6 Colo. Code Regs. § 1009-1, app 6 CCR 1009-1-A

Current through Register Vol. 47, No. 24, December 25, 2024

Appendix 6 CCR 1009-1-A - [Effective 1/14/2025] Reportable Diseases, Conditions, and Related Events Table

Disease/Event	Pathogen/Organism	Time*	Reporter1	Specimen Source(s)2	Send Clinical Material3
Acinetobacter baumannii, carbapenem-resistant (CRAB)4	Carbapenem-resistant Acinetobacter baumannii (species in the A.baumannii complex, e.g., A. baumanii, A. calcoaceticus, A. lactucae, A. nosocomialis, A. pittii, A. seifertii, etc.)	4 days	L	All	Required
Acute flaccid myelitis		4 days	P		Upon request
Amebae, free-living	Acanthamoeba spp. (excluding keratitis), Balamuthia mandrillaris, Naegleria fowleri	4 days	L & P	All	Required
Animal bites and exposures 5,6 Bites: by dogs, cats, bats, skunks, foxes, raccoons, coyotes, or other wild carnivores Exposures: any bat exposure		24 hrs	P		Not applicable
Animal bites by mammals not listed above5		4 days	P		Not applicable
Anthrax5	Bacillus anthracis	Immed	L & P	All	Required
Arboviral Disease	Eastern equine encephalitis, Japanese encephalitis, LaCrosse encephalitis virus, California encephalitis serogroup, Powassan virus, St. Louis encephalitis virus and Western equine encephalitis virus	4 days	L	All	Upon request
Bioterrorism agent or incident, known or suspected	Any pathogen	Immed	L & P	All	Required
Blastomycosis	Blastomyces species	4 days	L & P	All	Upon request
Botulism5	Clostridium botulinum	Immed	L & P	All	Upon request
Brucellosis5	Brucella species	4 days	L & P	All	Required
Campylobacteriosis	Campylobacter species	4 days	L & P	All	Upon request
Candida auris7	Candida auris	1 working day	L & P	All	Required
Candidemia8-Metro	Candida species	30 days	L	Blood	Upon request
Carbapenemase-producing organisms9	Positive phenotypic test for carbapenemase production or detection of a carbapenemase gene	1 working day	L	All	Required
Chagas disease	Trypanosoma cruzi	4 days	L & P	All	Upon request
Chancroid	Haemophilus ducreyi	4 days	L & P	All	Upon request
Chikungunya	Chikungunya virus	4 days	L	All	Upon request
Chlamydia, any site	Chlamydia trachomatis	4 days	L & P	All	Upon request
Cholera5	Vibrio cholerae	Immed	L & P	All	Required
Creutzfeld-Jakob Disease (CJD) and other transmissible spongiform encephalopathies (TSEs)5		4 days	P	All	Upon request
Clostridioides difficile8-Metro 10	Clostridioides difficile	30 days	L	All	Upon request
Coccidioidomycosis	Coccidioides species	4 days	L & P	All	Upon request
Colorado tick fever	Colorado tick fever virus	4 days	L	All	Upon request
COVID-1911	* SARS-CoV-2 (positive molecular and rapid antigen tests) * Lineage or sequencing results	4 days	L (ELR only)	All	Upon request
COVID-19-associated deaths, all ages	SARS-CoV-2	4 days	P		Upon request
COVID-19-associated hospitalization	SARS-CoV-2	4 days	L & P	All	Upon request
Coronavirus - severe or novel	Severe Acute Respiratory Syndrome coronavirus (SARS-CoV), Middle East Respiratory Syndrome coronavirus, (MERS-CoV) or other severe or novel coronavirus other than SARS-CoV-2	Immed	L & P	All	Upon request
Cronobacter invasive infections if <1 year of age	Cronobacter species (including C. sakazakii, C. malonaticus)	4 days	L & P	All	Required
Cryptosporidiosis	Cryptosporidium species	4 days	L & P	All	Upon request
Cyclosporiasis	Cyclospora species	4 days	L & P	All	Upon request
Congenital cytomegalovirus (CMV) if <1 year of age	Cytomegalovirus (positive results)	4 days	L & P	All	Upon request
Congenital cytomegalovirus (CMV) if <1 year of age	CMV DNA by NAAT or culture (negative results)	4 days	L (ELR only)	Urine	Upon request
Dengue	Dengue virus	4 days	L	All	Upon request
Diphtheria5	Corynebacterium diphtheriae	Immed	L & P	All	Required
Encephalitis5		4 days	P	All	Upon request
Enterobacterales, carbapenem-resistant (CRE)12	Carbapenem-resistant Enterobacterales including, but not limited to, Escherichia species, Klebsiella species, Enterobacter species Citrobacterspecies, Serratia species, Raoultella species, Providencia species, Proteus species, Morganella species	4 days	L	All	Required
