POLICY MANUAL

Health Examination, Clinics and Tests: Contagious and Infectious Diseases - Policy P7-51.1

A. Definition
1. Contagious (communicable) - caused by the passing of disease from one person to another.

2. Infectious - caused by the invasion of disease producing microorganism into a body where they may multiply causing disease.

B. Applicability
The policy in Subsection C following applies to students known to have infectious or contagious diseases as listed in Virginia State Board of Health, Regulation s3.2 List §of Reportable Diseases, July 1, 1993.

C. Policy 
1. The student who is infected with or a carrier of a contagious or infectious disease shall be excluded from school pending the decision procedures established in Subdivision (2) following. During this interim period homebound instructional services may be made available. (For homebound instruction see school board policy #6-65.)

2. Preliminary decision regarding the type of educational and care setting for a student with a contagious or infectious disease should be based on the behavior, neurologic development, and physical condition of the students and the expected type of interaction with others in that setting. Recommendations to the superintendent should be made by an evaluation committee composed of the student's physician, the public health director or physician designee, the division's medical advisor, the student's principal or designee and a member of the central administrative staff appointed by the superintendent. In each case, risks and benefits to both the infected student and to others in the setting should be weighed. A plan for periodic review will be established at the time the initial decision is made. The superintendent's decision will be subject to appeal to the school board upon written request of a parent or guardian.

3. When a decision is determined that a restrictive environment is advisable, the student shall continue on homebound instruction as provided in Subdivision (1) preceding.

A periodic review as provided in Subdivision (2) preceding will be held at appropriate intervals. This periodic review is important because the hygienic practices of a student with infection may improve sufficiently as he/she matures to allow for school attendance in the future.

4. Infected students who are returned to the school setting shall undergo periodic review as described in Subdivision (2) preceding.

D. Confidentiality of Records/Right to Privacy
Persons involved in the care and education of a student with a contagious or infectious disease shall respect the student's privacy, including maintaining confidential records. The number of personnel who are aware of the student's condition should be kept at a minimum needed to assure proper care and to detect situations where the potential for transmission may occur. (For student records see school board policy #7-29 and its implementing regulation #R 7-29.)

Legal Reference
Code of Va., § 22.1 -272. Contagious and infectious diseases.--"Persons suffering with contagious or infectious disease shall be excluded from the public schools while in that condition." (1980)

Editor's Note: See Opinion of Attorney General (VA) October 28, 1985 ". . . Turning to your second question, for purposes of § 22.1-272, the responsibility to determine that a child has an infectious disease requiring exclusion from the public schools is vested in the local school a uthorities, presumably the local superintendent. Because such a matter involves medically related judgements, the school official in making such a determination should consider qualified medical advice and information furnished from sources such as the child's physician, public health officials, and school nurses.

This may result in what some may regard as a lack of uniformity throughout the various local school divisions in Virginia in dealing with a particular disease. Under present law, however, the General Assembly has clearly vested the responsibility for these decisions in our local school officials and, as even the CDC recommendations are contained in its "Morbidity and Mortality Weekly Report," Vol. 34, No. 34, August 30, 1985. Ed.) concerning AIDS acknowledge, these difficult decisions are usually best made on a case-by-case basis.

Code of Va., § 32.1 -35. List and reports of diseases.--"The Board shall promulgate from time to time a list of diseases, including diseases caused by exposure to any toxic substance as defined in § 32.1-239, which shall be required to be reported.  The Board may classify such diseases and prescribe the manner and time of such reporting." (1979)

Virginia State Board of Health, § 3.2,List of Reportable Diseases. July 1, 1993.

