consultation with the Office of Epidemiology, shall recommend to the commissioner the least restrictive means of quarantine that effectively protects unexposed and susceptible individuals. The place of quarantine selected shall allow the most freedom of movement and communication with family members and other contacts without allowing disease transmission to others. The commissioner, in the commissioner's sole discretion, may order the quarantined individuals to remain in their residences, to remain in another place where they are present, or to report to a place designated by the commissioner for the duration of their quarantine.
D. The commissioner's order of quarantine shall be for a duration consistent with the known incubation period of the communicable disease of public health threat or, if the incubation period is unknown or uncertain, for a period anticipated as being consistent with the incubation period for other similar infectious agents. If an area is under quarantine, the duration of quarantine shall take into account the transmission characteristics and known or suspected incubation period.
E. The local health department shall deliver the order of quarantine or ensure its delivery by an appropriate party, such as a law-enforcement officer or health department employee, to the affected individual in person to the extent practicable. If, in the opinion of the commissioner, the scope of the notification would exceed the capacity of the local health department to ensure notification in a timely manner, then print, radio, television, Internet, or other available means shall be used to inform those affected.
F. For an individual identified as, or for whom probable cause exists that the individual may be, in violation of an order of quarantine, or for whom probable cause exists that the individual may fail or refuse to comply with an order, the enforcement authority directed by the commissioner to law-enforcement agencies shall include the power to detain or arrest.
An individual so detained shall be held in the least restrictive environment that can provide any required health care or other services for such individual. The commissioner shall ensure that law-enforcement personnel responsible for enforcing an order of quarantine are informed of appropriate measures to take to protect themselves from contracting the disease of public health threat.
G. The local health department shall monitor the health of individuals under quarantine either by regular telephone calls, visits, self-reports, or by reports of caregivers or health care providers or by other means. If individuals develop symptoms compatible with the communicable disease of public health threat, then 12VAC5-90-103 would apply to the individuals.
H. Upon issuance of an order of quarantine to an individual by the commissioner, the local health department shall manage the quarantine, in conjunction with local emergency management resources, such that the individual's essential needs can be met to the extent practicable. Upon issuance of an order of quarantine by the commissioner for an affected area, existing emergency protocols pursuant to Chapter 3.2 (§ 44-146.13 et seq.) of Title 44 of the Code of Virginia shall be utilized for mobilizing appropriate resources to ensure essential needs are met.
I. An individual subject to an order of quarantine or a court-ordered confirmation or extension of an order may file an appeal of the order of quarantine in accordance with the provisions of § 32.1-48.10 of the Code of Virginia. An appeal shall not stay any order of quarantine.
J. Once the commissioner determines that individuals are no longer at risk of becoming infected and pose no risk of transmitting the communicable disease of public health threat to other individuals, the order of quarantine has expired, or the order of quarantine has been vacated by the court, the individuals under the order of quarantine shall be released immediately. If the risk of an individual becoming infected and transmitting the communicable disease of public health threat to other individuals continues to exist, an order of quarantine may be developed to extend the restriction prior to release from quarantine.
K. If the criteria in subsection A of this section are met and an area is known or suspected to have been affected, then the commissioner shall notify the Governor of the situation and the need to order quarantine for the affected area. In order for an affected area to be quarantined, the Governor must declare a state of emergency for the affected area.
L. If an order of quarantine is issued for an affected area, the commissioner shall cause the order of quarantine to be communicated to the individuals residing or located in the affected area. The use of multiple forms of communication, including radio, television, Internet, or other available means, may be required in order to reach the individuals who were in the affected area during the known or suspected time of exposure.
