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---



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          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 




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          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 




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          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.  




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          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 




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          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 




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          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 




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          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 




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          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 submitted  signed by the veterinarian  
            on an approved form developed by the department and shall 
            include a signed statement by the veterinarian explaining 
             stating  the inadvisability of the vaccination, and  shall 
            include  a 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, 




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            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 been 
             either  vaccinated 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 --