[Federal Register Volume 64, Number 208 (Thursday, October 28, 1999)]
[Proposed Rules]
[Pages 58022-58031]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-27640]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

42 CFR Part 72

RIN 0920-AA02


Packaging and Handling of Infectious Substances and Select Agents

AGENCY: Centers for Disease Control and Prevention (CDC), HHS.

ACTION: Notice of proposed rulemaking.

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SUMMARY: The Centers for Disease Control and Prevention proposes to

[[Page 58023]]

amend the regulations concerning the interstate shipment of infectious 
substances in order to clarify and expand the existing requirements for 
proper packaging and handling of these agents. One purpose of the 
proposed rule is to ensure that all biological materials that are known 
or suspected of containing an infectious substance are packaged for 
interstate shipment to minimize the potential for leakage of contents 
that could contaminate the environment or come into direct physical 
contact with persons handling such packages during transit. A second 
purpose is to insure receipt of certain infectious substances. This new 
regulation will harmonize CDC regulations with other Federal agencies' 
regulations and with international regulations.
    It also updates the requirements for facilities transferring or 
receiving select agents, incorporating by reference the 4th edition of 
the CDC/NIH publication Biosafety in Microbiological and Biomedical 
Laboratories.

DATE: Written comments must be received on or before December 27, 1999. 
Written comments on the proposed information collection requirements 
should also be submitted on or before December 27, 1999.

ADDRESSES: Mail written comments to the following address: Nashandra 
Hayes, Office of Health and Safety, Centers for Disease Control and 
Prevention, 1600 Clifton Road, Mail Stop--FO5, Atlanta, Georgia 30333.
    Mail written comments on the proposed information collection 
requirements to: Wendy Taylor, Office of Information and Regulatory 
Affairs, Office of Management and Budget, New Executive Office 
Building, 725 17th Street, NW, rm. 10235, Washington, DC 20503, Att.: 
Desk Officer for CDC.

FOR FURTHER INFORMATION CONTACT: Dr. Jonathan Y. Richmond or Dr. 
Richard Knudsen, Office of Health and Safety, Centers for Disease 
Control and Prevention, 1600 Clifton Road, NE, Mail Stop F05, Atlanta, 
Georgia 30333; telephone (404) 639-2453 or 639-3235, respectively.

SUPPLEMENTARY INFORMATION:

Revised Proposed Notice of Rulemaking

    Replaces NPRM at 55 FR 7678, March 2, 1990.

I. Background

    Under 42 U.S.C. 264, the Department of Health and Human Services is 
authorized to promulgate regulations to prevent the introduction, 
transmission and spread of communicable diseases from foreign countries 
and between the states. Authority was given to CDC in 1971 to regulate 
the interstate shipment of infectious substances. The current 
regulations are at 42 CFR part 72. The regulations provide requirements 
for minimum packaging and labeling for biological products and 
diagnostic specimens, and include a list of infectious agents for which 
special tracking is required. These regulations were last updated in 
1980.
    A Notice of Proposed Rulemaking (NPRM) was published in the Federal 
Register on March 2, 1990 (55 FR 7678), to update the existing 
packaging requirements for infectious substances. Impetus for that NPRM 
came from postal workers and members of Congress who expressed concerns 
about the potential risk of exposure to infectious agents for people 
who handle improperly packaged or damaged packages of biomedical 
material during transit. Persons shipping these materials also stated 
that some definitions in the 1980 regulation were unclear. There had 
also been changes in the list of infectious agents that required 
notification of receipt.
    Comments on the 1990 NPRM focused on two major issues. Numerous 
parties, including United States Postal Service workers, submitted 
comments regarding the transport of clinical specimens for diagnostic 
studies. Several parties encouraged CDC to harmonize the proposed 
regulation with the international shipping regulations.
    Several government agencies and industry groups, in addition to 
CDC, regulate the packaging, labeling and shipment of infectious 
materials within the United States and internationally.
     The Department of Transportation (DOT) Hazardous Materials 
regulations, at 49 CFR parts 171-180, regulate the interstate 
transportation by surface or air of infectious substances, medical 
waste, chemical and radioactive materials. That regulation does not 
apply to the transport of clinical or diagnostic specimens, unless 
specifically known to contain an infectious substance (49 CFR 173.134).
     The United States Postal Service (USPS) regulates the 
shipment, by U.S. mail, of etiologic agents, infectious substances, 
clinical specimens, biological products, and sharps (e.g., contaminated 
needles and other sharp medical materials) and unsterilized containers 
(39 CFR and Domestic Mail Manual C023, Etiologic Agent Preparations, 
Clinical Specimens, and Biological Products; and International Mail 
Manual 135 Mailable Dangerous Goods).
     The Department of Labor, Occupational Safety and Health 
Administration (OSHA), at 29 CFR 1910.1030, Occupational Exposure to 
Bloodborne Pathogens, regulates the worker safety aspects of the 
handling, packaging and transport of human blood and body fluids, 
unfixed tissues, organs and cell cultures, and other fluids from humans 
and animals infected or possibly infected with bloodborne pathogens.
     The Department of Commerce (DOC) maintains a list of 
controlled items, including certain microorganisms that cannot be 
exported from the U.S. (15 CFR parts 768-799). The DOC recommends that 
shippers follow the CDC regulation for packaging when a shipment is 
allowed to a foreign country.
     The United Nations Committee of Experts on the Transport 
of Dangerous Goods makes recommendations on the international transport 
of infectious substances and clinical specimens. These recommendations 
are included in the International Civil Aeronautics Organization (ICAO) 
technical instructions, which have been adopted by the International 
Air Transport Association (IATA).

--ICAO publishes Technical Instructions for the Safe Transport of 
Dangerous Goods by Air, based on the United Nations (UN) 
recommendations for the domestic and international transport of 
infectious substances and clinical (diagnostic) specimens.
--IATA publishes the Dangerous Goods Regulations (DGR), which further 
describe for IATA member airlines, the national and international 
recommendations for air transport of infectious substances and clinical 
(diagnostic) specimens. The IATA DGR are followed by the domestic and 
international member airlines.

