BILL ANALYSIS AB 354 Page 1 ASSEMBLY THIRD READING AB 354 (Arambula) As Amended April 28, 2009 Majority vote HEALTH 19-0 APPROPRIATIONS 11-2 ------------------------------------------------------------------- |Ayes:|Jones, Fletcher, Adams, |Ayes:|De Leon, Ammiano, Charles | | |Ammiano, Block, Carter, | |Calderon, Davis, Fuentes, | | |Conway, De La Torre, De | |Hall, John A. Perez, Price, | | |Leon, Emmerson, Gaines, | |Skinner, Solorio, Torlakson | | |Hall, Hayashi, Hernandez, | | | | | | | | | |Bonnie Lowenthal, Nava, | | | | |V. Manuel Perez, Salas, | | | | |Audra Strickland | | | | | | | | |-----+--------------------------+-----+----------------------------| | | |Nays:|Nielsen, Audra Strickland | | | | | | ------------------------------------------------------------------- SUMMARY : Allows the Department of Public Health (DPH) to update vaccination requirements for children entering schools and child care facilities and adds the American Academy of Family Physicians (AAFP) to the list of entities whose recommendations DPH must consider when updating the list of required vaccinations. Specifically, this bill : 1)Deletes the age, grade, and date exemptions from the following vaccination requirements: a) haemophilus influenza type b (Hib) immunization after four years and six months of age; b) mumps immunization after seven years of age; c) pertussis immunization after seven years of age; d) hepatitis B immunization after kindergarten level; and, e) varicella (chickenpox) immunization of pupils who were admitted to California public or private schools at or above the kindergarten level before July 1, 2001. 2)Adds AAFP and makes clarifying changes to the list of entities whose recommendations DPH must consider when developing new disease immunization requirements. 3)Deletes a provision authorizing DPH to adopt emergency AB 354 Page 2 regulations to implement a varicella immunization requirement which was enacted in 2000. EXISTING LAW prohibits the governing authority of a school or other institution from unconditionally admitting any person as a pupil of any private or public elementary or secondary school, child care center, day nursery, nursery school, family day care home, or development center, unless he or she has been fully immunized against the following diseases: diphtheria; Hib; measles; mumps; pertussis; poliomyelitis; rubella; tetanus; hepatitis B; varicella; and, any other disease deemed appropriate by DPH, taking into consideration the recommendations of the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics (AAP). FISCAL EFFECT : According to the Assembly Appropriations Committee, net savings to the extent this bill reduces future health costs by increasing immunization rates and prevents future outbreaks. COMMENTS : According to the author, this bill is needed to allow DPH to require pertussis booster vaccines for students prior to the start of the seventh grade. The author states pertussis is the only vaccine-preventable disease that remains widespread despite high levels of vaccination in early childhood. Although childhood immunization against pertussis does not provide lasting immunity needed to control the disease and protect public health, current law limits the requirement for pertussis vaccination to children seven years old or younger. The author states that also vaccinating children upon entry to the seventh grade will reduce infection rates among adolescents and adults, which will also help protect infants who are too young to receive their first inoculations. Pertussis is a highly communicable disease that lasts for many weeks and is typically manifested in children with violent spasms of severe coughing that can cause difficulty breathing, eating, and sleeping; as well as vomiting. Children typically get pertussis infections from adults, rather than other children. Adolescents and adults become susceptible and can contract pertussis when immunity from childhood vaccinations wanes. They can then easily infect infants who are not fully vaccinated. In adults, pertussis can appear to be an ordinary upper respiratory tract infection, and is often not diagnosed. AB 354 Page 3 In infants, pertussis can be fatal. In California and nationally, pertussis incidence rises cyclically with peaks every three to five years. Between 2001 and 2006, pertussis incidence rose from 644 cases reported in 2001 to 3,160 cases in 2005, dropping down to 1,661 cases in 2006. CDC states that actual incidence may be many times greater than the reported numbers. The highest pertussis rates occur among infants, who are also at highest risk of complications. In California from 2001 through 2006, 91% of infant cases occurred in the first six months of life, before three doses of the vaccine were administered, and 74% of these infants were hospitalized. During the same period, 24 California infants under two months old died from pertussis. DPH reports that the age distribution of reported pertussis cases has been changing: in 1990, 11% of all reported cases in California were children over nine years old; by 2005, more than half of reported cases were children over nine years old. According to DPH, hospital charges for treating pertussis in 2005 exceeded $17 million, of which at least $12 million was paid by the Medi-Cal Program. DPH further states that the true costs are likely to be far higher, as most outpatient and some hospitalized cases of pertussis are never diagnosed but require services. DPH additionally notes that state funds also pay for the state and local health department response to pertussis cases and outbreaks. The Contra Costa County Health Department calculated that it required over $50,000 of staff time to respond to a single pertussis outbreak in a school in the spring of 2008. DPH contends that several pertussis outbreaks are likely to occur in California in a given year, and that requiring pertussis boosters would likely nearly eliminate pertussis among adolescents. Pertussis immunizations are given in combination with tetanus and diphtheria immunizations (called DTaP and DTP), at two months, four months, six months, 15 to 18 months, and four to six years of age. Because immunity from infection by the vaccine only lasts for approximately five to ten years, a booster shot is recommended in early adolescence. ACIP, AAP, and AAFP recommend Tdap booster vaccines at the age of eleven to twelve years for those who have completed the recommended childhood DTaP or DTP series. AB 354 Page 4 Analysis Prepared by : Allegra Kim / HEALTH / (916) 319-2097 FN: 0000931