BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 792
---------------------------------------------------------------
|AUTHOR: |Mendoza |
|---------------+-----------------------------------------------|
|VERSION: |April 7, 2015 |
---------------------------------------------------------------
---------------------------------------------------------------
|HEARING DATE: |April 15, 2015 | | |
---------------------------------------------------------------
---------------------------------------------------------------
|CONSULTANT: |Melanie Moreno |
---------------------------------------------------------------
SUBJECT : Day care facilities: immunizations: exemptions
SUMMARY :1. Prohibits, commencing September 1, 2016, a person from being
employed at a day care center or a day care home if he or she
has not been immunized according to the schedule for routine
adult immunizations, as recommended by the federal Centers for
Disease Control and Prevention Advisory Committee on
Immunization Practices, with the exception of immunization
against human papillomavirus.
Existing law:
1.Permits a person to be hired as a teacher in a day care center
if he or she is 18 years or older and meets certain
educational requirements.
2.Requires family day care homes for children to apply to the
Department of Social Services (DSS) for a license and requires
applicants to file an application on forms furnished by DSS,
as specified, and to include specified documentation related
to finances, fire safety, employee fingerprints, and
tuberculosis clearance.
3.Prohibits the governing authority of a school or other
institution from unconditionally admitting any person as a
pupil of private or public elementary or secondary schools,
child care centers, day nurseries, nursery schools, family day
care homes, or development centers, unless, prior to first
admission to that institution, he or she has been fully
immunized against diphtheria, haemophilus influenzae type b
(Hib), measles, mumps, pertussis, poliomyelitis, rubella,
tetanus, hepatitis b (except after 7th grade), and chickenpox,
as specified.
SB 792 (Mendoza) Page 2 of ?
4.Permits the Department of Public Health (DPH) to add to this
list any other disease deemed appropriate, taking into
consideration the recommendations of the Centers for Disease
Control and Prevention (CDC) Advisory Committee on
Immunization Practices (ACIP) and the American Academy of
Pediatrics (AAP) Committee on Infectious Diseases.
5.Waives the above immunization requirements if the parent or
guardian files with the governing authority a written
statement by a licensed physician to the effect that the
physical condition of the child or medical circumstances
relating to the child are such that immunization is not
considered safe. Requires the statement to indicate the
specific nature and probable duration of the medical condition
or circumstances that contraindicate immunization.
6.Waives the above immunization requirements if the parent or
guardian or adult who has assumed responsibility for the
child's care and custody, or the person seeking admission, if
an emancipated minor, files a letter with the governing
authority stating that the immunization is contrary to his or
her beliefs (commonly referred to as a "personal belief
exemption" or "PBE.")
7.Requires a separate form prescribed by DPH to accompany a PBE.
Requires the form to include:
a. A signed attestation from a health care
practitioner that indicates that the parent or
guardian of the person who is subject to the
immunization requirements, the adult who has assumed
responsibility for the care and custody of the person,
or the person if an emancipated minor, was provided
with information regarding the benefits and risks of
the immunization and the health risks of the
communicable diseases listed above to the person and
to the community. Requires the attestation to be
signed within six months of the date when the person
first becomes subject to the immunization requirement
for which the PBE is being sought.
b. A written statement signed by the parent or
guardian of the person who is subject to the
immunization requirements, the adult who has assumed
responsibility for the care and custody of the person,
SB 792 (Mendoza) Page 3 of ?
or the person if an emancipated minor, that indicates
that the signer has received the information provided
by the health care practitioner pursuant to a) above.
Requires the statement to be signed within six months
of the date when the person first becomes subject to
the immunization requirements.
8.Permits a child for whom the requirement has been waived,
whenever there is good cause to believe that he or she has
been exposed to one of the specified communicable diseases, to
be temporarily excluded from the school or institution until
the local health officer is satisfied that the child is no
longer at risk of developing the disease.
This bill:
1.Prohibits, commencing September 1, 2016, a person from being
employed at a day care center or a day care home if he or she
has not been immunized according to the schedule for routine
adult immunizations, as recommended by ACIP, with the
exception of immunization against human papillomavirus (HPV).
2.Exempts a person from this requirement only under either of
the following circumstances:
a. The person submits a written statement from a
licensed physician declaring that because of the
person's physical condition or medical circumstances,
immunization is not safe. Requires the statement to
indicate the probable duration of the medical
condition or circumstances that contraindicate
immunization; or,
b. The person submits a written statement from a
licensed physician providing that the person has
evidence of current immunity to the diseases included
on the immunization schedule.
3.Places the immunization requirement above specifically on day
care teachers.
4.Requires, as a condition of licensing by DSS commencing
September 1, 2016, family day care home applicants to provide
evidence of current immunity pursuant to 1) above for the
applicant and any other person who provides care and
supervision to the children.
SB 792 (Mendoza) Page 4 of ?
