wa-26-20-102: Health, State Board of — WSR 26-20-102

WSR 26-20-102 (26-20)WSR 26-20-102PROPOSED RULESSTATE BOARD OF HEALTH[Filed October 7, 2026, 7:59 a.m.]Original Notice.Preproposal statement of inquiry was filed as WSR 25-08-026.Title of Rule and Other Identifying Information: Chapter 246-101 WAC, Notifiable conditions; amendments to COVID-19 Reporting requirements. The Washington state board of health (board) is proposing updates to chapter 246-101 WAC to ease current COVID-19 notifiable condition reporting requirements while retaining key data needed for ongoing disease surveillance. This proposal was initiated in response to feedback from public health partners and changes in the national notifiable designation for COVID-19 by the Council of State and Territorial Epidemiologists (CSTE). Hearing Location(s): On November 18, 2026, at 1:00 p.m., at the Snohomish County Health Department, 3020 Rucker Avenue, Everett, WA 98201; or register to participate virtually via Zoom at https://us02web.zoom.us/webinar/register/WN_m0uliPy0Q_yQgZZHZdbKXA.Date of Intended Adoption: November 18, 2026.Submit Written Comments to: Shay Bauman, P.O. Box 47990, Olympia, WA 98504-7990, email notifiableconditions@sboh.wa.gov, fax 360-236-4088, AirTable https://airtable.com/appJhpwCyXDwC4zqC/pagci0W1aUGVm8j7c/form, beginning the date and time of filing, by November 8, 2026, at 11:59 p.m.Assistance for Persons with Disabilities: Contact board staff, phone 360-236-4110, fax 360-236-4088, TTY 711, email wsboh@sboh.wa.gov, by November 13, 2026.Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The purpose of this proposal is to reduce current COVID-19 reporting requirements in chapter 246-101 WAC. Under the current rules, health care providers, facilities, and laboratories must immediately report all COVID-19 cases to local health jurisdictions, which must then notify the department of health (department). Local health officers and regulated entities have expressed that these reporting requirements are burdensome and no longer reflect the transition from pandemic emergency response to routine surveillance of COVID-19 and other respiratory viruses.These proposed amendments would reduce COVID-19 reporting requirements while maintaining surveillance of severe cases of COVID-19 in alignment with national guidelines. The amendments would:•Require health care providers and facilities to report only severe COVID-19 cases (lab-confirmed hospitalizations and deaths) to local health jurisdictions within three business days.•Require laboratories to continue reporting all positive COVID-19 test results, but to report those directly to the department within two business days instead of immediately to local health jurisdictions.•Maintain immediate reporting for SARS, MERS, and novel coronavirus cases.•Add definitions for COVID-19 (SARS-CoV-2) and novel coronavirus in WAC 246-101-010.•Remove COVID-19 rapid screening tests (RST) reporting requirements in WAC 246-101-200.•Update terminology in WAC 246-101-805 to align with the proposed new definitions in WAC 246-101-010 and maintain immediate reporting of animal cases of SARS, MERS, novel coronavirus, and COVID-19 by the department of agriculture (DOA) to the department.Reasons Supporting Proposal: The proposed amendments are expected to reduce administrative and reporting burdens while maintaining timely reporting of COVID-19 outcomes that provide important information for public health surveillance. The board does not anticipate that the proposal will result in additional costs for regulated entities or public health partners because it does not require new reporting systems or processes and generally reduces or streamlines existing COVID-19 reporting requirements.Surveillance of severe COVID-19 disease remains important for identifying changes in disease activity, monitoring the impact of COVID-19 on the health care system, and informing public health response. The proposed amendments would shift health care provider and facility reporting toward severe outcomes while maintaining laboratory reporting of positive COVID-19 test results directly to the department. This approach would reduce reporting burdens while preserving information needed to monitor severe COVID-19 disease and overall disease activity.The proposal would also better align Washington state's COVID-19 reporting requirements with current national surveillance practices and the state's transition from pandemic emergency response to routine respiratory virus surveillance.Statutory Authority for Adoption: RCW 43.20.050 (2)(f).Statute Being Implemented: RCW 43.20.050.Rule is not necessitated by federal law, federal or state court decision.Name of Proponent: State board of health, governmental.Name of Agency Personnel Responsible for Drafting: Shay Bauman, 111 Israel Road S.E., Tumwater, WA 98501, 360-236-4110; Implementation and Enforcement: Alexandra Montaño, 111 Israel Road S.E., Tumwater, WA 98501, 360-236-4700.A school district fiscal impact statement is not required under RCW 28A.305.135.A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Shay Bauman, P.O. Box 47990, Tumwater, WA 98504, phone 360-236-4110, fax 360-236-4088, TTY 711, email WSBOH@SBOH.WA.GOV or notifiableconditions@sboh.wa.gov.This rule proposal, or portions of the proposal, is exempt from requirements of the Regulatory Fairness Act because the proposal: Is exempt under RCW 19.85.025(3) as the rules only correct typographical errors, make address or name changes, or clarify language of a rule without changing its effect.Explanation of exemptions: Portions of the proposal are exempt. Proposed changes in WAC 246-101-010 add definitions for SARS-CoV-2 and novel coronavirus to distinguish the terms from one another and from other coronaviruses referenced in the rule. This proposed change clarifies rule language without changing its effect. Additionally, WAC 246-101-805 clarifies that novel coronavirus and SARS-CoV-2-associated coronavirus are distinct reportable coronaviruses and must be reported by DOA to the department, consistent with the definitions in WAC 246-101-010. This proposed change clarifies rule language without changing its effect.Scope of exemption for rule proposal:Is partially exempt:Explanation of partial exemptions: [See above and below].The proposed rule does not impose more-than-minor costs on businesses. Following is a summary of the agency's analysis showing how costs were calculated. A brief description of the proposed rule, including the current situation/rule, followed by the history of the issue and why the proposed rule is needed. A description of the probable compliance requirements and the kinds of professional services that a small business is likely to need in order to comply with the proposed rule: The board is proposing amendments to the notifiable conditions rules in chapter 246-101 WAC to update COVID-19 reporting requirements. The proposed changes impact health care providers, health care facilities, laboratories, individuals and entities conducting rapid screening testing, and animal disease reporting by DOA.The board adopts rules under RCW 43.20.050 to support public health efforts to prevent and control certain infectious and noninfectious conditions. Chapter 246-101 WAC, Notifiable conditions, establishes reporting requirements for health care providers, health care facilities, laboratories, and other regulated entities. Public health authorities use the information reported under these rules to investigate and control outbreaks, provide treatment and preventive therapies, identify and address health risks, monitor disease trends and risk factors, and inform public health programs and policies.The board is proposing amendments to chapter 246-101 WAC to update COVID-19 reporting requirements. Under the current rule, health care providers, health care facilities, and laboratories must immediately report all COVID-19 cases to local health jurisdictions, which must then notify the department within three business days. Local health officers and regulated entities have expressed to the board that these requirements create a significant reporting burden and no longer reflect the transition from pandemic emergency response to routine surveillance of COVID-19 and other respiratory viruses.The proposed amendments would reduce COVID-19 reporting requirements while maintaining surveillance of severe disease. The amendments would:•Require health care providers and facilities to report only laboratory-confirmed COVID-19 hospitalizations and death to local health jurisdictions within three business days.•Require laboratories to continue reporting all positive COVID-19 test results, but to report those results directly to the department within two business days instead of immediately to local health jurisdictions.•Maintain immediate reporting for SARS, MERS, and novel coronavirus cases.•Add definitions for COVID-19 and novel coronavirus in WAC 246-101-010.•Remove COVID-19 rapid screening test reporting requirements in WAC 246-101-200.