Ryan White HIV/AIDS Treatment Extension Act of 2009

Purpose

  • Part G of the Ryan White HIV/AIDS Treatment Extension Act of 2009 outlines requirements for the notification of emergency response employees when exposed to a disease on the List of Potentially Life-Threatening Infectious Diseases.
  • NIOSH developed a list of potentially life-threatening infectious diseases and related guidelines.
EMTs blurred in motion as they move a patient from an ambulance to the emergency department.

Overview

Emergency response employeesA (EREs) are at risk of exposure to potentially life-threatening infectious diseasesB through contact with victims during emergencies. Part G of the Ryan White HIV/AIDS Treatment Extension Act of 2009 requires that medical facilities provide EREs with notification of when they may have been exposedC to potentially life-threatening infectious diseases while transporting or serving victims of an emergency. Knowing this information allows EREs the opportunity to seek timely medical care and to make informed decisions about addressing potential health issues arising from their exposures.

How the program works

NIOSH has developed a list of potentially life-threatening diseases, including emerging infectious diseases, to which EREs may be exposed while transporting or serving emergency victims taken to a medical facility. Along with the list, NIOSH has also developed guidelines describing circumstances in which EREs may be exposed to a listed disease and the manner in which a determination of an exposure shall be made by a medical facility.

Medical facilities that receive and treat the victims of an emergency or ascertain the cause of death are responsible for routinely notifying and responding to requests pertaining to any determinations that a victim of an emergency has a listed potentially life-threatening infectious disease, as described in the NIOSH guidelines.

When a medical facility determines that a victim of an emergency has a potentially life-threatening airborne or aerosolized infectious disease, the medical facility is responsible for initiating notification to the ERE who transported the victim.

If an ERE believes they have been exposed to any potentially life-threatening disease on the NIOSH list, and has transported, attended, treated, or assisted the victim pursuant to the emergency, the ERE may initiate a request for notification from the medical facility to which the victim of the emergency was transported.

Guidelines

NIOSH has established guidelines describing ways employees may be exposed to these diseases and the guidelines describing the manner in which medical facilities should make determinations about exposures.

Keep Reading: Guidelines for Ryan White Act Part G

Notification Process

There are two pathways for notification. Medical facilities should initiate notification if an ERE may have been exposed to an airborne or aerosolized infectious disease on the list. EREs who believe they have been exposed to a disease on the list can request notification.

Keep Reading: Notification Process

List of potentially life-threatening infectious diseases

Diseases often have multiple transmission pathways. However, for purposes of this classification, diseases routinely transmitted via the aerosol airborneD and aerosol dropletE routes are so classified, even if other routes, such as contact transmission, also occur. CDC will continue to monitor the scientific literature on these and other infectious diseases. If CDC determines that a newly emerged infectious disease fits criteria for inclusion in the List of Potentially Life-Threatening Infectious Diseases to Which Emergency Response Employees May Be Exposed required by the Ryan White HIV/AIDS Treatment Extension Act of 2009, CDC will amend the list and add the disease.

List of Potentially Life-Threatening Infectious Diseases to Which Emergency Response Employees May Be Exposed

Routinely transmitted by contact or by body fluid exposures
  • Anthrax, cutaneous (Bacillus anthracis)
  • Hepatitis B (HBV)
  • Hepatitis C (HCV)
  • Human immunodeficiency virus (HIV)
  • Rabies (Rabies virus)
  • Vaccinia (Vaccinia virus)
  • Viral hemorrhagic fevers (Lassa, Marburg, Ebola, Crimean-Congo, and other viruses yet to be identified)1
Routinely transmitted through aerosolized airborne means2
  • Measles (Rubeola virus)
  • Tuberculosis (Mycobacterium tuberculosis)—infectious pulmonary or laryngeal disease; or extrapulmonary (draining lesion)
  • Varicella disease (Varicella zoster virus)—chickenpox, disseminated zoster
Routinely transmitted through aerosolized droplet means2
  • Diphtheria (Corynebacterium diphtheriae)
  • Novel influenza A viruses as defined by the Council of State and Territorial Epidemiologists (CSTE)3
  • Meningococcal disease (Neisseria meningitidis)
  • Mumps (Mumps virus)
  • Pertussis (Bordetella pertussis)
  • Plague, pneumonic (Yersinia pestis)
  • Rubella (German measles; Rubella virus)
  • SARS-CoV
  • COVID-19 (SARS-CoV-2)
Caused by agents potentially used for bioterrorism or biological warfare
  • These diseases include those caused by any transmissible agent included in the HHS Select Agents List.4
  • Many are not routinely transmitted human to human but may be transmitted via exposure to contaminated environments.
  • The HHS Select Agents List is updated regularly.

