DHS 145.08DHS 145.08 Definitions. In this subchapter: DHS 145.08(1)(1) “Case management” means the creation and implementation of an individualized treatment plan for a person with tuberculosis infection or disease that ensures that the person receives appropriate treatment and support services in a timely, effective, and coordinated manner. DHS 145.08(2)(2) “Confinement” means the restriction of a person with tuberculosis to a specified place in order to prevent the transmission of the disease to others, to prevent the development of drug-resistant organisms or to ensure that the person receives a complete course of treatment. DHS 145.08(3)(3) “Contact” means a person who shares air with a person who has infectious tuberculosis. DHS 145.08(4)(4) “Contact investigation” means the process of identifying, examining, evaluating and treating a person at risk of infection with Mycobacterium tuberculosis due to recent exposure to infectious tuberculosis or suspected tuberculosis. DHS 145.08(5)(5) “Directly observed therapy” means the ingestion of prescribed anti-tuberculosis medication that is observed by a health care worker or other responsible person acting under the authority of the local health department. DHS 145.08(6)(6) “Infectious tuberculosis” means tuberculosis disease of the respiratory tract capable of producing infection or disease in others, as demonstrated by the presence of acid–fast bacilli in the sputum or bronchial secretions, or by radiographic and clinical findings. DHS 145.08(7)(7) “Isolate” means a population of Mycobacterium tuberculosis bacteria that has been obtained in pure culture medium. DHS 145.08(8)(8) “Isolation” means the separation of persons with infectious tuberculosis from other persons, in a place and under conditions that will prevent transmission of the infection. DHS 145.08(9)(9) “Licensed prescriber” means an advanced practice nurse prescriber, a physician assistant, or other person licensed to prescribe medication under Wisconsin law. DHS 145.08(10)(10) “Public health dispensary” means a program of a local health department or group of local health departments to prevent and control tuberculosis disease and infection by the identification, medical evaluation, treatment and management of persons at risk for tuberculosis infection or disease. DHS 145.08(11)(11) “Repository” means a central location at the Wisconsin State Laboratory of Hygiene for receipt and storage of patient isolates of Mycobacterium tuberculosis. DHS 145.08(12)(12) “Sputum conversion” means the conversion of serial sputum cultures for Mycobacterium tuberculosis from positive to negative, in response to effective treatment. DHS 145.08(13)(13) “Suspected tuberculosis” means an illness marked by symptoms, signs, or laboratory tests that may be indicative of infectious tuberculosis such as prolonged cough, prolonged fever, hemoptysis, compatible radiographic findings or other appropriate medical imaging findings. DHS 145.08(14)(14) “Tuberculosis disease” means an illness determined by clinical or laboratory criteria or both to be caused by Mycobacterium tuberculosis. DHS 145.08(15)(15) “Tuberculosis infection” means an infection with Mycobacterium tuberculosis in a person who has no symptoms of tuberculosis disease and is not infectious. DHS 145.08 HistoryHistory: Cr. Register, April, 1984, No. 340, eff. 5-1-84; r. and recr. Register, March, 2000, No. 531, eff. 4-1-00; CR 01-105: r. and recr. Register March 2002 No. 555, eff. 4-1-02. DHS 145.09(1)(1) Any laboratory that receives a specimen for tuberculosis testing shall report all positive results as specified in s. DHS 145.04, including those obtained by an out-of-state laboratory, to the local health officer and to the department. The laboratory shall also submit an isolate from a patient with a positive culture to the state repository. DHS 145.09 NoteNote: Isolates for the state repository should be sent to: Mycobacteriology Laboratory, Wisconsin State Laboratory of Hygiene, 2601 Agriculture Dr., Room 254, Madison, WI 53718.
DHS 145.09(2)(2) Any laboratory that performs primary culture for mycobacteria shall perform organism identification using an approved rapid testing procedure specified in the official statement of the Association of Public Health Laboratories, unless specified otherwise by the state epidemiologist. The laboratory shall ensure at least 80% of culture-positive specimens are reported as either Mycobacterium tuberculosis complex or not Mycobacterium tuberculosis complex within 21 calendar days of the laboratory’s receipt of the specimens. DHS 145.09 NoteNote: The official statement of the Association of Public Health Laboratory entitled “Mycobacterium tuberculosis: assessing your laboratory”, 2013 is on file in the Legislative Reference Bureau, and is available from the Department’s Division of Public Health, P.O. Box 2659, Madison, WI 53701–2659..
DHS 145.09(3)(3) Any laboratory that identifies Mycobacterium tuberculosis shall ensure that antimicrobial drug susceptibility tests are performed on all initial isolates. The laboratory shall report the results of these tests to the local health officer or the department. DHS 145.09 NoteNote: Reports may be submitted to the Department’s Division of Public Health, P.O. Box 2659, Madison, WI 53701-2659.
