BILL ANALYSIS                                                                                                                                                                                                    ”



                                                                     SB 792


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          SENATE THIRD READING


          SB  
          792 (Mendoza)


          As Amended  September 4, 2015


          Majority vote


          SENATE VOTE:  34-3


           -------------------------------------------------------------------- 
          |Committee       |Votes|Ayes                   |Noes                 |
          |                |     |                       |                     |
          |                |     |                       |                     |
          |                |     |                       |                     |
          |----------------+-----+-----------------------+---------------------|
          |Health          |17-1 |Bonta, Maienschein,    |Waldron              |
          |                |     |Bonilla, Burke, Chiu,  |                     |
          |                |     |Gomez, Gonzalez, Roger |                     |
          |                |     |HernŠndez, Lackey,     |                     |
          |                |     |McCarty, Nazarian,     |                     |
          |                |     |Patterson,             |                     |
          |                |     |Ridley-Thomas,         |                     |
          |                |     |Rodriguez, Steinorth,  |                     |
          |                |     |Thurmond, Wood         |                     |
          |                |     |                       |                     |
          |----------------+-----+-----------------------+---------------------|
          |Human Services  |6-1  |Chu, Calderon, Lopez,  |Mayes                |
          |                |     |Maienschein, Mark      |                     |
          |                |     |Stone, Thurmond        |                     |
          |                |     |                       |                     |
          |----------------+-----+-----------------------+---------------------|
          |Appropriations  |16-1 |Gomez, Bigelow, Bloom, |Jones                |








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          |                |     |Bonta, Calderon,       |                     |
          |                |     |Chang, Gordon, Eggman, |                     |
          |                |     |Gallagher,             |                     |
          |                |     |                       |                     |
          |                |     |                       |                     |
          |                |     |Eduardo Garcia,        |                     |
          |                |     |Holden, Quirk, Rendon, |                     |
          |                |     |Wagner, Weber, Wood    |                     |
          |                |     |                       |                     |
          |                |     |                       |                     |
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          SUMMARY:  Requires day care workers or volunteers to be  
          vaccinated for specified infectious diseases as a condition of  
          participation.  Specifically, this bill:


          1)Prohibits, after September 1, 2016, a day care center or a  
            family day care home from employing any person, or allowing  
            any person to volunteer, who has not been immunized against  
            measles, pertussis, and influenza (flu).


          2)Specifies circumstances under which a person would be exempt  
            from the immunization requirement based on medical safety,  
            current immunity, or, for flu vaccine, timing of hire or  
            employee declination.  


          3)Permits a person to be employed or volunteer conditionally for  
            30 days after submitting a written statement attesting that  
            they have been immunized as required, but need additional time  
            to obtain and provide their records. 


          4)Requires any person hired or volunteering as a teacher in a  
            day care center to present evidence of a current tuberculosis  
            clearance, as specified.  








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          FISCAL EFFECT:  According to the Assembly Appropriations  
          Committee, costs to Department of Social Services, which  
          licenses child care facilities, are expected to be minor and  
          absorbable.


          COMMENTS:  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.  The author states that this bill will protect children  
          in day care by requiring those who care for them to maintain  
          immunity.  


          Public health experts agree that vaccines represent one of the  
          greatest achievements of science and medicine in the battle  
          against disease.  Vaccines are responsible for the control of  
          many infectious diseases that were once common around the world,  
          including polio, measles, diphtheria, pertussis, rubella, mumps,  
          tetanus, and Hib meningitis.  Vaccines helped to eradicate  
          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.


          Some diseases, such as the flu, cause only a relative  
          inconvenience to healthy adults.  However, this same disease can  
          require hospitalization and be potentially fatal for infants or  
          individuals with suppressed immune systems.  Importantly, many  
          vaccines require multiple doses before a child is protected  
          against the disease, and children in day care settings are often  
          too young to complete the recommended series of vaccinations.