M. The provisions for documentation, means of quarantine, enforcement, health status monitoring, essential needs, and release from quarantine as described in this section apply to the quarantine of affected areas. Appropriate management of a disease of public health threat for an affected area may require the coordinated use of local, regional, state, and national resources. In specifying one or more affected areas to be placed under quarantine, the commissioner shall maintain the objective to protect as many people as possible using the least restrictive means. As a result, defining the precise boundaries and timeframe of the exposure may not be possible or may change as additional information becomes available. If this occurs, the commissioner shall ensure that the description of the affected area is in congruence with the Governor's declaration of emergency and shall ensure that the latest information is communicated to those in or exposed to the affected area.
Statutory Authority
§§ 32.1-12, 32.1-35, and 32.1-42 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 23, Issue 15, eff. May 2, 2007; amended, Virginia Register Volume 27, Issue 13, eff. March 28, 2011; Volume 36, Issue 6, eff. December 26, 2019; Volume 41, Issue 26, eff. September 10, 2025.
Part V
Immunization of Persons Less Than 18 Years of Age
12VAC5-90-110. Dosage and age requirements for immunizations; obtaining immunizations.
A. Every person in Virginia less than 18 years of age shall be immunized in accordance with the most recent Immunization Schedule developed and published by the CDC, Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP). Requirements for school and day care attendance are addressed in 12VAC5-110.
B. The required immunizations may be obtained from a physician, registered nurse, or other licensed professional as authorized by the Code of Virginia.
Statutory Authority
§ 32.1-35 of the Code of Virginia.
Historical Notes
Derived from VR355-28-100 § 5.1, eff. July 1, 1993; amended, Virginia Register Volume 15, Issue 6, eff. January 6, 1999; Volume 20, Issue 21, eff. July 28, 2004; Volume 23, Issue 15, eff. May 2, 2007; Volume 27, Issue 13, eff. March 28, 2011; Volume 33, Issue 2, eff. October 20, 2016.
12VAC5-90-120. (Repealed.)
Historical Notes
Derived from VR355-28-100 § 5.2, eff. July 1, 1993; repealed, Virginia Register Volume 15, Issue 6, eff. January 6, 1999.
Part VI
Venereal Disease
12VAC5-90-130. Prenatal testing.
Every physician, physician assistant, or nurse practitioner attending a pregnant patient during gestation shall examine and test such patient for syphilis, hepatitis B surface antigen (HBsAg), and any other sexually transmitted disease as clinically indicated within 15 days after beginning such attendance. A second prenatal test for syphilis and HBsAg shall be conducted at the beginning of the third trimester (28 weeks) for patients who are at higher risk for these diseases. Persons at higher risk for syphilis include those who have had multiple sexual partners within the previous year, those with any prior history of a sexually transmitted disease, and those living in communities and populations in which the prevalence of syphilis is high. Persons at higher risk for hepatitis B virus infection include injecting drug users and those with personal contact with a hepatitis B patient, multiple sexual partners, and/or occupational exposure to blood. If the patient first seeks care during the third trimester, only one test shall be required. As a routine component of prenatal care, every licensed practitioner who renders prenatal care, including any holder of a multistate licensure privilege to practice nursing, regardless of the site of such practice, shall inform every pregnant patient that human immunodeficiency virus (HIV) screening is recommended for all pregnant patients and that she will receive an HIV test as part of the routine panel of prenatal tests unless she declines (opt-out screening). The practitioner shall offer the pregnant patient oral or written information that includes an explanation of HIV infection, a description of interventions that can reduce HIV transmission from mother to infant, and the meaning of positive and negative test results. The confidentiality provisions of § 32.1-36.1 of the Code of Virginia and the test result disclosure conditions and appropriate counseling requirements of § 32.1-37.2 of the Code of Virginia shall apply to any HIV testing conducted pursuant to this section. The Centers for Disease Control and Prevention (CDC) recommends a second HIV test for patients who receive health care in jurisdictions with elevated incidence of HIV or AIDS among women aged 15 through 45 years, which includes Virginia. Practitioners should offer a second HIV test during the third trimester to all pregnant patients. Practitioners shall counsel all pregnant patients with HIV-positive test results about the dangers to the fetus and the advisability of receiving treatment in accordance with the then current CDC recommendations for HIV-positive pregnant patients. Any pregnant patient shall have the right to refuse testing for HIV infection and any recommended treatment. Documentation of such refusal shall be maintained in the patient's medical record.