•Update terminology in WAC 246-101-805 to distinguish novel coronavirus from COVID-19 to align with the proposed new definitions in WAC 246-101-010 and maintain immediate reporting of animal cases of SARS, MERS, novel coronavirus, and COVID-19 by DOA to the department.The board designated COVID-19 as a notifiable condition through emergency rule making in July 2020 in response to the COVID-19 pandemic and federal reporting requirements. The emergency rules required reporting by health care providers, health care facilities, laboratories, and local health jurisdictions. These requirements provided public health authorities with testing, demographic, and case information needed to monitor and respond to the pandemic.The board subsequently incorporated COVID-19 reporting requirements into the permanent revision of chapter 246-101 WAC, which was adopted in 2021 and took effect January 1, 2023. After the permanent rules took effect, the department used the state health officer's provisional reporting authority under WAC 246-101-015 to request additional COVID-19 laboratory data and other information. The department issued the provisional reporting request on June 1, 2023. The federal COVID-19 reporting requirements that supported the request expired in May 2023, and the provisional request will expire in October 2026.Since the current requirements were established, national COVID-19 surveillance practices have changed. In 2024, CSTE, in collaboration with the United States Centers for Disease Control and Prevention (CDC), revised the COVID-19 case definition and removed COVID-19 from the list of nationally notifiable conditions. National surveillance has shifted from comprehensive case-based reporting toward surveillance approaches that emphasize severe disease and other indicators of COVID-19 activity. Routine surveillance of COVID-19 alongside other respiratory viruses remains important for public health.The proposed amendments are intended to better align Washington state's reporting requirements with current national surveillance practices and the state's transition from pandemic emergency response to routine respiratory virus surveillance. Reporting severe COVID-19 cases will continue to provide information needed to identify changes in disease activity, monitor the impact of COVID-19 on the health care system, and inform public health response. Continued laboratory reporting of positive test results will provide information on overall COVID-19 activity. Health care providers, health care facilities, and laboratories are already required to report notifiable conditions to public health [authorities] under chapter 246-101 WAC. The proposed rule would reduce the frequency and scope of COVID-19 reporting compared with the current requirements. The board anticipates that the proposed changes would reduce the overall reporting burden for regulated entities because they generally reduce or streamline existing reporting requirements and do not require new equipment.Because the proposed rule is not expected to add significant new requirements or procedures, the board does not anticipate that small businesses will need to obtain additional professional services to comply. Businesses can use existing staff and existing information technology, compliance, or laboratory reporting systems and support to implement the changes. Some providers, facilities, or laboratories may incur negligible one-time costs to update reporting procedures, staff instructions, or electronic reporting systems. Businesses that choose to obtain outside assistance could use information technology or electronic reporting support to modify reporting systems or compliance, or legal services to review updated reporting procedures. These services are not expected to be necessary for compliance with the proposed rule. Overall, the proposed changes are expected to reduce the ongoing administrative burden associated with COVID-19 reporting.Identification and summary of which businesses are required to comply with the proposed rule using the North American Industry Classification System (NAICS):Table 1. Summary of Businesses Required to Comply with the Proposed RuleNAICS Code(4, 5, or 6 Digit)NAICSBusiness DescriptionNumber of Businesses in Washington StateMinor Cost Threshold6211Offices of Physicians3,910$9,580.58621399Offices of All Other Miscellaneous Health Practitioners4,265$1,428.08621491HMO Medical Centers37$204,733.09621493Freestanding Ambulatory Surgical and Emergency Centers64$33,370.97621511Medical Laboratories172$20,558.49621910Ambulance Services31$31,108.34621999All Other Miscellaneous Ambulatory Health Care Services59$10,609.52622110General Medical and Surgical Hospitals114$891,087.34623110Nursing Care Facilities (Skilled Nursing Facilities)174$24,215.05Analysis of probable costs of businesses in the industry to comply to the proposed rule and includes the cost of equipment, supplies, labor, professional services, and administrative costs. The analysis considers if compliance with the proposed rule will cause businesses in the industry to lose sales or revenue: The following sections are exempt from this analysis.WAC Section and TitleDescription of Proposed ChangesRationale for Exemption DeterminationWAC 246-101-010 Definitions, abbreviations, and acronyms.Addition of definitions for SARS-CoV-2 and novel coronavirus to clearly distinguish the terms from one another and from other types of coronaviruses referenced in the rule.The definitions proposed in this section are exempt from analysis under RCW 34.05.310 (4)(d) because they clarify how the terms are used throughout the chapter. The legal effects of the terms are defined in section 3 of this analysis.WAC 246-101-805 Duties—Department of agriculture.Clarifies that novel coronavirus and SARS-CoV-2-associated coronavirus are distinct reportable coronaviruses and must be reported by DOA to the department, consistent with the definitions in WAC 246-101-010.Both coronaviruses remain as reportable; however, the proposed rule now clarifies the differences without changing the effect of the rule and is therefore exempt from analysis under RCW 34.05.328 (4)(d).Recent COVID-19 trends in Washington state: Changes in COVID-19 testing practices over time have affected case reporting. People with asymptomatic or mild infections may not seek testing, and people who use at-home tests may not report their results to public health [authorities]. As a result, reported case counts likely underestimate the number of COVID-19 infections in Washington state.According to the department's 2024 Communicable Disease Report, reported COVID-19 cases decreased by 34 percent, from 148,632 in 2023 to 98,141 in 2024. In 2024, reported cases were highest in January (15,452) and lowest in November (2,522). Reported case rates were 25 percent higher in Eastern Washington than in Western Washington. There were 1,087 COVID-19 deaths in Washington state in 2024.Laboratory-confirmed COVID-19 hospitalizations have generally declined from earlier pandemic levels, although hospitalization rates continue to fluctuate seasonally in Washington state, consistent with national trends. These data provide a more consistent measure of severe COVID-19 illness than reported case counts as testing and reporting practices have changed.WAC 246-101-101 NOTIFIABLE CONDITIONS—HEALTH CARE PROVIDERS AND HEALTH CARE FACILITIES.Description: WAC 246-101-101, Table HC-1, establishes the conditions that health care providers and health care facilities, as defined under WAC 246-101-010, must report to public health authorities.Under the current rule, coronavirus infection (severe communicable), SARS-associated coronavirus, MERS-associated coronavirus, and COVID-19 are immediately reportable to local health jurisdictions. Additionally, providers and facilities performing COVID-19 RST are required to report as a laboratory and comply with the requirements in WAC 246-101-201 through 246-101-230.The proposed rule amendments would:•Clarify reporting requirements for different types of coronaviruses (defined under WAC 246-101-010).•Continue to require immediate reporting of SARS-associated coronavirus, MERS-associated coronavirus, and novel coronaviruses to local health jurisdictions.•Strike COVID-19 after novel coronavirus and add language to specify that "coronavirus infection" does not include SARS-CoV-2/COVID-19.•Update reporting requirements for COVID-19: Specifies that laboratory-confirmed COVID-19 hospitalizations and deaths are notifiable to local health jurisdictions within three business days.•Remove the requirement that providers and facilities performing COVID-19 RSTs report as laboratories.Cost(s): The board and department do not anticipate additional costs to health care providers or health care facilities as a result of the proposed amendments. The proposed rule reduces the frequency and scope of COVID-19 reporting compared with the current requirement that all COVID-19 cases be reported immediately to local health jurisdictions.In 2024, Washington state joined the national Respiratory Virus Hospitalization Surveillance Network (RESP-NET), a CDC-sponsored surveillance network that monitors laboratory-confirmed hospitalizations for COVID-19, influenza, and respiratory syncytial virus among children and adults. The RESP-NET catchment area includes eight participating counties across seven local health jurisdictions and more than 40 health care facilities, representing approximately 73 percent of Washington's population. Laboratory-confirmed COVID-19 hospitalization and death data are already being collected through RESP-NET. Expanding this surveillance approach statewide is expected to have minimal impact. The necessary data systems and reporting mechanisms are already in place, and the proposed rule formalizes this existing process.Providers and facilities may incur negligible one-time administrative costs associated with reviewing and updating internal reporting procedures to reflect the revised requirements. These proposed changes primarily clarify existing requirements and reduce reporting obligations. Providers