    CDC's regulation, currently at 42 CFR part 72, provides packaging 
and labeling requirements for shipments of infectious materials. There 
are several reasons why CDC regulates this area in addition to the 
other agencies listed above. The focus of the CDC regulation is on 
protection of the public health by minimizing the potential for (1) 
Direct physical contact with package contents by persons handling such 
packages during transit, (2) Contamination of the environment, and (3) 
The spread of disease into the community. The CDC regulations serve by 
filling the gaps where there is no governance, by complementing the 
requirements of other agencies where there is overlapping authority, 
and by providing CDC as a central reporting authority assures 
availability of CDC's infectious

[[Page 58024]]

disease expertise to assist in the response when packages are damaged.
    Although there had been some review of the requirements of other 
agencies when developing the 1990 NPRM, there had not been any 
comprehensive attempt to harmonize the various requirements. When 
comments to the 1990 NPRM were reviewed, it became clear that there was 
confusion among shippers and handlers as to how all the various 
requirements of other agencies related to the CDC regulations. Because 
of substantive differences in the requirements and use of different 
terminology, there was a clear need to harmonize the various 
requirements.
    In response to the comments on the 1990 NPRM, and as part of the 
regulatory reform/reinventing government initiative, CDC has 
collaborated with the other agencies and groups to prepare revised 
proposed CDC regulations that are in harmony with the other 
requirements, thereby reducing the burden on shippers while still 
maintaining, or even improving, packaging standards to protect the 
public health. In some instances, one or more of the other agencies/
groups will also be revising their requirements as part of our joint 
effort to achieve complementary regulations. We invite specific comment 
on any requirements contained in the proposed CDC regulations which are 
thought to be inconsistent or unclear in relation to the requirements 
of any other regulatory authority.
    CDC also serves as a Center for Applied Biosafety and Training for 
the World Health Organization (WHO) and for the UN. In conjunction with 
the National Institutes of Health, CDC has participated in developing 
revised international guidelines for the shipment of infectious 
materials and diagnostic specimens. This NPRM also reflects the 
recommendations of the WHO biosafety advisory group, as published in 
1997, in Guidelines for the Safe Transport of Infectious Substances and 
Diagnostic Specimens.
    As a result of this extensive collaboration, significant changes 
have been made to the 1990 NPRM, and a new NPRM is being published to 
provide the opportunity for laboratories and other shippers of 
infectious materials, persons who transport or handle packages, public 
health officials and other affected parties to comment on these 
proposed regulations to ensure that the final regulations are both 
complementary to other packaging and shipping requirements and 
protective of the public health.
    CDC believes these regulations will not be an additional burden to 
shippers because shippers interested in ensuring the integrity of their 
packages are already utilizing comparable packaging. These regulations 
will help to ensure that all shippers are aware of and utilize 
appropriate packaging when shipping infectious substances, thereby 
protecting the public health.

Comparison of CDC's Proposed Packaging and Labeling Requirements 
With Other Agencies' and Groups' Packaging and Labeling 
Requirements

    This NPRM proposes packaging and labeling requirements for: (1) 
Clinical specimens because they may contain infectious agents, and (2) 
materials known or suspected of containing infectious substances or 
toxins.
    Table 1 shows which types of infectious materials are covered by 
each regulating authority and the scope of that coverage. As noted in 
the table, no single agency covers all aspects regarding the shipment 
of infectious substances.

   Table 1.--Infectious Substances: Comparison of the CDC NPRM \1\ With OSHA,\2\ DOT,\3\ USPS,\4\ and IATA \5\
                                       Packaging and Labeling Requirements
----------------------------------------------------------------------------------------------------------------
                                                                                Regulations
               Requirements                 CDC NPRM \1\ -------------------------------------------------------
                                                            OSHA \2\       DOT \3\      USPS \4\      IATA \5\
----------------------------------------------------------------------------------------------------------------
Infectious materials:
    Biological products...................            +             +          -\6\             +             +
    Clinical (diagnostic) specimens.......            +             +          -\6\             +             +
    Cultures and reference stocks.........            +             +             +             +             +
Packaging materials:
    Watertight primary receptacle.........            +             +             +             +             +
    Absorbent material....................            +            na             +             +             +
    Watertight secondary packaging........            +            na             +             +             +
    List of contents......................            +            na             +          -\7\             +
    Outer packaging.......................            +            na             +             +             +
    Packaging performance standards.......            +            na             +             +             +
Packaging labels:
    Infectious substance/biohazard symbol             +             +             +             +             +
     label................................
    Shipping label,\8\ outer packaging....            +            na          -\9\             +             +
    Shipping label, secondary packaging...            +            na            na             +            na
Tracking special infectious substances....            +            na            na            na            na
Terminology...............................            +             +             +             +             +
Shipping modes covered....................          All           All           All     Mail only      Air only
----------------------------------------------------------------------------------------------------------------
Legend: + = same or very similar to the CDC NPRM; - = significantly different from the CDC NPRM; na = not
  addressed in regulation.
 
\1\ CDC: Centers for Disease Control and Prevention, 42 CFR Part 72 as proposed in this NPRM.
\2\ OSHA: Occupational Safety and Health Administration, 29 CFR 1910.1030.
\3\ DOT: Department of Transportation, 49 CFR Parts 171-180.
\4\ USPS: United States Postal Service, Domestic Mail Manual CO23.
\5\ IATA: International Air Transport Association, Dangerous Goods Regulations.
\6\ Only those biological products and clinical specimens known to contain infectious substances are covered
  under 49 CFR 173.134.
\7\ USPS requires a list of contents (manifest) for all sharps mailing containers, but only requires a list of
  contents for other items sent via air transportation
\8\ Shipping label: Names, addresses, contact names and phone numbers of person shipping the package and
  intended recipient (addressee).
\9\ DOT specifies that the shipper include an emergency response telephone number on the shipping documents (49
  CFR 172.604).


