BILL ANALYSIS                                                                                                                                                                                                    

                                                                  AB 354
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          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  


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            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.   


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          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.


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          Analysis Prepared by  :    Allegra Kim / HEALTH / (916) 319-2097    
          FN: 0000931