Public Health Law Map - Beta 5 - Medical and Public Health Law Site

The Court was rightly concerned with the severity of the disease. This would be
judged as a function of the morbidity of the disease, the duration of the disease, and
whether the disease has permanent sequelae. It is important to note when the
characteristics of the organism and the patient can increase the severity of the
disease. Diseases such as influenza are mildly incapacitating in healthy workers but
could be dangerous to the residents of a nursing home.
5. Probability of Transmission and Complications
This is the final element in the Court’s analysis, although it is more a synthesis of the
first three elements. The probability of transmission depends on the mode of
transmission and the infectivity of the diseases. This is sometimes called contact
effectiveness. The higher the contact effectiveness is, the higher is the probability that
a person coming into proper contact with a disease carrier will contract the disease.
For example, HIV is a disease with a low contact effectiveness; a sexual encounter
has a less than 5% chance of spreading the disease. There is no possibility of
spreading HIV by casual contact such as coughing. Conversely, measles is a disease
with a high contact effectiveness. A single exposure to a coughing person infected
with measles usually results in infection among susceptible persons.
If the usual mode of transmission does not occur in the workplace, then there is a
very low probability of transmission. This is the usual case for sexually transmitted
diseases that are not otherwise bloodborne. If the mode of transmission occurs in the
workplace but the contact efficiency is very low, there is also a low probability of
transmission. This would be the case for a disease such as leprosy that is spread by
physical contact but the contact efficiency is so low that it poses a risk only to
intimate family members. Conversely, active tuberculosis, an airborne disease with a
medium contact efficiency, poses a threat to anyone with whom the infected person
has frequent contact.
The Court did not specifically address the problem of persons with special
susceptibility to communicable diseases—primarily immunosuppressed persons and
pregnant women. The court has ruled that fertile women as a class cannot be
excluded from workplaces where there is exposure to teratogens. It is likely that
current law prevents pregnant women from being excluded from workplaces where
there is only a possibility of infection with a disease that adversely affects the fetus.
If there is a high probability of exposure, as on a hospital service caring for persons
infected with the disease, the court might allow some restrictions on pregnant
workers. The limited set of infections that pose a risk to the fetus and the fixed length
of pregnancy would make pregnancy- related restrictions unusual outside certain
medical care workplaces.
6. Federal and State Requirements
The communicable disease plan should identify all applicable federal and state
disease control laws and administrative regulations. These may include statutory
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