[[Page 58025]]

II. Proposed Rule

    This proposed rule would amend the existing regulations at 42 CFR 
part 72 concerning the interstate shipment of infectious substances to 
clarify and expand the existing requirements for proper packaging and 
handling of these agents. The purpose of this regulation is to ensure 
that all biological materials that contain, or may contain, an 
infectious substance are packaged for interstate shipment in a manner 
that minimizes the potential for leakage and possible contamination of 
the environment, or direct physical contact with the contents by 
persons handling such packages during transit. This rule will also 
require that infectious agents and toxins capable of causing serious 
infection, illness or death be labeled and tracked during shipment.
    It also updates the requirements for facilities transferring or 
receiving select agents, incorporating by reference the 4th edition of 
the CDC/NIH publication Biosafety in Microbiological and Biomedical 
Laboratories.

A. Definitions

    Biological products--Biological product means a biological product 
that is subject to preparation and manufacture in accordance with the 
provisions of 9 CFR part 102 (Licensed Veterinary Biological Products), 
9 CFR part 103 (Biological Products for Experimental Treatment of 
Animals), 9 CFR part 104 (Imported Biological Products), 21 CFR part 
312 (Investigational New Drug Application), or 21 CFR parts 600-680 
(Biologics) and that, in accordance with such provisions, may be 
shipped in interstate traffic. FDA-approved vaccines are exempt from 
this regulation.
    Only biological products that are known or presumed to contain an 
infectious substance are subject to this regulation.
    Clinical Specimens--A clinical specimen is any human or animal 
material including, but not limited to excreta, secreta, blood and its 
components, tissue and tissue fluids, that is collected for the purpose 
of diagnosis, research, or other purposes. Formalin-fixed specimens are 
excluded. Animal material clinical specimens are subject to the 
regulation only if known or suspected of containing human pathogens.
    Under the concept of Universal Precautions all bodily fluids of 
human origin must be handled as if they are infectious in order to 
minimize the potential for exposure to bloodborne pathogens. Section 
72.3 in this NPRM meets those requirements.
    Some clinical specimens are known or presumed to contain viable 
infectious micro-organisms that could result in an infection if an 
exposure occurred during a transport mishap. These specimens must be 
packaged and labeled as infectious substances (see Sec. 72.4(a)). If 
exposure could result in an extremely serious infection or illness in 
an exposed worker or the public, such specimens are considered special 
infectious substances and must be tracked during shipment.
    Infectious substance--CDC has replaced the term ``etiologic agent'' 
with the DOT and international term ``infectious substance''. For 
purposes of this regulation, an infectious substance is any substance, 
clinical specimen or culture, isolate, or other derivative of a 
clinical specimen that contains, or is suspected of containing a viable 
infectious virus, prion, or a viable microorganism, such as a 
bacterium, rickettsia, parasite or fungus, that is known or reasonably 
believed to cause disease in humans. Toxins known to be pathogenic are 
to be packaged and shipped either as infectious substances or as 
special infectious substances (Sec. 72.5), as applicable.
    Examples of infectious substances include:
    1. All cultures containing or suspected of containing a 
microorganism that causes or may cause disease in humans;
    2. All human or animal clinical specimens that are known or 
suspected of containing an infectious microorganism or toxin;
    3. Environmental samples to the extent that they are suspected of 
containing human pathogens at a level that presents risk of infection.
    4. Other specimens not included above and designated as infectious 
by a qualified person (e.g., physician, scientist, veterinarian, 
nurse).
    To maintain consistency with DOT regulations, a qualifying sentence 
has been added to the definition of an infectious substance that states 
that a microbial toxin that causes disease in humans will be packaged 
and shipped as an infectious substance.
    Packaging--A change in this NPRM is the adoption of DOT and IATA 
terminology to clarify that there is agreement among the various 
organizations involved in regulating this area. The terms ``primary 
container'', ``secondary container'', and ``outer container'' have been 
replaced with the DOT terms and definitions of ``primary receptacle'', 
``secondary packaging'', and ``outer packaging'.
    Special infectious substance means any of the microbiological 
agents or toxins listed in Sec. 72.5 or appendix A to part 72 (proposed 
to be recodified as appendix to subpart B). These special infectious 
substances include those agents listed in the CDC/NIH publication, 
Biosafety in Microbiological and Biomedical Laboratories, as biosafety 
level (BSL) 4 and most of the BSL3 agents. Special infectious 
substances present a potentially high risk of infection and/or death to 
persons exposed to them through either direct contact, aerosol or 
ingestion. Therefore, shipments of special infectious substances are 
tracked to assure their safe arrival.

B. Transport of Clinical Specimens

    Clinical specimens are to be packaged in such a manner that they 
will remain intact under conditions that normally occur during transit. 
If the primary receptacle were to break or leak during transit, the 
specimen would be contained by the absorbent material and by the 
secondary packaging, so no material would leak to the outside surface 
of the outer packaging.
    Packaging requirements for clinical specimens proposed in this NPRM 
are similar to those for infectious substances, except that the 
proposed performance standards are less rigorous. These packaging and 
labeling requirements meet the specifications established by OSHA and 
various international agencies.