Enterobacterales, extended-spectrum beta-lactamase (ESBL)8-Boulder,13	Escherichia species, Klebsiella species. Raoultella species	30 days	L	All	Upon request
Escherichia species, coli invasive infections8-Boulder	Escherichia species	30 days	L	Sterile only	Upon request
Escherichia coli O157:H7 and Shiga toxin-producing Escherichia coli	Shiga toxin-producing Escherichia coli14	4 days	L & P	All	Required
Giardiasis	Giardia lamblia	4 days	L & P	All	Upon request
Glanders	Burkholderia mallei	1 working day	L & P	All	Upon request
Gonorrhea, any site, including disseminated gonorrhea	Neisseria gonorrhoeae	4 days	L & P	All	Upon request
Group A streptococci15,8-Metro	Streptococcus pyogenes	4 days	L	Sterile only	Required
Group B streptococci8-Metro	Streptococcus agalactiae	30 days	L	Sterile only	Required
Haemophilus influenza	Haemophilus influenzae	1 working day	L & P	Sterile only	Required
Hantavirus disease5	Hantavirus	4 days	L & P	All	Upon request
Healthcare-associated infections16		30 days	P		Not applicable
Hemolytic uremic syndrome if <18 years of age5		4 days	P		Upon request
Hepatitis A5	* Hepatitis A virus (+IgM anti-HAV, +PCR or +NAAT) * Liver function test values for AST, ALT, and total bilirubin that were performed at or closest to the time of the positive hepatitis A result	1 working day	L & P	All	Upon request
Hepatitis B	* Hepatitis B virus (+HBsAg, +IgM anti-HBc, +HBeAg, or +HBV DNA) * Liver function test values for AST, ALT, and total bilirubin that were performed at or closest to the time of the positive hepatitis B result	4 days	L & P	All	Upon request
Hepatitis B	Hepatitis B virus (negative HBsAg, negative HBV DNA, and/or negative confirmatory assays)	4 days	L (ELR only)	All	Upon request
Hepatitis B in children <3 years of age	HBsAg and anti-HBs positive, negative, and inconclusive lab results	4 days	L	All	Upon request
Hepatitis C17	* Hepatitis C virus (+ serum antibody titer and/or + confirmatory assays) * Liver function test values for AST, ALT, and total bilirubin that were performed at or closest to the time of the positive hepatitis C result	4 days	L & P	All	Upon request
Hepatitis C17	Hepatitis C virus (negative HCV antibody, negative confirmatory assays)	4 days	L (ELR only)	All	Upon request
Hepatitis D	Hepatitis D virus (+anti-HDV IgM, +anti-HDV total, +HDAg, +HDV DNA, or +HDV RNA)	4 days	L & P	All	Upon request
Hepatitis, other viral	* Positive results * Liver function test values for AST, ALT, and total bilirubin	4 days	P		Upon request
Histoplasmosis	Histoplasma species	4 days	L & P	All	Upon request
Human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS)	* Human immunodeficiency virus * CD4 counts (any value) * HIV viral load (any value) * HIV genotype	4 days	* L & P * L & P * L & P * L	All	Upon request
Influenza11	* Influenza virus (positive molecular and rapid antigen tests) * Lineage or sequencing results	4 days	L (ELR only)	All	Upon request
Influenza-associated death if <18 years of age	Influenza virus	4 days	P	All	Upon request
Influenza-associated hospitalization	Influenza virus	4 days	L & P	All	Upon request
Influenza - novel	Influenza virus	Immed	L & P	All	Upon request
Legionellosis18	Legionella species	4 days	L & P	All	Required for all respiratory specimens
Leprosy (Hansen's Disease)	Mycobacterium leprae	4 days	P	All	Upon request
Listeriosis	Listeria monocytogenes	4 days	L & P	All	Required
Lyme disease	Borrelia burgdorferi	4 days	L & P	All	Upon request
Lymphogranuloma venereum (LGV)	Chlamydia trachomatis	4 days	L & P	All	Upon request
Malaria5	Plasmodium species	4 days	L & P	All	Upon request
Measles (rubeola)5	Measles virus	Immed	L & P	All	Upon request
Melioidosis	Burkholderia pseudomallei	1 working day	L & P	All	Upon request
Meningococcal disease5	Neisseria meningitidis or gram-negative diplococci	Immed	L & P	Sterile only	Required
