BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 354|
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THIRD READING
Bill No: AB 354
Author: Arambula (I)
Amended: 8/17/10 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 9-0, 6/17/09
AYES: Alquist, Aanestad, Cedillo, Cox, DeSaulnier, Leno,
Maldonado, Pavley, Wolk
NO VOTE RECORDED: Strickland, Negrete McLeod
SENATE APPROPRIATIONS COMMITTEE : 11-0, 8/12/10
AYES: Kehoe, Ashburn, Alquist, Corbett, Emmerson, Leno,
Price, Walters, Wolk, Wyland, Yee
ASSEMBLY FLOOR : 74-2, 5/28/09 - See last page for vote
SUBJECT : Health: immunizations
SOURCE : Author
DIGEST : This bill deletes certain age limits for
specified childhood immunizations required for admission to
specified schools or child care centers, and requires the
Department of Public Health to consider the immunization
recommendations of the American Academy of Family
Physicians.
ANALYSIS :
Existing law:
CONTINUED
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1. States legislative intent to provide a means for
specified age groups to achieve total immunization
against certain childhood diseases, to the extent that
funds are appropriated for this purpose from the annual
Budget Act.
2. 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
prior to his/her first admission to that institution
he/she has been fully immunized against the following
diseases: diphtheria, haemophilus influenzae type b,
measles, mumps, pertussis, poliomyelitis, rubella,
tetanus, hepatitis B, and varicella.
3. Establishes several exceptions to these requirements,
based on the age of the child:
A. Haemophilus influenzae type b immunization only
applies to children who have not reached the age of
four and a half years old.
B. Mumps immunization only applies to children who
have not reached the age of seven years old.
C. Pertussis (whooping cough) immunization only
applies to children who have not reached the age of
seven years old.
D. Hepatitis B immunization is required of all
children entering kindergarten after August 1, 1997.
Existing law prohibits a governing authority to
unconditionally admit any pupil to the seventh grade
unless the pupil has been fully immunized, beginning
July 1, 1999.
E. Varicella (chickenpox) immunization is required
only if a person has not already been admitted into a
California public or private school at the
kindergarten level or above. Existing law stipulates
that Varicella immunization requirements are
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operative to the extent that funds are appropriated
for this purpose from the annual Budget Act and
allows the Department of Public Health (DPH) to adopt
emergency regulations to implement this requirement,
as deemed necessary by the Office of Administrative
Law for the immediate preservation of the public
health or general welfare, to remain in effect for no
longer than 180 days.
4. Allows DPH to add any other disease that is consistent
with the most current immunization recommendations of
the Centers for Disease Control (CDC) and the American
Academy of Pediatrics to their list of required
vaccinations.
This bill:
1. Requires DPH to additionally consider the
recommendations of the American Academy of Family
Physicians when adding any other disease to their list
of required vaccinations.
2. Deletes current exceptions to immunization requirements
based on age or grade, specifically for haemophilus
influenzae type b, mumps, pertussis, and varicella.
3. Deletes the requirement that hepatitis B immunization
can only be required of children entering kindergarten
after August 1, 1997.
4. By deleting some of these exceptions, DPH will have the
latitude to adopt other regulations regarding
immunization requirements for school-age children.
5. Deletes the stipulation that the immunization
requirements for varicella are operative to the extent
that funds are appropriated for this purpose from the
annual Budget Act.
6. Deletes the provision allowing DPH to adopt emergency
regulations to implement the varicella immunization
requirement.
7. Provides that, commencing July 1, 2011, full
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immunization against hepatitis B shall not be a
condition by which the governing authority admits or
advances any pupil to the 7th grade level of any private
or public elementary or secondary school.
8. Provides that, commencing July 1, 2011, the governing
authority shall not unconditionally admit or advance any
pupil to the 7th through 12th grade levels, inclusive,
of any private or public elementary or secondary school
unless the pupil has been fully immunized against
pertussis, including all pertussis boosters appropriate
for the pupil's age.
9. Makes conforming changes.
Background
Pertussis (whooping cough) is an acute, infectious cough
illness that is highly communicable and can cause severe
disease, particularly among very young children. According
to the CDC, pertussis remains endemic in the United States
despite routine childhood pertussis vaccination for more
than half a century. The CDC asserts that the main reason
for the continued circulation of pertussis is that the
immunity created by the vaccine can wane approximately five
to 10 years after completion of the childhood pertussis
vaccination, leaving adolescents and adults susceptible to
the disease.
The disease is most detrimental in infants less than one
year of age, and can be fatal. Older preschool children
and school-age siblings who are not fully vaccinated and
who develop pertussis can easily become sources of
infection for infants. Adults can also transmit pertussis
to unvaccinated or incompletely vaccinated infants and
young children.
