Los Angeles County Municipal Code Part III Communicable

SEC. 10 - EXAMINATION FOR COMMUNICABLE DISEASE

Persons suspected of having a communicable disease are requested to contact their physicians or appear at a Department of Health Services clinic for examination. Failure to comply with this request must be reported to the Chief, Public Health Investigation.

SEC. 11 - SURVEILLANCE ORDERS ON INTERNATIONAL TRAVELERS

Issuance

The United States Public Health Service may issue a SURVEILLANCE ORDER, HSM-13.17. (Center for Disease Control), to any traveler from a foreign country infected with smallpox, cholera, yellow fever, or plague, who meets any of the following criteria:

Travelers who have an illness of unusual or severe nature which might possibly be a quarantinable disease. Suspicious signs and symptoms include:

Temperature of 100°F (38°C) or greater, accompanied or followed by rash, jaundice, or lymphadenopathy, or which has persisted for two days or more.

Diarrhea severe enough to interfere with work or normal activities.

Persons who have traveled on a conveyance with, or have otherwise been in close contact with, a person diagnosed or suspected of having a quarantinable disease.

Persons who arrive on a conveyance on which there are two or more unrelated persons with the same disease symptoms.

Persons arriving from a smallpox-infected country who do not have a valid international smallpox vaccination certification.

When an ill person is denied immediate quarantine clearance upon arrival, a United States Public Health Service consultant physician will be called to examine, diagnose and clear the traveler. If diagnostic tests or further observation are required, a SURVEILLANCE ORDER, HSM-13.17, will be issued allowing the person entry, subject to the condition that he remain under observation of the appropriate District Health Officer for a specified period of time. Similar surveillance orders may be issued to exposed contacts who are not ill. A copy of each SURVEILLANCE ORDER, HSM-13.17, is sent to the District Health Officer. Where urgency exists, the District Health Officer is informed by telephone or telegraph.

Since there is no inspection for travelers from Canada, Canadian ports of entry send a similar NOTICE OF SURVEILLANCE, QS24, on travelers under surveillance with ultimate destinations in the United States.

When such notices are received, the Chief, Public Health Investigation, should be immediately notified.

General Procedures

Public Health Investigation immediately contacts the traveler, and obtains the following information:

Address and telephone where the traveler can be contacted until surveillance order expires.

Detailed itinerary for 21 days preceding interview, and for the duration of the surveillance order.

History of fever, rash, jaundice, diarrhea, or glandular swelling within preceding 21 days.

Any information released by quarantine station or examining physician regarding diagnosis or laboratory tests.

This information is telephoned immediately to the District Health Officer, and a specific surveillance plan developed. These arrangements are reported to the Chief, Acute Communicable Disease Control.

If the detailed itinerary shows that the traveler plans to leave Los Angeles County before the expiration of the surveillance period, the further itinerary is reported to the Chief, Public Health Investigation, who notifies the State Department of Health.

Special Procedures

Smallpox. Persons under surveillance orders because of illness suspicious of (or exposure to) smallpox are examined immediately by the District Health Officer and continue to be examined daily until surveillance is completed. If specimens were taken for diagnosis at the port of entry, no laboratory diagnosis is generally required. Telephone the Chief, Acute Communicable Disease Control immediately.

Persons under surveillance orders only because of lack of valid small pox immunization are contacted immediately by Public Health Investigation. The specific surveillance plan developed is individualized; if the traveler is completely healthy, telephone surveillance may be instituted on approval by the District Health Officer. If any illness develops, the traveler is examined immediately by the District Health officer, who telephones findings immediately to the Chief, Acute Communicable Disease Control.

Plague. Persons under surveillance orders for plague are examined daily by the District Health Officer until surveillance order expires. If fever, cough or adenopathy develop during surveillance, telephone the Chief, Acute Communicable Disease Control, immediately.

