TITLE 77: PUBLIC HEALTH
CHAPTER I: DEPARTMENT OF PUBLIC HEALTH
SUBCHAPTER k: COMMUNICABLE DISEASE CONTROL AND IMMUNIZATIONS
PART 690 CONTROL OF COMMUNICABLE DISEASES CODE
SECTION 690.400 ESCHERICHIA COLI INFECTIONS (E. COLI O157:H7 AND OTHER SHIGA TOXIN PRODUCING E. COLI) (REPORTABLE BY TELEPHONE OR FACSIMILE AS SOON AS POSSIBLE, WITHIN 24 HOURS)


 

Section 690.400  Escherichia coli Infections (E. coli O157:H7 and Other Shiga Toxin Producing E. coli) (Reportable by telephone or facsimile as soon as possible, within 24 hours)

 

a)         Control of Case

 

1)         Food Handlers or Persons in Sensitive Occupations, Not Including Health Care Workers

Cases with E. coli infections caused by O157:H7 or other Shiga toxin-producing E. coli shall not work as food handlers or in sensitive occupations until diarrhea has ceased for at least 24 hours and two consecutive negative stool specimens are obtained.  Specimens shall be obtained following clinical recovery of the patient, no sooner than 48 hours after diarrhea has ceased, and not sooner than 48 hours after the last dose of antimicrobials, if administered.  Specimens shall be submitted beginning within one week after notification.  If noncompliant with stool testing, the food handler is eligible to return to work 30 days after the date diarrhea has ceased.

 

2)         Health Care Workers

Local health departments may require specimens from health care workers or those who work in occupations requiring standard precautions if there is reason to believe that specimen testing is necessary (e.g., the nature of the work, including feeding or oral care, hygienic practices of the worker, or as part of an investigation of a cluster).  Specimens shall be obtained following clinical recovery, at least 24 hours apart and not sooner than 48 hours after the last dose of antimicrobials, if administered.  Specimens shall begin to be submitted within one week after notification, or the individual shall be restricted from patient care.  If noncompliant with stool testing, the health care worker is eligible to return to work 30 days after the date diarrhea has ceased.

 

3)         Day Care Attendees

Cases of E. coli O157:H7 or other Shiga toxin  producing E. coli shall be excluded from attending a child care facility, an adult day care facility or a facility for the developmentally disabled if below the age of five years or incontinent of stool until two consecutive negative stool specimens are obtained.  Specimens shall be obtained following clinical recovery of the patient, at least 24 hours apart, and not sooner than 48 hours after the last dose of antimicrobials, if administered.  If noncompliant with stool testing, the day care attendee is eligible to return to day care 30 days after the date diarrhea has ceased.  

 

4)         Day Care Staff

Cases of E. coli O157:H7 or other Shiga toxin producing E. coli who work in a child care facility, an adult day care facility, or a facility for the developmentally disabled, and who directly care for attendees or handle food, shall not return to work until two consecutive negative stool specimens are obtained.  Specimens shall be obtained following clinical recovery of the patient, at least 24 hours apart, and not sooner than 48 hours after the last dose of antimicrobials, if administered. Specimens shall be submitted beginning within one week after notification. If noncompliant with stool testing, the day care staff member is eligible to return to work 30 days after the date diarrhea has ceased.

 

5)         Cases shall avoid swimming in public recreational water venues (e.g., swimming pools, whirlpool spas, wading pools, water parks, interactive fountains, lakes) while symptomatic and for two weeks after the date diarrhea has ceased.

 

b)         Control of Contacts

 

1)         Contacts Who Have Not Had Diarrhea During the Previous Four Weeks

 

A)        Food Handlers or Persons in Sensitive Occupations, Not Including Health Care Workers

 

i)          There are no work restrictions while submitting release specimens for contacts who are employed as food handlers or in sensitive occupations and who have had no symptoms of E. coli infections caused by O157:H7 or other Shiga toxin-producing strains during the previous four weeks.

 

ii)         Contacts to cases with E. coli infections caused by O157:H7 or other Shiga toxin-producing strains who are employed as food handlers or in sensitive occupations shall submit two consecutive negative stool specimens obtained at least 24 hours apart and not sooner than 48 hours after the last dose of antimicrobials, if administered.  These contacts shall be restricted from their occupations if they do not begin submitting release specimens within one week after notification. Release specimens shall be submitted at least once per week until two consecutive negative specimens are obtained, or the individual shall be restricted from working. If noncompliant with stool testing, the contact is eligible to return to day care 30 days after the date stool testing was first requested.

 

iii)        If either of the two release specimens is positive for E. coli infection caused by O157:H7 or other Shiga toxin-producing strains, contacts shall be considered cases and shall comply with subsection (a)(2).

 

B)        Health Care Workers

Local health departments may require specimens from health care workers or those who work in occupations requiring standard precautions if there is reason to believe that specimen testing is necessary (e.g., the nature of the work, including feeding or oral care, hygienic practices of the worker or as part of an investigation of a cluster).  Specimens shall be obtained at least 24 hours apart.  Specimens shall begin to be submitted within one week after notification, or the individual shall be restricted from patient care. If noncompliant with stool testing, the contact is eligible to return to work 30 days after the date stool testing was first requested. 

