BILL ANALYSIS
AB 158
Page 1
Date of Hearing: April 24, 2007
ASSEMBLY COMMITTEE ON HEALTH
Mervyn Dymally, Chair
AB 158 (Ma) - As Amended: April 10, 2007
SUBJECT : Public health.
SUMMARY : Requires the Department of Public Health (DPH) to
establish within its Office of Multicultural Health, a hepatitis
B prevention and management pilot program (pilot program) to
provide the following services: education, outreach, counseling,
and social services to ethnic populations that are at high risk
of hepatitis B infection, and to individuals among those
populations suffering from this disease. Requires the pilot
program to utilize existing programs and systems operated by
public and not-for-profit organizations in providing these
services. Requires DPH to make and administer grants to public
and not-for-profit organizations from funds appropriated by the
Legislature or donated to the state in order to provide these
services. Specifically, this bill :
1)Establishes the Hepatitis B Prevention and Management Pilot
Program Fund (fund).
2)Requires the fund to be made available to the Office of
Multi-Cultural Health at DPH, upon appropriation by the
Legislature, exclusively for the support of existing and
ongoing programs operated by nonprofit or academic
organizations that provide culturally and language appropriate
health education, public awareness campaigns, and community
outreach activities, especially to ethnic communities with
high rates of hepatitis B infection and other high-risk
groups, to promote public awareness and knowledge about the
value of hepatitis B immunization, risk factors, the
transmission and prevention of hepatitis B, and the value of
screening for early detection of hepatitis B infection, and to
conduct at least two of the following:
a) Testing programs to screen the high chronic hepatitis B
prevalence populations in order to identify chronically
infected individuals, and provide vaccines to protect
susceptible adults;
b) Programs for high-prevalence populations that provide
client-centered information, education, and counseling
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concentrating on any of the following:
i) Testing of family members;
ii) Modifying behaviors that place individuals at
risk of hepatitis B virus (HBV) infection;
iii) Reducing the risk of dying from end-stage
liver disease or liver cancer among individuals with
hepatitis B;
iv) Culturally appropriate health information for
pregnant women or those of childbearing age who are
chronically infected with hepatitis B to alleviate their
fears of becoming pregnant or raising a family; and,
v) Referring persons with chronic hepatitis B for
further medical evaluation, monitoring, and treatment, as
appropriate.
c) The training of health care professionals and health
educators to make them aware of the high rates of chronic
hepatitis B in certain adult ethnic populations, and the
importance of prevention, detection, and medical management
of hepatitis B and of liver cancer screening.
3)Requires the funds appropriated to the fund to be distributed
to nonprofit or academic organizations in the greater Los
Angeles and San Francisco Bay areas that during 2007 met the
requirements in # 2) above.
4)Requires a recipient organization to do the following to
receive distributions from the fund:
a) Submit audited financial statements setting forth its
expenditures made in 2007 for activities described in # 2)
above to demonstrate a history of successfully providing
services;
b) Commit to using all distributions from the fund in the
2008-09 fiscal year to meet the requirements of # 2) above;
and,
c) Submit audited financial statements setting forth
expenditures made in the 2008-09 fiscal year demonstrating
that it has met the requirements of # 2) above.
5)Requires distributions from the fund to be on a matching
dollar-for-dollar basis for each organization's expenditures
up to the total amount of funds available in the fund.
Requires funds to be distributed equally between the two
geographic areas.
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6)Requires DPH to report to the Legislature by January 1, 2010,
regarding implementation, and recommendations regarding the
pilot program.
7)Appropriates $4 million from the General Fund to the DPH for
deposit into the fund.
8)Makes legislative findings and declarations regarding HBV.
EXISTING LAW :
1)Renames the Department of Health Services (DHS) as the
Department of Health Care Services and transfers certain
public health responsibilities to a newly established DPH as
of July 1, 2007.
2)Establishes the Office of Multicultural Health within DHS to
coordinate activities and programs related to the racial and
ethnic populations in California.
FISCAL EFFECT : Unknown
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill
would address HBV health education, prevention, and treatment
in the greater Los Angeles and San Francisco Bay areas.
Currently, the state provides no specifically targeted support
to local efforts that provide HBV health education and
treatment. Local programs exist and are having an impact on
high risk communities but without state support, they cannot
sustain their efforts or make additional progress.
2)WHAT IS HEPATITIS B ? According to the Centers for Disease
Control and Prevention (CDC), HBV is a disease caused by a
highly infectious virus that attacks the liver and can cause
lifelong infection, cirrhosis of the liver, liver cancer,
liver failure, and death. HBV is the most common
life-threatening liver infection in the world and a major
global public health problem. Of all the various types of
viral hepatitis, HBV is the only type for which a vaccine is
available.
HBV is 100 times more infectious than AIDS, and is transmitted
through contact with blood and bodily fluids. The majority of
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those infected are able to fight off infection and clear the
virus from their blood within six months of infection.