Cholera. Persons under surveillance for cholera are contacted daily by telephone by Public Health Investigation until surveillance order expires. If diarrhea is present, the District Health Officer examines the person and obtains a feces specimen (special media required). This specimen is immediately carried to the Public Health Laboratory by the Public Health Investigator; simultaneously the Chief, Acute Communicable Disease Control is notified by telephone.

Yellow Fever. Persons under surveillance for yellow fever are contacted daily by telephone by the Public Health Investigator until the surveillance order expires. If fever, jaundice, rash, nosebleed, vomiting, or blood in stool are reported, the District Health Officer immediately examines the person and telephones findings to the Chief, Acute Communicable Disease Control.

SEC. 12 - SCHOOL EXCLUSION AND READMISSION

(References: Administrative Code, Title 5, Education, Article 7, Section 65; California Health and Safety Code, Division 4, Chapter 3, Section 3118)

EXCLUSION: State law requires officials of the public, private and Sunday schools to exclude persons with communicable disease or contacts of a communicable disease which is subject to strict isolation or quarantine. The school may exclude any nonimmune contact of a communicable disease case for the full or last portion of the incubation period. The County of Los Angeles Department of Health Services procedures will not abrogate that right.

If the disease in question is tuberculosis or venereal disease, the decision as to communicability is the responsibility of the Chiefs, Tuberculosis Control or Venereal Disease Control.

In an urban area, the closing of schools has not been shown to be an effective means of controlling an outbreak of any communicable disease. This procedure is, therefore, not generally recommended.

The SCHOOL EXCLUSION, H-451, is sent only to the school principal or his representative. This District Public Health Registrar immediately telephones the notice of exclusion to the proper school authority and confirms by sending the H-451 when the following diseases occur: cholera, diphtheria; plague, smallpox; typhus (louse-borne).

READMISSION: Upon release from strict isolation or quarantine, the SCHOOL READMISSION NOTICE, H-447, signed by the District Health Officer must be given to pupils or their parents or guardian.

Pupils or school employees with any other communicable disease may be readmitted by written notice, signed by the attending physician, school physician, nurse superintendent, principal or the District Health Officer.

Students with non-communicable forms of tuberculosis may be readmitted if recommended by the chest clinician. However readmission to the Los Angeles City Schools must be referred to the Unit for Control of Tuberculosis, 625-4003, for clearance.

SEC. 13 - SENSITIVE OCCUPATIONS: PROCEDURES AND DEFINITIONS

Persons with or in contact with communicable disease may be a threat to the community by virtue of their work duties. Reports of such cases or contacts in sensitive occupations are immediately telephoned to the Chief, Public Health Investigation. (See Sec. 2) If necessary, these persons will be removed from work.

SENSITIVE OCCUPATIONS—DEFINITIONS. Persons employed in sensitive occupations may include commercial food and milk handlers, child care workers, those treating, caring or cooking for others, or persons whose duties appreciably increase the risk of disease transmission. Preschool and early elementary aged children may need to be considered as sensitive occupations, in some circumstances.

FOOD HANDLERS—SPECIAL DEFINITIONS. A commercial food handler prepares, processes, serves or sells food commercially, unless such food is completely packaged before being handled and reaches the consumer with the wrapping intact. For example, a route man handling entirely wrapped bread is not a food handler. A bakery route salesman handling unwrapped bakery products from open trays is a food handler.

MILK HANDLERS—SPECIAL DEFINITION. A milk handler processes or distributes milk or handles milk containers. Those whose only contact is with (1) double-capped milk bottles or (2) packaged milk products are not milk handlers.

STATE DISABILITY INSURANCE BENEFITS. A case or contact in a sensitive occupation removed from work may apply for State disability insurance benefits by completing and submitting STATE DISABILITY INSURANCE BENEFITS, DE 2501. Consult Chief, Public Health Investigation, for assistance in completing form.

LABORATORY SPECIMENS. Laboratory slips for specimens submitted for cases or contacts in sensitive occupations must be marked with a red "SO" (Sensitive Occupation) to alert the laboratory of the need for urgent report.

