BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: SB 249
S
AUTHOR: Cox
B
AMENDED: As Introduced
HEARING DATE: April 15, 2009
2
CONSULTANT:
4
Moreno/cjt
9
SUMMARY
Requires the Department of Public Health DPH to include
children who are at least 11 years of age in any
meningococcal disease public awareness campaign it
implements.
CHANGES TO EXISTING LAW
Existing law:
Requires DPH to develop information about meningococcal
disease, as specified, and to make available, upon request,
that information to public and private postsecondary
institutions. Requires DPH to send an information notice
to each school district advising of the availability of the
meningococcal information and provide it upon request.
Permits DPH to use the information developed to design and
implement a public awareness campaign about meningococcal
disease to reach members of the population identified as
being at high risk for contracting the disease.
This bill:
Requires DPH to include children who are at least 11 years
of age in any meningococcal disease public awareness
campaign it implements.
FISCAL IMPACT
Continued---
STAFF ANALYSIS OF SENATE BILL SB 249(Cox) Page 2
This bill is keyed non-fiscal.
BACKGROUND AND DISCUSSION
According to the author, this bill is a result of a revised
recommendation of the Center for Disease Control and
Prevention (CDC) and its Advisory Committee on Immunization
Practices (ACIP) due to the development of a new vaccine,
MCV4. The author states that the August 2007 ACIP
recommendation is to vaccinate 11 to 18 year olds at the
earliest opportunity to prevent invasive meningococcal
disease, and this change is supported by the American
Academy of Pediatrics, the American Academy of Family
Physicians, and others. The author states that this bill
does not mandate vaccinations, but would assist in ensuring
that parents, healthcare providers and others are educated
about the disease, the newer recommendations of the ACIP
and the availability of a vaccine for 11 to 18 year olds to
prevent the meningococcal disease.
Meningococcal disease
According to the CDC, meningococcal disease is an acute
bacterial infection. Sudden onset of fever, intense
headache, neck stiffness, nausea, and often vomiting are
common signs and symptoms of meningococcal sepsis, with or
without meningitis, in persons over the age of two years.
These symptoms can develop over several hours, or they may
take one to two days. In infants, a slower onset of signs
and symptoms may occur with nonspecific symptoms, and neck
stiffness may be absent. Years ago, the case-fatality
ratio exceeded 50 percent, but early diagnosis, modern
therapy, and supportive measures have lowered the
case-fatality ratio to about 10 percent in developed
countries. Among survivors, 11 percent to 19 percent have
long-term disability, including hearing loss, neurologic
problems, or limb loss. According to DPH, infants under
one year of age have the highest rates of meningococcal
disease in California. Adolescents and young adults aged
14 to 22 years are also at increased risk.
In January 2005, the new MCV4 meningococcal vaccine was
licensed for use among persons aged 11 to 55 years. In
October 2007, the MCV4 vaccine was approved for use in
children aged two to ten years. ACIP recommends
vaccination with MCV4 at the earliest opportunity for
STAFF ANALYSIS OF SENATE BILL SB 249(Cox) Page 3
persons aged 11 to 18 years and for college freshmen living
in dormitories. Vaccination is also recommended for persons
who have certain medical conditions that place them at
increased risk of meningococcal disease. According to DPH,
Sanofi-Pasteur, the sponsor of this bill, is the only
company currently licensed to manufacture vaccine for
meningococcal disease.
Existing DPH efforts
According to DPH, its Immunization Branch has developed
materials about meningococcal disease and vaccine for
students, with a focus on high school rather than middle
school students. DPH also has a brochure available for
colleges to download from their website. In fact, DPH
posts all meningococcal disease materials on the web and
distributes them to local health departments. Two
campaigns were initiated in 2002 pursuant to existing law
permitting such activities: a small campaign aimed at
freshmen in dorms and the "Vaccinate Before you Graduate"
campaign aimed at high school students.
Prior legislation
SB 212 (Oller), Chapter 374, Statutes of 2001, requires the
State Department of Health Services to develop a
Meningococcal Disease Strategic Prevention Plan.
AB 1452 (Cox), Chapter 372, Statues of 2001, requires DPH
to develop information regarding meningococcal disease and
make the information available to requesting school
districts and degree-granting postsecondary educational
institutions.
Arguments in support
Sanofi-Pasteur writes that this bill is a follow-up measure
to AB 1452 (Cox) from 2001, and simply adds children who
are at least 11 years of age to current law, pursuant to
the recommendation of the ACIP. The California School
Nurses Association writes that it is vital that parents
receive information regarding how meningococcal disease is
spread and how it can be prevented, as vaccination is
available and, for many, is an appropriate option.
COMMENTS
1.Practical impact of the bill unclear. Current law
permits, rather than requires, DPH to conduct public
STAFF ANALYSIS OF SENATE BILL SB 249(Cox) Page 4
awareness campaigns, which have been done twice since the
authorizing legislation was signed into law. Inserting
the phrase "...including children who are at least 11
years of age" in subdivision (d), as this bill does in
its current form, would likely be read to mean any child
over 11 (including high schoolers or college students),
and would be consistent with existing efforts. In line
with the author's stated intent, this bill should be
amended to delete "...including children who are at least
11 years of age" in subdivision (d) and:
On page 2, line 15:
120395. (a) The State Department of Public Health
Services shall, no later than April 1, 2002 2010 ,
develop information about meningococcal disease ,
including, but not limited to, information pertaining to
children 11 to 18 years of age."
POSITIONS
Support: Sanofi-Pasteur (sponsor)
California School Nurses Association
National Meningitis Association
One individual
Oppose: None received
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