BILL ANALYSIS
AB 354
Page 1
ASSEMBLY THIRD READING
AB 354 (Arambula)
As Amended April 28, 2009
Majority vote
HEALTH 19-0 APPROPRIATIONS 11-2
-------------------------------------------------------------------
|Ayes:|Jones, Fletcher, Adams, |Ayes:|De Leon, Ammiano, Charles |
| |Ammiano, Block, Carter, | |Calderon, Davis, Fuentes, |
| |Conway, De La Torre, De | |Hall, John A. Perez, Price, |
| |Leon, Emmerson, Gaines, | |Skinner, Solorio, Torlakson |
| |Hall, Hayashi, Hernandez, | | |
| | | | |
| |Bonnie Lowenthal, Nava, | | |
| |V. Manuel Perez, Salas, | | |
| |Audra Strickland | | |
| | | | |
|-----+--------------------------+-----+----------------------------|
| | |Nays:|Nielsen, Audra Strickland |
| | | | |
-------------------------------------------------------------------
SUMMARY : Allows the Department of Public Health (DPH) to update
vaccination requirements for children entering schools and child
care facilities and adds the American Academy of Family
Physicians (AAFP) to the list of entities whose recommendations
DPH must consider when updating the list of required
vaccinations. Specifically, this bill :
1)Deletes the age, grade, and date exemptions from the following
vaccination requirements: a) haemophilus influenza type b
(Hib) immunization after four years and six months of age; b)
mumps immunization after seven years of age; c) pertussis
immunization after seven years of age; d) hepatitis B
immunization after kindergarten level; and, e) varicella
(chickenpox) immunization of pupils who were admitted to
California public or private schools at or above the
kindergarten level before July 1, 2001.
2)Adds AAFP and makes clarifying changes to the list of entities
whose recommendations DPH must consider when developing new
disease immunization requirements.
3)Deletes a provision authorizing DPH to adopt emergency
AB 354
Page 2
regulations to implement a varicella immunization requirement
which was enacted in 2000.
EXISTING LAW prohibits the governing authority of a school or
other institution from unconditionally admitting any person as a
pupil of any private or public elementary or secondary school,
child care center, day nursery, nursery school, family day care
home, or development center, unless he or she has been fully
immunized against the following diseases: diphtheria; Hib;
measles; mumps; pertussis; poliomyelitis; rubella; tetanus;
hepatitis B; varicella; and, any other disease deemed
appropriate by DPH, taking into consideration the
recommendations of the Advisory Committee on Immunization
Practices (ACIP) and the American Academy of Pediatrics (AAP).
FISCAL EFFECT : According to the Assembly Appropriations
Committee, net savings to the extent this bill reduces future
health costs by increasing immunization rates and prevents
future outbreaks.
COMMENTS : According to the author, this bill is needed to allow
DPH to require pertussis booster vaccines for students prior to
the start of the seventh grade. The author states pertussis is
the only vaccine-preventable disease that remains widespread
despite high levels of vaccination in early childhood. Although
childhood immunization against pertussis does not provide
lasting immunity needed to control the disease and protect
public health, current law limits the requirement for pertussis
vaccination to children seven years old or younger. The author
states that also vaccinating children upon entry to the seventh
grade will reduce infection rates among adolescents and adults,
which will also help protect infants who are too young to
receive their first inoculations.
Pertussis is a highly communicable disease that lasts for many
weeks and is typically manifested in children with violent
spasms of severe coughing that can cause difficulty breathing,
eating, and sleeping; as well as vomiting. Children typically
get pertussis infections from adults, rather than other
children. Adolescents and adults become susceptible and can
contract pertussis when immunity from childhood vaccinations
wanes. They can then easily infect infants who are not fully
vaccinated. In adults, pertussis can appear to be an ordinary
upper respiratory tract infection, and is often not diagnosed.
AB 354
Page 3
In infants, pertussis can be fatal.
In California and nationally, pertussis incidence rises
cyclically with peaks every three to five years. Between 2001
and 2006, pertussis incidence rose from 644 cases reported in
2001 to 3,160 cases in 2005, dropping down to 1,661 cases in
2006. CDC states that actual incidence may be many times
greater than the reported numbers. The highest pertussis rates
occur among infants, who are also at highest risk of
complications. In California from 2001 through 2006, 91% of
infant cases occurred in the first six months of life, before
three doses of the vaccine were administered, and 74% of these
infants were hospitalized. During the same period, 24
California infants under two months old died from pertussis.
DPH reports that the age distribution of reported pertussis
cases has been changing: in 1990, 11% of all reported cases in
California were children over nine years old; by 2005, more than
half of reported cases were children over nine years old.
According to DPH, hospital charges for treating pertussis in
2005 exceeded $17 million, of which at least $12 million was
paid by the Medi-Cal Program. DPH further states that the true
costs are likely to be far higher, as most outpatient and some
hospitalized cases of pertussis are never diagnosed but require
services. DPH additionally notes that state funds also pay for
the state and local health department response to pertussis
cases and outbreaks. The Contra Costa County Health Department
calculated that it required over $50,000 of staff time to
respond to a single pertussis outbreak in a school in the spring
of 2008. DPH contends that several pertussis outbreaks are
likely to occur in California in a given year, and that
requiring pertussis boosters would likely nearly eliminate
pertussis among adolescents.
Pertussis immunizations are given in combination with tetanus
and diphtheria immunizations (called DTaP and DTP), at two
months, four months, six months, 15 to 18 months, and four to
six years of age. Because immunity from infection by the
vaccine only lasts for approximately five to ten years, a
booster shot is recommended in early adolescence. ACIP, AAP,
and AAFP recommend Tdap booster vaccines at the age of eleven to
twelve years for those who have completed the recommended
childhood DTaP or DTP series.
AB 354
Page 4
Analysis Prepared by : Allegra Kim / HEALTH / (916) 319-2097
FN: 0000931