The following words, as used in these regulations, unless a
different meaning is required by the context, or as specifically prescribed,
shall have the following meanings:
Includes the Board, Selectman or officer having like powers
and duties in cities or towns.
A person who, without symptoms of a disease dangerous to
the public health, harbors and may disseminate the specific microorganisms
of that disease.
Any person known to have been sufficiently near an infected
person or animal to have been presumably exposed to transfer of infectious
material directly, or by articles freshly soiled with such material.
An "immune" person is one who has had the disease, or has
been artificially immunized against it, and is, presumably, protected
against another attack.
The usual period of time which elapses between the exposure
of a person to infection and the development of the symptoms of the
disease to which he may have been exposed.
The separation of persons suffering from any disease dangerous
to the public health, or carriers of the infecting microorganism from
other persons, in such places and under such conditions as wilt prevent
the direct or indirect conveyance of the infectious agent to susceptible
persons. [Note: In view of the various ambiguous and inaccurate uses
to which the words "isolation" and "quarantine" are frequently put,
it has seemed best to adopt arbitrarily the word "isolation" as describing
the limitations put upon the movements of an individual (animal) known
to be sick or be a "carrier," and the word "quarantine" as describing
the limitations put upon individuals exposed ("contacts") to disease.]
The date of the removal to a hospital, or the recovery or
death of the patient, or the date on which the nonimmune contact leaves
and remains out of the house where the patient is isolated.
An official notice, written or printed, posted as a warning
of the presence of a disease dangerous to the public health on the
premises or in the apartment or room so placarded.
The restriction to the premises, house or apartment of materials
and persons that presumably have been exposed to a disease dangerous
to the public health. [Note: In view of the various ambiguous and
inaccurate uses to which the words "isolation" and "quarantine" are
frequently put, it has seemed best to adopt arbitrarily the word "isolation"
as describing the limitations put upon the movements of an individual
(animal) known to be sick or be a "carrier," and the word "quarantine"
as describing the limitations put upon individuals exposed ("contacts")
to disease.]
A "susceptible" or "nonimmune" person is one who is not known
to have acquired immunity to the particular communicable disease in
question.
A.
Definition of "adult." Any person who has reached his 18th birthday
is considered to be an adult for purposes of these regulations.
B.
All of the above diseases except five should be reported to the local
Board of Health. The five exceptions (chancroid, gonorrhea, granuloma
inguinal, lymphogranuloma venereum and syphilis) should be reported
directly to the State Department of Public Health on special forms
provided upon request.
C.
Food handlers living in a household where a case of typhoid, cholera
bacillary, dysentery, or paratyphoid fever exists shall be excluded
from their occupation as long as they continue to live in the same
house in which the case exists, and thereafter until freedom from
infection, as judged by clinical and laboratory evidence, has been
demonstrated to the satisfaction of the Department of Public Health.
Food handlers living in a household with a recovered case which continues
to excrete typhoid bacilli after convalescence shall be excluded from
their occupations unless they have been inoculated with typhoid vaccine
within two years.
D.
Contacts shall be quarantined until three weeks have elapsed from
the date of last exposure unless immunized by a previous attack, by
a recent successful vaccination, or showing the immune reaction.
E.
Patients who have lesions of primary or secondary syphilis on exposed
parts of the body or in the mouth, and are employed in any occupation
requiring regular, direct contact with other persons such as barber,
hairdresser, manicurist, waiter, waitress, nursemaid, domestic, etc.,
shall be reported by name, address and occupation to the State Department
of Public Health, unless the physician will assume responsibility
for seeing that the patient discontinues such occupation until the
lesions are healed.
F.
Tuberculosis.
(1)
Patients with open tuberculosis should in most cases receive sanatorium
treatment, both for the benefit of the individual and the protection
of his family. Those who remain in their homes shall observe all precautions
necessary to prevent infections of the members of their families and
others with whom they may come in contact. This shall include approved
methods of collection and disposal of the sputum, the sterilization
of any articles of clothing and of toilet articles which may become
contaminated by the sputum, the use of separate dishes and eating
utensils and proper sterilization of the same. The patient should
sleep in a separate room.
(2)
For details concerning precautions in home care, a pamphlet of the
Massachusetts Department of Public Health entitled "Home Care of Tuberculosis
Patients" is available. As soon as a diagnosis of tuberculosis has
been established, arrangements should be made for the examination,
including an X-ray of the chest, of all members of the immediate family
and of other persons with whom the patient has been in close contact;
if the facilities are available through the various state, county
and municipal sanatorium. Persons with suspicious findings and those
who have had contact with a tuberculosis patient should be kept under
medical observation as long as advised by the physician. It is the
responsibility of the local Board of Health to provide hospital care
for cases of tuberculosis, when needed, and to see that contacts are
examined where such examinations have not been made through a private
physician.
