BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  AB 2069
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          Date of Hearing:  April 22, 2014

                            ASSEMBLY COMMITTEE ON HEALTH
                                 Richard Pan, Chair
                 AB 2069 (Maienschein) - As Amended:  April 21, 2014
           
          SUBJECT  :  Immunizations: influenza.

           SUMMARY  :  Requires the State Department of Public Health (DPH)  
          to post educational information regarding influenza (flu)  
          vaccinations on its Internet Website.  Specifically,  this bill  :   


          1)Requires DPH to annually post educational information  
            regarding flu and the availability of flu vaccines on its  
            Internet Website prior to the annual flu season, including,  
            but not limited to, all of the following:

             a)   The health benefits of a flu vaccine;

             b)   That the flu vaccine may be a covered benefit for those  
               with health insurance coverage; and,

             c)   That flu vaccines may be available for a minimal fee to  
               those individuals who do not have health insurance  
               coverage.

          2)Authorizes DPH to use additional available resources to  
            educate the public about flu vaccination, including public  
            service announcements, media events, public outreach to  
            individuals and groups who are susceptible to flu, and any  
            other preventive and wellness education efforts recommended by  
            public health officials.

          3)Makes various findings and declarations regarding the  
            importance of flu vaccination.

           EXISTING LAW  :  

          1)Requires DPH to promptly identify, prevent, and control  
            infectious diseases that pose a threat to public health,  
            including emerging and re-emerging infectious diseases,  
            vaccine-preventable agents, bacterial toxins, bioterrorism,  
            and pandemics. 









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          2)Requires DPH to provide appropriate flu vaccine to local  
            governmental or private, nonprofit agencies at no charge so  
            the agencies may vaccinate people, at a minimal cost, at  
            accessible locations.  Requires DPH and the California  
            Department of Aging to prepare, publish, and disseminate  
            information regarding the availability of the vaccine and the  
            effectiveness of the vaccine in protecting the health of older  
            persons. 

          3)Requires general acute care hospitals (GACHs) to offer, prior  
            to discharge, immunizations for flu and pneumococcal disease  
            to inpatients, aged 65 year or older, based upon the adult  
            immunization recommendations of the Advisory Committee on  
            Immunization Practices (ACIP), the Center for Disease Control  
            and Prevention (CDC), and the recommendations of appropriate  
            entities for the prevention, detection, and control of flu  
            outbreaks in California GACHs.  

           FISCAL EFFECT  :  This bill has not been analyzed by a fiscal  
          committee.

           COMMENTS  :

           1)PURPOSE OF THIS BILL  .  According to the author this bill will  
            provide additional information to the public regarding the  
            importance of getting a flu vaccine.  The author further  
            states that Sacramento County data show that the majority of  
            people hospitalized or who died from the flu in 2013 had not  
            been immunized and that state officials have been quoted as  
            saying that unfortunately, people are becoming ill or dying  
            because they do not take advantage of available vaccines.

           2)BACKGROUND  .  

             a)   Influenza.  According to DPH's Website, influenza, or  
               flu, is a contagious respiratory illness caused by flu  
               viruses, that can cause mild to severe illness and at times  
               can lead to death. The best way to prevent flu is by  
               getting a flu vaccination each year.   The CDC recommends a  
               yearly flu vaccine for everyone six months of age and older  
               as the first and most important step in protecting against  
               this serious disease.  While there are many different flu  
               viruses, the flu vaccine is designed to protect against the  
               three main flu strains that research indicate will cause  
               the most illness during the flu season.  