Methicillin-Resistant Staphylococcus aureus (MRSA) bacteremia19	Methicillin-Resistant Staphylococcus aureus (MRSA)	Per CMS17	P	Blood	Not applicable
Mpox (monkeypox)	Mpox virus (orthopox virus)	1 working day	L & P	All	Upon request
Multisystem Inflammatory Syndrome in Children (MIS-C) if <21 years		4 days	P		Upon request
Mumps5	Mumps virus (acute infection)	4 days	L & P	All	Upon request
Mycobacterium, nontuberculous (NTM) 8-Metro	Mycobacterium species (except tuberculosis complex, M. leprae, and M. gordonae)	30 days	L	All	Upon request
Outbreaks - known or suspected of all types - including those transmitted from food, water, animals, vectors, environmental contamination, person-to-person, and related to a healthcare setting5	Any pathogen	Immed	L & P		Upon request
Pertussis (whooping cough)5	Bordatella pertussis	1 working day	L & P	All	Upon request
Plague5	Yersinia pestis	Immed	L & P	All	Required
Poliomyelitis5	Poliovirus	Immed	L & P	All	Upon request
Pseudomonas, carbapenem-resistant20	Pseudomonas aeruginosa	4 days	L	All	Upon request
Psittacosis	Chlamydia psittaci	4 days	L & P	All	Upon request
Q fever5	Coxiella burnetii	4 days	L & P	All	Upon request
Rabies: human (suspected)5	Rabies virus (Lyssavirus)	Immed	L & P	All	Upon request
Respiratory syncytial virus (RSV)11	* Respiratory syncytial virus (positive molecular and rapid antigen tests) * Lineage or sequencing results	4 days	L (ELR only)	All	Upon request
Respiratory syncytial virus (RSV)-associated death if <18 years	Respiratory syncytial virus	4 days	P	All	Upon request
Respiratory syncytial virus (RSV)-associated hospitalizations	Respiratory syncytial virus	4 days	L & P	All	Upon request
Rickettsiosis	Rickettsia species, including Rocky Mountain spotted fever and typhus groups	4 days	L & P	All	Upon request
Rubella (acute infection)5	Rubella virus	1 working day	L & P	All	Upon request
Rubella (congenital)5	Rubella virus	4 days	L & P	All	Upon request
Salmonellosis	Salmonella species	4 days	L & P	All	Required
Shigellosis	Shigella species	4 days	L & P	All	Required
Smallpox5	Variola virus (Orthopox virus)	Immed	L & P	All	Upon request
Staphylococcus aureus, Vancomycin-non-susceptible21	Vancomycin non-susceptible Staphylococcus aureus	4 days	L	All	Required
Streptococcus pneumoniae22	Streptococcus pneumonia	4 days	L	Sterile only	Required
Syphilis5, 23	Treponema pallidum (positive results)	1 working day	L & P	All	Upon request
Syphilis5, 23	Treponema pallidum (negative results)	1 working day	L (ELR only)	All	Upon request
Tetanus5	Clostridium tetani	4 days	P	All	Upon request
Tick-borne relapsing fever5	Borrelia species and spirochetemia except burgdorferi species	4 days	L & P	All	Upon request
Toxic shock syndrome22 (streptococcal and non-streptococcal)	Streptococcus pyogenes and non-streptococcal bacteria	4 days	P	All	Upon request
Trichinosis5	Trichinella species	4 days	P	All	Upon request
Tuberculosis disease (active)5	Mycobacterium tuberculosis24	1 working day	L & P	All	Required
Tuberculosis immune reactivity indicated by a positive interferon gamma release assay test (IGRA)	Mycobacterium tuberculosis25	4 days	L (ELR only)	All	Not Required
Tularemia5	Francisella tularensis	1 working day	L & P	All	Required
Typhoid fever5	Salmonella Typhi	1 working day	L & P	All	Required
Varicella (chicken pox)5	Varicella virus	4 days	L & P	All	Upon request
Vibriosis	Vibrio species, non-cholera	4 days	L	All	Required
Viral hemorrhagic fever	Crimean-Congo hemorrhagic virus, Ebola virus, Lassa fever virus, Lujo virus, Marburg virus, Guanarito virus, Junin virus, Machupo virus, Sabia virus, Rift Valley fever	Immed	L & P	All	Required
West Nile virus (acute infection)	West Nile virus	4 days	L	All	Upon request
Yellow fever	Yellow fever virus	4 days	L	All	Upon request
Yersiniosis8-Seven	Yersinia non-pestis species	4 days	L	All	Required
Zika virus	Zika virus	4 days	L	All	Upon request

