BILL ANALYSIS Ó ------------------------------------------------------------ |SENATE RULES COMMITTEE | SB 614| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ------------------------------------------------------------ UNFINISHED BUSINESS Bill No: SB 614 Author: Kehoe (D) Amended: 7/12/11 Vote: 27 - Urgency PRIOR SENATE VOTES NOT RELEVANT ASSEMBLY FLOOR : Not available SUBJECT : Childhood immunization SOURCE : California Association of School Business Officials California Association of Suburban School Districts Riverside County School Superintendents Association San Diego Unified School District DIGEST : This bill allows a pupil in grades 7 through 12, to conditionally attend school for up to 30 calendar days beyond the pupils first day of attendance for the 2011-12 school year, if that pupil has not been fully immunized with all pertussis boosters appropriate for the pupil's age if specified conditions are met. Assembly Amendments delete the prior version of the bill regarding child care and safety awareness training, and implement the current language regarding childhood immunization. CONTINUED SB 614 Page 2 ANALYSIS : Existing law: 1. 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 influenza type b; measles; mumps; pertussis; poliomyelitis; rubella; tetanus; hepatitis B; varicella (chickenpox); and any other disease deemed appropriate by the Department of Public Health (DPH), taking into consideration the recommendations of the Advisory Committee on Immunization Practices of the United States Department of Health and Human Services, the American Academy of Pediatrics, and the American Academy of Family Physicians (AAFP). 2. Prohibits from July 1, 2011, until June 30, 2012, a governing authority from unconditionally admitting or advancing any pupil to the 7 through 12 grade levels 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. 3. Waives the requirements described above for medical reasons or if the parent, guardian, or adult who has assumed responsibility for the pupil files a letter or affidavit with the school governing authority stating that the immunization is contrary to his/her beliefs. 4. Allows a pupil who has had an immunization requirement waived, whenever there is good cause to believe that the person has been exposed to one of specified communicable diseases, to be temporarily excluded from the school or institution until the local health officer is satisfied that the pupil is no longer at risk of developing the CONTINUED SB 614 Page 3 disease. 5. Requires county health officers to organize and maintain a program to make immunizations available to all persons required to be immunized and specifies that counties shall pay costs that are not recovered from persons immunized. This bill: 1. Allows a pupil, advancing to or enrolling in any of grades 7 through 12, to conditionally attend school for up to 30 calendar days beyond the pupil's first day of attendance for the 2011-12 school year, if that pupil has not been fully immunized with all pertussis boosters appropriate for the pupil's age, and if all of the following conditions are met: A. The pupil was enrolled in the county office of education or school district in the prior year, and is continuing in the same or advancing to the next grade level. B. The pupil's first day of attendance in 2011-12 school year for that county office of education or school district occurs on or before the sixth Friday following the first day on which classes are offered at the school in which the pupil is enrolled. C. The county office of education or school district work with the pupil's parent or legal guardian so that the pupil receives all immunizations or boosters necessary for continued attendance. 2. Sunsets the provisions of this section on January 1, 2013. Background Pertussis . According to the United States Centers for Disease Control and Prevention (CDC), pertussis (also known as whooping cough), is a highly contagious respiratory disease that is known for uncontrollable, violent coughing which often makes it hard to breathe. After fits of many CONTINUED SB 614 Page 4 coughs, someone with pertussis often needs to take deep breaths which result in a "whooping" sound. Pertussis most commonly affects infants and young children and can be fatal, especially in babies less than one year of age. In infants younger than one year of age who get pertussis, more than half must be hospitalized. Of those infants who are hospitalized with pertussis, about 1 in 5 get pneumonia, half will have apnea (slowed or stopped breathing), 1 in 300 will have encephalopathy (disease of the brain); and 1 in 100 will die. According to the CDC, the incidence of pertussis is cyclical, with peaks occurring every three to five years in the United States. The last peak was in 2005, when approximately 25,000 cases were reported nationally and approximately 3,000 cases in California, including eight deaths in infants under three months of age. According to DPH, peak seasons for pertussis in California and the United States are typically summer and fall and it does not know yet how severe the peak seasons will be in 2011. California outbreak . In 2010, DPH saw a substantial increase in the number of pertussis cases reported. According to a report from the CDC, from January 1, 2010, to June 30, 2010, a total of 1,337 cases were reported in California, which was a 418 percent increase from the 258 cases reported during the same period in 2009. From January to June of 2010, the incidence of pertussis was 3.4 cases per 100,000 persons. County rates ranged from 0 to 76.9 cases per 100,000. By age group, incidence was highest (38.5 cases per 100,000) among infants aged less than one year; 89 percent of cases were among infants under 6 months, who are too young to be fully immunized. Incidence among children aged 7 to 9 years was 10.1 cases per 100,000, and for children 10 to 18 years old it was 9.3 cases per 100,000. Incidence among Latino infants (49.8 cases per 100,000) was higher than among other racial/ethnic populations. According to DPH, there were 10 deaths