DHS 145.09 HistoryHistory: Cr. Register, April, 1984, No. 340, eff. 5-1-84; am. (1), Register, February, 1989, No. 398, eff. 3-1-89; r. and recr. Register, March, 2000, No. 531, eff. 4-1-00; CR 01-105: r. and recr. Register March 2002 No. 555, eff. 4-1-02. DHS 145.10DHS 145.10 Restriction and management of patients and contacts. DHS 145.10(1)(1) All persons with infectious tuberculosis or suspected tuberculosis, and their contacts, shall exercise all reasonable precautions to prevent the infection of others, using the applicable methods of control set out in the official report of the American Public Health Association, unless specified otherwise by the state epidemiologist. DHS 145.10 NoteNote: The official report of the American Public Health Association entitled Control of Communicable Diseases Manual, 20th edition (2015), edited by David L. Heymann, is on file in the Department’s Division of Public Health and the Legislative Reference Bureau, and is available for purchase from the American Public Health Association, Publications Sales, PO Box 933019, Atlanta, GA 31193-3019.
DHS 145.10(2)(2) All persons with infectious tuberculosis or suspected tuberculosis shall be excluded from work, school and other premises that cannot be maintained in a manner adequate to protect others from being exposed to tuberculosis, as determined by the local health officer. DHS 145.10(3)(3) Official statements of the American Thoracic Society shall be considered in the treatment of tuberculosis, unless specified otherwise by the state epidemiologist. Specific medical treatment shall be prescribed by a physician or other licensed prescriber. DHS 145.10 NoteNote: The official statements of the American Thoracic Society may be found in the Centers for Disease Control and Prevention’s recommendations and report “Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection.” The report may be found in the Morbidity and Mortality Weekly Report, June 9, 2000, Vol. 49, No. RR-6. The official statements of the American Thoracic Society, entitled “Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis” may be found in Clinical Infectious Diseases, vol. 63, 2016, pp. e147-e195. These reports are on file in the Legislative Reference Bureau, and are available from the Department’s Division of Public Health, P.O. Box 2659, Madison, WI 53701-2659.
DHS 145.10(4)(a)(a) Any physician or licensed prescriber who treats a person with tuberculosis disease shall report all of the following to the local health officer: DHS 145.10(4)(a)2.2. The date of the person’s completion of the tuberculosis treatment regimen. DHS 145.10(4)(b)(b) The physician or his or her designee shall immediately report to the local health officer when a person with tuberculosis disease does any of the following: DHS 145.10(5)(5) Upon receiving a report under sub. (4) (b), the local health officer shall immediately investigate and transmit the report to the department. DHS 145.10(6)(6) The local health officer or the department may do any of the following: DHS 145.10(6)(d)(d) Order the confinement of a person if the local health officer or the department decides that confinement is necessary and all of the following conditions are met: DHS 145.10(6)(d)1.1. The department or local health officer notifies a court in writing of the confinement. DHS 145.10(6)(d)2.2. The department or local health officer provides to the court a written statement from a physician that the person has infectious tuberculosis or suspected tuberculosis. DHS 145.10(6)(d)3.3. The department or local health officer provides to the court evidence that the person has refused to follow a prescribed treatment regimen or, in the case of a person with suspected tuberculosis, has refused to undergo a medical examination under par. (a) to confirm whether the person has infectious tuberculosis. DHS 145.10(6)(d)4.4. In the case of a person with a confirmed diagnosis of infectious tuberculosis, the department or local health officer determines that the person poses an imminent and substantial threat to himself or herself or to the public health. The department or the local health officer shall provide to the court a written statement of that determination. DHS 145.10(6)(e)(e) If the department or local health officer orders the confinement of a person under par. (d), a law enforcement officer, or other person authorized by the local public health officer, shall transport the person, if necessary, to a location that the department or local health officer determines will meet the person’s need for medical evaluation, isolation and treatment. DHS 145.10(6)(f)(f) No person may be confined under par. (d) for more than 72 hours, excluding Saturdays, Sundays and legal holidays, without a court hearing under sub. (7) to determine whether the confinement should continue. DHS 145.10(7)(a)(a) If the department or a local health officer wishes to confine a person for more than 72 hours, the department or a local health officer may petition any court for a hearing to determine whether a person with infectious or suspected tuberculosis should be confined for longer than 72 hours. The department or local health officer shall include in the petition documentation that demonstrates all the following: DHS 145.10(7)(a)1.1. The person named in the petition has infectious tuberculosis; the person has noninfectious tuberculosis but is at high risk of developing infectious