However, for those whose immune systems cannot ward off
infection, these chronically infected patients form a carrier
reservoir, possibly infecting those around them. The danger
of HBV lies in its silent transmission and progression, as
many chronic carriers have no symptoms and feel healthy.
3)HBV INFECTION RATES . According to the World Health
Organization, two million people worldwide are infected with
HBV. Two-thirds reside in the Asian Pacific region where the
disease is endemic and carrier rates range from 5% to 20%. Of
these, 400 million are chronically infected and one million
die from the disease annually. Annually, 130 million
Americans become infected with HBV, and between five and six
thousand Americans die from HBV-related liver complications.
Of the 1.25 million Americans that are carriers, 67% are Asian
Pacific Islander Americans (API). Medical and work-loss costs
for HBV-related conditions total over $700 million annually.
The HBV incidence rate among all API Americans is 7% compared
to less than 0.4% in the general population. However, for
foreign-born API Americans, these rates average 9%. In
regions with high concentration of API immigrants, the
incidence rate is even higher.
4)HBV VACCINATION . Although there is no known cure, spread of
HBV can be prevented with a safe and effective vaccine,
administered in a three-dose series. The Advisory Committee
on Immunization Practices (ACIP) has recommended a
comprehensive strategy to eliminate HBV transmission,
including prevention of perinatal HBV transmission; universal
vaccination of infants; catch-up vaccination of unvaccinated
children and adolescents; and vaccination of unvaccinated
adults at increased risk for infection. According to CDC's
2004 data on HBV vaccination, the incidence of acute hepatitis
B has declined 75%, from 8.5 per 100,000 population in 1990 to
2.1 per 100,000 population in 2004, with the greatest declines
(94%) among children and adolescents. Incidence remains
highest among adults, who accounted for approximately 95% of
the estimated 60,000 new infections in 2004. To measure HBV
vaccination coverage among adults, data were analyzed from the
2004 National Health Interview Survey (NHIS). The results of
the NHIS analysis indicated that during 2004, 34.6% of adults
aged 18 to 49 years reported receiving HBV vaccine, including
45.4% of adults at high risk for HBV infection. The CDC
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points out that to accelerate elimination of HBV transmission
in the United States, public health programs and clinical care
providers should implement strategies to ensure that adults at
high risk are offered HBV vaccine.
5)NEW YORK CITY . To assess the prevalence of chronic HBV
infection among API populations living in New York City, the
Asian American Hepatitis B Program (AAHBP) conducted a
seroprevalence study among persons who participated in an
ongoing hepatitis B screening, evaluation, and treatment
program. The AAHBP is a collaboration of community groups and
academic and community health centers in New York City that
provides hepatitis B screening, vaccination, and treatment
free of charge. AAHBP also provides educational programs to
increase awareness of HBV infection among API communities in
New York City. AAHBP screening programs are held at 12
collaborating health-care centers and community sites that
serve API communities throughout New York City. Beginning in
2005, participants in this study were offered free hepatitis B
serologic testing at AAHBP screening events or on a drop-in
basis at participating clinics. At the time of testing,
demographic and epidemiologic information was collected using
self-administered questionnaires in English, Chinese, or
Korean, with the assistance of bilingual volunteers when
necessary. Blood was collected by venipuncture and tested for
hepatitis B surface antigen (HBsAg) and antibody to HBsAg
(anti-HBs). Clinical evaluation and treatment were offered to
persons infected with HBV, and Hepatitis B vaccination was
provided to persons susceptible to HBV infection. The
findings of the AAHBP indicate that approximately 15% of newly
tested persons living in New York City had chronic HBV
infection. The prevalence among participants in the screening
program was approximately 35 times that of the overall U.S.
population. Half of those with chronic HBV infection had been
living in the United States for more than 10 years, and the
infections were most likely acquired in the countries of
origin. The majority of infected participants were
successfully referred for medical evaluation and follow-up.
6)SUPPORT . Supporters state that HBV is an escalating public
health concern in California. Investment services, such as
those provided by this bill, will have an impact on some of
California's underserved, low-income and poor populations.
7)COMMENTS .
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a) Creation of the pilot program. This bill requires DPH
to establish the pilot program in Los Angeles and San
Francisco Bay areas but does not specify when DPH should do
this. The author may wish to amend this bill and specify
when DPH must establish the pilot program.
a) Report. This bill requires DPH to report to the
Legislature on the implementation and recommendations
regarding the pilot program by January 1, 2010. Depending
on when DPH establishes the pilot program, should the pilot
program be in effect for at least two years before the
report is submitted to the Legislature? In addition, the
author may wish to amend this bill to allow DPH to contract
with a private entity to write the report.
REGISTERED SUPPORT / OPPOSITION :
Support
Daughters of Charity Health System
Education for Healthy Choices
Hepatitis B Foundation
Opposition
None on file.
Analysis Prepared by : Rosielyn Pulmano / HEALTH / (916)
319-2097