FISCAL
EFFECT : This bill has not been analyzed by a fiscal committee.
COMMENTS :
1.Author's statement. According to the author, children in day
care settings have close, intimate contact with each other and
with the staff who work there. Many of these children are too
young to be fully immunized against potentially serious
communicable diseases. Children who are too young to be
vaccinated rely on those around them to be immunized to
prevent the spread of disease (community immunity). This bill
will protect children in day care by requiring those who care
for them to maintain immunity. Some diseases, such as the flu,
cause only a relative inconvenience to healthy adults.
However, this same disease can require hospitalization and
perhaps even be fatal in an infant or an individual with a
suppressed immune system. Other diseases in the ACIP schedule
include very serious conditions, formerly under control, that
have resurfaced in recent years, including pertussis and
measles. By requiring vaccination for pre-school workers,
vulnerable children will be "cocooned" from potentially
serious illness, and day care centers will be a safe and
healthy place for our little ones to learn and play.
2.Immunizations. According to the CDC, vaccines contain the
same antigens or parts of antigens that cause diseases, but
the antigens in vaccines are either killed or greatly
weakened. Vaccine antigens are not strong enough to cause
disease, but they are strong enough to make the immune system
produce antibodies against them. Memory cells prevent
re-infection when they encounter that disease again in the
future. Vaccines are responsible for the control of many
infectious diseases that were once common around the world,
including polio, measles, diphtheria, pertussis (whooping
cough), rubella (German measles), mumps, tetanus, and Hib.
Vaccines eradicated smallpox, one of the most devastating
diseases in history. Over the years, vaccines have prevented
countless cases of infectious diseases and saved literally
millions of lives. Vaccine-preventable diseases have a costly
impact, resulting in doctor's visits, hospitalizations, and
premature deaths. Sick children can also cause parents to lose
time from work. CDC recommends routine vaccination to prevent
SB 792 (Mendoza) Page 5 of ?
17 vaccine-preventable diseases that occur in infants,
children, adolescents, or adults.
3.ACIP. The ACIP consists of 15 experts who are voting members
and are responsible for making vaccine recommendations. The
Secretary of the U.S. Department of Health and Human Services
selects these members after an application, interview, and
nomination process. Fourteen of the members have expertise in
vaccinology, immunology, pediatrics, internal medicine,
nursing, family medicine, virology, public health, infectious
diseases, and/or preventive medicine; one member is a consumer
representative who provides perspectives on the social and
community aspects of vaccination. ACIP develops written
recommendations for the routine administration of vaccines to
pediatric and adult populations, along with schedules
regarding the appropriate periodicity, dosage, and
contraindications applicable to the vaccines and is the only
entity within the federal government which makes such
recommendations. The overall goals of ACIP are to provide
advice to assist in reducing the incidence of
vaccine-preventable diseases and to increase the safe usage of
vaccines and related biological products.
ACIP, along with AAP, the American Academy of Family
Physicians, and the American College of Obstetricians and
Gynecologists, approved the 2015 Recommended Immunization
Schedules for Persons Aged 0 Through 18 Years. Children under
six are recommended to receive vaccines for: hepatitis b;
rotavirus; diphtheria, tetanus, and pertussis (DTaP); Hib;
pneumococcal; polio; influenza; measles, mumps, rubella (MMR);
varicella; hepatitis a; and meningococcal.
4.California vaccination rates. According to an August 2014 DPH
fact sheet, vaccination coverage in California is at or near
all-time high levels. DPH states that the implementation of
current vaccine requirements has been effective in maintaining
greater than or equal to 92 percent immunization coverage
among children in licensed child care facilities and
kindergartens. DPH would like immunization rates to be as
close to 100 percent as possible, and is using national
Healthy People 2020 objectives as a benchmark to monitor
progress. These objectives include: toddlers/pre-school: 90
percent rate for four doses of DTaP, 3 or 4 doses of Hib
vaccine, 3 doses of hepatitis b vaccine, 1 dose of MMR, 3
doses of polio vaccine, and one dose of varicella vaccine;
SB 792 (Mendoza) Page 6 of ?
kindergarteners: 95 percent rate for 4 doses DTaP, 2 MMR, 3
polio vaccine, 3 hepatitis b vaccine, and 2 doses of varicella
vaccine; and for 13 to 15 year olds: 80 percent Tdap
vaccination rate. The DPH Immunization Branch maintains data
on its website related to vaccination rates and is searchable
statewide and by school (kindergarten and seventh grade rates)
and child care facility. This year, 89.4 percent of the
434,922 children aged two to five years enrolled in reporting
child care facilities received all required immunizations (4+
DTP, 3+ Polio, 1+ MMR, 1+ Hib, 3+ Hep B, and 1+ Vari or
physician-documented varicella disease), a 0.1 percent
increase from the prior year. 'Conditional' entrants (children
in process to be fully vaccinated but not yet having all
required vaccinations), decreased by 0.1 percent this past
year. There were 2,734 (0.56 percent) children with permanent
medical exemptions (PMEs) and 12,981 (2.67 percent) with PBEs.
