Which patients are required to be reported to public health authorities?

Which Patients Must Be Reported to Public Health Authorities

Healthcare providers are legally required to report all nationally notifiable diseases and conditions to their state or local health department (not directly to the CDC), with the specific list of reportable conditions varying by jurisdiction. 1

Understanding the Reporting Framework

The reporting system operates through a two-step process that is critical to understand:

• Providers report to state/local health departments first, never directly to the CDC, as mandated by state laws and regulations 1, 2
• State health departments then report to the CDC's National Notifiable Diseases Surveillance System (NNDSS) for national tracking 1
• Each state determines its own reportable disease list, though most align closely with nationally notifiable conditions 2, 3

Categories of Reportable Patients

Infectious Diseases (Most Common Category)

The following patients with laboratory-confirmed or clinically compatible infectious diseases must be reported 4:

Bacterial Infections:

• Salmonellosis - both symptomatic and asymptomatic infections, including extraintestinal sites 4
• Shigellosis - confirmation based on laboratory findings; clinical illness not required 4
• E. coli O157:H7 - including suspected cases with post-diarrheal HUS or TTP 4
• Campylobacter infection - any laboratory-confirmed case 4
• Gonorrhea - including asymptomatic infections 4
• Invasive group A Streptococcus - isolation from normally sterile sites 4
• Drug-resistant Streptococcus pneumoniae - invasive disease 4
• Invasive Haemophilus influenzae - from blood, CSF, or other sterile sites 4
• Leptospirosis - laboratory-confirmed or with supportive serology 4
• Hansen disease (Leprosy) 4
• Other bacterial meningitis - excluding specific organisms reported separately 4

Viral Infections:

• Arboviral encephalitides - St. Louis, Western equine, Eastern equine, California serogroup encephalitis 4
• Genital herpes - report only the first diagnosis per patient 4

Parasitic Infections:

• Amebiasis - both intestinal and extraintestinal (asymptomatic carriage should NOT be reported) 4
• Giardiasis - laboratory-confirmed cases 4
• Cyclospora infection - confirmed by oocyst demonstration or DNA detection 4

Sexually Transmitted Infections:

• Genital warts - report only the first diagnosis per patient 4
• Granuloma inguinale - laboratory-confirmed cases 4

Critical Reporting Requirements for Enteric Pathogens

For Salmonella, STEC (Shiga toxin-producing E. coli), Shigella, and Listeria, isolates must be submitted to public health laboratories for molecular subtyping and outbreak detection 4. This is essential for:

• PulseNet surveillance system participation 4
• Whole-genome sequencing for outbreak detection 4
• Identifying dispersed outbreaks across geographic areas 4

Special Populations Requiring Enhanced Surveillance

Healthcare workers, food handlers, and childcare providers with certain infectious diseases require follow-up testing before returning to work 1. Report these individuals promptly to enable appropriate public health follow-up.

When Clinical Suspicion Alone Triggers Reporting

Outbreak Situations

Report any unusual cluster of diarrheal illness to local health departments immediately, regardless of whether an etiology has been determined or if the specific pathogen is typically reportable 4. Most outbreaks are localized and detected by astute clinicians 4.

Aseptic Meningitis

A clinically compatible case diagnosed by a physician as aseptic meningitis, with no laboratory evidence of bacterial or fungal infection, should be reported 4.

Common Pitfalls to Avoid

Do NOT Report These Conditions:

• Asymptomatic intestinal carriage of E. histolytica - only symptomatic amebiasis is reportable 4
• Positive serologic tests alone in asymptomatic persons for extraintestinal amebiasis 4

Critical Timing Issues:

• Both probable and confirmed cases are reportable to NNDSS for most conditions 4
• Laboratory-confirmed isolates may have separate reporting pathways (e.g., PHLIS for certain enteric pathogens) 4
• Early reporting of suspected outbreaks enables prompt investigation and prevention of additional cases 1

Practical Reporting Algorithm

1. Identify if the condition is on your state's reportable disease list - contact your local or state health department for the current list 1, 2

2. Determine case classification:

   • Confirmed (laboratory-confirmed) 4
   • Probable (clinically compatible with supportive evidence or epidemiologic linkage) 4
   • Suspected (specific criteria for certain conditions like E. coli O157:H7) 4

3. Report to your state/local health department using their designated reporting mechanism 1

4. Submit isolates when required for Salmonella, STEC, Shigella, and Listeria 4

5. For suspected outbreaks, report immediately even without confirmed etiology 4, 1

Why Reporting Matters for Patient Outcomes

Disease reporting directly impacts morbidity and mortality by:

• Enabling outbreak detection and control to prevent additional cases 4, 1
• Facilitating contact tracing for communicable diseases 1
• Guiding public health interventions specific to at-risk communities 4
• Monitoring antimicrobial resistance patterns (e.g., drug-resistant S. pneumoniae) 4

The 66% of nationally notifiable infectious conditions that are explicitly reportable in 90% or more jurisdictions demonstrates broad consensus on reporting importance 3, though providers must verify their specific state requirements 2.