C. Transport of Infectious Substances

    Infectious substances are to be packaged in such a manner that they 
would withstand conditions which would normally occur during transit 
and would not leak even if the primary receptacle were to break. In 
addition, the proposed packaging requirements have been enhanced by 
adding a requirement that the packaging be capable of passing a drop 
test. The completed package must be capable of passing the tests 
specified in 49 CFR 178.609. The requirements established in this NPRM 
meet those of DOT, OSHA, various international agencies and are 
consistent with the 1999 IATA Dangerous Goods Regulations.
    In keeping with DOT and the international guidelines and 
regulations, volume/weight limits have been changed to four liters or 
four kilograms in a single package (excluding the packaging and coolant 
weights). An itemized list of contents must be enclosed between the 
secondary packaging and outer packaging. The proposed rule also details 
provisions associated with substances shipped refrigerated or frozen 
(prefrozen packs,

[[Page 58026]]

wet or dry ice), shipped in liquid nitrogen, or as lyophilized 
materials.
    The proposed rule requires on the outer packaging a black and white 
label bearing the words ``Infectious Substance'', CDC's telephone 
number for reporting damaged packages, and the biohazard symbol. The 
proposed rule also would require that the name, address, and telephone 
number of both the shipper and recipient be affixed to the outer 
package.

D. Transport of Special Infectious Substances; Failure to Receive

    This proposed rule would be unique in requiring that the most 
dangerous human pathogens be shipped as ``special infectious 
substances''. These agents include those identified for work at 
biosafety level 3 and 4 as specified in the Biosafety in 
Microbiological and Biomedical Laboratories publication.
    Special infectious substances must be shipped by the carrier and a 
system that provides for tracking the shipment and notifying CDC if the 
packages are not received. Information gathered by CDC from such 
notifications will be useful in identifying problems and implementing 
corrective actions.

E. Select Agents

    Some of the microorganisms listed as special infectious substances 
are also considered to be ``select agents'' and are regulated in 42 CFR 
72.6 (Additional Requirements for Facilities Transferring or Receiving 
Select Infectious Agents) (proposed here to be renumbered as Section 
72.11). The only changes in this proposed rule to Sec. 72.6 are at 
Sec. 72.6 (a)(5) (now Sec. 72.11 (a)(5)), and Sec. 72.6 (c)(1) (now 
Sec. 72.11(c)(1)), which are revised to incorporate the 4th edition of 
the CDC/NIH publication Biosafety in Microbiological and Biomedical 
Laboratories.

F. Variations

    To promote innovation and allow for new technologies, the proposed 
rule would allow the Director, CDC, to approve variations from the 
requirements of this subpart if, upon written application, it is found 
that such variations provide protection at least equivalent to that 
provided by the requirements in this subpart, as finalized, and such 
findings are made a matter of official written record.

G. Penalties

    Violations of the rule would be subject to criminal penalties as 
prescribed in 42 U.S.C. 271 and 18 U.S.C. 3559, 3571. Specifically, 
individuals in violation of the rule would be subject to a fine or 
imprisonment of not more than one year, or both.

III. Procurement of Labels

    Shippers will be able to order a supply of the two shipping labels 
described in the regulations from private printers by furnishing them 
the exact specifications provided in the final rule, or by purchasing 
the labels from the Superintendent of Documents (U.S. Government 
Printing Office, Mail Stop: SSOP, Washington, D.C. 20402-9328).

IV. Analysis of Impacts

A. Review Under Executive Order 12866, Sections 202 and 205 of the 
Unfunded Mandate Reform Act of 1995 (P.L. 104-4), and by the Regulatory 
Flexibility Act (5 U.S.C 603-605)

    The Department has examined the potential impact of this proposed 
rule as directed by Executive Order 12866, by sections 202 and 205 of 
the Unfunded Mandate Reform Act of 1995 (Pub. L. 104-4), and by the 
Regulatory Flexibility Act (5 U.S.C. 603-605).
    Executive Order 12866 directs Federal agencies to assess the costs 
and benefits of available regulatory alternatives, and, when regulation 
is necessary, to select regulatory approaches that maximize net 
benefits. This proposed rule is designed to ensure that all biological 
materials that contain, or may contain, an infectious substance are 
packaged in a manner for interstate shipment that minimizes the 
potential for leakage and possible contamination of the environment or 
direct physical contact with the contents by persons handling such 
packages during transit. The proposed rule is designed to complement 
other shipping requirements developed by the Departments of Commerce, 
Agriculture, and Transportation, the USPS, OSHA, and the International 
Air Transport Association and, thereby, to reduce the burden on 
shippers while imposing minimal administrative costs, and to prevent 
possible serious, harmful effects to public safety and health. (The 
proposal has been reviewed by the Office of Management and Budget under 
the terms of the Executive Order.)
    The Unfunded Mandates Reform Act of 1995, in sections 202 and 205, 
requires Federal agencies to prepare several analytic statements before 
proposing a rule that may result in expenditures of $100 million by 
State, local and tribal governments, or by the private sector in any 
one year. Because a final rule resulting from this proposal would not 
result in expenditures of this magnitude, such statements are not 
necessary.
    The Regulatory Flexibility Act requires Federal agencies to prepare 
a regulatory flexibility analysis of the potential impact of the 
proposed rule on small entities and permits agency heads to certify 
that a proposed rule will not, if promulgated, have a significant 
economic impact on a substantial number of small entities. CDC does not 
know how many small entities will be impacted by this regulation, and 
does not know what the economic impact on those small entities would 
be. However, CDC believes that packaging requirements set forth in this 
rule would not be an additional burden on shippers because this is an 
amendment to existing PHS rules with which shippers must comply. In 
addition, it will harmonize these rules with other existing regulations 
that shippers must follow. CDC believes that this rule will lessen 
confusion regarding proper packaging and shipping of infectious 
materials and will bring HHS regulations into conformity with other 
regulations. CDC is requesting information/comments on the number of 
small entities that would be impacted by this NPRM, the economic burden 
on those small entities and why the Secretary should not certify that 
this rule will have no significant impact on small entities. CDC is 
also requesting comments/recommendations on other possible less 
burdensome approaches to ensuring that all infectious or potentially 
infectious materials are packaged and shipped in a way that minimizes 
risks to workers, the public and the environment.
    These regulations will help to ensure that all shippers are aware 
of and utilize appropriate packaging when shipping infectious 
substances, thereby protecting the public health.