Statutory Authority
§ 32.1-35 of the Code of Virginia.
Historical Notes
Derived from VR355-28-100 § 6.1, eff. July 1, 1993; amended, Virginia Register Volume 15, Issue 6, eff. January 6, 1999; Volume 23, Issue 15, eff. May 2, 2007; Volume 27, Issue 13, eff. March 28, 2011.
Part VII
Prevention of Blindness from Ophthalmia Neonatorum
12VAC5-90-140. Procedure for preventing ophthalmia neonatorum.
The physician, nurse, or midwife in charge of the infant's care after delivery of a baby shall ensure that a 1-cm ribbon of 0.5% erythromycin ophthalmic ointment is administered in each eye of the infant as soon as possible after birth and shall record the treatment in the medical record of the infant.
Statutory Authority
§§ 32.1-12, 32.1-35, and 32.1-42 of the Code of Virginia.
Historical Notes
Derived from VR355-28-100 § 7.1, eff. July 1, 1993; amended, Virginia Register Volume 27, Issue 13, eff. March 28, 2011; Volume 36, Issue 6, eff. December 26, 2019; Volume 41, Issue 26, eff. September 10, 2025.
Part VIII
Cancer Reporting
12VAC5-90-150. Authority.
Article 9 (§ 32.1-70 et seq.) of Title 32.1 of the Code of Virginia authorizes the establishment of a statewide cancer registry.
Statutory Authority
§§ 32.1-12 and 32.1-35 of the Code of Virginia.
Historical Notes
Derived from VR355-28-100 § 8.1, eff. July 1, 1993; amended, Virginia Register Volume 15, Issue 6, eff. January 6, 1999.
12VAC5-90-160. Reportable cancers and tumors.
Clinically or pathologically diagnosed cancers, as defined in 12VAC5-90-10, and benign brain and central nervous system tumors shall be reported to the Virginia Cancer Registry in the department. Carcinoma in situ of the cervix is not reportable.
Statutory Authority
§§ 32.1-12 and 32.1-35 of the Code of Virginia.
Historical Notes
Derived from VR355-28-100 § 8.2, eff. July 1, 1993; amended, Virginia Register Volume 15, Issue 6, eff. January 6, 1999; Volume 20, Issue 21, eff. July 28, 2004.
12VAC5-90-170. Those required to report.
Any person in charge of a medical care facility, clinic, or independent pathology laboratory which diagnoses or treats cancer patients is required to report. Physicians are required to report cases of cancer in those instances when it has been determined that a medical care facility, clinic, or instate pathology laboratory has not reported. Any person making such report shall be immune from liability as provided by § 32.1-38 of the Code of Virginia.
Statutory Authority
§§ 32.1-12 and 32.1-35 of the Code of Virginia.
Historical Notes
Derived from VR355-28-100 § 8.3, eff. July 1, 1993; amended, Virginia Register Volume 15, Issue 6, eff. January 6, 1999.
12VAC5-90-180. Report contents and procedures.
Each report shall include the patient's name, address (including county or independent city of residence), age, date of birth, sex, date of diagnosis, date of admission or first contact, primary site of cancer, histology (including type, behavior, and grade), basis of diagnosis, social security number, race, ethnicity, marital status, usual occupation, usual industry, sequence number, laterality, stage, treatment, recurrence information (when applicable), name of reporting facility, vital status, cause of death (when applicable), date of last contact, history of tobacco and alcohol use, and history of service in Vietnam and exposure to dioxin-containing compounds, when applicable.
