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:
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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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