BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 792|
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UNFINISHED BUSINESS
Bill No: SB 792
Author: Mendoza (D)
Amended: 9/4/15
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
SENATE FLOOR: 34-3, 5/22/15
AYES: Allen, Bates, Beall, Berryhill, Block, Cannella, De
León, Gaines, Galgiani, Hall, Hancock, Hernandez, Hertzberg,
Hill, Hueso, Jackson, Lara, Leno, Leyva, Liu, McGuire,
Mendoza, Mitchell, Monning, Nguyen, Nielsen, Pan, Pavley,
Roth, Runner, Stone, Vidak, Wieckowski, Wolk
NOES: Anderson, Moorlach, Morrell
NO VOTE RECORDED: Fuller, Huff
ASSEMBLY FLOOR: 60-16, 9/08/15 - See last page for vote
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 or volunteering at a day care center
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Page 2
or a day care home if he or she has not been immunized against
influenza, pertussis, and measles.
Assembly Amendments add volunteers to those individuals that are
required to be immunized; narrow the required vaccines to
influenza, pertussis, and measles; add a 30-day grace period for
required immunizations; require day care centers to maintain
documentation of the required immunizations or exemptions, as
specified; specify that a violation of this bill would not be
subject to a crime; and, make other technical, clarifying
changes.
ANALYSIS:
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,
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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
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.
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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:
1)Prohibits, commencing September 1, 2016, a person from being
employed or being a volunteer at a day care center or a day
care home if he or she has not been immunized against
influenza, pertussis, and measles. Requires an employee or
volunteer to receive an influenza vaccination between August 1
and December 1 of each year.
2)Permits a person, if he or she meets all other requirements
for employment or volunteering, as applicable, but needs
additional time to obtain and provide his or her immunization
records, to be employed or volunteer conditionally for a
maximum of 30 days upon signing and submitting a written
statement attesting that he or she has been immunized as
required.
3) Exempts a person from this requirement if the person:
a) Submits a written statement from a licensed physician
declaring that because of the person's physical condition
or medical circumstances, immunization is not safe;
b) Submits a written statement from a licensed physician
providing that the person has evidence of current immunity
to influenza, pertussis, and measles; or
c) Submits a written declaration that he or she has
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declined the influenza vaccination.
d) Was hired after December 1 of the previous year and
before August 1 of the current year. Specifies that this
exemption applies only to the influenza vaccine during the
first year of employment or volunteering.
4)Requires the day care center to maintain documentation of the
required immunizations or exemptions from immunization, in the
person's personnel record that is maintained by the day care
center.
5)Places the immunization requirement above on day care
teachers. Requires any person hired as a day care teacher to
present evidence of a current tuberculosis clearance.
6)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.
7)Specifies that a violation of this bill would not be subject
to a crime.
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
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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
advice to assist in reducing the incidence of
vaccine-preventable diseases and to increase the safe usage of
vaccines and related biological products.
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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 % immunization coverage among
children in licensed child care facilities and kindergartens.
DPH would like immunization rates to be as close to 100 % as
possible, and is using national Healthy People 2020
objectives as a benchmark to monitor progress. These
objectives include: toddlers/pre-school: 90 % 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 % 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 % 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 % 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 %
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 % this past year.
There were 2,734 (0.56 %) children with permanent medical
exemptions (PMEs) and 12,981 (2.67 %) with PBEs. Children with
PBEs decreased from 2.94 % this past year. For all facilities,
immunization coverage was greater than or equal to 94 % for
each vaccine this year.
FISCAL EFFECT: Appropriation: No Fiscal
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Com.:YesLocal: No
According to Assembly Appropriations Committee, costs to the
Department of Social Services (DSS), which licenses child care
facilities, are expected to be minor and absorbable.
SUPPORT: (Verified9/8/15)
Health Officers Association of California (source)
Alameda County Board of Supervisors
American Academy of Pediatrics, California
American Nurses Association\California
California Academy of Family Physicians
California Academy of Preventative Medicine
California Federation of Teachers
California Hospital Association
California Immunization Coalition
California Medical 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
National Association of Social Workers, California Chapter
Santa Clara County Board of Supervisors
OPPOSITION: (Verified9/8/15)
Educate Operate
California Coalition for Health Choice
Your Family Your Choice
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Page 9
ASSEMBLY FLOOR: 60-16, 9/08/15
AYES: Alejo, Travis Allen, Baker, Bloom, Bonilla, Bonta, Brown,
Burke, Calderon, Campos, Chang, Chau, Chiu, Chu, Cooley,
Cooper, Dababneh, Daly, Dodd, Eggman, Frazier, Cristina
Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez,
Gordon, Gray, Hadley, Roger Hernández, Holden, Irwin,
Jones-Sawyer, Kim, Lackey, Levine, Lopez, Low, Maienschein,
McCarty, Medina, Mullin, Nazarian, O'Donnell, Perea, Quirk,
Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth,
Mark Stone, Thurmond, Ting, Wagner, Weber, Wood, Atkins
NOES: Achadjian, Brough, Dahle, Beth Gaines, Gallagher, Grove,
Harper, Jones, Linder, Mathis, Mayes, Melendez, Obernolte,
Patterson, Waldron, Wilk
NO VOTE RECORDED: Bigelow, Chávez, Olsen, Williams
Prepared by:Melanie Moreno / HEALTH /
9/8/15 19:34:35
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