This document discusses reporting requirements and procedures for communicable diseases. It notes that physicians are mandated to report certain illnesses like AIDS, syphilis, tuberculosis, and various childhood diseases. The purpose is for epidemiological monitoring and interrupting disease spread. It describes how health departments perform contact tracing to notify those exposed of potential infection for diseases like HIV, syphilis, and tuberculosis. It addresses issues around partner notification, maintaining patient confidentiality, and balancing patient autonomy with protecting public health.

1. 6. Reporting
Communicable
Disease:
Dr. Ayub Abdulkadir (Dr. Alto)
Medical Ethics

2. Reportable illness:
• Physicians and laboratories are mandated to report
a number of medical illnesses. The main purpose in
reporting illnesses is both epidemiologic as well as
to interrupt the spread of certain communicable
diseases.
• The illnesses that are always reportable include:
1. AIDS.
2. Syphilis.
3. Tuberculosis.
4. Gonorrhea.

3. • and all of the childhood diseases such as:
1. Measles.
2. Mumps.
3. Rubella.
4. Pertussis.
• These diseases are reportable by somebody,
not necessarily the physician.
• Physicians are always legally protected for
participating in partner notification.
• In general, the health department performs
the majority of contact-tracing events as well as
notifying those that have been in close contact of
the possibility of infection.

4. • Partner notification exists for diseases such as
HIV/AIDS, syphilis, gonorrhea, and tuberculosis.
• In addition, the health department can incarcerate
(jail) patients with tuberculosis to prevent the
spread of disease.
• If a patient won’t tell his or her partner, then you
must answer that you must follow your duty to
report.
• If the source patient still won’t tell his or her
partner, you are within your legal right to tell the
innocent third party.
The name of the source patient is always
protected.

5. • Partner notification and reportable illnesses are an
example of one of the few times that the patients
autonomy can be superseded because of the
necessity of protecting others.
• Tuberculosis has special reporting and public health
issues.
• In addition to doing contact tracing of the contacts
in order to do (purified protein derivative PPD)
testing, there is the special issue of incarceration
for tuberculosis.

6. • Patients with tuberculosis should be isolated for
about two weeks, which is approximately the
amount of time that is takes for sputum to become
negative for acid-fast bacilli.
• lf a patient refuses to take anti-tuberculosis
therapy, physicians have the option of incarcerating
the patient to prevent them from the spread of the
disease.
• This is only for those who still have positive stains
of their them sputum for acid fast bacilli.

7. HIV-Related Issues:
• Confidentiality:
• As with all medical information there is a
presumption of confidentiality on the part of the
physician.
• When a patient enters the hospital or other health-
care facility there is general consent given that
allows the routine testing of blood for chemistry
and hematology and so on.
• When a patient signs a release to distribute or
transmit medical information there is an additional
consent required for HIV or AIDS-related
information.

8. • For example, a woman comes at 10 weeks of
pregnancy for prenatal care. She has a history of
sexually transmitted diseases such as gonorrhea.
• You offer HIV testing, which the patient refuses, as a
routine part of prenatal care.
• She returns at 14 and l8 weeks of pregnancy but is still
refusing because of anxiety that she may be positive.
• You inform the patient that there are medications that
can reduce transmission from mother to child to less
than 2 percent.
• She persists in her refusal. What should you do now?

9. • Answer:
• Although there are medications to prevent
transmission of HIV to the fetus during pregnancy,
you cannot compel mandatory testing of pregnant
women.
• The woman has the right to refuse testing as well
as to refuse anti retrovirals.
• The autonomy of the mother is legally
superior to beneficence for the fetus.
• A woman has the right to refuse HIV testing in
pregnancy, to refuse antiretroviral medications
in pregnancy, and to refuse a C-section even if it
will markedly benefit the child.

10. PARTNER NOTIFICATION:
• The high level of confidentiality concerning HIV can
only be breached under very specific circumstances
such as when the health of a third party is at risk.
• A circumstance such as this would be when an HIV-
positive person has a sexual or needle-sharing partner
that is at risk.
• The method of notification follows the steps of first
counselling a patient to notify his partners voluntarily.
• This would be ideal and follows the general theme of
USMLE, which is to first answer "encourage
discussions” when listed as one of the choices.

11. • If the patient is either emotionally unable or
unwilling to notify their partners the next step is to
notify the Department of Health to start
the process of contact tracing.
• The health department interviews the patient and
attempts to construct a list of partners in order to
notify them.

12. HIV-POSITIVE HEATTH-CARE
WORKERS
• There is no duty on the part of an HlV-positive
health care worker to inform his patient of his HIV
status.
•Universal precautions are supposed to be
maintained. These should protect the patients.
• An HIV-positive physician who practices high-risk
surgical and obstetric procedures is expected to
maintain precautions to protect the patients from
transmission.

14. REFUSAl TO TREAT HIV-POSITIVE
PATIENTS:
• It is ethically unacceptable to refuse to treat HlV or
take care of HlV, positive patients simply because
they are HIV-positive.
• lf you have a physician to whom you refer patients
for various treatments, it would not be ethical for
that person to discriminate only on the basis of the
patient being HIV-positive.
• On the other hand, you cannot compel a physician
to take over the management of any patient if the
physician doesn’t want to do so.

15. Sexually Transmitted
Diseases (STD):
• The ethical issues surrounding STDs have to do with
partner notification, contact tracing, and reporting
requirements.
• Although reporting requirements vary some what from
state to state, certain diseases are reportable nationally
such as syphilis, gonorrhea, and AIDS.
• Herpes simplex is generally not reportable and there is
no contact tracing for herpes.
• Contac tracing is predominantly used to interrupt a
cycle of transmission.
• Contact tracing is a public health practice that health
departments use to identify and notify people who
have been exposed to someone with an infectious

16. • Herpes cannot be eradicated from the body; hence
there is no utility in treating the partner.
• Gonorrhea ands syphilis, however can be
asymptomatically carried by the contacts of our
patients and they can be transmitted to additional
partners even if the source patient is
asymptomatic.
• In addition, syphilis and gonorrhea can be
eradicated (cured) with treatment.

17. • For example,
• Bob is a 32-year-old man in your clinic being
treated for primary syphilis. He is very embarrassed
about his diagnosis and he asks you if his condition
will be kept confidential. What should you tell him?
• Answer:
• If there is a choice that says "encourage him to
notify his partners" or "ask if he has already told his
contacts“ that should be the first thing to do