Reporting shall be by electronic means where possible. Output file formats shall conform to the most recent version of the North American Association of Central Cancer Registries' standard data file layout. Facilities without electronic reporting means and physicians shall submit the required information on the Virginia Cancer Registry Reporting Form. A copy of the pathology report(s) should accompany each completed reporting form, when available. Medical care facilities and clinics reporting via the reporting form should also submit a copy of the admission form and discharge summary.
Reports shall be made within six months of the diagnosis of cancer and submitted to the Virginia Cancer Registry on a monthly basis. Cancer programs conducting annual follow-up on patients shall submit follow-up data monthly in an electronic format approved by the Virginia Cancer Registry.
Statutory Authority
§§ 32.1-12 and 32.1-35 of the Code of Virginia.
Historical Notes
Derived from VR355-28-100 § 8.4, eff. July 1, 1993; amended, Virginia Register Volume 15, Issue 6, eff. January 6, 1999; Volume 20, Issue 21, eff. July 28, 2004.
12VAC5-90-190. (Repealed.)
Historical Notes
Derived from VR355-28-100 § 8.5, eff. July 1, 1993; repealed, Virginia Register Volume 15, Issue 6, eff. January 6, 1999.
Part IX
Reporting and Control of Diseases
12VAC5-90-200. Reporting and control of diseases.
Chapter 2 (§ 32.1-35 et seq.) of Title 32.1 of the Code of Virginia relating to the Reporting and Control of Diseases is incorporated by reference and made a part of these regulations.
Statutory Authority
§§ 32.1-12 and 32.1-35 of the Code of Virginia.
Historical Notes
Derived from VR355-28-100 § 9.1, eff. July 1, 1993.
12VAC5-90-210. (Repealed.)
Historical Notes
Derived from VR355-28-100 §§ 10.1 and 10.2, eff. July 1, 1993; repealed, Virginia Register Volume 15, Issue 6, eff. January 6, 1999.
Part X
Protocol for Identification of Children with Elevated Blood Lead Levels
12VAC5-90-215. Schedule and criteria for and confirmation of blood lead testing and information to be provided.
A. A child shall be tested to determine the blood lead level at 12 months and 24 months of age if the health care provider determines that the child meets any of the criteria listed in subsection B of this section. A child 25 months through 72 months of age who presents for medical care and meets any of the criteria of subsection B of this section shall also be tested if the child has either not previously been tested for blood lead level or was previously tested but experienced a change since testing that has resulted in an increased risk of lead exposure based on the criteria listed in subsection B of this section.
B. The criteria for blood lead testing are as follows:
1. The child is eligible for or receiving benefits from Medicaid or the Special Supplemental Nutrition Program for Women, Infants and Children (WIC);
2. The child is living in or regularly visiting a house, apartment, dwelling, structure, or child care facility built before 1950;
3. The child is living in or regularly visiting a house, apartment, dwelling, structure, or child care facility built before 1978 that has (i) peeling or chipping paint or (ii) recent (within the last six months) ongoing or planned renovations;
4. The child is living in or regularly visiting a house, apartment, dwelling, or other structure in which one or more persons have blood lead testing yielding evidence of lead exposure;
5. The child is living with an adult whose job, hobby, or other activity involves exposure to lead;
6. The child is living near an active lead smelter, battery recycling plant, or other industry likely to release lead;
7. The child's parent, guardian, or other person standing in loco parentis requests the child's blood be tested due to any suspected exposure; or
8. The child is a recent refugee or immigrant or is adopted from outside of the United States.
C. A child who does not meet any of the schedule or criteria provided in subsection A or B of this section is considered to be at low risk, and testing is not required but may be conducted at the discretion of the health care provider. The testing requirement shall be waived if the parent, guardian, or other person standing in loco parentis of the child objects to the testing on the basis that the procedure conflicts with his religious tenets or practices.