B. Review Under the Paperwork Reduction Act of 1995

    The proposed rule contains information collection requirements that 
are subject to review by the Office of Management and Budget (OMB) 
under the Paperwork Reduction Act of 1995. The title, description and 
respondent description of the information collection are shown below 
with an estimate of the annual reporting burden. The estimate includes 
the time for reviewing instructions, gathering and maintaining the 
necessary data, and completing and reviewing the collection of 
information. With respect to the following collection of information, 
CDC invites comments on: (a) Whether the proposed collection of 
information is necessary for the proper performance of CDC's public

[[Page 58027]]

health functions, including whether the information shall have 
practical utility; (b) the accuracy of CDC's estimate of the burden of 
the proposed collection of information including the validity of the 
methodology and assumptions used; (c) ways to enhance the quality, 
utility, and clarity of the information to be collected; and (d) ways 
to minimize the burden of the collection of information on respondents, 
including through the use of automatic collection techniques or other 
forms of information technology.
    Title: Packaging and Handling of Infectious Substances and Select 
Agents.
    Description: The CDC proposes to amend the regulations concerning 
the interstate shipment of infectious substances in order to clarify 
and expand requirements for proper packaging and handling of these 
agents. The proposed rule would ensure that all biological materials 
that may contain an infectious substance are packaged for interstate 
shipment in a manner that minimizes the potential for leakage and 
possible contamination of the environment or direct physical contact 
with the contents by persons handling such packages during transport. 
It also updates the requirements for facilities transferring or 
receiving select agents, incorporating by reference the 4th edition of 
the CDC/NIH publication Biosafety in Microbiological and Biomedical 
Laboratories.
    Anyone handling damaged or leaking packages of infectious 
substances during interstate shipment must isolate the package, notify 
the shipper and intended recipient immediately and notify CDC as soon 
as feasible (1-800-232-0124). When notifying CDC, the caller should 
provide a description of the condition of the package, the name, 
address and telephone number of the shipper, and any other pertinent 
information, so that information and assistance can be provided, as 
necessary, regarding appropriate decontamination and disposal 
procedures.
    Persons who ship packages containing special infectious substances 
must notify the addressee of the date of shipment, and the addressee 
must confirm receipt by telephone or other electronic means. If the 
shipper does not receive such confirmation within 3 days of anticipated 
delivery, the shipper must then contact CDC within 24 hours to enable 
the agency to determine whether a public health response is necessary. 
Information gathered by CDC from such notifications will also be useful 
in identifying problems and implementing corrective actions.
    Description of Respondents: Government agencies, universities, 
research institutions, laboratories, private companies and others that 
ship or receive infectious substances, and government or commercial 
carriers of infectious substances.

                                        Estimated Annual Reporting Burden
----------------------------------------------------------------------------------------------------------------
                                                               Frequency      Total
                  CFR section                     Number of        of         annual     Hours per   Total hours
                                                 respondents   reporting    responses     response
----------------------------------------------------------------------------------------------------------------
72.4(b)........................................          500        1x/yr           50          0.1            5
72.5(b)........................................          200        10/yr        2,000          0.1          200
72.5(c)........................................          200        10/yr        2,000          0.1          200
72.5(d)........................................           20         1/yr           20          0.2            4
                                                ----------------------------------------------------------------
    Total                                                                                                   409
----------------------------------------------------------------------------------------------------------------

    Reporting or Disclosures: These estimates are an approximation of 
the average time expected to be necessary for a collection of 
information. They are based on past experiences of respondents 
reporting such information to CDC. There are no capital costs or 
operating and maintenance costs for the respondents associated with 
this information collection.
    The agency has submitted a copy of this proposed rule to OMB for 
its review of this information collection. Interested persons are 
requested to submit written comments regarding this information 
collection, including suggestions for reducing the burden, to the 
Office of Information and Regulatory Affairs, OMB, New Executive Office 
Building, 725 17th Street, NW, Rm. 10235, Washington, DC 20503, Att.: 
Desk Officer for CDC.

List of subjects in 42 CFR Part 72

    Biologics, packaging and containers, Transportation.

    Dated: March 12, 1999.
Jeffrey Koplan,
Director, Centers for Disease Control and Prevention.

    Dated: May 31, 1999.
Donna E. Shalala,
Secretary, Department of Health and Human Services.

    For the reasons stated in the preamble, it is proposed to amend 42 
CFR Chapter I, part 72, as follows:

PART 72--PACKAGING AND HANDLING OF INFECTIOUS SUBSTANCES AND SELECT 
AGENTS

    1. The authority citation for Part 72 is revised to read as 
follows:

    Authority: 42 U.S.C. 216, 264, 271; 31 U.S.C. 9701; 18 U.S.C. 
3559, 3571; 42 U.S.C. 262 note.

    2. The heading of part 72 is revised to read as set forth above.
    3. Sections 72.1-72.5 are revised.
    4. 72.6 is redesignated as Sec. 72.11.
    5. A new Sec. 72.6 is added.
    6. A heading for subpart A is added and sections Secs. 72.1-72.6 
are transferred to subpart A.
    7. A heading for subpart B is added and redesignated section 72.11 
is transferred to subpart B and amended by revising paragraphs (a)(5) 
and (c)(1).
    8. Section 72.7 is redesignated as section 72.21.
    9. A heading for subpart C is added and redesignated section 72.21 
is transferred to subpart C.
    10. Appendix A to Part 72 is transferred to subpart B and the 
heading is revised to read ``Appendix to Subpart B''.
    The additions and revisions to part 72 read as follows:

Subpart A--Interstate Shipment of Biological Materials That Contain 
or May Contain Infectious Substances


Sec. 72.1  Purpose.

    The purpose of this regulation is to ensure that all materials that 
contain or may contain an infectious substance are packaged for 
interstate shipment in a manner that minimizes the potential for 
leakage and possible contamination of the environment or direct 
physical contact with the contents by persons handling such packages 
during transit.