and facilities that currently perform COVID-19 RSTs would also no longer be required to report as laboratories under WAC 246-101-200, which may reduce administrative and financial burden and could result in ongoing cost savings.WAC 246-101-200 NOTIFIABLE CONDITIONS—RAPID SCREENING TESTING.Description: WAC 246-101-200 clarifies that individuals and entities, including health care providers and facilities conducting RSTs for certain conditions, meet the definition of a laboratory and must comply with sections of chapter 246-101 WAC that apply to laboratories. Chapter 70.42 RCW defines "test site," and chapter 246-338 WAC defines "test site" or "medical test site" to broadly include individuals or entities that conduct RSTs. The rule references these RCW and WAC in the definition of laboratory. This section was added during the last rule-making effort to clarify that these definitions include individuals or entities conducting RSTs.Under this section, individuals and entities conducting RSTs for blood lead testing, hepatitis C (chronic and acute infections), HIV, or COVID-19 are required to comply with WAC 246-101-201 through 246-101-230.The proposed amendment would remove novel coronavirus (COVID-19) from the list of conditions tested through RSTs that require individuals and entities conducting those tests to meet the definition of a laboratory and comply with the applicable laboratory reporting requirements in chapter 246-101 WAC.Cost(s): The proposed amendment does not require entities to establish new reporting systems or processes. As such, the board and department do not anticipate costs to individuals or entities that conduct COVID-19 RSTs as a result of the proposed amendment. Entities currently subject to laboratory reporting requirements for COVID-19 RSTs may incur negligible one-time administrative costs to review and update internal policies and procedures to reflect the removal of COVID-19 from the conditions subject to the laboratory requirements in WAC 246-101-200. As this amendment removes, rather than adds to, existing reporting requirements, removing this requirement could result in ongoing cost savings.WAC 246-101-201 NOTIFIABLE CONDITIONS—LABORATORIES. Description: WAC 246-101-201, Table Lab-1, establishes the conditions that laboratories, as defined under WAC 246-101-010, must report to public health authorities.Under the current rule, laboratories are required to immediately report coronavirus infection (severe communicable), SARS-associated coronavirus, MERS-associated coronavirus, and COVID-19 to local health jurisdictions.The proposed rule amendments would:•Clarify reporting requirements for different types of coronaviruses (defined under WAC 246-101-010).•Continue to require immediate reporting of SARS-associated coronavirus, MERS-associated coronavirus, and novel coronaviruses to local health jurisdictions.•Strike COVID-19 after novel coronavirus and add language to specify that "coronavirus infection" does not include SARS-CoV-2.•Update reporting requirements for COVID-19. Specify that laboratories are required to report positive COVID-19 results (by any method) to the department within two business days instead of immediately to local health jurisdictions. Cost(s): The board and department do not anticipate additional costs to laboratories as a result of the proposed amendments. The proposed rule changes the timing and reporting process for COVID-19 compared with the current requirement that laboratories immediately report COVID-19 cases to local health jurisdictions.Laboratories may incur negligible one-time administrative costs associated with reviewing and updating internal reporting procedures, policies, or reporting processes to reflect the revised requirements. These proposed amendments do not require laboratories to establish new reporting systems, and instead reduce the urgency of COVID-19 reporting by allowing laboratories to report positive SARS-CoV-2 test results within two business days rather than immediately.The proposed changes are not expected to require significant changes to existing reporting infrastructure. The board and department do not anticipate any ongoing costs associated with implementation of the proposed amendments.Table 2. Summary of Section 3 Probable Cost(s)WAC Section and TitleProbable Cost(s)WAC 246-101-101 Notifiable conditions—Health care providers and health care facilities.No additional ongoing costs.Negligible one-time administrative costs to review and update reporting procedures, policies, or systems.WAC 246-101-200 Notifiable conditions—Rapid screening testing.No additional ongoing costs.Negligible one-time administrative costs to update policies and procedures.WAC 246-101-201 Notifiable conditions—Laboratories.No additional ongoing costs.Negligible one-time administrative costs to review and update reporting procedures, policies, or processes.Analysis on if the proposed rule may impose more-than-minor costs for businesses in the industry. Includes a summary of how the costs were calculated: No. The proposed rule does not impose additional costs and will therefore not impose more-than-minor costs on businesses in the affected industries (identified in Table 1).Summary of how costs were calculated: The proposed amendments primarily reduce, clarify, or modify existing COVID-19 reporting requirements and will not create additional ongoing compliance costs for businesses.Businesses may incur negligible one-time administrative costs to review and update reporting procedures, policies, or processes to reflect the amended requirements. These costs will primarily involve routine administrative activities. The proposed amendments do not require businesses to purchase new equipment or supplies, establish new reporting systems, or obtain professional services.The proposed amendments also reduce or eliminate certain existing reporting requirements. Specifically, the amendments reduce the frequency and scope of COVID-19 reporting for health care providers and health care facilities; give laboratories additional time to report positive SARS-CoV-2 results, to the department within two business days instead of immediately to the local health jurisdiction; and remove laboratory reporting requirements for entities solely because they conduct COVID-19 RSTs. Businesses currently subject to these requirements may therefore experience ongoing administrative cost savings.The board and department calculated probable costs based on the compliance activities that businesses will undertake to implement the proposed amendments, including reviewing and revising internal reporting procedures, policies, and processes. The board and department did not identify costs for new equipment, supplies, facilities, reporting systems, or professional services.The board and department anticipate that businesses may incur negligible one-time administrative costs due to the proposed amendments requiring limited, routine updates to existing procedures and processes. The board and department do not anticipate additional ongoing compliance costs.The board and department also considered the cost savings that businesses may realize when they no longer need to perform certain COVID-19 reporting activities. These savings may include reduced staff time spent collecting information, maintaining reporting procedures, submitting reports, and ensuring compliance with existing COVID-19 laboratory reporting requirements.A copy of the detailed cost calculations may be obtained by contacting Shay Bauman, P.O. Box 47990, Tumwater, WA 98504, phone 360-236-4110, fax 360-236-4088, TTY 711, email WSBOH@SBOH.WA.GOV or notifiableconditions@sboh.wa.gov.October 7, 2026Michelle A. DavisExecutive DirectorRDS-7392.1AMENDATORY SECTION(Amending WSR 21-11-040 and 22-01-175, filed 5/12/21 and 12/17/21, effective 1/1/23)WAC 246-101-010Definitions, abbreviations, and acronyms.The definitions, abbreviations, and acronyms in this section apply throughout this chapter unless the context clearly requires otherwise:(1) "Animal case" means an animal, alive or dead, with a diagnosis or suspected diagnosis of a notifiable condition in Table Agriculture-1 of WAC 246-101-805 made by a veterinarian licensed under chapter 18.92 RCW, veterinary medical facility licensed under chapter 18.92 RCW, or veterinary laboratory as defined under chapter 16.70 RCW based on clinical criteria, or laboratory criteria, or both.(2) "Animal case report" means the data and other supporting information submitted by the Washington state department of agriculture to the department under WAC 246-101-810 for an individual animal with a notifiable condition.(3) "Associated death" means a death resulting directly or indirectly from a case of the specified condition, with no period of complete recovery between the onset of the condition and death.(4) "Blood lead level" means a measurement of lead content in whole blood.(5) "Board" means the Washington state board of health.(6) "Business day" means any day that the department is open for business.(7) "Carrier" means a person harboring a specific infectious agent without developing symptoms and serving as a potential source of infection to others.(8) "Case" means a person, alive or dead, with a diagnosis or suspected diagnosis of a condition made by a health care provider, health care facility, or laboratory based on clinical criteria, or laboratory criteria, or both, such as the Centers for Disease Control and Prevention, National Notifiable Diseases Surveillance System, Council of State and Territorial Epidemiologists case definitions.