Acquired Immune Deficiency             Lymphogranuloma venereum
Syndrome  (AIDS)                                 Malaria
Anthrax                                                    Measles (Rubeola)
Arboviral infections                               Meningococcal infections
Aseptic meningitis                                Mumps
Bacterial meningitis                             Nosocomial outbreaks
(specify etiology)                                   Occupational illnesses
Botulism                                                 Ophthalmia Neonatorum
Brucellosis                                             Pertussis
Campylobacter infections                   Phenylketonuria (PKU) 
(excluding C.pylori)                               Plague
Chancroid                                               Poliomyelitis
Chickenpox                                             Psittacosis
Chlamydia trachomatis infections     Q fever
Congenital Rubella Syndrome           Rabies in man
Diphtheria                                               Post-exposure rabies treatment
Encephalitis                                           Rabies in animals
   primary (specify etiology)                  Reye Syndrome
post-infectious                                       Rocky Mountain spotted fever
Foodborne outbreaks                           Rubella (German measles)
Giardiasis                                               Salmonellosis
Gonorrhea                                               Shigellosis
Granuloma Inguinale                            Smallpox
Haemophilus influenzae infections - invasive
Hepatitis                                                  Syphilis
   A (infectious)                                        Tetanus
   B (serum)                                              Toxic Shock Syndrome
   Non A, Non B                                        Toxic substance related illnesses
Unspecified                                             Trichinosis
Histoplasmosis                                      Tularemia
Human immunodeficiency virus (HIV) infection
Influenza                                                    Tuberculosis
Kawasaki Disease                                  Typhoid Fever
Lead-elevated levels in children           Typhus, flea-borne
Legionellosis                                            Vibrio infections including cholera
Leprosy                                                      Waterborne outbreaks
Leptospirosis                                            Yellow fever

Code of Va., § 32.1 -36. Reports by physicians and laboratory directors. Reports by physicians and laboratory directors

A. Every physician practicing in this Commonwealth who shall diagnose or reasonably suspect that any patient of his has any disease required by the Board to be reported and every director of any laboratory doing business in this Commonwealth which performs any test whose results indicate the presence of any such disease shall make a report within such time and in such manner as may be prescribed by regulations of the Board.

B. Any physician who diagnoses a venereal disease in a child twelve years of age or under shall, in addition to the requirements of subsection A hereof, report the matter, in accordance with the provisions of §63.1 -248.3, unless the physician reasonably believes that the infection was acquired congenitally or by a means other than sexual abuse.

C. Any physician practicing in this Commonwealth shall report to the local health department the identity of any patient of his who has tested positive for exposure to human immunodeficiency virus as demonstrated by such test or tests as are approved by the Board for this purpose. However, there is no duty on the part of the physician to notify any third party other than the local health department of such test result, and a cause of action shall not arise from any failure to notify any other third party.

D. Upon investigation by the local health department of a patient reported pursuant to subsection A, the Commissioner may, to the extent permitted by law, disclose the patient's identity and disease to the patient's employer if the Commissioner determines that (i) the patient's employment responsibilities require contact with the public and (ii) the nature of the patient's disease and nature of contact with the public constitutes a threat to the public health.

The patient's identity and disease state shall be confidential as provided in §§32.1-36.1 and 32.1 -41. Any unauthorized disclosure of reports made pursuant to this section shall be subject to the penalties of §32.1 -27.

E. Physicians and laboratory directors may voluntarily report additional information at the request of the Department of Health for special surveillance or other epidemiological studies. (1997)

Code of Va., § 32.1 -37. Reports by persons other than physicians A. The person in charge of any medical care facility, school or summer camp as defined in §35.1-1 shall immediately make or cause to be made a report of a disease required by the Board to be reported when such information is available to that person and that person has reason to believe that no physician has reported such disease as provided in §32.1 -36.

Such report shall be made by telephone or in person to the local health director or to the Commissioner.

B. The person in charge of any medical care facility, school or summer camp as defined in §35.1-1 may also voluntarily report additional information at the request of the Department of Health for special surveillance or other epidemiological studies. (1997)

Code of Va., 32.1-37.2. Informed consent for testing for human immundeficiency virus; condition on disclosure of test results; counseling required exceptions A. Prior to performing any test to determine infection with human immunodeficiency virus, the subject of the test shall be given an oral or written explanation of the meaning of the test. Except as otherwise authorized in this Code, informed consent shall be obtained before such a test is performed.