SEC. 14 - HOSPITALIZATION AT LOS ANGELES GENERAL MEDICAL CENTER

When referring persons with communicable disease, other than tuberculosis or venereal disease, to Los Angeles General Medical Center, a direct telephone call to the Communicable Disease Admitting Room (226-3703) is preferable. For routine referrals use REFERRAL SLIP, H-354. The District Health Officer is responsible for the tentative diagnosis and follow up, when necessary.

In quarantinable disease cases, arrangements for transportation and hospitalization are made by the Chief, Acute Communicable Disease Control. The person transporting the patient is instructed to:

Go directly to the Communicable Disease Unit, ambulance entrance, 1129 North State Street, Los Angeles, California, without contacting other persons enroute.

Keep the patient in a vehicle until examined by hospital personnel. In other communicable disease cases, the District Health Officer arranges for transportation and hospitalization directly with the Communicable Disease Admitting Room personnel.

In other communicable disease cases, the District Health Officer arranges for transportation and hospitalization directly with the Communicable Disease Admitting Room personnel.

(Ord. 2024-0001 § 4, 2024.)

SEC. 15 - QUARANTINE

(Reference: Sections 2514 and 2520, California Administrative Code)

Any reportable communicable disease may be quarantined at the discretion of the District Health Officer. (Section 3110, Health and Safety Code.) Quarantine will be routinely employed only for the diseases or circumstances listed in this section. The District Health Officer determines which contacts require quarantine, specifies the place of quarantine and issues appropriate instructions.

There are several types of quarantine; each one includes specific diseases and measures to be followed.

Violations: Violations of quarantine or of pass privileges must be reported immediately to the Chief, Public Health Investigation.

Classifications:

Complete quarantine

The limitation of freedom of movement or confinement of persons or domestic animals exposed to a communicable disease, for a period of time not longer than the longest usual incubation period of the disease, in such a manner as to prevent effective contact with unexposed persons.

Diseases requiring complete quarantine:

Lassa Fever
Marburg Virus Disease and African Hemorrhagic Fever
Plague (until treated with insecticide)
Relapsing Fever, louse-borne (until louse-free)
Smallpox
Typhus Fever, louse-borne (until louse-free)

Measures:

Post QUARANTINE PLACARD, H-734 (See Sec. 17)
While the patient is on the premises, no passes are issued.
The district Health Officer provides for daily observation of the contacts, arranges for delivery of groceries and other necessities and supervises the release of contacts from quarantine.
When the patient is off the premises, follow the procedures as indicated under the specific disease in PART IV.

Modified Quarantine:

Definition: A selective, partial limitation of freedom of movement of persons or domestic animals, based on known or presumed differences in susceptibility and/or because of disease transmission.

Diseases requiring modified quarantine:

Diarrhea of the Newborn (Hospital nurseries only)
Diphtheria
Staphylococcal Disease (Hospital only)

Measures:

When diphtheria occurs, post QUARANTINE PLACARD, H-734 (See Sec. 17)
For release from quarantine, follow procedure as indicated under the specific disease in PART IV.

Personal Surveillance:

Definition: The practice of close medical or other supervision of contacts in order to promote prompt recognition of infection or illness but without restricting their movements.

Diseases requiring surveillance: (See specific disease, PART IV, regarding duration of surveillance)

Cholera
Plague (following disinfestation)
Smallpox (International Travelers)
Yellow Fever (International Travelers)

Other Classifications

Animal quarantine

This quarantines biting animals, those having rabies, suspected rabies or exposed to rabies.
Post ANIMAL QUARANTINE PLACARD, H-733. (See Sec. 17.)
It is illegal to be in possession of pet skunks in the State of California (Sec. 2606, Title 17, California Administrative Code).

Mussel quarantine. This seasonal quarantine is established on all species of mussels from the ocean shore of California and is usually effective from May 1 to October 31. It prohibits the taking, sale or offering for sale of mussels, except for use as fish bait. Mussels for the use of fish bait shall be broken open at time of taking or prior to sale.

