Facilities have a special responsibility to their patients, especially those susceptible to adverse reactions to infection, to practice constant and systematic surveillance for early detection of nosocomial infections and to respond rapidly to contain outbreaks. Outbreaks can be caused by any number of organisms (bacteria, viruses, fungi, parasites) or their toxins. Early recognition of such adverse events followed by an immediate response to reduce their spread is vital. The California Department of Public Health (CDPH) can be of major assist to facilities in the recognition and control of outbreaks of infectious diseases.
While certain diseases are defined by law or public health decree to be reportable (the list for California can be found at http://www.cdph.ca.gov/HealthInfo/Pages/ReportableDiseases.aspx) any "OCCURRENCE of ANY UNUSUAL DISEASE" and "OUTBREAKS OF ANY DISEASE (including diseases not listed in Section 2500)" are reportable to the local public health officer. This means that even if not listed, the disease or event may be reportable if it is rare or the number of cases is beyond what is generally expected (definition of an "outbreak").
Reporting these events to the local Public Health Officer is the mandated duty of "every health care provider" or health facility administrator: all who "may know of a case, a suspected case or an outbreak of diseases within the facility." Certainly, if there is a question as to whether an event should be reported to either public health or one's licensing body, it is always better to ask the agency or Health Officer if they want to know about it, than not report the event at all.
The reportable diseases list was first published in 1945 and has been amended nine times to reflect the changing needs and priorities for Statewide surveillance. In 2004 legislation was signed into law to allow the list to be changed by CDPH in consultation with the California Conference of Local Health Offices (CCLHO), without going through the formal regulatory process.
In 2006 shiga toxin became reportable by both providers and laboratories. The Centers for Disease Control and Prevention (CDC) also recommended that all stool specimens be tested for the toxin. This necessitated a change in the collection of stool specimens: all stool specimens brought to the lab now had to be refrigerated and tested for shiga toxin, even if this test is not specifically requested by the physician.
In 2007 four disease additions were made to Section 2500 (list of diseases): avian influenza, chickenpox hospitalizations and deaths, Cruetzfeldt-Jakob Disease and other transmissible spongiform encephalopathies (TSE), and influenza deaths in persons less than 18 years of age.
More recently, in February 2008, Staphylcoccus aureus was added: "Staphylococcus aureus infection (only a case resulting in death or admission to an intensive care unit of a person who has not been hospitalized or had surgery, dialysis, or residency in a long-term care facility in the past year, and did not have an indwelling catheter or percutaneous medical device at the time of culture.)" See http://www.cdph.ca.gov/HealthInfo/news/Pages/Update%2003-08.aspx. This includes both the methicillin sensitive (MSSA) and methicillin resistant (MRSA) strains. The date as to when this regulation goes into effect has, as of February 2008, not been published.