All cases are to be reported with patient's name, date of birth, sex assigned at birth, race, ethnicity, phone number, physical address (including city and county), email address, preferred language and name and address and phone number of responsible physician or other healthcare provider; and such other information as is needed in order to locate the patient for follow up. The patient's pregnancy status shall be reported for cases of syphilis, HIV, hepatitis B and hepatitis C. In addition, all laboratory information reported shall include specimen accession number.

*Time: 1) "Immed" = by phone, within 4 hours of suspected diagnosis. 2) Unless the term "working day" is specified, "days" refers to calendar days.

1 Reporter: The party responsible for reporting is indicated by one of the following: L = Laboratory (whether or not associated with a hospital; by out-of-state laboratories that maintain an office or collection facility in Colorado or arrange for collection of specimens in Colorado; and by in-state laboratories which send specimens to an out-of- state laboratory referral laboratory), P = healthcare provider or other person knowing of or suspecting a case (including but not limited to coroners, persons in charge of hospitals or other institutions licensed by the Department (or their designees), persons in charge of schools (including nursing staff) and licensed child care centers), L & P = Both.

2 Specimen sources: A condition is reportable when the pathogen is isolated or detected from any specimen source unless otherwise indicated. A normally "sterile site" is defined as blood, cerebrospinal fluid (CSF), pleural fluid (includes chest fluid, thoracentesis fluid), peritoneal fluid (includes abdominal fluid, ascites), pericardial fluid, bone (includes bone marrow), joint or synovial fluid, needle aspirate or culture of any specific joint, internal body sites (sterilely obtained from biopsy/tissue/abscess/ aspirate/fluid/swab from lymph node, brain, heart, liver, spleen, vitreous fluid, kidney, pancreas, vascular tissue, or ovary). Skin and skin abscesses are not considered sterile sites.