 

2)         Contacts Who Currently Have Diarrhea or Have Had Diarrhea During the Previous Four Weeks

 

A)        Food Handlers or Persons in Sensitive Occupations, Not Including Health Care Workers

 

i)          All contacts to cases of E. coli infections caused by O157:H7 or other Shiga toxin-producing strains employed as food handlers or in sensitive occupations, and who currently have diarrhea or have had diarrhea during the previous four weeks, shall not work in their occupations until diarrhea has ceased for at least 48 hours and they have submitted two consecutive negative stool specimens.  Specimens shall be obtained following clinical recovery of the patient, at least 24 hours apart, and not sooner than 48 hours after the last dose of antimicrobials, if administered.  Specimens shall begin to be submitted within one week after notification.  If noncompliant with stool testing, the contact is eligible to return to work 30 days after the date diarrhea has ceased.

 

ii)         If either of the two release specimens is positive for E. coli infection caused by O157:H7 or other Shiga toxinproducing strains, contacts shall be considered cases and shall comply with subsection (a)(1).

 

B)        Health Care Workers

Local health departments may require specimens from health care workers or those who work in occupations requiring standard precautions if there is reason to believe that specimen testing is necessary (e.g., the nature of the work, including feeding or oral care, hygienic practices of the worker, or as part of an investigation of a cluster).  Specimens shall be obtained following clinical recovery of the patient, at least 24 hours apart and not sooner than 48 hours after the last dose of antimicrobials, if administered.  Specimens shall begin to be submitted within one week after notification, or the individual shall be restricted from patient care.  If noncompliant with stool testing, the health care worker is eligible to return to work 30 days after the date diarrhea has ceased.

 

C)        Day Care Attendees

Contacts to cases of E. coli O157:H7 or other Shiga toxin producing E. coli who currently have or have had diarrhea during the previous four weeks who attend a child care facility, an adult day care facility or a facility for the developmentally disabled and are below the age of five years or incontinent of stool shall submit two consecutive negative stool specimens.  Specimens shall be obtained following clinical recovery of the patient, at least 24 hours apart, and not sooner than 48 hours after the last dose of antimicrobials, if administered. Release specimens shall be submitted within one week after notification, or the individual shall be restricted from attendance.  If either of the two specimens is positive for E. coli infection caused by O157:H7 or other Shiga toxin producing strains, contacts shall be considered cases and shall comply with subsection (a)(3).  If noncompliant with stool testing, the day care attendee is eligible to return to day care 30 days after the date diarrhea has ceased.

 

D)        Day Care Staff

Contacts to cases of E. coli O157:H7 or other Shiga toxin producing E. Coli who currently have or have had diarrhea during the previous four weeks who work in a child care facility or an adult day care facility and directly care for attendees or handle food shall submit two consecutive negative stool specimens.  Specimens shall be obtained following clinical recovery of the patient, at least 24 hours apart, and not sooner than 48 hours after the last dose of antimicrobials, if administered. Specimens shall be submitted beginning within one week after notification, or the individual shall be restricted from working.  If either of the two specimens is positive for E. coli infection caused by O157:H7 or other Shiga toxin producing strains, contacts shall be considered cases and shall comply with subsection (a)(4).  If noncompliant with stool testing, the day care staff is eligible to return to work 30 days after the date diarrhea has ceased.

 

c)         Shiga Toxin Producing E. coli Outbreaks at a Facility Where Food Handling Occurs

 

1)         When an outbreak occurs in a facility where food handling exists, food handlers at the facility shall be considered contacts to cases and shall submit two consecutive negative stool specimens obtained at least 24 hours apart and not sooner than 48 hours after the last dose of antimicrobials, if administered.  If specimens are not submitted within one week after notification and at least once per week until two consecutive negative specimens are obtained, food handlers shall be restricted from food handling.  A food handler who is symptomatic and noncompliant with providing stool specimens shall be restricted from food handling for 30 days after the date diarrhea has ceased.  A food handler who is asymptomatic and noncompliant with providing stool specimens shall be restricted from food handling for 30 days after the last outbreak case's diarrhea onset date.

 

2)         If there is a reason to believe food handlers may be the source of an outbreak or could transmit the disease, local health departments, in consultation with the Department, may require two consecutive negative stool specimens from food handlers at the facility before food handlers return to food handling.

 

d)         Sale of Food, Milk, etc. (See Section 690.30(b).)

 

e)         Laboratory Reporting

 

1)         Laboratories shall report to the local health authority all patients who have a positive result from a stool specimen or any laboratory test indicative of and specific for detecting Escherichia coli O157, other Shiga toxin producing E. coli.

 

2)         Laboratories shall submit E. coli O157 or other Shiga toxin producing isolates, broth or specimens to the Department's laboratory. 

 

(Source:  Amended at 43 Ill. Reg. 2386, effective February 8, 2019)