BILL ANALYSIS                                                                                                                                                                                                    Ó






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          |SENATE RULES COMMITTEE            |                        SB 792|
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                                   THIRD READING 


          Bill No:  SB 792
          Author:   Mendoza (D)
          Amended:  4/30/15  
          Vote:     21  

           SENATE HEALTH COMMITTEE:  8-0, 4/15/15
           AYES:  Hernandez, Nguyen, Hall, Mitchell, Monning, Pan, Roth,  
            Wolk
           NO VOTE RECORDED:  Nielsen

           SENATE HUMAN SERVICES COMMITTEE:  3-0, 4/28/15
           AYES:  McGuire, Berryhill, Hancock
           NO VOTE RECORDED:  Liu, Nguyen

           SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

           SUBJECT:   Day care facilities: immunizations: exemptions


          SOURCE:    Health Officers Association of California


          DIGEST:  This bill 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.


          ANALYSIS:   









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          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. 

          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  







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            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, 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:








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          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 if the person submits:

             a)   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; 
             b)   A written statement from a licensed physician providing  
               that the person has evidence of current immunity to the  
               diseases included on the immunization schedule; or
             c)   A written declaration that he or she has declined the  
               influenza vaccination.

          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.

          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  







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            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  
            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  







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            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;  
            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  







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            equal to 94 percent for each vaccine this year.

          FISCAL EFFECT:   Appropriation:    No          Fiscal  
          Com.:YesLocal:   Yes

          SUPPORT:   (Verified5/18/15)

          Health Officers Association of California (sponsor)
          American Academy of Pediatrics California
          American Nurses Association, California
          California Academy of Family Physicians
          California Academy of Preventive Medicine
          California Chapter National Association of Social Workers
          California Federation of Teachers
          California Hospital Association
          California Primary Care Association
          California Public Health Association - North
          Child Care Law Center
          Children Now
          County Health Executives Association of California
          First 5 California
          Knowledge Universe
          Los Angeles County Board of Supervisors
          March of Dimes California Chapter
          Santa Clara County Board of Supervisors


          OPPOSITION:   (Verified       5/18/15)


          AWAKE California
          California Chiropractic Association
          California Right to Life Committee, Inc.
          Educate. Advocate.


           


           


          Prepared by:Melanie Moreno / HEALTH / 
          5/20/15 12:06:05







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