Ryan White HIV/AIDS Treatment Extension Act of 2009

Notification of Possible Exposure to Infectious Diseases

Emergency response employees (EREs) are at risk of exposure to potentially life-threatening infectious diseases through contact with victims during emergencies. Part G of the Ryan White HIV/AIDS Treatment Extension Act of 2009 requires that medical facilities provide EREs with notification of when they may have been exposed to potentially life-threatening infectious diseases while transporting or serving victims of an emergency. Knowing this information allows EREs the opportunity to seek timely medical care and to make informed decisions about addressing potential health issues arising from their exposures.

How it Works

NIOSH has developed a list of potentially life-threatening diseases, including emerging infectious diseases, to which EREs may be exposed while transporting or serving emergency victims taken to a medical facility. Along with the list, NIOSH has also developed guidelines describing circumstances in which EREs may be exposed to a listed disease and the manner in which a determination of an exposure shall be made by a medical facility.

Medical facilities that receive and treat the victims of an emergency or ascertain the cause of death are responsible for routinely notifying and responding to requests pertaining to any determinations that a victim of an emergency has a listed potentially life-threatening infectious disease, as described in the NIOSH guidelines.

When a medical facility determines that a victim of an emergency has a potentially life-threatening airborne or aerosolized infectious disease, the medical facility is responsible for initiating notification to the ERE who transported the victim.

If an ERE believes he or she has been exposed to any potentially life-threatening disease on the NIOSH list, and has transported, attended, treated, or assisted the victim pursuant to the emergency, the ERE may initiate a request for notification from the medical facility to which the victim of the emergency was transported.

To learn more about the guidelines describing ways employees may be exposed to these diseases and the guidelines describing the manner in which medical facilities should make determinations about exposures, visit the Guidelines page.

To learn more about how EREs who believe they have been exposed to a disease on the list can request notification or about how medical facilities should initiate notification if an ERE may have been exposed to an airborne or aerosolized infectious disease on the list, visit the Notification Process page.

List of Potentially Life-Threatening Infectious Diseases to Which Emergency Response Employees May Be Exposed

Diseases often have multiple transmission pathways. However, for purposes of this classification, diseases routinely transmitted via the aerosol airborne and aerosol droplet routes are so classified, even if other routes, such as contact transmission, also occur. CDC will continue to monitor the scientific literature on these and other infectious diseases. If CDC determines that a newly emerged infectious disease fits criteria for inclusion in the List of Potentially Life-Threatening Infectious Diseases to Which Emergency Response Employees May Be Exposed required by the Ryan White HIV/AIDS Treatment Extension Act of 2009, CDC will amend the list and add the disease.

Table 1: List of Potentially Life-Threatening Infectious Diseases to Which Emergency Response Employees May Be Exposed, by Exposure Type

Routinely Transmitted by Contact or Body Fluid Exposures
Routinely Transmitted Through Aerosolized Airborne Means[1]
Routinely Transmitted Through Aerosolized Droplet Means[2] 
Caused by Agents Potentially Used for Bioterrorism or Biological Warfare
Routinely Transmitted by Contact or Body Fluid Exposures
  • Anthrax, cutaneous (Bacillus anthracis)
  • Hepatitis B (HBV)
  • Hepatitis C (HCV)
  • Human immunodeficiency virus (HIV)
  • Rabies (Rabies virus)
  • Vaccinia (Vaccinia virus)
  • Viral hemorrhagic fevers (Lassa, Marburg, Ebola, Crimean-Congo, and other viruses yet to be identified)[3]
Routinely Transmitted Through Aerosolized Airborne Means[1]
  • Measles (Rubeola virus)
  • Tuberculosis (Mycobacterium tuberculosis)—infectious pulmonary or laryngeal disease; or extrapulmonary (draining lesion)
  • Varicella disease (Varicella zoster virus)—chickenpox, disseminated zoster
Routinely Transmitted Through Aerosolized Droplet Means[2] 
  • Diphtheria (Corynebacterium diphtheriae)
  • Novel influenza A viruses as defined by the Council of State and Territorial Epidemiologists (CSTE)[4]
  • Meningococcal disease (Neisseria meningitidis)
  • Mumps (Mumps virus)
  • Pertussis (Bordetella pertussis)
  • Plague, pneumonic (Yersinia pestis)
  • Rubella (German measles; Rubella virus)
  • SARS-CoV
  • COVID-19 (SARS-CoV-2)
Caused by Agents Potentially Used for Bioterrorism or Biological Warfare

These diseases include those caused by any transmissible agent included in the HHS Select Agents Listexternal icon. [5]

Many are not routinely transmitted human to human but may be transmitted via exposure to contaminated environments.

