Menu of Suggested Provisions For State Tuberculosis Prevention and Control Laws

D. Isolation

Descriptive Note: Quarantine is a disease control measure that applies to individuals who have been exposed to a communicable disease but are not yet ill. Individuals who are latently infected with TB pose no risk of transmission; therefore, quarantine is not an appropriate disease control measure for TB. Isolation is the separation of ill persons who have a communicable disease from those who are healthy and restriction of their movement to stop the spread of that disease or illness. Public health officials generally may isolate individuals with TB disease if they pose a threat to the public’s health. The second bullet below is an example of a provision that could be utilized for home isolation or isolation in a facility. The third bullet is a state regulatory provision that authorizes electronic monitoring if an individual is ordered by the court to be committed but the location of commitment is the individual’s home. Isolation in the home with electronic monitoring is a less restrictive alternative to confinement in a facility. The fourth and fifth bullets are examples of state laws that authorize isolation (in the home or in a facility) if an individual ceases treatment against medical advice. Individuals who cease treatment may become infectious, or the period of infectiousness may be extended if currently infectious, and also are at risk of developing drug resistance (or increased drug resistance). The final bullet is an example of a state regulatory provision that prescribes the minimum period of isolation.

• If the local health officer determines that the public health in general or the health of a particular person is endangered by exposure to a person who is known to have active tuberculosis disease, or to a person for whom there are reasonable grounds to believe has active tuberculosis disease, the health officer may issue any orders he or she deems necessary to protect the public health or the health of any other person, and may make application to a court for enforcement of the orders…The orders may include, but shall not be limited to, any of the following:
  • An order for isolation of persons with infectious tuberculosis disease to their place of residence until the health officer has determined that they no longer have infectious tuberculosis disease. Cal. [Health & Safety] Code § 121365 (Deering 2009).
• Isolation order – enforcement – court review
  • Whenever a health officer determines that isolation of a person in a particular tuberculosis case is necessary for the preservation and protection of the public health, the health officer shall make an isolation order in writing.
  • When a health officer is determining whether to issue an isolation order for a person, the health officer shall consider, but is not limited to, the following factors:
    • 1) Whether the person has active tuberculosis;
    • 2) If the person is violating the rules promulgated by the board of health or the orders issued by the appropriate health officer to comply with rules or orders; and
    • 3) Whether the person presents a substantial risk of exposing other persons to an imminent danger of infection.
  • All isolation orders shall set forth the name of the person to be isolated and the initial period, not to exceed six months, during which the order shall remain effective, the place of isolation, and such other terms and conditions as may be immediately necessary to protect the public health. The isolation order shall advise the person being detained that he or she has the right to request release from detention by contacting a person designated in the order and that the detention shall not continue for more than five business days after the request for release, unless the detention is authorized by court order. The health officer shall serve a copy of the isolation order upon the person. The person shall be reexamined at the time the initial order expires to ascertain whether or not [he/she continues to be infectious]. When it has been medically determined that the person no longer has active tuberculosis, the person shall be relieved from all further liability or duty imposed by [statutory provisions on tuberculosis], and the health officer shall rescind the order.
  • A health officer may detain a person who is the subject of an isolation order issued pursuant [above] without a prior court order. The health officer may detain the person in a hospital or other appropriate place for examination or treatment. Colo. Rev. Stat. § 25-4-507 (2009).
• If the location of commitment is a private residence, law enforcement may use an electronic device to monitor adherence to the commitment order. N.J. Admin. Code § 8:57-5.11 (2009).
• In a case of a person with multidrug-resistant tuberculosis, the health officer may issue an isolation order to such person if it is determined that the person has ceased taking prescribed medications against medical advice. Such order may be issued even if the person is no longer contagious so long as the person has not completed an entire course of therapy. Colo. Rev. Stat. § 25-4-507 (2009).
• A health officer may require an individual having tuberculosis in a noncommunicable stage to be under medical supervision, which may include physical isolation from others, if the individual refuses to receive adequate chemotherapy. Md. Code Regs. 10.06.01.21 (2009).
• Minimum period of isolation of patient – pulmonary tuberculosis (also includes mediastinal, laryngeal, pleural, or miliary). Until bacteriologically negative based on three appropriately collected and processed sputum smears that are collected in eight – 24 hour intervals (one of which should be an early morning specimen), and/or until 14 days after the initiation of appropriate effective chemotherapy, provided therapy is continued as prescribed, and there is demonstration of clinical improvement (i.e., decreasing cough, reduced fever, resolving lung infiltrates, or AFB smears showing decreasing numbers of organisms). 105 Mass. Code Regs. § 300.200 (2009).