In addition to the findings of any lab test suggesting the presence of a communicable disease, the director of a medical lab must also submit microbiologic cultures, subcultures, culture-independent diagnostic tests or other specimens or clinical material to the State Public Health Laboratory.
The director or other person in charge of a medical laboratory
In addition to the below listed organisms, public health personnel may also request further specimen or isolate submission as deemed necessary for disease investigation purposes, on a case-by-case basis.
General Communicable Diseases:
Bacillus:
Non-motile and non-hemolytic Bacillus isolates must be submitted to the State or Local Public Health Laboratory for definitive identification and subtyping.
Botulism:
Clostridium botulinum testing should only occur after consult with the public health authority and the Centers for Disease Control and Prevention. If testing is deemed necessary, the specimens must be submitted to the State or Local Public Health Laboratory for shipment to the appropriate reference laboratory for testing.
Pertussis and Parapertussis:
Any clinical laboratory that identified Bordetella pertussis and Bordetella parapertussis via culture must submit isolates to the State or Local Public Health Laboratory for definitive identification.
Brucella:
Brucella isolates must be submitted to the State or Local Public Health Laboratory for definitive identification and subtyping.
Burkholderia:
Isolates of Burkholderia mallei or Burkholderia pseudomallei must be submitted to the State or Local Public Health Laboratory for definitive identification and subtyping.
Campylobacter:
Any clinical laboratory that identifies Campylobacter spp. from a clinical specimen using a culture-independent diagnostic test (CDIT) must submit specimen to the State or Local Public Health Laboratory for definitive identification, subtyping, genetic sequencing, and antibiotic susceptibility testing.
COVID-19:
All clinical laboratories that identify SARS-CoV-2 via a laboratory-based molecular testing mechanism, must submit all positive samples with a CT value < 30 to the State Public Health Laboratory for genomic sequencing. At this time, the Nevada State Public Health Laboratory in Northern Nevada is performing genomic sequencing for the State.
Diphtheria:
Corynebacterium diptheriae isolates must be submitted to the State or Local Public Health Laboratory for definitive identification and subtyping.
Haemophilus influenza:
Isolates of Haemophilus influenza from a sterile site must be submitted to the State or Local Public Health Laboratory for definitive identification and subtyping.
Legionella:
Legionella isolates must be submitted to the State or Local Public Health Laboratory for definitive identification and subtyping.
Listeria monocytogenes:
Listeria monocytogenes isolates must be submitted to the State or Local Public Health Laboratory for definitive identification, subtyping, genetic sequencing, and antibiotic susceptibility testing.
Neisseria meningitidis:
Any clinical laboratory that identified Neisseria meningitidis from a sterile site must immediately submit the isolate the State or Local Public Health Laboratory for definitive identification and antibiotic susceptibility testing.
Malaria:
Any clinical laboratory that makes a finding of Plasmodium or malaria parasites in the blood film of a patient shall immediately submit one or more such blood films for confirmation to the State or Local Public Health Laboratory.
Q Fever:
Coxiella burnetti isolates must be submitted to the State or Local Public Health Laboratory for definitive identification and subtyping.
Salmonella:
Any clinical laboratory that identifies Salmonella spp. via culture or using a culture-independent diagnostic test (CDIT) must submit the isolate or specimen to the State or Local Public Health Laboratory for definitive identification, subtyping, genetic sequencing, and antibiotic susceptibility testing.
Shiga toxin-producing Escherichia coli (STEC):
The following specimens or isolates must be submitted to the State or Local Public Health Laboratory for definitive identification, subtyping, genetic sequencing, and antibiotic susceptibility testing:
• STEC isolates, including O157 and non-O157 strains, identified via culture
• E. coli O157 isolates without confirmation of the H antigen, detection of Shiga toxin, or detection of Shiga toxin genes
• Detection of Shiga toxin or Shiga toxin genes using a culture-independent diagnostic test (CDIT)
• Detection of E. coli O157 or STEC/Enterohemorrhagic E. coli (EHEC) using CDIT.
Shigella:
Any clinical laboratory that identifies Shigella spp. via culture or using a culture-independent diagnostic test (CDIT) must submit the isolate or specimen to the State or Local Public Health Laboratory for definitive identification, subtyping, genetic sequencing, and antibiotic susceptibility testing.
Staphylococcus Aureus:
Any clinical laboratory that identified vancomycin-intermediate or vancomycin-resistant Staphylococcus aureus via culture must submit the isolate to the State or Local Public Health Laboratory for definitive identification and antibiotic susceptibility testing.