Contacts

If you have any questions about the list of potentially life-threatening infectious diseases to which emergency response employees may be exposed and accompanying guidelines, contact CDC/NIOSH Ryan White Coordinator via email or mail.

Please provide your return contact information, if seeking a reply. Please do not provide information of a sensitive nature in this email, such as any disease status for yourself or another person.

Email: NIOSHRyanWhiteAct@cdc.gov

Mail: Ryan White Act Coordinator, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, 1600 Clifton Road, NEMS E20 Atlanta, GA 30329

If you have questions on other sections of Part G, please contact the call center of U.S. Department of Health and Human Services headquarters at 1-877-696-6775.

Resources

Current Guidance: Infectious diseases and circumstances relevant to notification of emergency response employees: implementation of Sec. 2695 of the Ryan White HIV/AIDS Treatment Extension Act of 2009.

This 2020 publication includes the current version of the list of potentially life-threatening infectious diseases and the accompanying guidelines.

Historical Documentation: Implementation of section 2695 (42 U.S.C. 300ff–131) of Public Law 111– 87: Infectious diseases and circumstances relevant to notification requirements; Final Notice

This Federal Register notice includes the first version of the list of potentially life-threatening infectious diseases and the accompanying guidelines, developed in 2011. It also has NIOSH responses to public comments.

Legislation: The Ryan White HIV/AIDS Treatment Extension Act of 2009; Part G—Notification of Possible Exposure to Infectious Diseases.

Part G authorizes NIOSH to develop the list of potentially life-threatening infectious diseases and the accompanying guidelines.

State Health Department Support: Occupational safety and health contacts at state health departments

State health departments can answer specific questions about the jurisdiction's role in facilitating infectious disease notification and reporting, including providing assistance to designated officers.

Part G mandates that States require the following:

  • State public health officers to select persons to serve as Designated Officers of EREs for each employer of EREs in their states.
  • Medical facilities to establish procedures for:
    • Notifying Designated Officers within 48 hours of any instances in which it is known that a patient who has been transported to the medical facility is infected with an airborne disease; and
    • Responding within 48 hours to written requests from Designated Officers for determinations of possible exposure to diseases included on NIOSH's list.
  • ERE employers to establish procedures by which EREs can make requests of Designated Officers and procedures by which the Designated Officers would make appropriate disposition of such requests.
  • Public health officers of communities in which medical facilities are located to establish procedures for handling requests for evaluations from Designated Officers.
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Content Source:
; National Institute for Occupational Safety and Health
  1. Firefighters, law enforcement officers, paramedics, emergency medical technicians, funeral service practitioners, and other individuals (including employees of legally organized and recognized volunteer organizations, without regard to whether such employees receive nominal compensation) who, in the course of professional duties, respond to emergencies in the geographic area involved.
  2. An infectious disease to which EREs may be exposed and that has reasonable potential to cause death or fetal mortality in either healthy EREs or in EREs who are able to work but take medications or are living with conditions that might impair host defense mechanisms.
  3. To be in circumstances in which there is recognized risk for transmission of an infectious agent from a human source to an ERE or, in the case of a Select Agent, from a surface or environment contaminated by the agent to an ERE.
  4. Person-to-person transmission of an infectious agent by an aerosol of small particles able to remain airborne for long periods of time. These can transmit diseases on air currents over long distances, cause prolonged airspace contamination, and can be inhaled into the trachea and lung.
  5. Person-to-person transmission of an infectious agent by large particles only able to remain airborne for short periods of time. These generally transmit diseases through the air over short distances (approximately 6 feet), do not cause prolonged airspace contamination, and are too large to be inhaled into the trachea and lung.
  1. For most viral hemorrhagic fevers (VHFs), routine transmission is limited to transmission from a zoonotic reservoir or direct contact with an infected person (e.g. Ebola virus, Marburg virus) or through arthropod-borne transmission (Rift Valley fever, Crimean-Congo hemorrhagic fever). For a small number of VHF viruses, transmission may occur through droplet transmission (e.g. Nipah virus), however prolonged close contact is likely necessary. Aerosol transmission does not occur in natural (non-laboratory) settings.
  2. Section 2695(b) [42 U.S.C. § 300ff–131(b)].
  3. Council of State and Territorial Epidemiologists, Position Statement Number: 09–ID–43. Available at https://cdn.ymaws.com/www.cste.org/resource/resmgr/PS/09-ID-43.pdf
  4. 42 C.F.R. §§ 73.3, 73.4.