BILL ANALYSIS Ó SENATE HEALTH COMMITTEE ANALYSIS Senator Ed Hernandez, O.D., Chair BILL NO: AB 258 A AUTHOR: Hagman B AMENDED: As Introduced HEARING DATE: June 8, 2011 2 CONSULTANT: 5 Orr 8 SUBJECT Rabies: vaccinations SUMMARY Exempts from the rabies vaccination requirement a dog that a licensed veterinarian determines, on an annual basis, would be endangered from the vaccine due to disease or other conditions. CHANGES TO EXISTING LAW Existing federal regulations: Requires a valid rabies vaccination for dogs 12 weeks of age and older imported to the United States from countries where canine rabies is present, with certain exceptions. Existing state law: Requires every dog owner, after the dog attains the age of four months, to obtain a license for the dog no less than once every two years, and to vaccinate the dog against rabies no more than once per year. Authorizes cities and counties to specify the means by which a dog owner is required to provide proof of his or her dog's rabies vaccination, including but not limited to electronic transmission or facsimile. Continued--- STAFF ANALYSIS OF ASSEMBLY BILL 258 (Hagman) Page 2 Requires the governing body of each city, county, or city and county to maintain or provide for the maintenance of a pound system and a rabies control program. Requires fees for dog licensure to be fixed by the city, county, or city and county. Authorizes the governing body to impound any dogs found to be in violation of these provisions. Declares that it is the responsibility of the governing body to provide or arrange for the provision of dog vaccination clinics. Authorizes the California Department of Public Health (CDPH) to investigate reported cases of rabies in any county or city, and to declare a quarantine against designated animals if the department finds that rabies exists. The department may issue regulations instead of a quarantine order, when appropriate. Establishes that any person who willfully conceals information about the location or ownership of an animal subject to rabies, or who has exposed a person to rabies with the intent to prevent the quarantine or isolation of that animal by the local health officer, is guilty of a misdemeanor. Defines "rabies area" to mean any area within a region where the existence of rabies constitutes a public health hazard. Existing state regulations: Require that dogs be licensed no later than 30 days after the dog attains the age of 4 months, and no later than 60 days after the expiration of the previously issued license. Prohibit a dog license from being issued for a period beyond the dog's revaccination due date, with specified exceptions. Local authorities may require revaccination prior to issuance of a license provided that revaccination does not occur prior to specified times. Require any person having knowledge of the whereabouts of an animal known or suspected to have rabies, to report to the local public health officer. Establish that the local health officer (LHO) is to be notified when a person is bitten by an animal of a species subject to rabies within a rabies area, whether or not the animal is suspected of STAFF ANALYSIS OF ASSEMBLY BILL 258 (Hagman) Page 3 having rabies. Establish standards for the isolation and strict confinement of any rabid animal or animal that is suspected to be rabid. Allow the LHO discretion to isolate any animal which bites or otherwise exposes a person to rabies for a specified length of time. Establish guidelines for canine rabies vaccines to be approved for use in California, including meeting specified federal vaccine standards for sterility and safety. This bill: Provides an exception to the rabies vaccination requirement if a licensed veterinarian determines, on an annual basis, that a rabies vaccination would endanger a dog's life due to disease or other considerations. Requires that dogs exempt from the vaccination requirement be confined to the premises of the owner, and requires a leash when off of the premises of the owner. Prohibits dogs exempt from the vaccination requirement from having contact with other unvaccinated dogs or cats. Requires a dog owner to sign a statement affirming they understand the consequences of the exemption and accepts all liability associated with owning a dog that has not received the canine rabies vaccine. Requires CDPH to develop a form for exemption applications. Stipulates that the form must include the statement from the owner and be signed by the veterinarian. Requires the form to be submitted to the LHO. Allows an LHO to issue an exemption from the canine antirabies vaccination (CAV). Requires the LHO to report exemptions to CDPH. Prohibits the local jurisdiction issuing dog licenses from extending the license period beyond one year for dogs exempted from the vaccination requirement. FISCAL IMPACT According to the Assembly Appropriations Committee analysis, CDPH estimates costs of approximately $40,000 for one-half of 2011-12 and $80,000 for 2012-13 for a STAFF ANALYSIS OF ASSEMBLY BILL 258 (Hagman) Page 4 veterinary research scientist to amend the regulations and develop the exemption form. BACKGROUND AND DISCUSSION The author contends that current state law makes it impossible for veterinarians to make a decision in the best interest of a sick or compromised animal. The author claims that rabies vaccinations are powerful medical tools with potentially powerful side effects, and that the labeling instructions on rabies vaccine products instruct veterinarians to vaccinate only healthy dogs. Research indicates that rabies vaccine-associated reactions in dogs can be significant. Pet owners who are deeply concerned about their dogs' health, and are deprived of a vaccination exemption option, may choose to 'fly under the radar,' eluding both vaccination and licensing entirely. The author believes the public is actually put at greater potential risk for zoonotic disease without an exemption from rabies vaccination provision. The author believes AB 258 will provide a uniform statewide vaccination waiver protocol to streamline licensing and support better monitoring of unvaccinated dogs. Dogs exempt under AB 258 will be medically evaluated by