Section 410IAC1-2.5-93. Cyclosporiasis; specific control measures

   The specific control measures for cyclosporiasis (infectious agent: Cyclospora cayetanensis) are as follows:

(1) An investigation by the local health officer shall meet the following conditions:

(A) Be performed within seventy-two (72) hours.

(B) Include a seven (7) day history of the following prior to symptom onset:

(i) Food and drink consumption.

(ii) Domestic and international travel.

(iii) Water exposures.

(C) Determine if the case is part of an outbreak.

(D) Determine if the case is a:

(i) food employee;

(ii) daycare worker;

(iii) health care worker; or

(iv) daycare attendee, a school attendee, or anyone who lives at a residential institution.

(E) If a commercial food source is suspected, active surveillance shall be undertaken. Direct person-to-person transmission is unlikely, so focus should be on a water or food source.

(2) In addition to standard precautions, contact precautions shall be followed for diapered or incontinent people for the duration of illness. For others, the following instructions apply:

(A) Cases employed as food employees, daycare workers, health care workers, or in similar positions shall be excluded from employment involving food handling and the direct care of children or hospitalized or institutionalized patients until all of the following have occurred:

(i) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours.

(ii) The case has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.

(iii) The local health officer has discussed the following topics with the employer:

(AA) The employer's duty to comply with local and state rules pertaining to prevention of infectious diseases.

(BB) The availability of required proper hand washing facilities for employees.

(CC) The correction of any observed lapses in hygienic measures by employees.

(B) Cases shall be excluded from attending schools, preschools, and daycare facilities until all of the following have occurred:

(i) The local health officer has determined the case has been asymptomatic for at least twenty-four (24) hours.

(ii) The case has completed effective treatment, if indicated.

(iii) The case or case's guardian has been counseled about preventive measures, such as hand washing procedures, that must be followed to prevent transmission of disease.

(iv) The local health officer has discussed with the appropriate school, preschool, or daycare facility staff the need:

(AA) for proper hand washing and other infection control practices; and

(BB) to comply with all local and state rules pertaining to prevention of infectious diseases.

(C) If an outbreak of the infection occurs in a daycare facility or preschool, the following may occur:

(i) All attendees and staff may be required to submit stool specimens for examination.

(ii) Instead of exclusion, attendees and staff may be isolated from other attendees and staff in the same facility based on symptoms, laboratory testing, and treatment. This alternative shall only be considered if the physical structure and staff organization of the facility can accommodate isolation of various attendee and staff groups from one another. If this alternative is selected, increased emphasis on hand washing procedures and environmental cleaning is necessary.

(iii) Admission of all new attendees may be suspended while the outbreak continues.

(3) Concurrent disinfection of feces and feces soiled articles is required. Feces may be discarded in a sanitary sewer.

(4) Quarantine is not required.

(5) Immunization is not applicable. Protection of contacts is not applicable.

(6) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.

(Indiana State Department of Health; 410 IAC 1-2.5-93; filed Nov 25, 2015, 2:54 p.m.: 20151223-IR-410150039FRA)