In 2005, the first pertussis booster vaccines (referred to
as Tdap, a combination of vaccines for tetanus, diphtheria,
and pertussis) were licensed in the United States for use
in adolescents and adults. Since 2005, Tdap vaccine has
been included in DPH's Vaccines for Children Program, a
federal program that provides recommended immunizations to
eligible clients through the age of 18 years.
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According to the CDC's Advisory Committee on Immunization
Practices (ACIP), optimal response to a vaccine depends on
multiple factors, including the nature of the vaccine and
the age and immune status of the recipient.
Recommendations for the age at which vaccines are
administered are influenced by age-specific risks for
disease, age-specific risks for complications, ability of
persons of a certain age to respond to the vaccine, and
potential interference with the immune response by
passively transferred maternal antibody. Vaccines are
recommended for members of the youngest age group at risk
for experiencing the disease for whom efficacy and safety
have been demonstrated.
ACIP consists of 15 experts selected by the Secretary of
the United States Department of Health and Human Services
to provide advice and guidance to the Secretary, the
Assistant Secretary for Health, and the CDC on the most
effective means to prevent vaccine-preventable diseases.
ACIP includes representation by a variety of national
organizations, including the American Academy of Pediatrics
(AAP) and the American Academy of Family Physicians (AAFP)
as well as other federal departments, such as the Centers
for Medicare and Medicaid Services, Food and Drug
Administration, and the National Vaccine Program Office.
The overall goals of the ACIP are to provide advice which
will assist in reducing the incidence of vaccine
preventable diseases, and to increase the safe usage of
vaccines and related biological products. ACIP, in
conjunction with AAP and AAFP, publishes a schedule of
recommended childhood and adolescent immunizations and
revises it annually. ACIP is the only entity in the
federal government which makes such recommendations.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12 2012-13 Fund
Medi-Cal vaccination likely $0
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$300-$875$300-$875 General/*
administrative fee Federal
School reimbursement likely $0
$706-$2,100 $706-$2,100 General**
for vaccine confirmation
Potential increased ADA likely $0
$50-$550$50-$550 General***
* Costs would be shared 50 percent General Fund and 50
percent federal funds
** Counts toward Proposition 98 guarantee
*** Since potential costs to this bill will occur only if
DPH made a decision to promulgate regulations to update
its immunization requirements, the fiscal years in
which potential costs and savings will occur are
unknown and will depend on when DPH regulations went
into effect.
SUPPORT : (Verified 8/17/10)
American Academy of Pediatrics
American Federation of State, County and Municipal
Employees
California Academy of Family Physicians
California Immunization Coalition
California Medical Association
California School Nurses Organization
California State PTA
GlaxoSmithKline
OPPOSITION : (Verified 8/17/10)
Capitol Resource Family Impact
ARGUMENTS IN SUPPORT : Supporters, such as the California
Medical Association, claim this bill will make statutory
vaccination requirements more consistent with current
federal recommendations for childhood immunizations. The
California Academy of Family Physicians argues that
pediatric vaccinations are some of the safest and most
cost-effective public health inventions of this century.
The California Immunization Coalition claims this bill
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could lead to Medi-Cal savings of over $16 million, not
including savings in the private sector. The American
Federation of State, County and Municipal Employees
believes this bill will help to ensure that schools are
healthy and disease free.
ARGUMENTS IN OPPOSITION : The California Resource Family
Impact opposes this bill on the grounds that the AAFP
recommends vaccinations against the Human Papillomavirus
(HPV) for 11-year-old girls. They believe that passage of
this bill will lead to HPV vaccinations being mandated for
all girls.
ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Arambula, Beall, Bill Berryhill, Tom
Berryhill, Blakeslee, Block, Blumenfield, Brownley,
Buchanan, Caballero, Charles Calderon, Carter, Chesbro,
Conway, Cook, Coto, Davis, De La Torre, De Leon,
Emmerson, Eng, Evans, Feuer, Fletcher, Fong, Fuentes,
Fuller, Furutani, Gaines, Galgiani, Garrick, Gilmore,
Hall, Hayashi, Hernandez, Hill, Huber, Huffman, Jeffries,
Jones, Knight, Krekorian, Lieu, Logue, Bonnie Lowenthal,
Ma, Mendoza, Miller, Monning, Nava, Nestande, Niello,
John A. Perez, V. Manuel Perez, Portantino, Price,
Ruskin, Salas, Saldana, Silva, Skinner, Smyth, Solorio,
Audra Strickland, Swanson, Torlakson, Torres, Torrico,
Tran, Villines, Yamada, Bass
NOES: Anderson, Hagman
NO VOTE RECORDED: DeVore, Duvall, Harkey, Nielsen
CTW:mw 8/17/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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