(9) "Case report" means the data and other supporting information submitted by a health care provider or health care facility to public health authorities under WAC 246-101-115 for an individual patient with a notifiable condition.(10) "Communicable disease" means an infectious disease that can be transmitted from a person, animal, or object to a person by direct or indirect means including, but not limited to, transmission through an intermediate host or vector, food, water, or air.(11) "Condition" means an infectious or noninfectious condition as these terms are defined in this chapter.(12) "Department" or "DOH" means the Washington state department of health.(13) "Health care-associated infection" means a localized or systemic condition that results from adverse reaction to the presence of an infectious agent or its toxins and that was not present or incubating at the time of admission to the health care facility.(14) "Health care facility" means:(a) Assisted living facilities licensed under chapter 18.20 RCW;(b) Birthing centers licensed under chapter 18.46 RCW;(c) Nursing homes licensed under chapter 18.51 RCW;(d) Hospitals licensed under chapter 70.41 RCW;(e) Adult family homes licensed under chapter 70.128 RCW;(f) Ambulatory surgical facilities licensed under chapter 70.230 RCW;(g) Private establishments licensed under chapter 71.12 RCW;(h) Enhanced service facilities licensed under chapter 70.97 RCW;(i) Clinics, or other settings where one or more health care providers practice; and(j) In reference to a sexually transmitted infection, other settings as defined in chapter 70.24 RCW. (15) "Health care provider" means any person having direct or supervisory responsibility for the delivery of health care whose scope of practice allows for diagnosis and treatment of notifiable conditions and who is:(a) Licensed or certified in this state under Title 18 RCW; or(b) Military personnel providing health care within the state regardless of licensure.(16) "Immediately" means without delay, ((twenty-four))24 hours a day, seven days a week.(a) For health care providers and health care facilities, immediately means at the time a case is identified;(b) For laboratories, immediately means upon receiving a presumptive or final test result; or(c) For state agencies and local health jurisdictions, immediately means upon receiving notification of a case.(17) "Infection control measures" means the management of an infected person, or of a person suspected to be infected, and others in a manner to prevent transmission of the infectious agent. Infection control measures include, but are not limited to, isolation and quarantine.(18) "Infectious condition" means a disease caused by a pathogenic organism such as bacteria, virus, fungus, parasite, or infectious agent, and includes communicable disease and zoonotic disease.(19) "Influenza, novel" or "influenza virus, novel" means a human infection with an influenza A virus subtype that is different from currently circulating human influenza subtypes. Novel subtypes include, but are not limited to, H2, H5, H7, and H9 subtypes.(20) "Institutional review board" has the same meaning as defined in RCW 70.02.010.(21) "Investigation report" means the data and other supporting information submitted by a local health jurisdiction to the department under WAC 246-101-513(2) for an individual patient with a notifiable condition.(22) "Isolation" means the separation of infected or contaminated persons or animals from others to prevent or limit the transmission of the infectious agent or contaminant from those infected or contaminated to those who are susceptible to disease or who may spread the infectious agent or contaminant to others.(23) "Laboratory" means any facility licensed as a test site or medical test site under chapter 70.42 RCW and chapter 246-338 WAC, including any laboratory that is granted a Clinical Laboratory Improvement Amendment (CLIA)-Waiver.(24) "Laboratory director" means the person, or person's designee, by whatever title known, having the administrative responsibility for a laboratory.(25) "Laboratory report" means the data and other supporting information submitted by a laboratory director to public health authorities under WAC 246-101-225 for an individual patient with a notifiable condition.(26) "Local health jurisdiction" or "LHJ" means a county health department under chapter 70.05 RCW, city-county health department under chapter 70.08 RCW, or health district under chapter 70.46 RCW.(27) "Local health officer" means the legally qualified physician who has been appointed as the health officer for the local health jurisdiction under chapter 70.05 RCW, or their designee.(28) "MERS" means Middle East respiratory syndrome.(29) "Noninfectious condition" means a disease or health concern that may lead to disease caused by nonpathogenic factors.(30) "Notifiable condition" means a condition identified in Table HC-1 of WAC 246-101-101, Table Lab-1 of WAC 246-101-201, or Table Agriculture-1 of WAC 246-101-805, a case of which requires notification to public health authorities under this chapter; or a condition designated by the local health officer as notifiable within their jurisdiction under WAC 246-101-505 (4)(d). Notifiable condition does not include provisional conditions as defined under WAC 246-101-015.(31) "Novel coronavirus" means a coronavirus that has not previously been identified in humans, and that may cause a new or emerging disease.(32) "Outbreak" means the occurrence of a condition in an area over a given period of time in excess of the expected number of occurrences including, but not limited to, foodborne disease, waterborne disease, and health care-associated infection.(((32)))(33) "Outbreak report" means the data and other supporting information about an outbreak that local health jurisdictions submit to the department under WAC 246-101-513(3) following investigation of an outbreak.(((33)))(34) "PCR" means polymerase chain reaction.(((34)))(35) "Pesticide poisoning" means the disturbance of function, damage to structure, or illness in humans resulting from the inhalation, absorption, ingestion of, or contact with any pesticide.(((35)))(36) "Presumptive" means a preliminary test result that has not yet been confirmed as a definitive result.(((36)))(37) "Principal health care provider" means the attending health care provider recognized as primarily responsible for diagnosis or treatment of a patient, or in the absence of such, the health care provider initiating diagnostic testing or treatment for the patient.(((37)))(38) "Provisional condition" means a condition the department has requested be reported under WAC 246-101-015.(((38)))(39) "Public health authorities" includes local health jurisdictions, the department, the department of labor and industries, the department of agriculture, sovereign tribal nations, and tribal epidemiology centers.(((39)))(40) "Quarantine" means the limitation of freedom of movement of persons or domestic animals that have been exposed to, or are suspected to have been exposed to, an infectious agent:(a) For a period of time not longer than the longest usual incubation period of the infectious agent; and(b) In a way to prevent effective contact with those not exposed.(((40)))(41) "Rapid screening test" or "RST" means a U.S. Food and Drug Administration-approved or authorized test that provides same day results and is suitable for obtaining presumptive test results. RST includes point-of-care testing.(((41)))(42) "Reference laboratory" means a laboratory licensed inside or outside of Washington state that receives a specimen from another licensed laboratory and performs one or more tests on that specimen.(((42)))(43) "School" has the same meaning as in RCW 28A.210.070.(((43)))(44) "SARS" means severe acute respiratory syndrome.(((44)))(45) "SARS-CoV-2" means severe acute respiratory syndrome coronavirus 2, the virus that causes COVID-19.(46) "Secretary" means the secretary of the Washington state department of health.(((45)))(47) "Secure electronic data transmission" means electronic communication and accounts developed and maintained to prevent unauthorized access, loss, or compromise of sensitive information including, but not limited to, secure file transfer, secure email, secure facsimile, a health information exchange authorized under RCW 41.05.039, and secure electronic disease surveillance system.(((46)))(48) "Secure electronic disease surveillance system" means the secure electronic data transmission system maintained by the department and used by local health jurisdictions to submit notifications, investigation reports, and outbreak reports under this chapter.(((47)))(49) "Sexually transmitted disease" or "sexually transmitted infection" means a bacterial, viral, fungal, or parasitic disease or condition which is usually transmitted through sexual contact, including:(a) Acute pelvic inflammatory disease;(b) Chancroid;(c) Chlamydia trachomatis infection;(d) Genital and neonatal Herpes simplex;(e) Genital human papilloma virus infection;(f) Gonorrhea;(g) Granuloma inguinale;(h) Hepatitis B infection;(i) Human immunodeficiency virus (HIV) infection;(j) Lymphogranuloma venereum;(k) Nongonococcal urethritis (NGU); and(l) Syphilis.(((48)))(50) "Specimen" means material associated or suspected to be associated with a notifiable condition including, but not limited to, isolates, blood, serum, stool, urine, tissue, respiratory secretions, swab, other body fluid, or an environmental sample.