BILL ANALYSIS                                                                                                                                                                                                    

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          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  :


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          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  

                            Fiscal Impact (in thousands)

           Major Provisions         2010-11      2011-12       2012-13     Fund
          Medi-Cal vaccination   likely $0 $300 - $875 $300 -  
          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  


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          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)  


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