3 Testing laboratories shall routinely submit bacterial culture isolates or patient clinical material that yields positive findings to the Department, State Public Health Laboratory. The isolate or clinical material shall be received at the Department, State Public Health Laboratory no later than one working day after the observation of positive findings. Clinical material is defined as: (i) A culture isolate containing the infectious organism for which submission of material is required, or (ii) If an isolate is not available, material containing the infectious organism for which submission of material is required, in the following order of preference: (A) a patient specimen; (B) nucleic acid; or (C) other laboratory material. All specimens shall be accompanied by the following information: (a) Patient's name, date of birth, sex assigned at birth, race, ethnicity, phone number, physical address (including city and county), email address, and preferred language; pregnancy status shall be reported for cases of syphilis, HIV, hepatitis B, and hepatitis C (b) Name and address and phone number of responsible physician or other healthcare provider; (c) Name of disease or condition; and (d) Laboratory information - test name, collection date, specimen accession number, and specimen type.

4 Acinetobacter baumannii (including species in the A. baumannii complex, e.g., A. baumannii, A. calcoaceticus, A. lactucae, A. nosocomialis, A. pittii, A. seifertii, etc.) that are resistant to at least one carbapenem (including imipenem, meropenem, or doripenem).

5 Report shall be based on the diagnosis or suspected diagnosis of the attending physician or other healthcare provider, whether or not supporting laboratory data are available.

6 For animal bites by dogs, cats, bats, skunks, foxes, raccoons, coyotes, and other wild carnivores, the name and locating information of the owner of the biting animal shall be reported, if known, by the healthcare provider or reporter.

7 Candida auris identified, or any suspected Candida auris. Clinical material may not be available for screening tests.

8 Condition reportable only among residents of a specific catchment area.

8-Metro Condition reportable only among residents of Denver Metropolitan Area (Adams, Arapahoe, Denver, Douglas, and Jefferson Counties)

8-Seven Condition reportable only among residents of seven-county Denver Metropolitan Area (Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, and Jefferson counties)

8-Boulder Condition only reportable among residents of Boulder county

9 Clinical or screening test positive for a carbapenemase using a phenotypic, molecular test, or next generation sequencing. Common carbapenemase genes include: blaKPC, blaNDM, blaVIM,blaIMP, blaOXA-48, but other carbapenemase genes include but are not limited to: blaSIM, blaGIM, blaSPM, other OXA genes, etc. Phenotypic testing methods include but are not limited to: metallo-[BETA]-lactamase test, modified Hodge test, Carba NP, carbapenem inactivation method (CIM), modified carbapenem inactivation method (MCIM), EDTA-modified carbapenem inactivation method (ECIM), or immunochromatography tests (ICT). Molecular tests for carbapenemase genes include but are not limited to: Xpert Carba-R, VERIGENE, Streck ARM-D, Cepheid, validated laboratory-developed NAAT, etc. Clinical material may not be available for screening tests.

10 Any positive tests shall be reported. All positive results from multi-step algorithms (including non-toxin detecting tests such as antigen tests (e.g., glutamate dehydrogenase or GDH, and cultures, etc.) shall also be reported, regardless of where the test falls within the algorithm.

11 All positive results for all test types including molecular tests, antigen tests, and sequencing lineage or mutation profile results are reportable. Positives will be reported by laboratories capable of electronic laboratory reporting (ELR) and only reported by ELR. Serology/antibody testing and at-home antigen tests are not reportable.

12 Enterobacterales including, but not limited to, Escherichia species, Klebsiella species, Enterobacter species, Citrobacter species, Serratia species, and Raoultella species that are resistant to at least one carbapenem (including imipenem, meropenem, doripenem, or ertapenem); or Providencia species, Proteus species, Morganella species that are resistant to at least one carbapenem (including meropenem, doripenem, or ertapenem; but not including imipenem); or Enterobacterales of any genus and species that test positive for production of carbapenemase (e.g., KPC, NDM, VIM, IMP, OXA-48, others).

13 Escherichia species, Klebsiella species, or Raoultella species resistant to at least one extended-spectrum cephalosporin (ceftazidime, cefotaxime or ceftriaxone) or Escherichia species, Klebsiella species, or Raoultella species that test positive for production of an extended-spectrum beta-lactamase (ESBL) demonstrated by a recognized test (e.g., broth microdilution, disk diffusion).