a licensed veterinarian and monitored by LHOs; therefore California's public health will remain safeguarded. Rabies Rabies is a viral disease that affects the central nervous system and causes acute inflammation of the brain. Rabies is almost invariably fatal if post-exposure prophylaxis is not administered prior to the onset of severe symptoms. In California, most cases of rabies occur in skunks and bats, however, any mammal can contract rabies. Domestic animals account for three percent of animal rabies, and the rest occurs in a variety of wild animals, including foxes. Rabies can be prevented by vaccination. Human rabies is rare in the United States. The virus is generally passed to humans via the bite of a rabid animal. The majority of human cases in the U.S. are caused by rabid bats. Although uncommon, human rabies retains its public health significance because of the lethality of human infections. STAFF ANALYSIS OF ASSEMBLY BILL 258 (Hagman) Page 5 CDPH received reports of 1,747 animal rabies cases from 2001 through 2008. During that time, reported animal cases decreased in California by 44.5 percent. Among animal rabies cases, the most frequently reported species were bats (73.0 percent), skunks (23.5 percent), foxes (2.3 percent), and cats (0.6 percent). According to the "Epidemiologic Summary of Animal and Human Rabies in California, 2001 - 2008, Key Findings and Public Health Messages," CDPH found that appropriate domestic and wild animal management, animal vaccination programs, public health and medical management of persons exposed to potentially rabid animals, public education about animal risk reduction strategies, and avoiding wild animal contact apparently provide the best opportunities for reducing rabies in humans and animals. Federal regulations currently require proof of valid rabies vaccination for imported dogs, but allow the importation of some unvaccinated dogs, including dogs less than 3 months of age, provided certain requirements for confinement are met until the dog is vaccinated. The regulation does not require a health screen for these dogs prior to arrival in the U.S. Importers are expected to appropriately confine and vaccinate imported dogs that lack valid rabies vaccination. Enforcement of this regulation is problematic because there is no federal requirement, mechanism, or capacity for documenting compliance. Rabies control in California The primary components of the California Rabies Control Program include companion animal immunization and licensing; stray animal control; animal bite reporting, investigation, and animal isolation; and public education. The program works to control stray domestic animals and follow-up on potential human exposures. The program also keeps track of animal rabies throughout the state. Existing statutes require vaccination and licensing of all dogs, but because cats are the most frequently reported rabid domestic animal in the U.S., vaccination of all cats is also strongly advised. There are vaccines for other domestic animals as well. The California Health and Safety Code mandates that the governing body of each city, city and county, or county STAFF ANALYSIS OF ASSEMBLY BILL 258 (Hagman) Page 6 maintain or provide a local rabies control program. Rabies control programs must include an animal shelter system, provide for animal bite reporting and investigations, stray animal control, animal rabies case investigation, quarantine of biting dogs and cats, quarantine of domestic animals potentially exposed to rabies, and include other activities for the purpose of carrying out and enforcing the provisions of the California Rabies Control Program. The county and/or city must also provide or arrange for canine rabies vaccination clinics. All counties in the state are declared "rabies areas" due to the ongoing cycles of rabies in California's wildlife, and the resulting threat of exposure to domestic animals, livestock and humans. According to CDPH's California's Compendium of Rabies Control and Prevention, 2004, a local health officer may, upon a written recommendation of a veterinarian, issue a rabies immunization exemption where an illness or veterinary medical condition in a dog warrants it. The exempted animal must be kept under strict rabies isolation conditions, which are at the discretion of the local health officer, until the medical condition is resolved and the animal can obtain a canine rabies vaccine. Rabies vaccine Vaccines are designed to enhance the specific immune response to particular pathogens in order to prevent disease upon exposure and natural infection. Vaccine types can be noninfectious and infectious. Noninfectious vaccines include killed whole virus and are generally stable, and safe; thus they can often be used in debilitated or pregnant animals with minimal risk. However, the duration of immunity tends to be shorter than that of infectious vaccines, and multiple boosters are often required. Most rabies vaccines are noninfectious. Any vaccine has the potential to cause a reaction; however, killed vaccines are possibly more likely to induce an allergic vaccine reaction than the live vaccines. The killed vaccines often contain large amounts of viral material as well as additives that stimulate a better immune reaction, which are both very immunoreactive. It is possible for a dog or cat to develop a vaccine-induced form of rabies 10 to 21 days after receiving a live virus rabies STAFF ANALYSIS OF ASSEMBLY BILL 258 (Hagman) Page 7 vaccine. These animals may get better if cared for well for up to three months, through nutritional support and, in some cases, ventilatory support. Rabies vaccinated dogs can also get a severe infection of the brain and spinal cord (called encephalomyelitis) which mimics the rabies disease itself. This condition will progress and there is no cure. The vaccine-associated rabies does not seem to occur with the killed/inactivated vaccine, only the live vaccines, so prevention is possible by using killed vaccines. Prior legislation AB 2000 (Hagman) of the 2009-2010 Session would have exempted from the rabies vaccination requirement an owner of a dog that a licensed veterinarian determines, on