The HHS Select Agents List is updated regularly and can be found on the National Select Agent Registry Web site: http://www.selectagents.govexternal icon/

[1] Section 2695(b) [42 U.S.C. § 300ff–131(b)].
[2] Section 2695(b) [42 U.S.C. § 300ff–131(b)].
[3] For most viral hemorrhagic fevers (VHFs), routine transmission is limited to transmission from a zoonotic reservoir or direct contact with an infected person (e.g. Ebola virus, Marburg virus) or through arthropod-borne transmission (Rift Valley fever, Crimean-Congo hemorrhagic fever). For a small number of VHF viruses, transmission may occur through droplet transmission (e.g. Nipah virus), however prolonged close contact is likely necessary. Aerosol transmission does not occur in natural (non-laboratory) settings.
[4] Council of State and Territorial Epidemiologists, Position Statement Number: 09–ID–43. Available at https://c.ymcdn.com/sites/www.cste.org/resource/resmgr/PS/09-ID-43.pdfpdf iconexternal icon. Accessed January 15, 2019.
[5] 42 C.F.R. §§ 73.3, 73.4.

Resources

  1. Infectious diseases and circumstances relevant to notification of emergency response employees: implementation of Sec. 2695 of the Ryan White HIV/AIDS Treatment Extension Act of 2009 Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2020-119.
    • This publication includes the current version of the list of potentially life-threatening infectious diseases and the accompanying guidelines.
  2. Implementation of section 2695 (42 U.S.C. 300ff–131) of Public Law 111– 87: Infectious diseases and circumstances relevant to notification requirements; Final Noticepdf icon Centers for Disease Control and Prevention, 76 Fed. Reg. 67736 (November 2, 2011).
    • This publication includes the first version of the list of potentially life-threatening infectious diseases and the accompanying guidelines, developed in 2011. This Federal Register notice includes NIOSH responses to public comments.
  3. The Ryan White HIV/AIDS Treatment Extension Act of 2009; Part G—Notification of Possible Exposure to Infectious Diseasespdf icon
    • Part G authorizes NIOSH to develop the list of potentially life-threatening infectious diseases to which emergency response employees may be exposed in responding to emergencies; guidelines describing the circumstances in which employees may be exposed to such diseases, and guidelines describing the manner in which medical facilities should make determinations.
  4. Occupational safety and health contacts at State and Territorial Health Departments
    • State and territorial health departments can answer specific questions about the jurisdiction’s role in facilitating infectious disease notification and reporting, including providing assistance to designated officers.
    • Part G mandates that States require the following:
      • State public health officers to select persons to serve as Designated Officers of EREs for each employer of EREs in their states.
      • Medical facilities to establish procedures for:
        • Notifying Designated Officers within 48 hours of any instances in which it is known that a patient who has been transported to the medical facility is infected with an airborne disease; and
        • Responding within 48 hours to written requests from Designated Officers for determinations of possible exposure to diseases included on NIOSH’s list.
      • ERE employers to establish procedures by which EREs can make requests of Designated Officers and procedures by which the Designated Officers would make appropriate disposition of such requests.
      • Public health officers of communities in which medical facilities are located to establish procedures for handling requests for evaluations from Designated Officers.
Contact Information

If you have any questions about the list of potentially life-threatening infectious diseases to which emergency response employees may be exposed and accompanying guidelines, contact CDC/NIOSH Ryan White Coordinator via email or mail.

Please provide your return contact information, if seeking a reply. Please do not provide information of a sensitive nature in this email, such as any disease status for yourself or another person.

Email: NIOSHRyanWhiteAct@cdc.gov

Mail: Ryan White Act Coordinator
Centers for Disease Control and Prevention
National Institute for Occupational Safety and Health
1600 Clifton Road, NE
MS E20
Atlanta, GA 30329

If you have questions on other sections of Part G, please contact the call center of U.S. Department of Health and Human Services headquarters at 1-800-696-6775.

Page last reviewed: October 15, 2013