BILL ANALYSIS
SB 249
Page 1
Date of Hearing: June 30, 2009
ASSEMBLY COMMITTEE ON HEALTH
Dave Jones, Chair
SB 249 (Cox) - As Amended: April 27, 2009
SENATE VOTE : 36-0
SUBJECT : Vaccinations: meningitis.
SUMMARY : Requires the Department of Public Health (DPH) to
include, no later than April 1, 2010, as part of information
about meningococcal disease DPH is already required to develop,
information pertaining to children between 11 and 18 years of
age.
EXISTING LAW :
1)Requires DPH to develop information about meningococcal
disease, including symptoms, risk, treatment, and vaccination,
and to make that information available to each public and
private degree-granting postsecondary institution and upon
request.
2)Requires DPH to send each school district an information
notice advising of the availability of the meningococcal
information and provide it upon request.
3)Authorizes DPH to use the information developed in 1) above 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.
FISCAL EFFECT : According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS .
1)PURPOSE OF THIS BILL . According to the author, in August
2007, the United States (U.S.) Centers for Disease Control and
Prevention (CDC) and Advisory Committee on Immunization
Practices (ACIP) issued a recommendation to vaccinate children
ages 11 to18 years at the earliest opportunity to prevent
invasive meningococcal disease. The author states this
recommendation is supported by the American Academy of
SB 249
Page 2
Pediatrics, the American Academy of Family Physicians, and
others. The author contends this bill would help ensure that
parents, health care providers and others are educated about
the disease, the recent ACIP recommendations, and the
availability of a vaccine to prevent meningococcal disease in
11 to 18 year olds.
2)MENINGOCOCCAL DISEASE . According to CDC, meningococcal
disease is caused by Neisseria meningitidis, or the
meningococcus, and is a potentially severe bacterial infection
that can cause meningitis, bloodstream infection, and
localized infections. Although meningococcal disease is not
common in the U.S., the disease is of concern because it can
progress rapidly and lead to death within hours of onset.
Meningococcal disease takes several forms, including
meningitis, which is characterized by fever, headache, and
stiff neck, and in some cases, nausea, vomiting, and changes
in mental status. Another form of meningococcal disease,
meningococcal bacteremia, is a bloodstream infection
characterized by sudden fever and, in severe cases, small red
or purple spots or red or purple discolorations on the skin.
Meningococcal bacteremia can lead to joint infection,
pneumonia, organ system failure, shock, and death. According
to DPH, approximately 10% of persons with meningococcal
disease die from the infection, and 11%-19% of those who
survive suffer long-term complications, such as limb loss,
neurologic disability, or hearing loss.
Meningococcal disease is spread by respiratory droplets or
secretions (from coughing, sneezing, and kissing) of people
with the disease or healthy carriers of the meningococcus who
have no symptoms. Infants are at greatest risk of
meningococcal disease, although DPH reports that the incidence
among adolescents and young adults has been increasing.
Close household contacts to infected persons are at greatly
increased risk of infection. Smoking and second-hand smoke,
upper respiratory viral infections, and crowded living
conditions also appear to increase risk of infection.
3)MENINGOCOCCAL VACCINES . According to CDC, two meningococcal
vaccines are available in the U.S. These vaccines cannot
prevent all types of meningococcal disease but can prevent two
of the three types most common in the U.S. and a type that
causes epidemics in Africa. The federal Food and Drug
Administration approved meningococcal polysaccharide vaccine
SB 249
Page 3
(MPSV4) in 1981. In January 2005, the meningococcal conjugate
vaccine (MCV4) was licensed for use among persons 11 to 55
years of age. According to CDC, MCV4 is the preferred vaccine
for people two to 55 years of age, but MPSV4 can be used if
MCV4 is not available. MPSV4 is the only meningococcal
vaccine approved for persons older than 55 years.
