Section 410 IAC 1-2.5-145 - Varicella (chickenpox); specific control measuresAuthority: IC 16-19-3-4; IC 16-41-2-1
Affected: IC 16-41-2; IC 16-41-9
Sec. 145.
The specific control measures for varicella (chickenpox) (infectious agent: Varicella-zoster virus) are as follows:
(1) Every case of primary varicella disease shall be reported to the local health officer within seventy-two (72) hours. For all cases of primary varicella disease, an investigation shall be performed to ascertain the following:(A) An immunization history.(B) Primary varicella disease history.(C) A history of underlying chronic or immunosuppressive disease.(D) Disease severity and hospitalization.(E) Characteristics of the rash, reported as the following: (ii) Macules (flat spots).(iii) Papules (solid bumps).(iv) Vesicles (fluid-filled blisters).(F) Location of the rash, reported as the following:(G) Name and contact information for employer or school/daycare attended.(H) Identification of any known case of varicella with an epidemiologic link.(2) For hospitalized patients, institute airborne and contact precautions.(3) Concurrent disinfection of articles soiled by nose or throat discharges.(4) Infected persons shall avoid contact with susceptible individuals outside of the household and shall be excluded from: (C) daycare facilities; and(D) public gatherings; until lesions have crusted over (severe cases) or disappeared (mild or atypical cases). Individuals with shingles (herpes zoster) do not need to remain excluded as long as the rash is covered with a clean, dry bandage. (5) Individuals with known recent exposure to a single case of chickenpox: (A) Varicella vaccine given to healthy inadequately vaccinated persons within five (5) days (one hundred twenty (120) hours) of exposure may provide protection against disease.(B) Individuals who must remain in a hospital setting for medical reasons shall be quarantined from the eighth day to the twenty-first day following exposure. Individuals who receive varicella-zoster immune globulin shall be quarantined for a period of up to twenty-eight (28) days.(C) Persons without evidence of immunity who have contraindications for vaccination and who are at risk for severe disease and complications may be given varicella-zoster immune globulin within ninety-six (96) hours of exposure to prevent or modify disease. Other susceptible high-risk individuals who should be considered for varicella-zoster immune globulin include the following: (i) Newborns of mothers who develop chickenpox within five (5) days before or forty-eight (48) hours after delivery.(ii) Immunocompromised susceptible children and adults.(iii) Preterm infants born at twenty-eight (28) weeks gestation or later who are exposed during the neonatal period and whose mothers do not have evidence of immunity.(iv) Premature infants of less than twenty-eight (28) weeks gestation, or weighing one thousand (1,000) grams or less (regardless of maternal history of disease or vaccination).(v) Susceptible pregnant women.(D) Exposed health care workers must provide evidence of immunity (chickenpox or shingles). Evidence of immunity in health care workers includes documentation of two (2) doses of varicella vaccine given at least twenty-eight (28) days apart (after the first birthday), history of varicella or herpes zoster based on physician diagnosis, laboratory evidence of immunity, or laboratory confirmation of disease. Health care workers who cannot provide evidence of immunity should be furloughed from the eighth day to the twenty-first day following exposure.(6) Individuals with suspected "break-through" disease, or those developing varicella within seven (7) to forty-two (42) days postvaccination should undergo appropriate laboratory testing that includes viral culture and polymerase chain reaction for viral strain typing.(7) Individuals who are hospitalized due to the infection should have appropriate laboratory evidence to support diagnosis including viral culture or polymerase chain reaction. Serologic testing should be undertaken in cases of suspected death due to primary varicella.(8) Outbreak control measures. An outbreak of chickenpox is defined as five (5) or more cases in persons less than thirteen (13) years of age that are related in place and epidemiologically linked. For individuals thirteen (13) years of age and older, a total of three (3) cases related in place and epidemiologically linked meets the outbreak definition. The cases may be linked by affiliation or attendance at the same school or facility. In order to reach the outbreak threshold, the cases must reside in at least two (2) different households. (A) Varicella vaccine should be offered to all healthy, susceptible individuals within five (5) days of exposure to provide additional protection against disease. Individuals who remain susceptible shall be quarantined for twenty-one (21) days following last known exposure. This includes exclusion from school attendance, daycare settings, and employment.(B) Vaccination or disease history, or both, for varicella shall be obtained in schools and daycare settings for each exposed individual.(9) The Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists set the standard clinical and laboratory case definition.Indiana State Department of Health; 410 IAC 1-2.5-145; filed 11/25/2015, 2:54 p.m.: 20151223-IR-410150039FRAReadopted filed 11/12/2021, 8:41 a.m.: 20211208-IR-410210385RFA