Informed consent for testing for infection with human immunodeficiency virus shall be deemed to have been obtained (i) when an individual seeks the services of a facility offering anonymous testing for infection with human immunodeficiency virus; (ii) when blood specimens which were obtained for routine diagnostic purposes are tested in order to conduct seroprevalence studies of infection with human immunodeficiency virus if such studies are designed to prevent any specimen from being identified with any specific individual; and (iii) when an individual donates or sells his blood.

B. Every person who is the subject of any test to determine infection for human immunodeficiency virus shall be afforded the opportunity for individual face-to -face disclosure of the test results and appropriate counseling. Appropriate counseling shall include, but not be limited to, the meaning of the test results, the need for additional testing, the etiology, prevention and effects of acquired immunodeficiency syndrome, the availability of appropriate health care, mental health care and social services, the need to notify any person who may have been exposed to the virus and the availability of assistance through the Department of Health in notifying such individuals.

C. Opportunity for face-to-face disclosure of the test results and appropriate counseling shall not be required when the tests are conducted by blood collection agencies. However, all blood collection agencies shall notify the Board of Health of any positive tests.

D. In the case of a person applying for accident and sickness or life insurance who is the subject of a test to determine infection for human immunodeficiency virus, insurers' practices including an explanation of the meaning of the test, the manner of obtaining informed consent, the method of disclosure of the test results and any counseling requirements shall be as set forth in the regulations of the State Corporation Commission.

Virginia State Board of Health, Regulation #3.01.04, Persons in Charge of a School-- "Any person in charge of a school shall report immediately to the local health department the presence or suspected presence in his school of children who have common symptoms suggesting an epidemic or outbreak situation." (August 21, 1984)

Code of Va., § 32.1 -38.  Immunity from liability.-- Any person making a report or disclosure required or authorized by this chapter, including any voluntary reports submitted at the request of the Department of Health for special surveillance or other epidemiological studies, shall be immune from civil liability or criminal penalty connected therewith unless such person acted with gross negligence or malicious intent. Further, except for such reporting requirements as may be established in this chapter or by any regulation promulgated pursuant thereto, there shall be no duty on the part of any blood collection agency or tissue bank to notify any other person of any reported test results, and a cause of action shall not arise from any failure by such entities to notify others. Neither the Commissioner nor any local health director shall disclose to the public the name of any person reported or the name of any person making a report pursuant to this chapter. (1997)

Code of Va., § 32.1 -41. Anonymity of patients and practitioners to be preserved in use of medical records. The Commissioner or his designee shall preserve the anonymity of each patient and practitioner of the healing arts whose records are examined pursuant to § 32.1 -40 except that the Commissioner, in his sole discretion, may divulge the identity of such patients and practitioners if pertinent to an investigation, research or study. Any person to whom such identities are divulged shall preserve their anonymity. (1997)

Code of Va., § 32.1 -78. Reporting information about children with health problems or handicapping conditions  Notwithstanding §32.1-271 or any other law to the contrary, the Commissioner shall report to the Superintendent of Public Instruction or to the appropriate school division superintendent within the Commonwealth the identity of, and pertinent information about, children with health problems or handicapping conditions which might affect the child's career in school and his need for special education.

Editor's Note: See Opinion of Attorney General (VA) January 3, 1986 ". . . In my opinion,§32.1-78 is clear and requires the Commissioner to report to the Superintendent of Public Instruction or the appropriate school division the names of, and pertinent information about, students who have AIDS, if the Commissioner determines that those students have health problems associated with the disease which might affect their career in school and require that they receive special education."

See also "Acquired Immunodeficiency Syndrome (AIDS)", Virginia Department of Health

Recommendations for School Attendance, November 1985
Adopted by School Board: September 2, 1986

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