resulting from pertussis infection in 2010. According to DPH's June 2011 Pertussis Report, disease activity in 2011 is still at relatively increased levels throughout the state with 1,428 cases reported (7.8 cases CONTINUED SB 614 Page 5 per 100,000). This includes 326 new cases being reported since the last update in May 2011. Pertussis vaccine . According to the CDC, the best way to prevent pertussis is to get vaccinated. In the United States, the recommended pertussis vaccine for infants and children is called DTaP, which is a combination vaccine that protects against three diseases: diphtheria; tetanus; and pertussis. For maximum protection against pertussis, children need five DTaP shots. The first three shots are given at two, four, and six months of age. The fourth shot is given between 15 and 18 months of age, and a fifth shot is given before a child enters school, at four to six years of age. Parents can also help protect infants by keeping them away as much as possible from anyone who has cold symptoms or is coughing. Vaccine protection for pertussis, tetanus, and diphtheria fades with time. Before 2005, the only booster available contained protection against tetanus and diphtheria, and was recommended for teens and adults once every 10 years. There are currently boosters for pre-teens, teens and adults that contain protection against tetanus, diphtheria, and pertussis. Current guidelines recommend that pre-teens going to the doctor for their regular check-up at age 11 or 12 years get a dose, and that teens who did not get this vaccine at the 11- or 12-year-old check-up get vaccinated at their next visit. Adults who did not get the booster as a pre-teen or teen should get a dose. Pregnant women who had not previously received the booster shot should get one postpartum before leaving the hospital or birthing center. Adults age 65 years and older, as well as parents, grandparents, child care providers, and health care providers who have close contact with infants should also get vaccinated. FISCAL EFFECT : Appropriation: No Fiscal Com.: No Local: No According to the Senate Appropriations Committee, although this bill is keyed non-fiscal, there would be a multi-million dollar fiscal effect associated with its passage. Without this bill, children would not be able to attend school until they were vaccinated, which would result in a loss of average daily attendance (ADA) Proposition 98 funds to local education agencies. Any loss CONTINUED SB 614 Page 6 in ADA would revert to the Proposition 98 Reversion Account for expenditure on general educational purposes. SUPPORT : (Verified 7/13/11) California Association of School Business Officials (co-source) California Association of Suburban School Districts (co-source) Riverside County School Superintendents' Association (co-source) San Diego Unified School District (co-source) Adolescent Health Collaborative Alvord Unified School District American Academy of Pediatrics - California Association of California School Administrators Attendance Works Beaumont Unified School District California Association of Family Physicians California County Superintendents Educational Services Association California Immunization Coalition California Medical Association California School Boards Association California School Health Centers Association California School Nurses Organization California State PTA Central Valley Education Coalition Children Now Clovis Unified School District Corona-Norco Unified School District El Dorado County Superintendent of Schools Elk Grove Unified School District Elsie Allen Health Center Fresno Unified School District Hemet Unified School District Irvine Unified School District Jurupa Unified School District Long Beach Unified School District Los Angeles County Office of Education Los Angeles Unified School District Menifee Union School District Monterey County Office of Education Newport-Mesa Unified School District CONTINUED SB 614 Page 7 Oakland Unified School District Rialto Unified School District Riverside School District Roseland Children's Health Center Sacramento Unified School District San Jacinto Unified School District Santa Cruz City Schools Santa Rosa Community Health Centers Small School Districts Association Temecula Valley Unified School District Tulare City School District ARGUMENTS IN SUPPORT : Numerous school districts write in support that despite extensive district outreach over the past six months, including public education campaigns, parent contacts, and school -sponsored clinics, it is now clear that a significant number of 2011-12 year's incoming grade 7 through 12 students are not yet immunized. These school districts state that with summer vacation now underway, their ability to reach families of non-immunized students is severely diminished. The San Diego Unified School District (SDUSD), one of the bill's sponsors, writes that since schools receive state funding based on attendance, turning away students will result in the loss of up to $1 million per day in funding for SDUSD schools. SDUSD states that this loss of funds would severely set back their ability to deliver educational programs to students, and may result in serious mid-year cuts. Further, SDUSD writes that the unattainable current deadline may also have negative health impact as some families who find it difficult to get their students immunized quickly may sign personal belief waivers just to keep their students in school - which could undermine the very purpose of the pertussis immunization requirement. Other supporters write that an extension is in the best interest of students because a more realistic time frame will allow schools, providers, and local public health entities to work together to ensure complete immunization and students will be less likely to be excluded from school. Supporters are concerned that the current time frame will cause parents to seek waivers and possibly never have their children immunized. CONTINUED SB 614 Page 8 CTW:mw 7/14/11 Senate Floor Analyses SUPPORT/OPPOSITION: SEE ABOVE **** END **** CONTINUED