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          1)Pertussis is a highly contagious bacterial disease that can be  
            spread by coughing.  People with pertussis have severe  
            coughing attacks that can last for months.  Infants too young  
            for vaccination are at greatest risk for life-threatening  
            cases of pertussis.  Pertussis vaccinations are given starting  
            at two months of age, but multiple doses are required before  
            the child is considered fully immunized.  According to the  
            California Department of Public Health, during a major  
            pertussis outbreak in 2010, there were 9,000 cases of  
            pertussis resulting in 10 infant deaths.  In 2014, there were  
            11,114 reported cases of whooping cough with three infant  
            deaths.  As of June 1, 2015 there have been 2,552 new cases of  
            pertussis in California this year.  Sixty-two infants younger  
            than four months of age have been hospitalized and one death  
            was reported in an infant that contracted pertussis at three  
            weeks of age.  


          2)Measles is a highly contagious viral disease, and is  
            considered the most deadly of all childhood rash/fever  
            illnesses.  It is recommended that children receive their  
            first measles vaccination at 12 to 15 months; to be most  
            effective, a second dose is recommended at four to six years.   
            Measles is particularly dangerous for babies and young  
            children.  From 2001-13, 28% of children younger than five  
            years old who had measles had to be treated in the hospital.   
            For some children, measles can lead to pneumonia, lifelong  
            brain damage, deafness, or death.  According to the Centers  
            for Disease Control and Prevention (CDC), the United States  
            declared that measles was eliminated from this country in  
            2000; however, measles is one of the first diseases to  
            reappear when vaccination coverage rates fall.  In 2014, there  
            were over 600 cases reported to the CDC, the highest in many  
            years.  Between 2000 and 2007, the average number of cases was  
            63 per year, less than half the number of the December 2014  
            outbreak in California, which is one of five outbreaks so far  
            this year reported by the CDC.  










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          3)Influenza, or flu, is a contagious respiratory illness caused  
            by influenza viruses.  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.   
            Because there are many different flu viruses, the flu vaccine  
            is redesigned annually to protect against the flu strains that  
            research indicates will cause the most illness during the flu  
            season.  Last year in California, 10 children died of  
            influenza.  According to the CDC's nationwide surveillance,  
            142 children passed away during the 2014-15 flu season due to  
            complications with the flu, bringing the total of pediatric  
            deaths since 2004 to over 1,000.  


          Herd immunity occurs when a significant proportion of the  
          population (or the herd) has been vaccinated, and this provides  
          protection for unprotected individuals. The larger the number of  
          people who are vaccinated in a population, the lower the  
          likelihood that a susceptible (unvaccinated) person will  
          physically come into contact with the infection.  It is more  
          difficult for diseases to spread between individuals if large  
          numbers of people are already immune, and the chain of infection  
          is broken.  The reduction of herd immunity places unvaccinated  
          persons at risk, including those who cannot receive vaccinations  
          for medical reasons.  Those who cannot receive vaccines include  
          those with compromised immune systems, older adults, small  
          children and babies, all depending on the vaccine.


          In recent years a few other states, including Vermont, Colorado,  
          and Illinois have considered legislation to require vaccinations  
          for teachers or child care workers.  In 2014, Texas passed a law  
          requiring child-care facilities to develop and implement a  
          policy concerning vaccination of employees.  


          The Health Officers Association of California, sponsor of this  
          bill, writes that given that child care workers have close,  
          intimate contact with children who are unable to be fully  








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          immunized, it is important to ensure that these dedicated  
          professionals are not inadvertently exposing children to  
          potentially fatal, yet vaccine-preventable, childhood diseases.   
          Knowledge Universe, the Santa Clara County Board of Supervisors  
          and other supporters state that it is important to ensure that  
          child care professionals are not inadvertently exposing children  
          to potentially fatal, yet vaccine-preventable, childhood  
          diseases.




          The California Right to Life Committee and several other groups  
          opposed to vaccination mandates state that this bill places an  
          unwarranted burden on child care employees, as well as an  
          unnecessary mandate that day care owners must enforce.


          Analysis Prepared by:                                             
                          Dharia McGrew / HEALTH / (916) 319-2097  FN:  
          0002104