(((49)))(51) "State health officer" means the person appointed by the secretary under RCW 43.70.020 to serve as statewide health officer, or, in the absence of such appointment, the secretary.(((50)))(52) "Veterinarian" means an individual licensed and practicing under provisions of chapter 18.92 RCW.(((51)))(53) "Zoonotic disease" means an infectious condition of animals that can cause disease when transmitted to humans.AMENDATORY SECTION(Amending WSR 21-11-040 and 22-01-175, filed 5/12/21 and 12/17/21, effective 1/1/23)WAC 246-101-101Notifiable conditions—Health care providers and health care facilities.(1) For the purposes of this section:(a) "Local health jurisdiction" means where the patient resides, or, in the event the patient's residence cannot be determined, the local health jurisdiction in which the patient received treatment.(b) "Unexplained critical illness or death" means a severe illness or death with infectious hallmarks, but no known etiology, in a previously healthy person one to ((forty-nine))49 years of age excluding those with chronic medical conditions such as malignancy, diabetes, AIDS, or cirrhosis.(2) The conditions identified in Table HC-1 are notifiable to public health authorities under this table and this chapter.Table HC-1 (Conditions Notifiable by Health Care Providers and Health Care Facilities)Notifiable Condition (Agent)Laboratory Confirmation Required Before Submitting Case ReportTime Frame for Notification from Identification of a CaseWho Must Be NotifiedWho Must Report: Health Care Providers (Providers) or Health Care Facilities (Facilities)Acquired immunodeficiency syndrome (AIDS) Within 3 business daysDOH (for facilities) and LHJ (for providers)BothAmebic meningitis ImmediatelyLHJBothAnaplasmosis Within 3 business daysLHJBothAnthrax (Bacillus anthracis and confirmed Bacillus cereus biovar anthracis only - Do not report all Bacillus cereus)YesImmediatelyLHJBothArboviral disease (acute disease only) including, but not limited to:     Chikungunya     Dengue     Eastern and western equine        encephalitis     Japanese encephalitis     La Crosse encephalitis     Powassan virus infection     St. Louis encephalitis     West Nile virus infection     Zika virus infectionSee also "Yellow fever" Within 3 business daysLHJBothAsthma, occupational Within 30 daysWashington state department of labor and industries (L&I)BothBabesiosis Within 3 business daysLHJBothBaylisascariasis Within 24 hoursLHJBothBirth defects - Abdominal wall defects (inclusive of gastroschisis and omphalocele) Within 30 daysDOHFacilitiesBirth defects - Autism spectrum disorders Within 30 daysDOHBothBirth defects - Cerebral palsy Within 30 daysDOHBothBirth defects - Down syndrome Within 30 daysDOHFacilitiesBirth defects - Alcohol related birth defects Within 30 daysDOHBothBirth defects - Hypospadias Within 30 daysDOHFacilitiesBirth defects - Limb reductions Within 30 daysDOHFacilitiesBirth defects - Neural tube defects (inclusive of anencephaly and spina bifida) Within 30 daysDOHFacilitiesBirth defects - Oral clefts (inclusive of cleft lip with/without cleft palate) Within 30 daysDOHFacilitiesBlood lead levelRST results(See WAC 246-101-200) Providers and facilities performing blood lead level RST shall report as a laboratory and comply with the requirements of WAC 246-101-201 through 246-101-230.Botulism, foodborne, infant, and wound ImmediatelyLHJBothBrucellosis Within 24 hoursLHJBothCampylobacteriosis Within 3 business daysLHJBothCancer (See chapter 246-102 WAC)    Candida auris infection or colonization Within 24 hoursLHJBothCarbapenem-resistant Enterobacteriaceae infections limited to:     Klebsiella species     E. coli     Enterobacter speciesYesWithin 3 business daysLHJBothChagas disease Within 3 business daysLHJBothChancroid Within 3 business daysLHJBothChlamydia trachomatis infectionYesWithin 3 business daysLHJBothCholera (Vibrio cholerae O1 or O139)YesImmediatelyLHJBothCoccidioidomycosis Within 3 business daysLHJBothCoronavirus infection (severe communicable infection only) including, but not limited to:     SARS-associated coronavirus     MERS-associated coronavirus     Novel coronavirus (((COVID-19)))Note: This does not include SARS-CoV-2 (COVID-19) (see below).YesImmediatelyLHJBoth((Coronavirus infection (severe communicable)     Novel coronavirus (COVID-19)RST results(See WAC 246-101-200) Providers and facilities performing Novel coronavirus (COVID-19) RST shall report as a laboratory and comply with the requirements of WAC 246-101-201 through 246-101-230.))SARS-CoV-2 (COVID-19) associated hospitalization (laboratory confirmed)YesWithin 3 business daysLHJBothSARS-CoV-2 (COVID-19) associated death (laboratory confirmed)YesWithin 3 business daysLHJBothCryptococcus gattii or undifferentiated Cryptococcus species (i.e., Cryptococcus not identified as C. neoformans)YesWithin 3 business daysLHJBothCryptosporidiosis Within 3 business daysLHJBothCyclosporiasis Within 3 business daysLHJBothCysticercosis Within 3 business daysLHJBothDiphtheria ImmediatelyLHJBothDomoic acid poisoning ImmediatelyLHJBothE. coli (See "Shiga toxin-producing E. coli")    Echinococcosis Within 3 business daysLHJBothEhrlichiosis Within 3 business daysLHJBothGiardiasis Within 3 business daysLHJBothGlanders (Burkholderia mallei)YesImmediatelyLHJBothGonorrhea Within 3 business daysLHJBothGranuloma inguinale Within 3 business daysLHJBothGunshot wounds (nonfatal) Within 30 daysDOHFacilitiesHaemophilus influenzae (invasive disease, children under 5 years of age)YesImmediatelyLHJBothHantaviral infection Within 24 hoursLHJBothHepatitis A (acute infection)YesWithin 24 hoursLHJBothHepatitis B (acute infection)YesWithin 24 hoursLHJBothHepatitis B, report pregnancy in hepatitis B virus infected patients (including carriers)YesWithin 3 business daysLHJBothHepatitis B (chronic infection) - Initial diagnosis, and previously unreported prevalent casesYesWithin 3 business daysLHJBothHepatitis B (perinatal) - Initial diagnosis, and previously unreported casesYesWithin 3 business daysLHJBothHepatitis C (acute infection)YesWithin 24 hoursLHJBothHepatitis C (acute infection)RST results(See WAC 246-101-200) Providers and facilities performing hepatitis C (acute infection) RST shall report as a laboratory and comply with the requirements of WAC 246-101-201 through 246-101-230.Hepatitis C (chronic infection)YesWithin 3 business daysLHJBothHepatitis C (perinatal) - Initial diagnosis, and previously unreported casesYesWithin 24 hoursLHJBothHepatitis C (chronic infection)RST results(See WAC 246-101-200) Providers and facilities performing hepatitis C (chronic infection) RST shall report as a laboratory and comply with the requirements of WAC 246-101-201 through 246-101-230.Hepatitis D (acute and chronic infection)YesWithin 24 hoursLHJBothHepatitis E (acute infection)YesWithin 24 hoursLHJBothHerpes simplex, neonatal and genital (initial infection only) Within 3 business daysLHJProvidersHistoplasmosis Within 3 business daysLHJBothHuman immunodeficiency virus (HIV) infection Within 3 business daysLHJBothHuman immunodeficiency virus (HIV) infectionRST results(See WAC 246-101-200) Providers and facilities performing HIV infection RST shall report as a laboratory and comply with the requirements of WAC 246-101-201 through 246-101-230.Human prion disease Within 3 business daysLHJBothHypersensitivity pneumonitis, occupational Within 30 daysL&IBothInfluenza, novel or unsubtypable strain ImmediatelyLHJBothInfluenza-associated death (laboratory confirmed)YesWithin 3 business daysLHJBothLegionellosis Within 24 hoursLHJBothLeptospirosis Within 24 hoursLHJBothListeriosis Within 24 hoursLHJBothLyme disease Within 3 business daysLHJBothLymphogranuloma venereum Within 3 business daysLHJBothMalaria Within 3 business daysLHJBothMeasles (rubeola) - Acute disease only ImmediatelyLHJBothMelioidosis (Burkholderia pseudomallei)YesImmediatelyLHJBothMeningococcal disease, invasive ImmediatelyLHJBothMonkeypox ImmediatelyLHJBothMumps, acute disease only Within 24 hoursLHJBothOutbreaks and suspected outbreaks ImmediatelyLHJBothParalytic shellfish poisoning ImmediatelyLHJBothPertussis Within 24 hoursLHJBothPesticide poisoning (hospitalized, fatal, or cluster) ImmediatelyDOHBothPesticide poisoning (all other) Within 3 business daysDOHBothPlague ImmediatelyLHJBothPoliomyelitis ImmediatelyLHJBothPregnancy in patient with hepatitis B virus See "Hepatitis B, report pregnancy in hepatitis B virus infected patients (including carriers)"Psittacosis Within 24 hoursLHJBothQ fever Within 24 hoursLHJBothRabies (suspect or laboratory confirmed human cases and laboratory confirmed animal cases)Yes for animal casesImmediatelyLHJBothRabies, suspected human exposure (suspected human rabies exposures due to a bite from or other exposure to an animal that is suspected of being infected with rabies) ImmediatelyLHJBothRelapsing fever (borreliosis) Within 3 business daysLHJBothRickettsia infection Within 3 business daysLHJBothRubella, acute disease only (including congenital rubella syndrome) ImmediatelyLHJBothSalmonellosis Within 24 hoursLHJBothSerious adverse reactions to immunizations Within 3 business daysLHJBothShiga toxin-producing E. coli (STEC) infections/enterohemorrhagic E. coli infectionsYesImmediatelyLHJBothShigellosis Within 24 hoursLHJBothSilicosis Within 30 daysL&IBothSmallpox ImmediatelyLHJBothSyphilis Within 3 business daysLHJBothTaeniasis Within 3 business daysLHJBothTetanus Within 3 business daysLHJBothTick paralysis Within 3 business daysLHJBothTrichinosis Within 3 business daysLHJBothTuberculosis disease (confirmed or highly suspicious, i.e., initiation of empiric treatment) Within 24 hoursLHJBothTularemia ImmediatelyLHJBothTyphus Within 3 business daysLHJBothVaccinia transmission ImmediatelyLHJBothVancomycin-resistant Staphylococcus aureus (not to include vancomycin-intermediate)YesWithin 24 hoursLHJBothVaricella-associated death Within 3 business daysLHJBothVibriosis (Vibrio species not including Vibrio cholerae O1 or O139)See Cholera (Vibrio cholerae O1 or O139)YesWithin 24 hoursLHJBothViral hemorrhagic fever ImmediatelyLHJBothYellow fever ImmediatelyLHJBothYersiniosis Within 24 hoursLHJBothUnexplained critical illness or death Within 24 hoursLHJBothAMENDATORY SECTION(Amending WSR 21-11-040 and 22-01-175, filed 5/12/21 and 12/17/21, effective 1/1/23)WAC 246-101-200Rapid screening testing.An individual or entity including, but not limited to, health care providers and health care facilities, that conduct an RST for any of the following conditions, meets the definition of a laboratory under this chapter, and shall comply with WAC 246-101-201 through 246-101-230:(1) Blood lead level testing;(2) Hepatitis C (acute infection);(3) Hepatitis C (chronic infection); or(4) HIV infection((; or(5) Novel coronavirus (COVID-19))).AMENDATORY SECTION(Amending WSR 21-11-040 and 22-01-175, filed 5/12/21 and 12/17/21, effective 1/1/23)WAC 246-101-201Notifiable conditions—Laboratories.