D. Blood lead level testing shall be performed on venous or capillary blood. Tests of venous blood performed by a laboratory certified by the federal Centers for Medicare & Medicaid Services in accordance with 42 USC § 263a, the Clinical Laboratory Improvement Amendment of 1988 (CLIA-certified), are considered confirmatory. Tests of venous blood performed by any other laboratory and tests of capillary blood shall be confirmed by a repeat blood test, preferably venous, performed by a CLIA-certified laboratory. Confirmatory testing is not required if the result of the capillary test is below the CDC reference value. Confirmatory testing shall be performed:
1. Within one to three months if the result of the capillary test is at or above the CDC reference value and up to nine micrograms of lead per deciliter of whole blood (µg/dL);
2. Within one week to one month if the result of the capillary test is 10-44 µg/dL. The higher this test result, the more urgent the need for a confirmatory test is;
3. Within 48 hours if the result of the capillary test is 45-59 µg/dL;
4. Within 24 hours if the result of the capillary test is 60-69 µg/dL; and
5. Immediately as an emergency laboratory test if the result of the capillary test is 70 µg/dL or higher.
E. As part of regular well-check visits for all children, the health care provider shall make available to parents, guardians, or other persons standing in loco parentis information on the dangers of lead poisoning, potential sources of lead and ways to prevent exposure, and a list of available lead-related resources. When blood lead level testing is performed, the health care provider shall share the child's blood lead level test result with the child's parent, guardian, or other person standing in loco parentis and shall report to the local health department in accordance with the requirements of 12VAC5-90-80.
Statutory Authority
§§ 32.1-12, 32.1-35, and 32.1-42 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 12, eff. March 11, 2016; amended, Virginia Register Volume 36, Issue 6, eff. December 26, 2019; Volume 41, Issue 26, eff. September 10, 2025.
12VAC5-90-220. (Repealed.)
Historical Notes
Derived from VR355-28-100 §§ 10.1 and 10.2, eff. July 1, 1993; repealed, Virginia Register Volume 15, Issue 6, eff. January 6, 1999.
Part XI
Tuberculosis Control
12VAC5-90-225. Additional data to be reported related to persons with active tuberculosis disease (confirmed or suspected).
A. Physicians and directors of medical care facilities shall submit the following to the department:
1. An initial report to be completed when there are reasonable grounds to suspect that a person has active TB disease, but no later than when antituberculosis drug therapy is initiated. The report shall include the following: the affected person's name; age; date of birth; gender; address; pertinent clinical, radiographic, microbiologic, and pathologic reports, whether pending or final; other information as may be needed to locate the patient for follow-up; and name, address, and telephone number of the treating physician.
2. A secondary report to be completed simultaneously or within one to two weeks following the initial report. The report shall include: the date, method, and results of tests for tuberculosis infection; the date and results of the initial and follow-up chest radiographs; the dates and results of bacteriologic or pathologic testing, the antituberculosis drug regimen, including names of the drugs, dosages and frequencies of administration, and start date; the date and results of drug susceptibility testing; HIV status; contact screening information; and name, address, and telephone number of treating physician.
3. Subsequent reports when updated information is available. Subsequent reports are required when clinical status changes, the treatment regimen changes; treatment ceases for any reason; or there are any updates to laboratory results, treatment adherence, name, address, and telephone number of current provider, patient location or contact information, or other additional clinical information.
B. Physicians or directors of medical care facilities responsible for the care of a patient with active tuberculosis disease shall develop and maintain a written treatment plan that shall be in place no later than the time when antituberculosis drug therapy is initiated. Patient adherence to this treatment plan must be documented. The treatment plan and adherence record are subject to review by the local health director or the local health director's designee at any time during the course of treatment.
C. The treatment plan for the following categories of patients shall be submitted to the local health director or the local health director's designee for approval no later than the time when antituberculosis drug therapy is started or modified:
1. Individuals who are inpatients or incarcerated, for whom the responsible provider or facility shall submit the treatment plan for approval prior to discharge or transfer.