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               In February 2010, the ACIP, which advises the CDC on  
               vaccine issues, voted to recommend that all people aged six  
               months and older obtain a flu vaccine.  However, the CDC  
               also points out that while everyone should get flu vaccine  
               each flu season, it is especially important that the  
               following groups get vaccinated either because they are at  
               a high risk of having serious flu-related complications or  
               because they live with or care for people at high risk for  
               developing flu-related complications: pregnant women;  
               children younger than five; but especially children younger  
               than two years old; people 50 years of age and older;  
               people of any age with certain chronic medical conditions;  
               people who live in nursing homes and other long-term care  
               facilities; and, people who live with or care for those at  
               high risk for complications from flu.

             b)   National and California seasonal flu immunization rates.  
                According to CDC estimates, the California rate of  
               immunization was below the national average during each of  
               the last four flu seasons for individuals age six months  
               and older.
               i)     2009-10 season:  National average: 41.2%.   
                 California average: 36.9%;
               ii)    2010-11 season:  National average: 43%.  California  
                 average: 38.9%;
               iii)   2011-12 season: National average: 41.8%. California  
                 average: 40.5%; and,
               iv)    2012-13 season: National average: 45%.  California  
                 average: 44.2%.

           3)SUPPORT  .  The American Federation of State, County and  
            Municipal Employees, AFL-CIO (AFSCME) states this bill would  
            help hospitals combat the flu by educating discharged patients  
            about the vaccine available to protect them from contracting  
            the virus.  AFSCME also notes, given the level of misdirected  
            hysteria surrounding the use of vaccinations, it would benefit  
            patients to have access to information regarding the  
            advantages of vaccinating against preventable ailments.  The  
            California Children's Hospital Association also supports this  
            bill and says they believe educating the public on the  
            availability of vaccinations that can prevent a potentially  
            deadly virus infection is a critical component in reducing the  
            severity of the annual flu season.
           4)PREVIOUS LEGISLATION  .  








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             a)   AB 689 (Bonta) of 2013 would have required each GACH to  
               offer an onsite flu vaccine annually to all patients prior  
               to discharge, as specified, and required hospitals to  
               inform patients they may be required to pay for the  
               vaccination.  AB 689 was held in the Assembly  
               Appropriations Committee.

             b)   AB 599 (Donnelly) of 2013 would have provided that  
               existing law, which allows a minor who is 12 years of age  
               or older and who may have come into contact with an  
               infectious, contagious, or communicable disease to consent  
               to medical care, as specified, does not authorize a minor  
               to receive a vaccine without the consent of the parent or  
               guardian of the minor.  AB 599 failed passage in the  
               Assembly Judiciary Committee. 

             c)   AB 2109 (Pan), Chapter 821, Statutes of 2012, requires  
               on and after January 1, 2014, a separate form prescribed by  
               DPH to accompany a letter or affidavit to exempt a child  
               from immunization requirements under existing law on the  
               basis that an immunization is contrary to beliefs of the  
               child's parent or guardian.

             d)   AB 106 (Berg), Chapter 378, Statutes of 2007, requires a  
               GACH to offer, prior to discharge, immunizations for flu  
               and pneumococcal disease to its inpatients aged 65 years of  
               age or older, as specified.

             e)   AB 1711 (Strickland), Chapter 58, Statutes of 2005,  
               authorizes a registered nurse or licensed pharmacist in  
               skilled nursing facilities to administer flu and  
               pneumococcal immunizations to a patient over 50 years of  
               age, pursuant to standing orders and without patient  
               specific orders, if the immunization standing orders that  
               are not patient-specific meet prescribed federal  
               recommendations and are approved by the medical director of  
               the facility.

             f)   AB 691 (Daucher), Chapter 36, Statutes of 2004, requires  
               specified nursing facilities to offer immunizations for flu  
               and pneumococcal disease to residents that are 65 years or  
               older.

           5)SUGGESTED AMENDMENTS  .  DPH currently posts educational  








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            information regarding the flu and the availability of  
            vaccinations on its Internet Website, although not all of the  
            information required by this bill.  In order to improve the  
            content on the DPH Website, committee staff suggest the  
            following amendments:

             a)   Delete the requirement that information be posted prior  
               to flu season, and require it to be posted year round; and,

             b)   Require DPH to include information on where low or  
               no-cost flu vaccinations can be obtained.






           REGISTERED SUPPORT / OPPOSITION  :  

           Support 
           
          American Academy of Pediatrics, California District IX
          American Federation of State, County and Municipal Employees,  
          AFL-CIO
          Biocom
          California Children's Hospital Association

           Opposition 
           
          None on file.
           


          Analysis Prepared by  :    Lara Flynn / HEALTH / (916) 319-2097