(1) For the purposes of Table Lab-1:(a) "At least annually" means deidentified negative screening results may be submitted in a single report no less than once per year, but may be submitted more frequently as a single report or as individual screening results.(b) "Deidentified negative screening result" means an initial test result that indicates the absence of disease, and that has personally identifiable information removed from it using the Health Insurance Portability and Accountability Act of 1996 Safe Harbor method defined in 45 C.F.R. 164.514. A deidentified negative screening result does not include a negative test result associated with a previous positive test result, such as a negative nucleic acid or viral load test that is performed after a positive antibody or antigen test.(c) "LHJ" means where the patient resides, or, in the event that patient residence cannot be determined, the local health jurisdiction in which the ordering health care provider practices, or the local health jurisdiction in which the laboratory operates.(d) "Within two business days" means specimens must be in transit to the Washington state public health laboratories within two business days of:(i) Completing a test and the specimen being ready for packaging; or(ii) Receiving a request from a local health jurisdiction or the department, provided the specimen is still available at the time of the request.(2) This chapter does not require a laboratory to:(a) Test for agents (conditions) or speciate if the laboratory does not perform the test as part of its normal work. A laboratory director shall only report a condition if it is identified as part of their normal testing protocols; or(b) Retain specimens indefinitely in anticipation of a request from a local health jurisdiction or the department.(3) The agents (conditions) in Table Lab-1 are notifiable by a laboratory director as indicated in Table Lab-1 and this chapter.Table Lab-1 (Conditions Notifiable by Laboratory Directors)Agent (Condition)Notification of ResultsSpecimen Submission to the Washington State Public Health LaboratoriesWhat to Submit in a Laboratory ReportWhen and Whom to Notify Upon Receiving Presumptive or Final Test ResultWhat to SubmitWhen to SubmitAmebic meningitisPositive result by any methodImmediately to LHJSpecimen associated with positive result, if availableWithin 2 business daysAnaplasma species (Anaplasmosis)Positive result by any methodWithin 2 business days to LHJSpecimen associated with positive result, if availableWithin 2 business days of request by LHJ or DOHBabesia species (Babesiosis)Positive result by any methodWithin 2 business days to LHJSpecimen associated with positive result, if availableWithin 2 business days of request by LHJ or DOHBacillus anthracis (Anthrax)Positive result by any methodImmediately to LHJPresumptive positive isolateWithin 2 business days   If no isolate available, specimen associated with presumptive positive result Bacillus cereus, biovar anthracis onlyConfirmed positive result by any methodImmediately to LHJDo not ship specimenDo not ship specimenBaylisascaris (Baylisascariasis)Positive result by any methodWithin 24 hours to LHJSpecimen associated with positive result, if availableWithin 2 business daysBlood lead levelResults equal to or greater than 5 micrograms per deciliter for:  RST  VenousWithin 2 business days to DOHN/AN/AResults less than 5 micrograms per deciliter for:  RST  VenousWithin 30 days to DOHBordetella pertussis (Pertussis)Positive results by:  Culture or  Nucleic acid detection ((nucleic acid testing (NAT)) or (nucleic acid amplification testing (NAAT))Within 24 hours to LHJIsolateWithin 2 business daysIf no isolate available, specimen associated with positive resultWithin 2 business days of request by LHJ or DOHBorrelia burgdorferi or Borrelia mayonii (Lyme disease)Positive result by any methodWithin 2 business days to LHJSpecimen associated with positive resultWithin 2 business days of request by LHJ or DOHBorrelia hermsii, parkeri, turicatae, miyamotoi, or recurrentis (Relapsing fever, tick- or louse-borne)Positive result by any methodWithin 2 business days to LHJSpecimen associated with positive resultWithin 2 business days of request by LHJ or DOHBrucella species (Brucellosis)Positive result by any method excluding Immunoglobulin G (IgG)Within 24 hours to LHJIsolate, excluding confirmed positive B. melitensis, B. abortus, or B. suisWithin 2 business days   If no isolate available, specimen associated with positive result Burkholderia mallei (Glanders)Positive result by any method excluding IgGImmediately to LHJPresumptive positive isolateWithin 2 business days   If no isolate available, specimen associated with presumptive positive result Burkholderia pseudomallei (Melioidosis)Positive result by any method excluding IgGImmediately to LHJPresumptive positive isolateWithin 2 business days   If no isolate available, specimen associated with presumptive positive result California serogroup viruses, acute (Arbovirus)Positive result by any method excluding IgGWithin 2 business days to LHJSpecimen associated with positive resultWithin 2 business days of request by LHJ or DOHCampylobacter species (Campylobacteriosis)Positive result by:  Culture,  Nucleic acid detection (NAT or NAAT), or  Antigen detectionWithin 2 business days to LHJIsolateWithin 2 business days of request by LHJ or DOH  If no isolate available, specimen associated with positive result Candida aurisPositive result by any methodWithin 24 hours to LHJIsolateWithin 2 business days   If no isolate available, specimen associated with positive result Carbapenem-resistant Enterobacteriaceae:  Klebsiella species  E. coli  Enterobacter speciesPositive for known carbapenemase resistance gene (including, but not limited to, KPC, NDM, VIM, IMP, OXA-48) demonstrated by nucleic acid detection (NAT or NAAT), or whole genome sequencingPositive on a phenotypic test for carbapenemase production including, but not limited to, Metallo-B-lactamase test, modified Hodge test (MHT) (for E. coli and Klebsiella species only), CarbaNP, Carbapenem Inactivation Method (CIM) or modified CIM (mCIM)Resistant to any carbapenem including, but not limited to, doripenem, ertapenem, imipenem or meropenemWithin 2 business days to LHJIsolateIf no isolate available, specimen associated with positive resultWithin 2 business daysCD4 + counts1, or CD4 + percents2, or both(patients aged thirteen or older)All resultsWithin 30 days to DOH except in King County where this is notifiable to the LHJN/AN/AChikungunya virus, acute (Arbovirus)Positive result by any method excluding Immunoglobulin G (IgG)Within 2 business days to LHJSpecimen associated with positive resultWithin 2 business days of request by LHJ or DOHChlamydia psittaci (Psittacosis)Positive result by any method excluding IgGWithin 24 hours to LHJSpecimen associated with positive resultWithin 2 business days of request by LHJ or DOHChlamydia trachomatisPositive and indeterminate result by any methodWithin 2 business days to LHJN/AN/AChlamydia trachomatisDeidentified negative screening resultAt least annually to DOHN/AN/AClostridium botulinum (Botulism)Positive result by any methodImmediately to LHJPresumptive positive isolateWithin 2 business days   If no isolate available, specimen associated with presumptive positive result Coccidioides(Coccidioidomycosis)Positive result by any methodWithin 2 business days to LHJIsolateWithin 2 business daysIf no isolate available, specimen associated with positive resultWithin 2 business days of request by LHJ or DOHCoronavirus including, but not limited to:  SARS-associated coronavirus  MERS-associated coronavirusPositive result by any methodImmediately to LHJ((Presumptive positive))IsolateWithin 2 business days of request by LHJ or DOH  Novel coronavirus (((SARS-CoV-2)))Note: This does not include SARS-CoV-2 (COVID-19) (see below).If no isolate available, specimen associated with presumptive positive resultWithin 2 business days of request by LHJ or DOHSARS-CoV-2 (COVID-19)Positive result by any methodWithin 2 business days of DOHIsolateWithin 2 business days of request by LHJ or DOHIf no isolate available, specimen associated with positive resultWithin 2 business days of request by LHJ or DOHCorynebacterium diphtheriae (Diphtheria)Positive result by:  Culture or  Nucleic acid detection (NAT or NAAT)Immediately to LHJIsolateWithin 2 business daysIf no isolate available, specimen associated with positive resultWithin 2 business days of request by LHJ or DOHCoxiella burnetii(Q fever)Positive result by any methodWithin 24 hours LHJSpecimen associated with presumptive positive resultWithin 2 business daysCrimean-Congo hemorrhagic fever virus (Viral hemorrhagic fever)Positive result by any methodImmediately to LHJPresumptive positive isolateIf no isolate available, specimen associated with presumptive positive resultWithin 2 business daysCryptococcus gattii or undifferentiated Cryptococcus species (i.e., Cryptococcus not identified as C. neoformans)Positive results by any method excluding cryptococcal antigenWithin 2 business days to LHJIsolateIf no isolate available, specimen associated with positive result (excluding serum)Within 2 business daysSerumWithin 2 business days of request by LHJ or DOHCryptosporidium (Cryptosporidiosis)Positive result by any methodWithin 2 business days to LHJSpecimen associated with positive resultWithin 2 business days of request by LHJ or DOHCyclospora cayetanensis (Cyclosporiasis)Positive result by any methodWithin 2 business days to LHJSpecimen associated with positive resultWithin 2 business days of request by LHJ or DOHDengue virus, acute (Arbovirus)Positive result by any method excluding IgGWithin 2 business days to LHJSpecimen associated with positive resultWithin 2 business days of request by LHJ or DOHE. coli - Refer to "Shiga toxin-producing E. coli"    Eastern and western equine encephalitis virus, acute (Arbovirus)Positive result by any method excluding IgGWithin 2 business days to LHJSpecimen associated with positive result excluding specimens from viral cultureWithin 2 business days of request by LHJ or DOHEbola virus (Viral hemorrhagic fever)Positive result by any methodImmediately to LHJPresumptive positive specimenWithin 2 business daysEchinococcus granulosus or E. multilocularis (Echinococcosis)Positive result by any methodWithin 2 business days to LHJSpecimen associated with positive resultWithin 2 business days of request by LHJ or DOHEhrlichia species(Ehrlichiosis)Positive result by any methodWithin 2 business days to LHJSpecimen associated with positive resultWithin 2 business days of request by LHJ or DOHFrancisella tularensis (Tularemia)Positive result by any methodImmediately to LHJPresumptive positive isolateWithin 2 business days   If no isolate available, specimen associated with presumptive positive result Giardia duodenalis, G. lamblia, G. intestinalis (Giardiasis)Positive result by any methodWithin 2 business days to LHJSpecimen associated with positive resultWithin 2 business days of request by LHJ or DOHGuanarito virus (Viral hemorrhagic fever)Positive result by any methodImmediately to LHJPresumptive positive isolateWithin 2 business days   If no isolate available, specimen associated with presumptive positive result Haemophilus influenzae(children < 5 years of age)Positive result for specimen from a normally sterile site by:  Culture or  Nucleic acid detection (NAT or NAAT)Immediately to LHJIsolateIf no isolate available, specimen associated with positive resultWithin 2 business daysHantavirus including, but not limited to:  Andes virus  Bayou virus  Black Creek Canal virus  Dobrava-Belgrade virus  Hantaan virus  Seoul virus  Sin nombre virusPositive result by any methodWithin 24 hours to LHJSpecimen associated with positive resultWithin 2 business daysHepatitis A virusPositive results for:  IgM or  Nucleic acid detection (NAT or NAAT)Hepatocellular enzyme levels to accompany report, if available, for positive IgM resultsWithin 24 hours to LHJSpecimen associated with positive resultWithin 2 business days of request by LHJ or DOHHepatitis B virusPositive results for:  IgM anti-HBc,  HBsAg,  HBeAg, or  HBV Nucleic acid detection (NAT or NAAT) either qualitative or quantitative, for example PCR or genotypingIf associated with a positive result listed above, and available:  Hepatocellular enzyme levels,  Pregnancy status, and  Negative IgM anti-HBc resultWithin 24 hours to LHJSpecimen associated with positive resultWithin 2 business days of request by LHJ or DOHHepatitis C virusPositive result by any methodPositive and nonpositive results for:  HCV nucleic acid detection (NAT or NAAT) for qualitative, quantitative, and genotype testsIf associated with a positive result and available:  Hepatocellular enzyme levels, Pregnancy status,  Negative result for IgM anti-HAV, and  Negative result for IgM anti-HBcWithin 2 business days to LHJSpecimen associated with positive resultWithin 2 business days of request by LHJ or DOHHepatitis C virusDeidentified negative screening resultAt least annually to DOHN/AN/AHepatitis D virusPositive result by any methodIf associated with a positive result and available:  Hepatocellular enzyme levelsWithin 24 hours to LHJSpecimen associated with positive resultWithin 2 business days of request by LHJ or DOHHepatitis E virusPositive result by any methodIf associated with a positive result and available:  Hepatocellular enzyme levelsWithin 24 hours to LHJSpecimen associated with positive resultWithin 2 business days of request by LHJ or DOHHistoplasma capsulatum (histoplasmosis)Positive result by any methodWithin 2 business days to LHJIsolateWithin 2 business daysSerumWithin 2 business days of request by LHJ or DOHHuman immunodeficiency virus (HIV)Positive and indeterminate results and subsequent negative results associated with those positive or indeterminate results for the tests below:  Antibody detection tests (including RST),  Antigen detection tests (including RST), or  Viral cultureAll HIV nucleic acid detection (NAT or NAAT) tests:  Qualitative and quantitative  Detectable and undetectableHIV antiviral resistance testing genetic sequencesWithin 2 business days to DOH except in King County where this is notifiable to the LHJN/AN/A    Human immunodeficiency virus (HIV)Deidentified negative screening resultAt least annually to DOHN/AN/AHuman prion diseasePositive result by any method excluding Tau proteinWithin 2 business days to LHJSpecimen associated with positive resultWithin 2 business days of request by LHJ or DOHInfluenza virus, novel or unsubtypable strainPositive novel and unsubtypable resultImmediately to LHJIsolateIf no isolate available, specimen associated with positive resultWithin 2 business daysJapanese encephalitis virus, acute (Arbovirus)Positive result by any method excluding IgGWithin 2 business days to LHJSpecimen associated with positive resultWithin 2 business days of request by LHJ or DOHJunin virus (Viral hemorrhagic fever)Positive result by any methodImmediately to LHJPresumptive positive isolateIf no isolate available, specimen associated with presumptive positive resultWithin 2 business daysLa Crosse encephalitis virus, acute (Arbovirus)Positive result by any method excluding IgGWithin 2 business days to LHJSpecimen associated with positive resultWithin 2 business days of request by LHJ or DOHLassa virus (Viral hemorrhagic fever)Positive result by any methodImmediately to LHJPresumptive positive isolateIf no isolate available, specimen associated with presumptive positive resultWithin 2 business daysLegionella species (Legionellosis)Positive result by any methodWithin 24 hours to LHJIsolateIf no isolate available but respiratory specimen available and associated with a positive test (as in the case of a PCR positive), respiratory specimen associated with positive resultWithin 2 business daysLeptospira species (Leptospirosis)Positive result by any methodWithin 24 hours to LHJIsolateIf no isolate available, specimen associated with positive resultWithin 2 business days of request by LHJ or DOHListeria monocytogenes(Listeriosis)Positive result for specimen from a normally sterile site by:  Culture or  Nucleic acid detection (NAT or NAAT)Within 24 hours to LHJIsolateIf no isolate available, specimen associated with positive resultWithin 2 business daysLujo virus (Viral hemorrhagic fever)Positive result by any methodImmediately to LHJPresumptive positive isolateIf no isolate available, specimen associated with presumptive positive resultWithin 2 business daysMachupo virus (Viral hemorrhagic fever)Positive result by any methodImmediately to LHJPresumptive positive isolateIf no isolate available, specimen associated with presumptive positive resultWithin 2 business daysMarburg virus (Viral hemorrhagic fever)Positive result by any methodImmediately to LHJPresumptive positive isolateIf no isolate available, specimen associated with presumptive positive resultWithin 2 business daysMeasles virus - See "Rubeola (measles virus)"    Mumps virusPositive result for:  Culture,  Nucleic acid detection (NAT or NAAT), or  IgMWithin 24 hours to LHJIsolateIf no isolate available, specimen associated with positive resultWithin 2 business daysSpecimen associated with positive IgMWithin 2 business days of request by LHJ or DOHMycobacterium tuberculosis complex(Tuberculosis)Positive result for:  Culture  Nucleic acid detection (NAT or NAAT)  Drug susceptibilities (molecular and culture based)Within 2 business days to DOHMycobacterium tuberculosis complex positive isolate (earliest available isolate for the patient)Within 2 business daysNeisseria gonorrhoeae (Gonorrhea)Positive and indeterminate result by any methodWithin 2 business days to LHJN/AN/ANeisseria gonorrhoeae (Gonorrhea)Deidentified negative screening resultAt least annually to DOHN/AN/ANeisseria meningitidis (Meningococcal disease)Positive result for specimen from a normally sterile site by any methodImmediately to LHJIsolate from a normally sterile siteWithin 2 business daysIf no isolate available, specimen associated with positive resultWithin 2 business days of request by LHJ or DOHPlasmodium species (Malaria)Positive results for:  Nucleic acid detection (NAT or NAAT),  Malaria-specific antigens by rapid diagnostic test,  PCR, or  Microscopy (thick or thin smear)Within 2 business days to LHJSpecimen associated with positive resultWithin 2 business days of request by LHJ or DOHPoliovirus (Poliomyelitis)IgM positivity; PCR positivityImmediately to LHJIsolateIf no isolate available, specimen associated with positive resultWithin 2 business daysPowassan virus, acute (Arbovirus)Positive result by any method excluding IgGWithin 2 business days to LHJSpecimen associated with positive resultWithin 2 business days of request by LHJ or DOHRabies virusPositive result by any methodImmediately to LHJSpecimen associated with positive resultWithin 2 business daysRickettsia species including, but not limited to:  Rickettsia rickettsii  Rickettsia africae  Rickettsia conorii  Rickettsia typhi  Rickettsia parkeri  Rickettsia philipiiPositive results by any methodWithin 2 business days to LHJSpecimen associated with positive resultWithin 2 business days of request by LHJ or DOHRubellaPositive result by:  Culture,  IgM, or  Nucleic acid detection (NAT or NAAT)Immediately to LHJIsolateIf no isolate available, specimen associated with positive resultWithin 2 business daysOther specimenWithin 2 business days of request by LHJ or DOHRubeola (measles virus)Positive result by:  Culture,  IgM, or  Nucleic acid detection (NAT or NAAT)Immediately to LHJIsolate and specimen associated with positive cultureIsolate and specimen association with positive NAT or NAAT resultWithin 2 business daysSpecimen associated with positive IgMOther specimenWithin 2 business days of request by LHJ or DOHSabia virus (Viral hemorrhagic fever)Positive result by any methodImmediately to LHJPresumptive positive isolateIf no isolate available, specimen associated with presumptive positive resultWithin 2 business daysSalmonella species (Salmonellosis, typhoid fever)Positive result by any methodWithin 24 hours to LHJIsolateIf no isolate available, specimen associated with positive resultWithin 2 business daysShiga toxin-producing E. coli/enterohemorrhagic E. coli (STEC)Positive result by any methodImmediately to LHJIsolateIf no isolate available, specimen associated with positive resultWithin 2 business daysShigella species (Shigellosis)Positive result by any methodWithin 24 hours to LHJIsolateIf no isolate available, specimen associated with positive resultWithin 2 business daysSt. Louis encephalitis virus, acute (Arbovirus)Positive result by any method excluding IgGWithin 2 business days to LHJSpecimen associated with positive resultWithin 2 business days of request by LHJ or DOHTaenia solium (Taeniasis or Cysticercosis)Positive result by any methodWithin 2 business days to LHJSpecimen associated with positive resultWithin 2 business days of request by LHJ or DOHTreponema pallidum (Syphilis)Positive and indeterminate result by any methodWithin 2 business days to LHJSpecimen associated with positive resultWithin 2 business daysTreponema pallidum (Syphilis)Deidentified negative screening resultAt least annually to DOHN/AN/ATrichinella species (Trichinellosis)Positive serologic test for  TrichinellaWithin 2 business days to LHJSpecimen associated with positive resultWithin 2 business days of request by LHJ or DOHTrypanosoma cruzi (Chagas disease)Positive result by any methodWithin 2 business days to LHJSpecimen associated with positive resultWithin 2 business daysVacciniaAny request for testing associated with a suspect caseImmediately to LHJAny specimen collected from a suspect caseImmediatelyVancomycin-resistant Staphylococcus aureusResistance to vancomycinWithin 24 hours to LHJIsolateIf no isolate available, specimen associated with positive resultWithin 2 business daysVariola virus (smallpox)Any request for testing associated with a suspect caseImmediately to LHJSpecimen collected from a suspect caseImmediatelyVibrio cholerae O1 or O139 (Cholera)Positive result by any methodImmediately to LHJIsolateIf no isolate available, specimen associated with positive resultWithin 2 business daysVibrio species (Vibriosis) not including Vibrio cholerae O1 or O139 (Cholera)See "Vibrio cholerae O1 or O139 (Cholera)"Positive result by any methodWithin 24 hours to LHJIsolateIf no isolate available, specimen associated with positive resultWithin 2 business daysWest Nile virus, acute (Arbovirus)Positive result by any method excluding IgGWithin 2 business days to LHJSpecimen associated with positive resultWithin 2 business days of request by LHJ or DOHYellow fever virus (Arbovirus)Positive result by any method excluding IgGImmediately to LHJSpecimen associated with positive resultWithin 2 business daysYersinia enterocolitica, Y. pseudotuberculosis, Y. intermedia, Y. fredericksenii, or Y. kristensenii (Yersiniosis)Positive result by any methodWithin 24 hours to LHJIsolateIf no isolate available, specimen associated with positive resultWithin 2 business days of request by LHJ or DOHYersinia pestis (Plague)Positive result by any methodImmediately to LHJPresumptive positive isolateIf no isolate available, specimen associated with presumptive positive resultWithin 2 business daysZika virus, acute (Arbovirus)Positive result by any method excluding IgGWithin 2 business days to LHJSpecimen associated with positive resultWithin 2 business days of request by LHJ or DOH1"CD4 + counts" means CD4 + (T4) lymphocyte counts.2"CD4 + percents" means CD4 + (T4) percents of total lymphocytes.AMENDATORY SECTION(Amending WSR 21-11-040 and 22-01-175, filed 5/12/21 and 12/17/21, effective 1/1/23)WAC 246-101-805Duties—Department of agriculture.(1) For the purposes of this section, "new, emerging, or unusual animal diseases or disease clusters with potential public health significance" means zoonotic or potentially zoonotic diseases in animals that have never or rarely been observed in Washington state (new or emerging); or appear in a new species or show evidence of higher pathogenicity than expected (unusual); or appear in a higher than expected number of animals clustered in time or space (cluster).(2) The department of agriculture shall:(a) Submit an individual animal case report for each animal case of a condition identified in Table Agriculture-1 to the department immediately upon being notified of the animal case using secure electronic data transmission under this table and this chapter.(b) Call the department and confirm receipt immediately after submitting an animal case report for the following conditions:(i) Anthrax (Bacillus anthracis or Bacillus cereus biovar anthracis);(ii) Coronavirus infection (SARS-associated coronavirus, MERS-associated coronavirus, and Novel coronavirus (((COVID-19))));(iii) Influenza virus in swine, influenza H5 and H7 (avian);(iv) Livestock exposed to toxic substances which may threaten public health;(v) Plague (Yersinia pestis);(vi) Rabies (suspected human or animal);(vii) Transmissible Spongiform Encephalopathy; and(viii) Tularemia (Francisella tularensis).Table Agriculture-1 (Conditions Notifiable by the Department of Agriculture)Notifiable Condition (Agent)Anthrax (Bacillus anthracisor B. cereus biovar anthracis)Arboviral Diseases California serogroup Chikungunya Dengue Eastern equine encephalitis Japanese encephalitis La Crosse encephalitis Powassan St. Louis encephalitis Western equine encephalitis West Nile virus ZikaBrucellosis (Brucella species)Coccidioidomycosis (Coccidioides species)Coronavirus infection SARS-associated coronavirus MERS-associated coronavirus SARS-CoV-2-associated coronavirus Novel coronavirus (((COVID-19)))Cryptococcus gattii or undifferentiated Cryptococcus species (i.e., Cryptococcus not identified as C. neoformans)Cysticercosis (Taenia solium)Echinococcosis (Echinococcus species)Ehrlichiosis (Ehrlichia species)Glanders (Burkholderia mallei)Influenza virus in swine, influenza H5 and H7 (avian)Leptospirosis (Leptospira species)Livestock exposed to toxic substances which may threaten public healthPsittacosis (Chlamydia psittaci)Plague (Yersinia pestis)Q Fever (Coxiella burnettii)Rabies (suspected human or animal)Shiga toxin-producing E. coli infections/enterohemorrhagic E. coli infectionsTransmissible Spongiform EncephalopathyTrichinosis (Trichinella spiralis)TuberculosisTularemia (Francisella tularensis)Vancomycin-resistant (Staphylococcus aureus)Zoonotic Viral Hemorrhagic FeverNew, emerging, or unusual animal diseases or disease clusters with potential public health significance.(3) The department of agriculture may provide additional health information, demographic information, or infectious or noninfectious condition information than is required under this chapter to the department, local health jurisdiction, or both when it determines that the additional information will aid the public health authority in protecting and improving the public's health through prevention and control of infectious and noninfectious conditions.(4) When the department of agriculture submits information under subsection (3) of this section, they shall submit the information using secure electronic data transmission.(5) The department shall:(a) Consult with the department of agriculture on all animal cases; and(b) Notify the local health jurisdiction of animal cases submitted to the department.