Tetanus:
Clostridium tetanus isolates must be submitted to the State or Local Public Health Laboratory for definitive identification and subtyping.
Tuberculosis:
Any clinical laboratory that identifies Mycobacterium spp. via culture or using a culture-independent diagnostic test (CDIT) must submit the isolate or specimen to the State or Local Public Health Laboratory for definitive identification, subtyping, genetic sequencing, and antibiotic susceptibility testing.
Tularemia:
Isolates of Francisella tularensis must be submitted to the State or Local Public Health Laboratory for definitive identification and subtyping.
Vibrio:
Any clinical laboratory that identifies Vibrio spp. via culture or using a culture-independent diagnostic test (CDIT) must submit the isolate or specimen to the State or Local Public Health Laboratory for definitive identification and subtyping.
Yersinia:
The following specimens or isolates must be submitted to the State or Local Public Health Laboratory for definitive identification and subtyping:
• Yersinia pestis and non-pestis isolates identified via culture
• Specimens that detected Yersinia pestis specific DNA or antigens, including F2 antigen, by direct fluorescent antibody assay (DFA), immunohistochemical assay (IHC), or polymerase chain reaction (PCR).
Sexually Transmitted Infections:
Neisseria gonorrhea:
The following isolates must be submitted to the State or Local Public Health Laboratory for definitive identification and antibiotic susceptibility testing:
• Disseminated Neisseria gonorrhea isolates
• Isolates of Neisseria gonorrhea from patients with severe disease
• Isolates of Neisseria gonorrhea found by a clinical laboratory to be resistant to cephalosporin or azithromycin
Healthcare Associated Infections:
Enterobacteriaceae:
The below table is a complete list of Enterobacteriaceae of public health importance. Any isolates of these organisms should be sent to the State or Local Public Health Laboratory for definitive identification and antibiotic susceptibility testing if:
• The clinical laboratory is unable to perform complete antibiotic susceptibility testing
• The organism is determined to be resistant to Imipenem, Doripenem, Ertapenem or Meropenem
Nevada State Public Health Laboratory (NSPHL) 1660 N. Virginia Street Reno, NV 89503 (775) 688-1335
Nevada State Public Health Laboratory (unr.edu)
Southern Nevada Public Health Laboratory (SNPHL) 700 S. Martin King Blvd Las Vegas, NV 89106 (702) 759-1020
The health authority shall annually publish and post on its Internet website a list of communicable diseases for which microbiologic cultures, subcultures, culture-independent diagnostic tests or other specimens or clinical material, if available, must be submitted pursuant to subsection 3. For each communicable disease included on the list, the health authority must specify:
(a) The microbiologic cultures, subcultures, culture-independent diagnostic tests or other specimens or clinical material to be submitted;
(b) The justification for requiring the microbiologic cultures, subcultures, culture-independent diagnostic tests or other specimens or clinical material to be submitted;
(c) The name of the medical laboratory to which the microbiologic cultures, subcultures, culture-independent diagnostic tests or other specimens or clinical material must be submitted; and
(d) The process by which the microbiologic cultures, subcultures, culture-independent diagnostic tests or other specimens or clinical material must be submitted.
NAC 441A.235 Duty of director or other person in charge of medical laboratory to report findings of communicable disease, causative agent of communicable disease or immune response to causative agent; contents of report; submission of certain microbiologic cultures, subcultures, culture-independent diagnostic tests or other specimen or clinical material; required reporting of results of certain tests relating to human immunodeficiency virus. (NRS 439.200, 441A.120, 441A.167)
1. Except as otherwise provided in NAC 441A.240, the director or other person in charge of a medical laboratory in which a test or examination of any specimen derived from the human body yields evidence suggesting the presence of a communicable disease, a causative agent of a communicable disease or an immune response to a causative agent of a communicable disease shall:
(a) If the medical laboratory is in this State, report the findings to the health authority having jurisdiction where the office of the health care provider who ordered the test or examination is located or to an electronic clearinghouse approved by the health authority.
(b) If the medical laboratory performed the test or examination on specimens obtained in this State or from residents of this State, and the medical laboratory is located outside of this State, report the findings to the Chief Medical Officer.
The report must be made in the manner provided in NAC 441A.225.
2. The report must include:
(a) The date and result of the test or examination performed.
(b) The name, address and, if available, telephone number of the person from whom the specimen was obtained.
(c) The sex, age and date of birth of the person from whom the specimen was obtained, if available.
(d) The name of the health care provider who ordered the test or examination.
(e) The name and the address or telephone number of the medical laboratory making the report.
