BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | SB 792| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- 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: SB 792 Page 2 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 SB 792 Page 3 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: SB 792 Page 4 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 SB 792 Page 5 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 SB 792 Page 6 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 SB 792 Page 7 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 SB 792 Page 8 **** END ****