14 This includes any Shiga toxin test or O157 antigen test that is positive, even if no culture is performed. If the laboratory does not have the capacity to perform H (flagellar) antigen tests, then Escherichia coli O157 should be reported.

15 If group A streptococci is isolated from a wound or surgical tissue/specimen and is accompanied by necrotizing fasciitis or streptococcal toxic shock syndrome, the case shall be reported and the isolate shall be submitted.

16 Reportable only by facilities that are voluntarily participating in applied public health projects. Appendix B includes a definition of healthcare-associated infections, a list of included infections, and a list of included health facility types.

17 All associated results, including negative (nonreactive) and positive (reactive) HCV confirmatory assays from persons who have been diagnosed with or who have laboratory evidence of HCV infection are reportable (e.g., antigen or nucleic acid amplification for HCV RNA [including qualitative, quantitative or genotype testing]). Negative HCV test results will be reported by laboratories capable of electronic laboratory reporting (ELR) and only reported by ELR.

18 Submission of urine specimens is not required. If respiratory samples are available on patients positive for legionellosis by urine antigen test, submit a respiratory sample.

19 Reporting requirement is fulfilled through the Department's access to the National Healthcare Safety Network (NHSN) for those healthcare facilities that are required to report methicillin-resistant Staphylococcus aureus (MRSA) bacteremia to the Centers for Medicare & Medicaid services (CMS). In these instances these healthcare facilities shall confer rights to the Department to access the NHSN data for these conditions.

20 Pseudomonas aeruginosa resistant to at least one of the following carbapenems: imipenem, meropenem, or doripenem; OR P. aeruginosa that tests positive for production of a carbapenemase (i.e., KPC, NDM, VIM, IMP, OXA, others).

21 Staphylococcus aureus that are non-susceptible to vancomycin, which include isolates with minimum inhibitory concentration (MIC) of [GREATER THAN EQUALS TOO]4 mcg/ml.

22 Clinical material shall be submitted from laboratories when the material is from residents of the 5-county metro area (Adams, Arapahoe, Denver, Douglas and Jefferson counties). For Toxic Shock Syndrome, submission of Streptococcus pyogenes isolates from residents of the 5-county metro area is required.

23 All associated results for syphilis shall be reported for positive syphilis test findings including treponemal tests (Enzyme Immunoassay [EIA], Chemoluminescence Assay [CIA], Fluorescent Treponemal Antibody Absorption [FTA-ABS], Polymerase Chain Reaction [PCR], Multiplex Flow Immunoassay [MFI], Treponema pallidum Particle Agglutination [TP-PA], Treponema pallidum Antibody [TPA]) and Non-treponemal Tests (Rapid Plasma Reagin [RPR], Venereal Disease Research Laboratory [VDRL], Cerebrospinal Fluid [CSF] Quantitative Titers). Negative syphilis test results will be reported by laboratories capable of electronic laboratory reporting (ELR) and only reported by ELR.

24 Including (+) AFB sputum smear, culture (regardless of specimen site) and nucleic acid amplification tests (NAAT). See regulation 4f.

25 All positive interferon gamma release assays (IGRAs) will be reported by labs capable of electronic laboratory reporting (ELR), and only reported by ELR.

6 CCR 1009-1, app 6 CCR 1009-1-A

37 CR 18, September 25, 2014, effective 10/15/2014

38 CR 20, October 25, 2015, effective 11/14/2015

40 CR 08, April 25, 2017, effective 5/15/2017

41 CR 12, June 25, 2018, effective 7/15/2018

42 CR 10, May 25, 2019, effective 7/1/2019

44 CR 18, September 25, 2021, effective 10/15/2021

46 CR 06, March 25, 2023, effective 2/15/2023

46 CR 10, May 25, 2023, effective 6/14/2023

47 CR 24, December 25, 2024, effective 1/14/2025