an annual basis, is immune-compromised, or has a documented medical record of a preexisting condition that may affect the dog's ability to develop antirabies antibodies. Would have prohibited the license period from extending beyond one year, in the event that a dog is exempted from the vaccination requirement. Failed passage in the Senate Appropriations Committee. AB 2689 (Smyth), Chapter 45, Statutes of 2010, authorizes cities and counties to specify the means by which a dog owner is required to provide proof of his or her dog's rabies vaccination, including but not limited to electronic transmission or facsimile. AB 1634 (Levine) of 2007 would have enacted the California Responsible Pet Ownership Act and provided that a person who owns a dog or cat that is not licensed (or is improperly licensed) and that has not been spayed or neutered may be cited and, if cited, must pay civil penalties. Also would have increased existing fines for nonspayed or unneutered dogs and cats, and required microchipping of animals upon a second violation, as specified. Failed passage on the Senate Floor. AB 647 (Koretz) of the 2005 - 2006 Session would have removed domestic ferrets from the list of wild animals that are unlawful to import, transport, possess, or release into this state if the owner of the ferret produced and maintained documentation that the ferret has been vaccinated against rabies and that the ferret, if over the STAFF ANALYSIS OF ASSEMBLY BILL 258 (Hagman) Page 8 age of six months, is spayed or neutered. The bill specified that any ferret that is sold or offered for sale is required to be spayed or neutered before the sale, and permitted local animal control agencies to enforce these provisions. Held in the Senate Appropriations Committee. Arguments in support The Humane Society Veterinary Medical Association (HSVMA) claims veterinary professionals know that vaccinations should only be administered to animals for whom the medical benefits outweigh the potential medical risks. HSVMA claims that a small but significant number of companion animals have medical conditions for whom vaccination is contraindicated, including those with terminal diseases like cancer, immune-mediated diseases, severe endocrine disorders, and other conditions. HSVMA believes that AB 258 provides a safe and medically sound mechanism to protect dogs in California whose health could be seriously compromised by vaccination. The California Federation of Dog Clubs (Dog Clubs) claims there is much scientific documentation regarding acute or chronic adverse reactions to the rabies vaccine in dogs, and that the current rabies risk to the community is low and is overwhelmingly related to wildlife. The Dog Clubs also claim that recent studies show that duration of immunity from an initial rabies vaccination can range up to seven years, making frequent re-vaccination unnecessary. PRIOR ACTIONS Assembly Agriculture:9- 0 Assembly Appropriations:17- 0 Assembly Floor: 70- 0 COMMENTS 1. Public health implications. Canine rabies vaccines have been effective at curbing the spread of rabies in the domestic dog population, but are reported to have side effects ranging from vomiting, swelling in the face or at the injection site, diarrhea, and even death. As drafted, this bill allows any veterinarian to apply to exempt a dog STAFF ANALYSIS OF ASSEMBLY BILL 258 (Hagman) Page 9 from a vaccination requirement if the dog's life would be endangered by the vaccine due to disease or other considerations. If dogs are allowed to be exempt from the canine rabies vaccine, they will not only be at risk for contracting the rabies virus themselves, but they could potentially spread it to other dogs, and potentially infect humans. Does this bill strike the right balance of protecting the relatively few animals that are at risk of severe complications from the vaccine with the need to ensure the human and pet populations are protected from a potentially lethal disease? Aside from this basic question, it is unclear under what circumstances a dog's life would be endangered by the CAV. Simply experiencing an adverse reaction to the vaccine, while unpleasant for the dog, might not necessarily warrant an exemption. However, a dog that has a disease or condition that would render the CAV ineffective may be an appropriate candidate for an exemption, even if the vaccine itself is not life-threatening. The bill currently gives discretion to the LHO to determine exemptions. The author may wish to further clarify which circumstances could be appropriate for a potential exemption in order to limit the number of inappropriate exemption requests. 2. Clarifying amendments. The author may wish to clarify paragraph 2 on page 3, lines 5-13 to read: A request for an exemption from the requirements of this subdivision shall be submittedsigned by the veterinarianon an approved form developed by the department and shall include a signed statement by the veterinarian explainingstatingthe inadvisability of the vaccination, andshall includea signed statement by the dog owner affirming that the owner understands the consequences and accepts all liability associated with owning a dog that has not received the canine antirabies vaccine. The request shall be submitted to the local health officer, who may issue an exemption from the canine antirabies vaccine. 3. Clarifying amendments. An additional suggested clarifying amendment would be found on page 4, lines 11-17: In addition to the authority provided in subdivision (a), the ordinance of the responsible city, city and county, STAFF ANALYSIS OF ASSEMBLY BILL 258 (Hagman) Page 10 or county may provide for the issuance of a license for a period not to exceed three years for dogs that have attained the age of 12 months or older and have beeneithervaccinated against rabies or one year for dogs exempted from the vaccination requirement pursuant to subdivision (b). POSITIONS Support: Humane Society Veterinary Medical Association (sponsor) California Federation of Dog Clubs California Veterinary Medical Association Sacramento Council of Dog Clubs San Lorenzo Dog Training Club, Inc. Southland Weimaranaer Club Oppose: None received. -- END --