(3)
When a case is reported, the public health nurse representing the
Board of Health should visit the patient's home. She should instruct
the family in the sanitary precautions described above, see that arrangements
are made for the examination of contacts and if necessary provide
transportation to the place where they are to be X-rayed, and should
aid the patient in obtaining admission to a sanatorium if this has
been recommended by his physician.
(4)
Thereafter, the nurse should make visits to the home at least once
in six months to determine whether the patient has moved, whether
the above-mentioned precautions are still being observed, and whether
any new measures are needed to control the spread of the disease.
If the patient has moved to another town or state, the Massachusetts
Department of Public Health should be notified. In cases where the
physician wishes to exercise complete supervision, the nurse should
obtain such information from him.
(5)
The only acceptable reasons for the Board of Health failing to exercise
the supervision outlined above are: refusal of the family physician
to permit periodic visits by the nurse; or placing of the patient's
name on the "inactive list" as a result of examination including X-ray.
(6)
No person who has had or has tubercle bacilli in the sputum or other
bodily discharges shall be allowed to engage in teaching, nursing,
dairying or occupations involving food handling or the care of children
until he has received a certificate from the Board of Health stating
that his employment would not be dangerous to the public health.
G.
Persons living in a family in which a case of tuberculosis exists
or has existed within two years, and whose occupations involve food
handling or contact with children, shall be required to have an X-ray
of the chest to determine whether they shall be allowed to continue
in such occupations.
According to MGL c. 111, § 111, as amended, "If a
physician knows or has cause to believe that a person whom he visits
is infected with a disease dangerous to the public health, he shall
immediately give written notice thereof signed by him. . ." The act
further provides, "The foregoing provisions of this section and the
provisions of section one hundred and nine shall not apply to gonorrhea
and syphilis, except in the case of eye infections in infants under
two weeks of age. Any person having either of said diseases shall
be reported to the local Boards of Health, either directly or through
the department, in accordance with such special rules and regulations
as the department may make, having due regard for the best interests
of the public."
When a householder knows that a person within his family or
house is sick with a disease dangerous to the public health, he shall
immediately give notice thereof to the Board of Health in the manner
required by the statute (MGL c. 111, § 109, as amended by
Chapter 265 of the Acts of 1938); provided, however, that in cases
in which a physician has been called in, his notification will be
accepted in place of the householder.
MGL c. 111, § 110, as amended by Chapter 180 of the
Acts of 1932: "If either eye of an infant becomes inflamed, swollen
and red, or shows an unnatural discharge within two weeks after birth,
the nurse, relative or other attendant having charge of such infant
shall report in writing, within six hours thereafter, to the Board
of Health of the town where the infant is, the fact that such inflammation,
swelling and redness of the eyes or unnatural discharge exists. On
receipt of such report, or of notice of the same symptoms given by
the physician, or a hospital medical officer registered under Section
nine of Chapter 112, as provided by the following section, the Board
of Health shall take such immediate action as it may deem necessary,
including so far as may be possible, consultation with an oculist
and the employment of a trained nurse in order that blindness may
be prevented."
A.
Houses or portions of houses in which there is a person sick shall
be placarded for those diseases dangerous to the public health, for
which placarding is required under the minimum isolation and quarantine
requirements of the State Department of Public Health. This card shall
not be removed except on the authority of the Board of Health.
B.
In the case of tenement houses, apartment houses, apartment houses
or like structures, as much of the building shall be placarded as
in the judgment of the Board of Health is consistent with the best
interests of the public.
No person, except physicians, nurses, and those whose duty it
is to minister to the patient, shall be allowed to enter the place
of isolation during the continuance of the disease unless permitted
to do so by the Board of Health or its agent.
Nurses and others caring for a person isolated as above shall
wash their hands thoroughly with hot water, soap and scrubbing brush
immediately after handling the patient, his discharges or any article
soiled by his discharges, before mingling with others. They shall
change their outer clothing before going out.
All eating utensils and linen used by the patient shall be boiled
for at least five minutes immediately after being taken from the room.
Upon release of the patient, woolen articles shall be exposed to sunlight
and air for at least eight hours.
The discharges of a person sick with typhoid fever, paratyphoid
fever, or dysentery isolated in the house shall be mixed with chloride
of lime or other disinfectant approved by the Board of Health and
shall be kept in contact therewith for at least 30 minutes before
being emptied into the hopper or privy unless permission for another
method of handling is given by the Board of Health.
A.
Children who have recovered from or have been exposed to any disease declared dangerous to the public health (see § 310-2) may return to school only after certification by the Board of Health or after examination by the school physician as prescribed in MGL c. 71, § 55, as amended by Chapter 265 of the Acts of 1938.
B.
The following regulations are promulgated under authority of MGL
c. 111, § 31.
C.
Public schools are no longer required to exclude from schools children
exposed to the diseases listed in this table unless the regulations
of the local Board of Health require such exclusion. (MGL c. 71, § 55,
as amended by Chapter 89 of the Acts of 1952).
|
NOTE: These requirements are subject to change to comply with
Massachusetts Department of Public Health regulations.
|