[[Page 58028]]

The rule also requires the tracking of shipments of special infectious 
substances and requires registration of certain select agents. The 
requirements of this subpart are in addition to and not in lieu of any 
other packaging or other requirements for the transportation of 
infectious substances in interstate traffic as prescribed by the US 
Department of Transportation, the US Postal Service and other agencies 
of the Federal Government.


Sec. 72.2  Definitions.

    As used in this subpart:
    Absorbent material means material that is capable of absorbing 
liquids. It may be either particulate or non-particulate, but if 
particulate, it shall be contained so it does not leak out of the 
package.
    Biological product means a biological product that is subject to 
preparation and manufacture in accordance with the provisions of 9 CFR 
part 102 (Licensed Veterinary Biological Products), 9 CFR part 103 
(Biological Products for Experimental Treatment of Animals), 9 CFR part 
104 (Imported Biological Products), 21 CFR part 312 (Investigational 
New Drug Application), or 21 CFR parts 600-680 (Biologics) and that, in 
accordance with such provisions, may be shipped in interstate traffic. 
Only biological products that are known or presumed to contain an 
infectious substance are subject to this regulation. FDA-approved 
vaccines are exempt from this regulation.
    Clinical specimen (diagnostic specimen) is any human or animal 
material including, but not limited to excreta, secreta, blood and its 
components, tissue and tissue fluids, that is collected for the 
purposes of diagnosis, research, or other purposes. Formalin-fixed 
specimens are exempt from this regulation. Animal material clinical 
specimens are subject to this regulation only if known or suspected of 
containing human pathogens. All human clinical specimens are covered.
    Coolant material means material such as ice, dry ice, liquid 
nitrogen, and gel packs, that is included in the package to cool the 
contents.
    Infectious substance (etiologic agent) and infectious material are 
considered synonymous. An infectious substance is defined as a 
substance containing or suspected of containing an infectious virus, 
prion, or a viable microorganism, such as a bacterium, rickettsia, 
parasite or fungus, that is known or reasonably believed to cause 
disease in humans. Toxins known to be pathogenic to humans are to be 
packaged and shipped as infectious substances or special infectious 
substances (Sec. 72.5). The term ``infectious substance'' excludes any 
medical waste that is regulated under other federal regulations. For 
purposes of this regulation, infectious substances include:
    (1) All cultures containing or suspected of containing a 
microorganism that causes or may cause disease in humans;
    (2) All human or animal clinical specimens that are known or 
suspected of containing an infectious microorganism or toxin;
    (3) Environmental samples if they are suspected of containing human 
pathogens at a level that presents risk of infection.
    (4) Other specimens not included above and designated as infectious 
by a qualified person (e.g., a physician, scientist, veterinarian, 
nurse).
    Interstate traffic means the movement, including any portion 
entirely within a State or possession, from a point of origin in any 
State or possession or from outside the Untied States, to a point of 
destination in any other State or possession; or form any State or 
possession to another country; or between a point of origin and a point 
of destination in the same State or possession but through any other 
State, possession or contiguous foreign country.
    Outer packaging means the container in which a primary receptacle 
and secondary package, together with any absorbent materials and 
cushioning, is shipped.
    Primary receptacle means a tube, vial, bottle, ampule, or similar 
item that contains the material being shipped.
    Secondary packaging means a container into which the primary 
receptacle is placed.
    Special infectious substance means any of the microbiological 
agents or toxins listed in Sec. 72.5 or appendix to subpart B of this 
part, including any human or animal specimens known or suspected of 
containing such a microbial agent, or any other microorganism that 
could cause serious infection and/or death in persons exposed to them 
through either direct contact, aerosol or ingestion. Additional changes 
to this list may be made through publication of a notice in the Federal 
Register.


Sec. 72.3  Transportation of clinical specimens; minimum packaging 
requirements.

    (a) General requirements. No person may knowingly transport or 
cause to be transported in interstate traffic, directly or indirectly, 
any clinical specimen unless such material is packaged, labeled, and 
shipped in accordance with the requirements of this section. However, 
any clinical specimens known or suspected to contain an infectious 
substance shall be labeled and packaged as described under Sec. 72.4.
    (1) Clinical specimens shall be packaged to withstand conditions 
incident to ordinary handling in transit, including shocks and pressure 
changes, so that if leakage of the primary receptacle(s) occurs during 
transit, the contents will be contained within the outer packaging. 
Required packaging and components are as follows:
    (i) A watertight primary receptacle.
    (ii) Watertight secondary packaging.
    (iii) Absorbent material must be placed between the primary 
receptacle(s) and the secondary packaging. If multiple primary 
receptacles are placed in a secondary packaging, they msut be placed so 
as to ensure that contact between them is prevented. The absorbent 
material must be sufficient to absorb the entire contents of all 
primary receptacles.
    (iv) Outer packaging must be of adequate strength for its capacity, 
mass and intended use. Any package with liquid contents shall have 
sturdy outer packaging constructed of corrugated cardboard, fiberboard, 
wood, metal, or rigid plastic. Styrofoam, plastic bags and paper 
envelopes are unacceptable outer packaging for such packages.
    (2) The size of the outer package must be at least 100 mm (3.9 
inches) in the smallest overall external dimension.
    (3) The primary receptacle and the secondary packaging must be 
capable of withstanding, without leakage, an internal pressure which 
produces a pressure differential of not less than 95kPA (0.95 bar, 
13.8lb/in2) in the temperature range of -40 deg. C to 
+55 deg. C (-40 deg. F to 131 deg. F).
    (4) An itemized list of contents must be enclosed between the 
secondary packaging and the outer packaging.
    (5) For substances shipped at ambient temperatures or higher, means 
of ensuring a leak-proof seal of the primary receptacle, such as a heat 
seal, skirted stopper or metal crimp seal must be provided. Screw caps 
must be reinforced to ensure they do not leak. Evacuated specimen 
collection tubes such as Vacutainer (Becton-Dickinson, 
Franklin Lakes, NJ) tubes do not require additional sealing.
    (6) For substances shipped refrigerated or frozen (wet ice, 
prefrozen packs, dry ice), ice or dry ice must be placed outside the 
secondary packaging(s). Interior support must be provided to secure the 
secondary packaging(s) in the original position as the ice or dry ice 
melts or sublimates, respectively. If ice is used, the outer

