BILL ANALYSIS AB 354 Page 1 CONCURRENCE IN SENATE AMENDMENTS AB 354 (Arambula and Fletcher) As Amended August 17, 2010 Majority vote ----------------------------------------------------------------- |ASSEMBLY: |74-2 |(May 28, 2009) |SENATE: |25-5 |(August 20, | | | | | | |2010) | ----------------------------------------------------------------- Original Committee Reference: HEALTH SUMMARY : Permits 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 influenzae 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 regulations to implement a varicella immunization requirement which was enacted in 2000. The Senate amendments : AB 354 Page 2 1)Delete a requirement that varicella provisions are only operative if funds are appropriated for that purpose in the annual Budget Act. 2)Delete, commencing July 1, 2011, the requirement that schools check that all 7th graders have been immunized against Hepatitis B and instead require that schools check that all 7th graders have been immunized against pertussis. 3)Make other technical, clarifying changes. AS PASSED BY THE ASSEMBLY , this bill was substantially similar to the version approved by the Senate. FISCAL EFFECT : According to the Senate Appropriations Committee: Fiscal Impact (in thousands) Major Provisions 2010-11 2011-12 2012-13 Fund Medi-Cal vaccination likely $0 $300 - $875 $300 - $875General/* administrative fee Federal School reimbursement likely $0 up to $400up to $400 General** for vaccine confirmation Potential increased ADAlikely $0 $50 - $550$50 - $550 General** *Costs would be shared 50% General Fund and 50% federal funds. **Counts toward Proposition 98 guarantee *** Since potential costs to this bill would occur only if DPH made a decision to promulgate regulations to update its immunization requirements, the fiscal years in which potential costs and savings would occur are unknown and would depend on when DPH regulations went into effect. 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 AB 354 Page 3 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. 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 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 undiagnosed upper respiratory tract infection but, in infants, it can be fatal. 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. According to DPH, as of August 2010 there have been 2,774 reported cases of pertussis in 2010 (7 cases per 100,000). This is a seven-fold increase from the 395 cases reported through the same date in 2009. DPH reports that seven deaths have been reported, all in infants less than 2 months of age at time of disease onset; none of whom had received any doses of pertussis-containing vaccine because of their age. The majority of infant cases in 2010 were 3 months of age or younger. In response to the outbreak, the DPH issued a recommendation for broader use of the Tdap booster vaccine. In addition to the typical series of childhood pertussis immunizations, DPH now recommends the administration of the Tdap vaccine for children as young as seven years old and for California residents over 64 years of age for the duration of the epidemic. Analysis Prepared by : Melanie Moreno / HEALTH / (916) 319-2097 AB 354 Page 4 FN: 0006579