BILL ANALYSIS Ó
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 922
S
AUTHOR: Negrete McLeod
B
AMENDED: March 22, 2011
HEARING DATE: April 13, 2011
9
CONSULTANT:
2
Orr
2
SUBJECT
Immunizations: disclosure of information: tuberculosis
screening
SUMMARY
Adds tuberculosis (TB) screening results to the list of
information that may be collected by local health
departments and the California Department of Public Health
(CDPH) for immunization information systems.
CHANGES TO EXISTING LAW
Existing law:
Authorizes local health officers to operate immunization
information systems in conjunction with the CDPH
Immunization Branch. Information systems may be operated
jointly among more than one health jurisdiction.
Information contained within the systems may be shared with
other health officers operating the systems.
Allows health care providers and other agencies to disclose
specified information from a patient's medical record, or
from a client's record, to local health departments (LHD)
operating county or regional immunization systems and to
CDPH. Allows LHDs and CDPH to disclose this information to
each other and to health care providers providing medical
Continued---
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care for the patient, upon request. This information
includes:
The names of the patient and his/her parent or
guardian;
The patient or client's date of birth, birthplace,
and gender;
Types and dates of immunizations received by the
patient or client, including the manufacturers and lot
numbers of the immunizations, as well as any adverse
reactions to the immunizations received;
Other nonmedical information necessary to establish
identity; and
The current address and phone number of the patient
or client and the parents or guardians of the patient
or client.
Prior to disclosing patient or client information to an
immunization system, requires the disclosing entity to
inform the patient or client, or the parent or guardian,
that the information may be shared with specified entities.
Allows a patient or a patient's parent or guardian to
refuse to allow records to be shared. Permits the patient
or client, or parent or guardian, to examine the
immunization record and correct errors.
Allows LHDs and CDPH to disclose the information they
receive, with the exception of the current address and
phone number, to other specified entities upon request.
Provides that the information may only be used for
specified purposes including, but not limited to, compiling
immunization population data and protecting the public
health. Requires health care providers, LHDs, CDPH and
other specified entities to maintain the confidentiality of
this information.
Allows CDPH to add any other disease to the list of
required vaccinations for school entry that is consistent
with the most current immunization recommendations of the
federal Centers for Disease Control and Prevention (CDC)
and the American Academy of Pediatrics.
This bill:
Adds TB screening results to the list of information that
may be collected by LHDs and CDPH for the purpose of
STAFF ANALYSIS OF SENATE BILL 922 (Negrete McLeod) Page
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immunization information systems.
FISCAL IMPACT
The bill has not yet been analyzed by a fiscal committee.
BACKGROUND AND DISCUSSION
The author believes this bill represents a simple but
important fix in the current immunization system. TB
screening results are currently collected by physicians and
provided to patients/parents on the same documents as
immunization information (commonly known as yellow cards).
The medical provider either has to re-enter (by hand) the
TB screening results on the yellow card each time they
print out a new yellow card from the registry, or have the
parents keep the old yellow cards, so that they have a
record of the TB screening results. The author states that
health care providers throughout California who use the
registry have consistently requested that the TB screening
results be collected in the registry and printed on the
yellow card for ease of maintaining this information and
providing it to patients and parents. The author believes
this information will also help schools to expedite the
registration of students because TB screening results could
be reviewed at the same time school personnel are reviewing
immunization information in the registry.
TB
TB disease is a highly contagious bacterial infection that
is passed from person to person through droplets in the
air. The bacteria usually attack the lungs, but can also
attack any part of the body such as the kidney, spine,
lymph glands and brain. TB disease can be fatal if not
treated properly, and was once the leading cause of death
in the United States according to the CDC.
TB germs are spread when a person with TB disease of the
lungs or throat coughs, sneezes, speaks, or sings. These
germs can stay in the air for several hours, depending on
the environment. Persons who breathe in the air containing
these TB germs can acquire a latent TB infection, which
means the TB germs are in their bodies but lay dormant.
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Persons with latent TB infections do not show symptoms of
TB and cannot spread TB to others, but may develop TB
disease in the future. This latent infection can become
active at any time and can then be spread to other
individuals.
When TB germs become active, they are multiplying and
destroying tissue in the body. A person infected with TB
disease could experience symptoms such as weakness, weight
loss, fever, night sweats, coughing, chest pain, and
coughing up blood, or other symptoms depending on the
location of TB bacteria inside the body. TB can be curable
with effective antibiotic drug treatment, which can last
several months and must be taken exactly as prescribed in
order to be effective.
There are two tests that can be used to help detect TB
infection: a skin test or a special TB blood test. The
Mantoux tuberculin skin test is performed by injecting a
small amount of fluid (called tuberculin) into the skin on
the lower part of the arm. A person given the tuberculin
skin test must return within 48 to 72 hours to have a
trained health care worker look for a reaction on the arm.
The special TB blood test measures how the patient's immune
system reacts to the germs that cause TB.
A vaccine for TB disease called Bacille Calmette-Gučrin
(BCG) is used in many countries outside the United States
where TB is still prevalent, but does not completely
prevent people from getting TB and is not generally
recommended in the U.S. For persons who were born outside
of the U.S. and received BCG, it may cause a false positive
tuberculin skin test.