[[Page 58029]]

packaging must be leak-proof. If dry ice is used, the outer packaging 
must permit the release of carbon dioxide gas. The primary receptacle 
must maintain its containment integrity at the temperature of the 
refrigerant as well as the temperatures and pressure of air transport 
to which the receptacle could be subjected if refrigeration were to be 
lost.
    (7) For substances shipped in liquid nitrogen, a watertight 
material, capable of withstanding cryogenic temperatures must be used 
as the primary receptacles. Secondary packaging must also withstand 
very low temperatures. All requirements for shipment of liquid nitrogen 
must also be observed. The primary receptacle must maintain its 
containment integrity at the temperature of the refrigerant as well as 
at the temperatures and pressure of air transport to which the 
receptacle could be subjected if refrigeration were to be lost.
    (8) For lyophilized substances, primary receptacles capable of 
containing lyophilized substances must be used (including, but not 
limited to, flame-sealed glass ampules or rubber-stoppered glass vials 
with metal seals).
    (9) The completed package must be capable of withstanding at least 
a 1.2 meter drop on a hard unyielding surface without release of its 
contents.
    (10)(i) Biohazard Labeling is required for the primary receptacle 
and outer packaging as described in 29 CFR 1910.1030, Occupational 
Exposure to Bloodborne Pathogens.
    (ii) The outer packaging shall bear a label as illustrated and 
described below:
[GRAPHIC] [TIFF OMITTED] TP28OC99.052

    (A) The color of material on which the label is printed shall be 
bright orange; the printing shall be black. The color of the biohazard 
symbol shall be black.
    (B) The label shall be a rectangle measuring 51 mm (2 inches) high 
by 102.5 mm (4 inches) long.
    (C) The biohazard symbol, measuring 40 mm (1.56 inches) in 
diameter, shall be centered on a square measuring 51 mm (2 inches) on 
each side.
    (D) Size of the letters (Helvetica) on the label shall be as 
follows:

Biohazard--16 pt.
Clinical specimens--14 pt.
Packaged in compliance with 42 CFR part 72--6 pt.
In case of damage or leakage, notify--10 pt.
Shipper and Receiver--10 pt.

    (iii) The outer packaging shall also bear a shipping label with the 
names, addresses, and contact names and telephone numbers of the 
individual/institution sending the package and the intended recipient 
(addressee).
    (b) Leaking packages. The carrier, the receiver, or anyone handling 
a package described in paragraph (a) of this section that is leaking, 
shall upon discovery of leakage, isolate the package, and immediately, 
or as soon as feasible, notify the shipper and intended recipient to 
receive instructions on clean-up and disposition of the package.


Sec. 72.4  Transportation of infectious substances; minimum packaging 
requirements.

    (a) General requirements. No person may knowingly transport or 
cause to be transported in interstate traffic, directly or indirectly, 
any infectious substance, including clinical specimens or biological 
products that are known or presumed to contain infectious substances, 
unless such material is packaged, labeled, and shipped in accordance 
with the requirements of this section.
    (1) Infectious substances shall be packaged to meet the 
requirements of Sec. 72.3(a) (1)-(8).
    (2) The maximum amount of infectious substances that may be placed 
in a single outer shipping package shall not exceed four liters or four 
kilograms, excluding the packaging and coolant weights.
    (3) In addition, each complete package must be capable of passing 
the tests specified in 49 CFR 178.609.
    (4)(i) Biohazard Labeling is required for the primary receptacle 
and outer package as described in 29 CFR 1910.1030, Occupational 
Exposure to Bloodborne Pathogens.
    (ii) The outer packaging shall bear a label as illustrated and 
described below:

[[Page 58030]]

[GRAPHIC] [TIFF OMITTED] TP28OC99.053


    (A) The color of material on which the label is printed shall be 
white and the printing shall be in black; the biohazard symbol shall be 
in black.
    (B) The label shall be a diamond-on-point measuring, at a minimum, 
51 mm (4 inches) on each side.
    (C) The black biohazard symbol, measuring 21 mm (.81 inches) in 
diameter, shall be centered on a square measuring 51 mm (2 inches) on 
each side.
    (D) Size of the letters (Helvetica) on the label shall be as 
follows:

Infectious Substance--16 pt.
Packaged in compliance with 42 CFR Part 72--5 pt.
In case of damage or leakage--7 pt.
Immediately notify--7 pt.
Public Health Authority--7 pt.
In U.S.A.--5 pt
Centers for Disease Control and Prevention--5 pt.
Atlanta, GA--5 pt
1-800-232-0124--5 pt.
6--24 pt.

    (E) The number 6 (mandated by the DOT) shall be centered at the 
bottom of the label.
    (iii) The outer packaging and the secondary packaging shall also 
bear labels with the names, addresses, and contact names and telephone 
numbers of the individual/institution sending the package and of the 
intended recipient (addressee).
    (b) Damaged or leaking packages. The carrier, the receiver, or 
anyone handling a package described in paragraph (a) of this section 
that is damaged or leaking, shall upon discovery of damage or leakage, 
isolate the package and immediately, or as soon as feasible, in order 
to receive instructions on appropriate decontamination and disposal, 
notify the shipper, receiver, and the Centers for Disease Control and 
Prevention by telephone at 1-800-232-0124. The caller shall provide a 
description of the condition of the package; the name, address and 
telephone number of the shipper; and other pertinent information.

