BILL ANALYSIS
AB 354
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CONCURRENCE IN SENATE AMENDMENTS
AB 354 (Arambula and Fletcher)
As Amended August 17, 2010
Majority vote
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|ASSEMBLY: |74-2 |(May 28, 2009) |SENATE: |25-5 |(August 20, |
| | | | | |2010) |
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Original Committee Reference: HEALTH
SUMMARY : Permits 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 influenzae 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
regulations to implement a varicella immunization requirement
which was enacted in 2000.
The Senate amendments :
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1)Delete a requirement that varicella provisions are only
operative if funds are appropriated for that purpose in the
annual Budget Act.
2)Delete, commencing July 1, 2011, the requirement that schools
check that all 7th graders have been immunized against
Hepatitis B and instead require that schools check that all
7th graders have been immunized against pertussis.
3)Make other technical, clarifying changes.
AS PASSED BY THE ASSEMBLY , this bill was substantially similar
to the version approved by the Senate.
FISCAL EFFECT : According to the Senate Appropriations
Committee:
Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12 2012-13 Fund
Medi-Cal vaccination likely $0 $300 - $875 $300 -
$875General/*
administrative fee Federal
School reimbursement likely $0 up to $400up to
$400 General**
for vaccine confirmation
Potential increased ADAlikely $0 $50 - $550$50 -
$550 General**
*Costs would be shared 50% General Fund and 50% federal funds.
**Counts toward Proposition 98 guarantee
*** Since potential costs to this bill would occur only if DPH
made a decision to promulgate regulations to update its
immunization requirements, the fiscal years in which potential
costs and savings would occur are unknown and would depend on
when DPH regulations went into effect.
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
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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.
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 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 undiagnosed upper
respiratory tract infection but, in infants, it can be fatal.
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.
According to DPH, as of August 2010 there have been 2,774
reported cases of pertussis in 2010 (7 cases per 100,000). This
is a seven-fold increase from the 395 cases reported through the
same date in 2009. DPH reports that seven deaths have been
reported, all in infants less than 2 months of age at time of
disease onset; none of whom had received any doses of
pertussis-containing vaccine because of their age. The majority
of infant cases in 2010 were 3 months of age or younger. In
response to the outbreak, the DPH issued a recommendation for
broader use of the Tdap booster vaccine. In addition to the
typical series of childhood pertussis immunizations, DPH now
recommends the administration of the Tdap vaccine for children
as young as seven years old and for California residents over 64
years of age for the duration of the epidemic.
Analysis Prepared by : Melanie Moreno / HEALTH / (916)
319-2097
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FN: 0006579