2. Individuals, whether inpatient, incarcerated, or outpatient, who also have one of the following conditions:
a. HIV infection;
b. Known or suspected active TB disease resistant to rifampin, rifabutin, rifapentine, or other rifamycin with or without resistance to any other drug;
c. A history of prior treated or untreated active TB disease, or a history of relapsed active TB disease; or
d. A demonstrated history of nonadherence to any medical treatment regimen.
D. A laboratory director shall submit the following:
1. Results of smears that are positive for acid fast bacilli;
2. Results of cultures positive for any member of the Mycobacterium tuberculosis complex or any other mycobacteria;
3. Results of rapid methodologies, including acid hybridization or nucleic acid amplification, which are indicative of M. tuberculosis complex or any other mycobacteria;
4. Results of tests for antimicrobial susceptibility performed on cultures positive for M. tuberculosis complex; and
5. Results of tests for tuberculosis infection.
Whether testing is done in-house or referred to an out-of-state laboratory, a laboratory director shall submit a representative and viable sample of the initial culture positive for any member of the M. tuberculosis complex to the Division of Consolidated Laboratory Services or other laboratory designated by the board to receive such specimen.
Statutory Authority
§§ 32.1-12, 32.1-35, and 32.1-42 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 20, Issue 21, eff. July 28, 2004; amended, Virginia Register Volume 23, Issue 15, eff. May 2, 2007; Volume 27, Issue 13, eff. March 28, 2011; Volume 36, Issue 6, eff. December 26, 2019; Volume 41, Issue 26, eff. September 10, 2025.
Part XII
(Repealed)
12VAC5-90-230. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 14, Issue 26, eff. October 14, 1998; repealed, Virginia Register Volume 34, Issue 8, eff. January 26, 2018.
12VAC5-90-240. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 14, Issue 26, eff. October 14, 1998; repealed, Virginia Register Volume 34, Issue 8, eff. January 26, 2018.
12VAC5-90-250. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 14, Issue 26, eff. October 14, 1998; amended, Virginia Register Volume 23, Issue 15, eff. May 2, 2007; repealed, Virginia Register Volume 34, Issue 8, eff. January 26, 2018.
12VAC5-90-260. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 14, Issue 26, eff. October 14, 1998; amended, Virginia Register Volume 23, Issue 15, eff. May 2, 2007; repealed, Virginia Register Volume 34, Issue 8, eff. January 26, 2018.
12VAC5-90-270. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 14, Issue 26, eff. October 14, 1998; amended, Virginia Register Volume 23, Issue 15, eff. May 2, 2007; repealed, Virginia Register Volume 34, Issue 8, eff. January 26, 2018.
Part XIII
Reporting of Dangerous Microbes and Pathogens
12VAC5-90-280. Reporting of dangerous microbes and pathogens.
A. Definitions. The following term when used in this part shall have the following meaning unless the context clearly indicates otherwise:
"Select agent or toxin" or "select agent and toxin" means all those biological agents or toxins as defined by federal regulations in 42 CFR Part 73, including Health and Human Services select agents and toxins and overlap select agents and toxins. "Dangerous microbes and pathogens" will be known as "select agents and toxins."
B. Items to report. Each report shall contain the following: name, source, and characterization information on select agents and toxins and quantities held and the name and address of the laboratory and the name, position, and identification information of one responsible official as a single point of contact for the organization.
C. Timing of reports. By January 31 of every year, the responsible official at a laboratory as designated by the Federal Select Agent Program shall provide a written report to the Division of Surveillance and Investigation in the Office of Epidemiology containing the information specified in subsection B of this section.
In the event of a suspected release, loss, or theft of any select agent or toxin, the responsible official at a laboratory as designated by the Federal Select Agent Program shall make a report to the department immediately by the most rapid means available, preferably by telephone. The report shall be submitted to the Division of Surveillance and Investigation in the Office of Epidemiology. The rapid report shall be followed up by a written report within seven calendar days and shall include the following information:
1. The name of the biologic agent and any identifying information (e.g., strain or other characterization information);
2. An estimate of the quantity released, lost, or stolen;
3. An estimate of the time during which the release, loss, or theft occurred;
4. The location (building, room) from or in which the release, loss, or theft occurred. The report may contain additional information as required by 42 CFR Part 73 or the department; and
5. If a release has occurred, the report shall also include the nature, environment, and location of the release; number, names, and position of exposed individuals; and actions taken as a result of the release.