(This information collection has been approved by OMB (0920-0199)).


Sec. 72.5  Packaging and method of shipment of special infectious 
substances; failure to receive.

    (a) List of special infectious substances. (1) The following 
microorganisms and toxins are considered special infectious substances 
because they present a potentially high risk of infection and/or death 
to persons exposed to them through either direct contact, aerosol or 
ingestion. Shipments of special infectious substances must be tracked 
to assure their safe arrival.

Bacterial Agents

Bacillus anthracis
Bartonella bacilliformis
Brucella, all species
Burkholderia (Pseudomonas) mallei
Burkholderia (Pseudomonas) pseudomallei
Clostridium botulinum
Francisella tularensis
Mycobacterium tuberculosis (drug-resistant strains)
Yersinia pestis

Viral and Rickettsial Agents

    Arboviruses assigned to Biosafety level 3 or 4 in the CDC/NIH 
publication Biosafety in Microbiological and Biomedical 
Laboratories, which may be purchased from the Superintendent of 
Documents, U.S. Government Printing Office, Washington, D.C. 20402.

Other Viral Agents

Crimean-Congo hemorrhagic fever virus
Eastern Equine Encephalitis virus
Ebola virus
Hantaan virus (Korean hemorrhagic fever virus)
Hantavirus (all viruses of genus)
Herpesvirus simiae (B virus)
Lassa fever virus
Lymphocytic choriomeningitis virus
Marburg virus
Pox viruses pathogenic for humans (e.g., smallpox, monkeypox)
South American Hemorrhagic fever viruses (Junin, Machupo, Sabia, 
Flexal, Guanarito)
Tick-borne Encephalitis complex viruses
Venezuelan Equine Encephalitis virus
Yellow fever virus

Rickettsial Agents:

Rickettsia rickettsiae
Rickettsia prowazekii
Coxiella burnetti

Fungal Agents

Coccidioides immitis
Histoplasma capsulatum
Histoplasma duboisii

Toxins

    Toxins listed in appendix to Subpart B of this part are to be 
shipped as special infectious substances. Other microbial toxins 
known to be pathogenic shall be shipped as infectious substances, as 
provided under Sec. 72.4.

    (2) This list may be supplemented through publication of a notice 
in the Federal Register. Call 1-888-232-3299 (the FAX Information 
system in CDC's Office of Health and Safety) for a copy of the current 
list, or check the CDC website at http://www.cdc.gov/od/ohs.
    (b) Packaging and method of shipment. All materials that contain or 
are reasonably believed to contain a special infectious substance shall 
be packaged and labeled for interstate shipment according to the 
requirements of Sec. 72.4. In addition, the shipper shall: Use a 
shipping system that provides for tracking during transport (e.g., 
registered mail or those of certain

[[Page 58031]]

private carriers); Provide 24 hours-per-day telephonic response to 
emergency calls from carriers in case of a spill or incident involving 
a package containing a special infectious agent; and, Notify the 
addressee by telephone or other electronic means of the date of 
shipment on the date of shipment, or provide a written schedule of 
shipment in advance, and request confirmation of receipt of each 
shipment. Records of such notifications shall be retained by the 
shipper until notified of receipt.
    (c) Confirmation of receipt. Upon receipt, the addressee shall 
provide confirmation to the shipper by telephone or other electronic 
means.
    (d) Failure to receive. When confirmation of receipt of material 
designated in paragraph (a) of this section is not received by the 
shipper within 3 days following anticipated delivery of the package, 
the shipper shall notify the carrier which shall immediately seek to 
ascertain the disposition of the package. In addition, the shipper 
shall notify the Centers for Disease Control and Prevention within 24 
hours by telephone at 1-800-232-0214 to enable the agency to determine 
whether a public health response is necessary.


Sec. 72.6  Requirements; variations.

    The Director, Centers for Disease Control and Prevention, may 
approve variations from the requirements of this subpart if, upon 
written application, review and evaluation, it is found that such 
variations provide protection at least equivalent to that provided by 
compliance with the requirements specified in this subpart, and such 
findings are made a matter of official written record.


Sec. 72.7  [Redesignated as Sec. 72.21]

Subpart B--Handling of Select Agents


Sec. 72.11  Additional requirements for facilities transferring or 
receiving select agents.

    (a) * * *
    (5) The requirements for BSL-2, 3, and 4 operations pertaining to 
this section are contained in the CDC/NIH publication, ``Biosafety in 
Microbiological and Biomedical Laboratories,'' Fourth Edition, May 1999 
which is hereby incorporated by reference. The Director of the Federal 
Register has approved under 5 U.S.C. 552(a) and 1 CFR part 51 the 
incorporation by reference of the above publication. Copies may be 
obtained from the Superintendent of Documents, U.S. Government Printing 
Office, Washington, DC 20402. Copies may be inspected at the Centers 
for Disease Control and Prevention, 1600 Clifton Road, Atlanta, 
Georgia, or at the Office of the Federal Register, 800 North Capitol 
Street NW, Suite 700, Washington, DC. The manual is also available on 
the CDC web site at www.cdc.gov/od/ohs/biosfty/bmbl4/bmbl4toc.htm.
* * * * *
    (c) * * *. (1) The Secretary may authorize a state agency or 
private entity to register facilities under paragraph (a) of this 
section, if the Secretary determines that the registering entity's 
criteria for determining the biosafety standards for facilities 
handling select agents are consistent with the requirements contained 
in the CDC/NIH publication ``Biosafety in Microbiological and 
Biomedical Laboratories,'' Fourth Edition.
* * * * *

Subpart C--Penalties


Sec. 72.21  [Redesignated from Sec. 72.7]

Appendix A to Part 72 [Transferred to Subpart B and heading 
revised]

Appendix to Subpart B

* * * * *
[FR Doc. 99-27640 Filed 10-27-99; 8:45 am]
BILLING CODE 4163-18-P