2 Any Confirmed Case Not Exhibiting Clinically Consistent Acute Symptoms Or Illness

Case status is to be determined after Routine Case Investigation and further action taken according to the following table:

One Apparent HC Exposure Community Resident Residential Facility Resident More than One HC Exposure with no Exposure other than HC Case Status No Non- One or More Healthcare Non- Risk Healthcare Behaviors4 Risk Behaviors Clinically Consistent Acute Initial Epi Monitor Monitor Full Epi Case1 Other Case2, Single Documented Seroconversion3 Initial Epi Monitor Monitor Full Epi Case

Other Case2, Monitor Monitor Monitor Full Epi No Documented Seroconversion Documented seroconversions or more than one clinically Full Epi Initial Epi Initial Epi Full Epi Multiple consistent acute case1 Cases5 Other Cases2, No Documented Initial Epi Initial Epi Initial Epi Initial Epi Seroconversion

1 As described in CDC/CSTE case definition for the particular infection. For hepatitis, a clinically consistent acute case is a case patient with documented illness with a discrete onset of any sign or symptom consistent with acute viral hepatitis (e.g., anorexia, abdominal discomfort, nausea, vomiting), and either a) jaundice, or b) elevated serum alanine aminotransferase (ALT) levels (typically >400 IU/L) (see http://www.cdc.gov/ncphi/disss/nndss/casedef/case_definitions.htm). 2 Any confirmed case not exhibiting clinically consistent acute symptoms or illness. 3 Laboratory documentation of a seronegative result drawn within 1-2 years prior to the first seropositive result. 4 Non-Healthcare Risk Factors (e.g., intravenous drug use) at any time in the patient’s life 5 Case detection and/or healthcare exposures must be clustered in time and space (e.g., same practice within a facility, same procedure, etc.) 6 If at least one of the cases has no risk factors, Full Epi 7 If multiple cases share the same HC exposures, Full Epi. If all HC exposures shared by all cases, Initial Epi (to determine where to focus Full Epi)

Note: A portion of additional steps may be conducted if aggravating factors are present. Such factors may include an allegation of an infection control breach, NJDHSS oversight of a facility or practice, NYSDOH is a stakeholder of a facility or program, or the total number of healthcare exposures.