Bird quarantine. Birds with or suspected of having a disease transmissible to man are quarantined and placed on medicated feed for 45 days.

For specific details, consult with Acute Communicable Disease Control.

Turtle quarantine. Turtles offered for sale must be certified to be free from salmonella and Arizona organisms. Any not so certified must be quarantined pending appropriate dispositions.

Dairy quarantine.

This quarantine is imposed when:

a) A milk supply is suspected as the source of an infection transmitted through milk or

b) A patient who resides on a dairy premises has or is suspected of having a disease transmitted through milk.

The County health Office as agent for the Department of Food and Agriculture prohibits the use, sale or disposal of milk until the following measures are observed:

a) The patient must be isolated.

b) The water used in milk processing must be free of infection.

c) Household members must be free of infection and must not contact dairy workers or any dairy facility used in processing milk.

d) The milk must be pasteurized off the premises until (1) the patient is removed and the household contacts cleared according to specific disease requirements; (2) the producing herd is declared free of infection by the Department of Food and Agriculture.

SEC. 16 - ISOLATION

(Reference: Sections 2516 and 2518, Title 17, California Administrative Code)

Any reportable communicable disease may be isolated at the discretion of the District Health Officer (Section 3110, Health and Safety Code).

Legal isolation is accomplished by posting a placard and/ or serving a written order by Public Health Investigation personnel.

Violations

Violations of isolation orders must be reported immediately to the District Health Officer.

Violations of strict isolation and special isolation must also be reported immediately to the Chief, Public Health Investigation.

Classifications:

General definition:

Isolation is the separation of infected persons from others, for the period of communicability, in places and under conditions that will prevent the transmission of the infectious agent. There are several types of isolation, each one encompassing particular diseases and measures to be followed.

Strict isolation (Section 2516)

Diseases requiring strict isolation

Anthrax—inhalation
Cholera
Diarrhea of the Newborn (Hospital nurseries only)
Diphtheria
Gonococcal Ophthalmia Neonatorum
Lassa Fever
Marburg Virus Disease
Plague-pneumonic
Pneumonia, (Staphylococcus aureus or Group A streptococcus)
Smallpox

Measures

The severity of these diseases and/or potential hazard to others warrants immediate hospitalization.
Pending hospitalization the following measures are taken:

a) Post ISOLATION PLACARD, H-734 (See Sec. 17)

b) A private room

c) Those caring for patient must wear gowns, gloves and masks and must follow proper handwashing procedures

d) Visitors are excluded

e) For disinfection and cleaning, refer to the State Health Department Communicable Disease Manual

f) In the absence of a sanitary sewage system and if the disease is one in which the infectious agent may be present in the feces or urine, the District Health Officer issues instructions for the disposal of feces and urine.

Modified Isolation

Diseases subject to modified isolation:

Anthrax—wound

Chancroid

Congenital Rubella Syndrome

Dengue

Encephalitis, Post infectious & Post vaccination

German measles

Gonococcus Infection

Granuloma Inguinale

Hepatitis, Viral (Types A, B, Unspecified)

Lymphogranuloma Venereum (Lymphogranuloma Inguinale)

Measles (Rubeola)

Meningitis, Aseptic Syndrome

Meningitis, Meningococcal

Mumps

Pertussis (Whooping Cough)

Plague—bubonic

Poliomyelitis

Psittacosis

Rabies, Human and Animal

Salmonellosis

Shigellosis

Staphylococcal Disease

Streptococcal Infections Hemolytic (including Scarlet Fever and Streptococcal Sore Throat)

Syphilis

Trachoma

Tuberculosis

Tularemia

Typhoid Fever

Whooping Cough

Measures. Isolation measures depend upon the mode of transmission of the disease and the potential threat to susceptible persons (See specific disease in PART IV). These may range from:

exclusion from school
exclusion from work of persons in sensitive occupation
avoidance by pregnant women of contact to a case of rubella
secretion, excretion and blood precautions
abstinence from sexual contact

Typhoid Fever Carrier isolation. The District Health Officer issues specific written orders to the patient or contact who must adhere to all requirements.