Shortly after the approval of MCV4 in 2005, ACIP recommended
routine vaccination with one dose of MCV4 for 11 to 12 year
olds, persons entering high school if not previously
vaccinated, college freshmen in dormitories, and others at
increased risk. In June 2007, based on MCV4 use and supply
projections as well as data on the epidemiology of
meningococcal disease, safety, and cost-effectiveness, ACIP
extended its recommendation to include routine vaccination of
all persons 11 to 18 years of age at the earliest opportunity.
Thus, the current ACIP and CDC recommendation is for all
children to receive MCV4 at their routine preadolescent
medical visit (11 to 12 years of age) or at the earliest
opportunity for 11 to 18 year olds, and, for those who have
never gotten MCV4, at high school entry. CDC and ACIP further
recommend routine vaccination for people at increased risk,
including college freshmen living in dormitories,
microbiologists who are routinely exposed to meningococcal
bacteria, U.S. military recruits, people with specified
medical conditions, anyone who is traveling to countries with
a meningococcal disease outbreak, and those who might have
been exposed to meningitis during an outbreak.
4)MENINGOCOCCAL DISEASE AND PREVENTION IN CALIFORNIA . According
to DPH, between 1995 and 2000, the number of cases of
meningococcal disease ranged from 306 to 436 annually. In
2000-01, outbreaks of meningococcal disease in young adults in
five California public schools focused attention on this
disease. In response to the outbreaks, SB 212 (Oller),
Chapter 374, Statutes of 2001, requires DPH to develop a
meningococcal disease strategic prevention plan. DPH convened
a working group and published the Meningococcal Disease
Prevention Plan in September 2002. The working group adopted
recommendations for vaccine use and information, education,
and training, including recommendations to follow ACIP
guidelines and that DPH make information on meningococcal
disease and prevention available to college-bound and other
high school seniors. Accordingly, DPH developed materials
about meningococcal disease and vaccine for students,
SB 249
Page 4
including the "Vaccinate Before you Graduate" campaign aimed
at high school students. DPH also developed a brochure aimed
at freshmen in dorms, and sent letters to colleges to inform
them of the availability of the brochure for download and
inclusion in registration materials. DPH also posts all
meningococcal disease materials on its Web site and
distributes the materials to local health departments. After
the introduction of MCV4, DPH made the vaccine available to
all eligible children in publicly funded health programs
through the Vaccines for Children Program, and states the
vaccine was quickly adopted.
5)RELATED AND PREVIOUS LEGISLATION .
a) SB 212 (Florez), pending in the Assembly, authorizes
each school district with a high school to provide for the
annual cleaning and sterilizing of wrestling equipment, and
requires the Superintendent of Public Instruction to
develop information and guidelines regarding the prevention
of communicable diseases, including meningococcal disease,
at school sites.
b) AB 1452 (Cox), Chapter 372, Statutes 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.
c) SB 212 (Oller), Chapter 374, Statutes of 2001, requires
DPH to develop a Meningococcal Disease Strategic Prevention
Plan.
6)SUPPORT . Sanofi-Pasteur, the sponsor of this bill, writes in
support that meningococcal disease fatality rates are up to
five times higher among 15 to 24 year olds and that this bill
simply adds children who are at least 11 years old to current
law, pursuant to the 2007 recommendation of ACIP and CDC. The
California School Nurses Organization states in support of
this bill that it is vital that parents receive information
regarding this disease and the vaccine so they can decide
whether to vaccinate their children. The California State PTA
also contends this bill educates parents and will enable
parents to make informed decisions regarding their children's
health. The National Meningitis Association argues in support
of this bill that no parent should lose a child to a
SB 249
Page 5
potentially vaccine-preventable disease.
REGISTERED SUPPORT / OPPOSITION :
Support
Sanofi-Pasteur (sponsor)
California School Nurses Organization
California State PTA
National Meningitis Association
Opposition
None on file.
Analysis Prepared by : Allegra Kim / HEALTH / (916) 319-2097