A state administrative rule states that isolation or quarantine orders for diseases or conditions “for which control measures have been established shall require compliance with applicable control measures and shall state penalties for failure to comply. These isolation and quarantine orders may be no more restrictive than the applicable control measures.” 10A N.C.A.C. 41A .0201(d) (emphasis added). All persons are required to comply with communicable disease control measures regardless of whether an isolation or quarantine order has been issued, G.S. 130A-144(f), and failure to comply may result in a misdemeanor charge, G.S. 130A-25. However, an isolation or quarantine order directing a person to comply with control measures is typically issued (if practicable) before enforcement proceedings are initiated. Since more restrictive control measures than the established measures may not be included in such an order, it seems reasonable to conclude additional control measures may not be required. However, public health officials may request voluntary compliance with additional, appropriate control measures.

The rule is unclear about what constitutes an “established” control measure. The term seems clearly to include control measures that the Commission for Public Health has adopted as rules. The Commission has adopted rules establishing the control measures for HIV, hepatitis B, sexually transmitted diseases, tuberculosis, smallpox/vaccinia disease, SARS, and hepatitis C. The control measures for other diseases and conditions are derived from other sources—primarily the guidelines and recommendations of the Centers for Disease Control and Prevention (CDC), or in the absence of CDC materials, the American Public Health Association’s Control of Communicable Diseases Manual. Public health officials are also authorized to devise control measures that follow several general principles that are set out in 10A N.C.A.C. 41A. 0201(b). Those principles are:

• Control measures must be reasonably expected to decrease the risk of transmission and be consistent with recent scientific and public health information.
• Control measures for diseases/conditions transmitted by the airborne route must require physical isolation for the duration of infectivity.
• Control measures for diseases/conditions transmitted by the fecal-oral route must require exclusion from situations in which transmission can reasonably be expected to occur, such as food-handling work, for the duration of infectivity.
• Control measures for diseases/conditions transmitted by sexual or bloodborne routes must include prohibitions on donating blood or tissue, needle-sharing, and sexual contact in a manner likely to result in transmission for the duration of infectivity.

It is unclear when control measures derived from other sources or devised in accordance with the above principles are “established” for purposes of determining what may be included in an isolation or quarantine order. In practice, it is probably wise to consider the “established” control measures to be those that appear in the state communicable disease control manuals, or any that are issued by the state Division of Public Health in the course of responding to an outbreak or emerging illness.

Posted on October 26, 2014

Yes. A local health director has the duty to ensure that control measures are given for both reportable communicable diseases and “any other communicable disease or communicable condition that represents a significant threat to the public health.” G.S. 130A-144(e). While giving the control measures is the local health director’s duty, if there is a communicable disease or condition representing a significant threat to the public health in North Carolina, it is likely that the state Division of Public Health will be involved in devising and disseminating the control measures.

Yes. G.S. 130A-144(f) states: “All persons shall comply with control measures, including submission to examinations and tests, prescribed by the Commission [for Public Health,]” subject to some limitations related to HIV testing. Failure to comply with control measures is a misdemeanor and is punishable by a sentence of up to two years. G.S. 130A-25.