The TYPHOID CARRIER AGREEMENT, SDH 262-516 (Spanish, SDH 262-517), is issued by the District Health Officer to typhoid carriers (convalescent and chronic).

Isolation in nursing homes. In general, patients, with communicable diseases are not permitted to remain in nursing homes. Asymptomatic carriers, such as salmonella or typhoid carriers, are not permitted in nursing homes unless prior written

approval is obtained from the Chief, Acute Communicable Disease Control.

Special isolation. This isolation confines a patient with communicable disease, including tuberculosis and venereal disease, to his home, a hospital, sanitarium, jail facility or other specified location. Cooperative patients may be on voluntary isolation (home and hospital). Others may need an ORDER OF ISOLATION, H-474.

SEC. 17 - QUARANTINE AND ISOLATION PLACARDS

Quarantine or isolation (see Sections 15 and 16) is not established until a placard is posted and/or written instructions given to the patient or contact. The courts only recognize quarantine by placard or written instruction. Oral notice is not legally recognized.

When a residence is quarantined, the District Health Officer or his representative attaches the placard(s) at the front or principal entrance. More than one placard may be posted.

Placards must contain the name of the disease or suspected disease, the name of the District Health Officer, signature of deputy posting, date of posting, address and telephone number of the district health center.

The employee who establishes a quarantine or isolation by placard or issues passes reports the details to the Chief of Acute Communicable Disease Control and Public Health Investigation.

All correspondence with other Health Departments, relative to violations of quarantine or legal orders of isolation, is handled by Chief, Public Health Investigation.

SEC. 18 - HOSPITAL VISITS BY QUARANTINED PERSONS

Upon approval by the Los Angeles General Medical Center medical staff (226-3703), quarantined persons may visit the patient in the hospital. Persons under quarantine must travel by private conveyance to and from home. They are permitted to enter the Communicable Disease Unit under the supervision of the hospital staff. Persons under modified quarantine, who hold quarantine passes do not have to travel by private conveyance.

In emergencies, and when other means of patient transportation are not available, Public Health Investigation personnel are called to assist.

(Ord. 2024-0001 § 5, 2024.)

SEC. 19 - RELEASE FROM ISOLATION OR QUARANTINE

When laboratory tests are required for release from isolation or quarantine of cases, contacts or carriers, exclusive of tuberculosis patients, the specimens must be submitted to a Public Health Laboratory approved by the State Department of Health. Within the geographic area of Los Angeles County, Public Health Laboratories approved by the State Department of Health are those of the County of Los Angeles Community Health Services, the City of Pasadena Health Department, and the City of Long Beach Health Department.

A NOTICE OF RELEASE TO RETURN TO WORK, H-1066, is issued by the District Health Officer, his representative, or the Public Health Investigator.

Release from an order of isolation is by written notice from the Chief, Public Health Investigation. For additional procedure, consult with Tuberculosis Control.

SEC. 20 - TERMINAL CLEANING, VERMIN CONTROL AND DELOUSING

Terminal Cleaning. Quarantine is not lifted until terminal cleaning of the residence is completed to the satisfaction of the District Health Officer. The isolation area and fomites should be washed with soap and water or suitable disinfectant solution. (See chart at back of California State Department of Health Control of Communicable Diseases Manual.)

Vermin Control. Where a quarantinable vector-borne disease is suspected or known, a licensed pest control operator should properly treat, spray, or fumigate the premises, as necessary. This would be done under the direction of appropriate personnel of Environmental Management.

Delousing. When infestation is evident and personal treatment is involved, treat the patient as outlined in PART IV— PEDICULOSIS. All suspected infested clothing, bedding, and personal articles, should be thoroughly washed in hot water (140°F) or dry cleaned, whichever is appropriate. The interior of the premises suspected to be infested should be thoroughly cleaned and vacuumed. If needed, a licensed pest control operator should treat the interior and exterior premises under the direction of appropriate personnel of Environmental Management.