D. Release of reported information. Reports submitted to the select agent and toxin registry shall be confidential and shall not be a public record pursuant to the Freedom of Information Act, regardless of submitter. Release of information on select agents or toxins shall be made only by order of the State Health Commissioner to the CDC and state and federal law-enforcement agencies in any investigation involving the release, theft, or loss of a select agent or toxin required to be reported to the department under this regulation. A person making a report as authorized in this section shall be immune from liability as provided by § 32.1-38 of the Code of Virginia.
Statutory Authority
§§ 32.1-12, 32.1-35, and 32.1-42 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 20, Issue 21, eff. July 28, 2004; amended, Virginia Register Volume 23, Issue 15, eff. May 2, 2007; Volume 33, Issue 2, eff. October 20, 2016; Volume 36, Issue 6, eff. December 26, 2019; Volume 41, Issue 26, eff. September 10, 2025.
12VAC5-90-290. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 20, Issue 21, eff. July 28, 2004; repealed, Virginia Register Volume 33, Issue 2, eff. October 20, 2016.
12VAC5-90-300. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 20, Issue 21, eff. July 28, 2004; repealed, Virginia Register Volume 33, Issue 2, eff. October 20, 2016.
12VAC5-90-310. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 20, Issue 21, eff. July 28, 2004; repealed, Virginia Register Volume 33, Issue 2, eff. October 20, 2016.
12VAC5-90-320. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 20, Issue 21, eff. July 28, 2004; repealed, Virginia Register Volume 33, Issue 2, eff. October 20, 2016.
12VAC5-90-330. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 20, Issue 21, eff. July 28, 2004; amended, Virginia Register Volume 23, Issue 15, eff. May 2, 2007; repealed, Virginia Register Volume 33, Issue 2, eff. October 20, 2016.
12VAC5-90-340. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 20, Issue 21, eff. July 28, 2004; repealed, Virginia Register Volume 33, Issue 2, eff. October 20, 2016.
12VAC5-90-350. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 20, Issue 21, eff. July 28, 2004; amended, Virginia Register Volume 23, Issue 15, eff. May 2, 2007; repealed, Virginia Register Volume 33, Issue 2, eff. October 20, 2016.
12VAC5-90-360. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 20, Issue 21, eff. July 28, 2004; amended, Virginia Register Volume 23, Issue 15, eff. May 2, 2007; repealed, Virginia Register Volume 33, Issue 2, eff. October 20, 2016.
Part XIV
Reporting of Healthcare-Associated Infections
12VAC5-90-370. Reporting of health care-associated infections.
A. A health care facility that reports data into the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN) as a requirement of the Centers for Medicare and Medicaid Services shall share the data, through the NHSN, with the department.
B. A person making a report as authorized in this section shall be immune from liability as provided by § 32.1-38 of the Code of Virginia. Infection rate data may be released to the public by the department upon request. Data shall be aggregated to ensure that no individual patient may be identified.
Statutory Authority
§§ 32.1-12 , 32.1-35, and 32.1-42 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 24, Issue 19, eff. July 1, 2008; amended, Virginia Register Volume 27, Issue 13, eff. March 28, 2011; Volume 31, Issue 26, eff. September 25, 2015; Volume 36, Issue 6, eff. December 26, 2019; Volume 41, Issue 26, eff. September 10, 2025.
Forms (12VAC5-90)
No form is currently required by the regulation.
Documents Incorporated by Reference (12VAC5-90)
Control of Communicable Diseases Manual, 20th Edition, 2015, American Public Health Association