tuberculosis; or that the person has suspected tuberculosis. DHS 145.10(7)(a)2.2. The person has failed to comply with the prescribed treatment regimen or with any rules promulgated by the department under s. 252.07 (11), Stats.; or that the disease is resistant to the medication prescribed to the person. DHS 145.10(7)(a)3.3. All other reasonable means of achieving voluntary compliance with treatment have been exhausted and no less restrictive alternative exists; or that no other medication to treat the resistant disease is available. DHS 145.10(7)(a)4.4. The person poses an imminent and substantial threat to himself or herself or to the public health. DHS 145.10(7)(b)(b) If the department or a local health officer petitions the court for a hearing under par. (a), the department or local health officer shall provide the person who is the subject of the petition written notice of a hearing at least 48 hours before a scheduled hearing is to be held. Notice of the hearing shall include all the following information: DHS 145.10(7)(b)2.2. The grounds, and underlying facts, upon which confinement of the person is being sought. DHS 145.10(8)(8) A person who is the subject of a petition for a hearing under sub. (6) (a) has the right to appear at the hearing, the right to present evidence and cross-examine witnesses and the right to be represented by counsel. At the time of the filing of the petition, the court shall assure that the person who is the subject of the petition is represented by counsel. If the person claims or appears to be indigent, the court shall refer the person to the authority for indigency determinations under s. 977.07 (1), Stats. If the person is a child, the court shall refer that child to the state public defender who shall appoint counsel for the child without a determination of indigency, as provided in s. 48.23 (4), Stats. Unless good cause is shown, a hearing under this paragraph may be conducted by telephone or live audiovisual means, if available. DHS 145.10(9)(9) An order issued by the court under sub. (6) (a) may be appealed as a matter of right. An appeal shall be heard within 30 days after the appeal is filed. An appeal does not stay the order. DHS 145.10(10)(10) If the court orders confinement of a person under sub. (6) (a), the person shall remain confined until the department or local health officer, with the concurrence of a treating physician, determines that treatment is complete or that the person is no longer a substantial threat to himself or herself or to the public health. If the person is to be confined for more than 6 months, the court shall review the confinement every 6 months, beginning with the conclusion of the initial 6-month confinement period. DHS 145.10(11)(a)(a) If the administrative officer of the facility where a person is isolated or confined has good cause to believe that the person may leave the facility, the officer shall use any legal means to restrain the person from leaving. DHS 145.10(11)(b)(b) The local health officer or a person designated by the local health officer shall monitor all persons under isolation or confinement as needed to ascertain that the isolation or confinement is being maintained. DHS 145.10(11)(c)(c) The local health officer or a person designated by the local health officer shall monitor all persons with tuberculosis disease until treatment is successfully completed. DHS 145.10(12)(12) The local health officer or the department may order an examination of a contact to detect tuberculosis. Contacts shall be reexamined at times and in a manner as the local health officer may require. DHS 145.10 HistoryHistory: Cr. Register, April, 1984, No. 340, eff. 5-1-84; r. and recr. Register, March, 2000, No. 531, eff. 4-1-00; CR 01-105: r. and recr. Register March 2002 No. 555, eff. 4-1-02; CR 07-090: am. (1) Register February 2008 No. 626, eff. 3-1-08; CR 17-014: am. (1), Register June 2018 No. 750 eff. 7-1-18. DHS 145.11DHS 145.11 Discharge from isolation or confinement. The local health officer or the department shall authorize the release of a person from isolation or confinement if all the following conditions are met: DHS 145.11(1)(1) An adequate course of chemotherapy has been administered for a minimum of 2 weeks and there is clinical evidence of improvement, such as a decrease in symptom severity, radiographic findings indicating improvement, or other medical determination of improvement. DHS 145.11(2)(2) Sputum or bronchial secretions are free of acid–fast bacilli. DHS 145.11(3)(3) Specific arrangements have been made for post–isolation or post–confinement care. DHS 145.11(4)(4) The person is considered by the local health officer or the department not to be a threat to the health of the general public and is likely to comply with the remainder of the treatment regimen. DHS 145.11 HistoryHistory: Cr. Register, April, 1984, No. 340, eff. 5-1-84; r. and recr. Register, March, 2000, No. 531, eff. 4-1-00; CR 01-105: r. and recr. Register March 2002 No. 555, eff. 4-1-02. DHS 145.12DHS 145.12 Certification of public health dispensaries. DHS 145.12(1)(1) A local health department or 2 or more local health departments jointly may be certified by the department as a public health dispensary under s. 252.10, Stats., if the public health dispensary provides or ensures provision of all of the following: DHS 145.12(1)(b)(b) Medication for treatment of tuberculosis disease and infection.