Children with PBEs decreased from 2.94 percent this past year.
For all facilities, immunization coverage was greater than or
equal to 94 percent for each vaccine this year.
5.Double referral. This bill is double referred. Should it pass
out of this committee, it will be referred to the Senate
Committee on Human Services.
6.Related legislation. SB 277 (Pan and Allen) eliminates the
personal belief exemption from the requirement that children
receive specified vaccines for certain infectious diseases
prior to being admitted to any public or private elementary or
secondary school or day care center. SB 277 passed the Senate
Health Committee by a vote of 6-2 on April 8, 2015 and is set
for hearing on April 15, 2015 in the Senate Committee on
Education.
7.Prior legislation. SB 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 for a
PBE. Requires the form to include:
a. A signed attestation from a health care practitioner
that indicates he or she provided information regarding
the benefits and risks of the immunization and the health
risks of the communicable diseases, as specified; and,
b. A written statement signed by the parent or guardian
or an emancipated minor that indicates that the signer
SB 792 (Mendoza) Page 7 of ?
has received the information provided by the health care
practitioner pursuant a) above.
The Governor included a message with his signature on this
bill, which stated, in part:
"I will direct (DPH) to allow for a separate religious
exemption on the form. In this way, people whose religious
beliefs preclude vaccinations will not be required to seek
a health care practitioner's signature."
AB 2064 (V. Manuel Pérez), of 2012, would have required a
health care service plan or health insurer that provides
coverage for childhood and adolescent immunizations to
reimburse a physician or physician group in an amount not less
than the actual cost of acquiring the vaccine plus the cost of
administration of the vaccine, as specified. AB 2064 was held
on the Assembly Appropriations Committee suspense file.
SB 614 (Kehoe), Chapter 123, Statutes of 2011, allows a pupil
in grades seven 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 if specified conditions are met.
AB 354 (Arambula), Chapter 434, Statutes of 2010, allows DPH
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 DPH must consider when updating the list of
required vaccinations. Requires children entering grades 7
through 12 receive a TDaP booster prior to admittance to
school.
AB 1201 (V. Manuel Pérez), of 2009, would have required a
health care service plan or health insurer that provides
coverage for childhood and adolescent immunizations to
reimburse a physician or physician group the entire cost of
acquiring and administering the vaccine, and prohibits a
health plan or insurer from requiring cost-sharing for
SB 792 (Mendoza) Page 8 of ?
immunizations. AB 1201 was held on the Assembly Appropriations
Committee suspense file.
SB 1179 (Aanestad), of 2008, would have deleted DPH'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. SB 1179 died in Senate Health Committee.
AB 2580 (Arambula), of 2008, would have required pupils
entering the seventh grade to be fully immunized against
pertussis by receiving any necessary adolescent booster
immunization. AB 2580 was held on the Senate Appropriations
Committee suspense file.
SB 676 (Ridley-Thomas), of 2007, would have required pupils
entering the seventh grade to be fully immunized against
pertussis. SB 676 was held on the Assembly Appropriations
Committee suspense file.
SB 533 (Yee), of 2007, would have added pneumococcus to the
list of diseases that pupils are required to be immunized
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. SB 533 was
vetoed by the Governor, who stated that a mandate for this
vaccination was not necessary.
8.Support. The Health Officers Association of California writes
that given that child care workers have close, intimate
contact with children who are unable to be fully immunized, it
is important to ensure that these dedicated professionals that
are not inadvertently exposing children to potentially fatal,
yet vaccine-preventable, childhood diseases. The California
Primary Care Association states that vaccines are a modern
medical miracle, but the are only effective if people working
with our vulnerable children are required to be vaccinated.
Knowledge Universe states the U.S. is experiencing a
multi-state outbreak of measles, and at one child care center
alone this year, 12 infants became sick with the measles as
this highly contagious illness spread from one infant to all
other infants in the center. March of Dimes states that they
support this bill because it will help protect children in day
SB 792 (Mendoza) Page 9 of ?
cares from vaccine-preventable diseases but recommend that it
be amended to allow for an exemption for medical reasons to be
consistent with existing state law on immunizations.
9.Opposition. The California Right to Life Committee, Inc.
states that it does not support governmental agencies
interfering with private businesses in this circumstance as it
would place an undue burden on small businesses.
SUPPORT AND OPPOSITION :
Support: Health Officers Association of California (sponsor)
American Academy of Pediatrics
California Academy of Family Physicians
California Chapter National Association of Social
Workers
California Primary Care Association
Children Now
County Health Executives Association of California
Knowledge Universe
March of Dimes California Chapter
Oppose: AWAKE California
California Right to Life Committee, Inc.
Three individuals
-- END --