The HIV epidemic and the reemergence of other infectious diseases have lead to increased interest in communicable disease control in the workplace. Concern with discrimination against the disabled and HIV-infected persons led Congress to pass the Americans with Disabilities Act (ADA) in 1990. The ADA reduces employers’ right to ask about a potential employee’s health. It also limits the right of employers to refuse to hire persons who are at increased risk of injury in the workplace or who may pose a risk to others.

These limitations come as the courts and legislatures are expanding employers’ duty to protect workers and the public. With diseases such as tuberculosis on the rise, employers need comprehensive plans to manage communicable diseases in the workplace. With the ADA’s stress on the individual evaluation of employees, physicians must play the central role in these communicable disease plans. This requires assessing the risk posed by individual infected employees and developing legally sound protocols for balancing the risk of contagion against the employee’s right to continued employment. The ADA and its administrative regulations provide little guidance because they are silent on all communicable diseases except for those that are foodborne. This section presents a general approach to communicable diseases in the workplace. Medical care workplaces are treated as a special case of the general communicable disease plan.