Ryan White HIV/AIDS Treatment Extension Act of 2009

About Part G of the Ryan White HIV/AIDS Treatment Extension Act of 2009

Purpose of Part G

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 provides EREs with notification of when they may have been exposed to potentially life-threatening infectious diseases while responding to victims during 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

Part G is intended to establish a process to facilitate the notification of EREs that may have been exposed to certain potentially life-threatening diseases while transporting or serving victims of an emergency. This Part requires the development of 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, as well as accompanying 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.  The list and guidelines are to be distributed to state public health officers for further dissemination throughout the state and are to be made available to the public.  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, as indicated by the guidelines, that a victim of an emergency has a listed potentially life-threatening infectious disease.  To facilitate notification, designated officers and public health officers within each state are to act on behalf of EREs in receiving these notifications and submitting any requests to medical facilities concerning exposure determinations.

To learn more about the guidelines for EREs and medical facilities, visit the Background page.

To learn more about the steps for notifying, visit the Notification Process page.

NIOSH’s Role

NIOSH has created the following:

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.

Contact Information

If you have any questions about Infectious Diseases and Circumstances Relevant to Notification Requirementspdf icon (Section 2695 of Part G), contact CDC/NIOSH Ryan White Coordinator via email, phone 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.

Phone: 404-718-7926

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