(f) Any other information requested by the health authority, if available.
3. The director or other person in charge of the medical laboratory shall also submit microbiologic cultures, subcultures, culture-independent diagnostic tests or other specimens or clinical material, if available, to the State Public Health Laboratory or other laboratory designated by the health authority for diagnosis, confirmation or further testing if:
(a) Requested by the health authority;
(b) The communicable disease is included on the list of diseases published by the health authority pursuant to subsection 4 and the health authority has provided the director or other person in charge of the medical laboratory with a copy of the list; or
(c) The microbiologic cultures, subcultures, or other specimens or clinical material consist of:
(1) Isolates of Bordetella pertussis or Bordetella parapertussis;
(2) Isolates of non-motile and non-hemolytic Bacillus spp.;
(3) Isolates of Brucella spp.;
(4) Isolates of Burkholderia mallei or Burkholderia pseudomallei;
(5) Isolates of Campylobacter spp.;
(6) Isolates of Clostridium botulinum;
(7) Isolates of Clostridium tetani;
(8) Isolates of Corynebacterium diptheriae;
(9) Isolates of Coxiella burnetii;
(10) Isolates of E. coli O157:H7;
(11) Isolates of Francisella tularensis;
(12) Isolates of Haemophilus influenza (invasive only);
(13) Isolates of Legionella spp.;
(14) Isolates of Listeria monocytogenes;
(15) Isolates of Mycobacterium spp.;
(16) Isolates of Neisseria meningitidis from a sterile site;
(17) Blood smears containing Plasmodium spp.;
(18) Isolates of Salmonella spp.;
(19) Isolates of, or broth positive results for, Shiga toxin-producing Escherichia coli;
(20) Isolates of Shigella spp.;
(21) Isolates of Vibrio spp.;
(22) Isolates of Vancomycin-intermediate Staphylococcus aureus;
(23) Isolates of Vancomycin-resistant Staphylococcus aureus;
(24) Isolates of Yersinia pestis; or
(25) Isolates of Yersinia spp., other than Yersinia pestis.
4. The health authority shall annually publish and post on its Internet website a list of communicable diseases for which microbiologic cultures, subcultures, culture-independent diagnostic tests or other specimens or clinical material, if available, must be submitted pursuant to subsection 3. For each communicable disease included on the list, the health authority must specify:
(a) The microbiologic cultures, subcultures, culture-independent diagnostic tests or other specimens or clinical material to be submitted;
(b) The justification for requiring the microbiologic cultures, subcultures, culture-independent diagnostic tests or other specimens or clinical material to be submitted;
(c) The name of the medical laboratory to which the microbiologic cultures, subcultures, culture-independent diagnostic tests or other specimens or clinical material must be submitted; and
(d) The process by which the microbiologic cultures, subcultures, culture-independent diagnostic tests or other specimens or clinical material must be submitted.
5. If the director or other person in charge of the medical laboratory submits a culture-independent diagnostic test pursuant to subsection 3, the State Public Health Laboratory must conduct reflex testing for the purpose of surveillance.
6. Except as otherwise provided in NAC 441A.240, the director or other person in charge of a medical laboratory shall report as required by this section the results of any test of any specimen derived from the human body, if the test is approved by the Food and Drug Administration of the United States Department of Health and Human Services, and:
(a) The results of the test confirm the presence of the human immunodeficiency virus (HIV) or antibodies to the human immunodeficiency virus (HIV); or
(b) The test was conducted to monitor the progression of a human immunodeficiency virus (HIV) infection, including, without limitation, all levels of CD4, human immunodeficiency virus (HIV) nucleotide sequences or genotype results and both detectable and undetectable viral loads.
7. With respect to a test described in subsection 6, if the interpretation of the laboratory diagnostic testing algorithm is positive, indicating the presence of infection with the human immunodeficiency virus (HIV), the laboratory must report to the health authority:
(a) The overall result or conclusion of the algorithm; and
(b) Results from all such tests, including, without limitation, negative, nonreactive or intermediate results, that are performed as part of the testing algorithm, including, without limitation:
(1) Fourth-generation and third-generation tests for the human immunodeficiency virus (HIV);
(2) Human immunodeficiency virus antibody differentiation tests (HIV-1/-2); and
(3) Nucleic acid amplification tests (NAT) for the presence of the human immunodeficiency virus (HIV).
(Added to NAC by Bd. of Health, eff. 1-24-92; A 11-1-95; R087-08, 1-13-2011; R121-14, 10-27-2015; R187-18, 6-26-2019)