Immunization information systems
According to the CDC, over 20 percent of the children in
the U.S. typically have seen more than one health care
provider by two years of age, resulting in scattered paper
medical records. An immunization information system (IIS)
can help providers and families by consolidating
immunization information into one reliable source. An IIS
is a confidential, computerized, population-based system
that collects and consolidates vaccination data from health
care providers administering vaccines and provides tools
for designing and sustaining effective immunization
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strategies at the provider and program levels. Among the
capabilities of an IIS are the capacity to inform health
care providers administering vaccines of upcoming patient
vaccination needs; generate vaccination coverage reports,
patient reminders, or recalls for past due vaccinations;
and interoperate with electronic health record systems.
They save money by ensuring that children get only the
vaccines they need and improve office efficiency by
reducing the time needed to gather and review immunization
records.
California's statewide immunization system is called the
California Immunization Registry (CAIR). CAIR consists of
10 regional immunization registries (mostly covering
multi-county regions). Each registry provides a
computerized system designed to assist providers in
tracking patient immunization records by using web-based
registry software to enter immunization data on their
patients. Regional registries work with the state to
maintain accurate, complete, and up-to-date immunization
histories of patients served by local providers, assist
with reminder notices for immunizations due or recall
notices for those overdue, and inform parents and guardians
about record-sharing and their right to opt out.
Relevant agencies, such as schools, child care centers,
service providers for the California Special Supplemental
Food Program for Women, Infants, and Children (WIC), health
care plans, foster care agencies, and county welfare
departments may access the immunization data in CAIR to
verify a pupil or client's immunization status or assist in
providing medical care or services for a client. CAIR may
also be used to provide the state with the data to assess
immunization coverage rates, identify pockets of need, and
analyze how best to ensure full immunization coverage.
Participation in CAIR is not mandatory for patients or
health care providers, but certain immunizations are
required for school entry, including Diphtheria,
Haemophilus influenzae type b, Measles, Mumps, Pertussis,
Poliomyelitis, Rubella, Tetanus, Hepatitis B, and
Varicella. TB screening results are not currently mandated
for school entry, but TB is included on the list of
communicable diseases mandated to be reported by health
providers to their LHDs.
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Related bills
AB 186 (Williams) would permit CDPH to modify the list of
communicable diseases and conditions for which clinical
labs must submit specimens to the local public health
laboratory to undergo further testing and allows CDPH to
modify the list at any time in consultation with the
California Conference of Local Health Officers and the
California Association of Public Health Laboratory
Directors. Pending on the Assembly Second Reading file.
AB 1192 (Garrick) would require CDPH to create and
distribute information for use by hospitals that includes
specified information relating to pertussis. AB 1192 would
also require hospitals to distribute that information to
the parents of newborn children prior to release from the
hospital. Pending hearing in the Assembly Health Committee.
Prior legislation
AB 354 (Arambula), Chapter 434, Statutes of 2010, permits
CDPH to update vaccination requirements for children
entering schools and child care facilities and adds the
American Academy of Family Physicians to the list of
entities whose recommendations CDPH must consider when
updating the list of required vaccinations.
AB 2786 (Committee on Health) of 2010 was nearly identical
to AB 186. AB 2786 was vetoed by Governor Schwarzenegger,
who stated in part: "The Department of Public Health, in a
public health emergency, already has broad authority to
request and receive laboratory data. I am also
concerned that the Department, without such a public health
emergency, could enact changes that affect both private and
public laboratories without any regulatory
oversight."
AB 2658 (Horton), Chapter 449, Statutes of 2008, requires
laboratories to submit all cases of reportable diseases and
conditions electronically, within one year of the
establishment of the new state electronic laboratory
reporting system, with the exception of HIV reports.
SB 533 (Yee)of 2007 would have added pneumococcus to the
list of diseases that pupils are required to be immunized
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against before entry into any private or public elementary
or secondary school, child care center, day nursery,
nursery school, family day care home, or development
center, except for children who are 24 months of age or
older. Vetoed by the governor, who claimed that a mandate
for this vaccination was not necessary.
SB 1179 (Aanestad) of 2008 would have deleted CDPH's
authority to add diseases to the list of those requiring
immunizations prior to entry to any private or public
elementary or secondary school, child care center, day
nursery, nursery school, family day care home, or
development center. Set for hearing in the Senate Health
Committee, but was pulled at the author's request.
AB 576 (Wolk), Chapter 329, Statutes of 2006 requires,
among other things, CDPH to submit by January 31, 2008, a
sustainability plan for full funding of a statewide
immunization information system, as specified.
Arguments in support
The Health Officers Association of California believes that
not being able to collect TB screening information in the
immunization registry is an inconvenience for parents and
time-consuming for providers. SB 922 will fix this by
allowing the registry to record TB screening results, which
they believe will have the added benefit of helping schools
expedite student registration.
COMMENTS
1. Suggested technical amendment. On page 4 line 2,
strike (6) and insert (7).
POSITIONS
Support: Health Officers Association of California
(sponsor)
Oppose: None received.
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