BILL ANALYSIS �
AB 1192
Page 1
Date of Hearing: May 3, 2011
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 1192 (Garrick) - As Amended: April 25, 2011
SUBJECT : Immunization information: pertussis.
SUMMARY : Requires the Department of Public Health (DPH) to make
available on its Internet Website the following information for
use by hospitals: the signs of pertussis; the availability of a
vaccine to protect against pertussis; and, the recommendation of
the federal Centers for Disease Control and Prevention (CDC)
that those with close contact with newborns receive vaccination
against pertussis. Permits hospitals to distribute this
information to the parents of newborn children. Prohibits
anything in this bill from requiring a hospital to provide or
pay for vaccination against pertussis.
EXISTING LAW :
1)Creates various programs relating to the prevention and
treatment of communicable diseases and sets forth related
duties, including the creation and distribution of information
relating to immunizations for various communicable diseases.
2)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 prior to his or her
first admission to that institution he or she has been fully
immunized against the following diseases: diphtheria;
haemophilus influenzae type b; measles; mumps; pertussis;
poliomyelitis; rubella; tetanus; hepatitis B; varicella
(chickenpox); and any other disease deemed appropriate by DPH,
taking into consideration the recommendations of the Advisory
Committee on Immunization Practices of the United States
Department of Health and Human Services, the American Academy
of Pediatrics, and the American Academy of Family Physicians
(AAFP).
3)Waives the requirement in 2) above for medical reasons or if
the parent or guardian or adult who has assumed responsibility
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for the child files a letter or affidavit with the school
governing authority stating that the immunization is contrary
to his or her beliefs.
4)Permits a child who has had an immunization requirement
waived, whenever there is good cause to believe that the
person has been exposed to one of specified communicable
diseases, to be temporarily excluded from the school or
institution until the local health officer is satisfied that
the person is no longer at risk of developing the disease.
5)Requires county health officers to organize and maintain a
program to make immunizations available to all persons
required to be immunized as specified under 2) above and other
specified statutes, and specifies that counties shall pay
costs that are not recovered from persons immunized.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill
creates a mechanism for informing parents about the risk of
pertussis to their newborn and how that risk can be minimized
through immunization of all close contacts of the infant. The
issue of raising immunization rates against pertussis is
particularly important in California due to the ongoing
pertussis epidemic, in which the number of cases in 2010
represents the most cases reported in 65 years.
2)BACKGROUND . According to the CDC, pertussis (also known as
whooping cough), is a highly contagious respiratory disease
that is known for uncontrollable, violent coughing which often
makes it hard to breathe. After fits of many coughs, someone
with pertussis often needs to take deep breaths which result
in a "whooping" sound. Pertussis most commonly affects
infants and young children and can be fatal, especially in
babies less than one year of age. In infants younger than one
year of age who get pertussis, more than half must be
hospitalized. Of those infants who are hospitalized with
pertussis, about one in five get pneumonia, half will have
apnea (slowed or stopped breathing), one in 300 will have
encephalopathy (disease of the brain); and one in 100 will
die.
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3)CALIFORNIA OUTBREAK . In 2010, DPH saw a substantial increase
in the number of pertussis cases reported. According to a
report from the CDC, from January 1 to June 30, 2010, a total
of 1,337 cases were reported, which was a 418% increase from
the 258 cases reported during the same period in 2009. From
January to June that year, the incidence of pertussis was 3.4
cases per 100,000 population. County rates ranged from zero
to 76.9 cases per 100,000. By age group, incidence was
highest (38.5 cases per 100,000) among infants aged less than
one year; 89% of cases were among infants under six months,
who are too young to be fully immunized. Incidence among
children aged seven to nine years was 10.1 cases per 100,000
and for 10 to 18 years old it was 9.3 cases per 100,000,
respectively. Incidence among Latino infants (49.8 cases per
100,000) was higher than among other racial/ethnic
populations. Five deaths were reported, all in previously
healthy Latino infants who were under two months at disease
onset; none of whom had received any pertussis-containing
vaccines. According to the DPH's April 2011 Pertussis Report,
disease activity in 2011 is still at relatively increased
levels throughout the state with 733 cases reported through
March 2011 (23.7 cases per 100,000). According to the CDC,
the incidence of pertussis is cyclical, with peaks occurring
every three to five years in the United States. The last peak
was in 2005, when approximately 25,000 cases were reported
nationally and approximately 3,000 cases in California,
including eight deaths in infants aged under three months of
age.
4)PERTUSSIS VACCINE . According to the CDC, the best way to
prevent pertussis is to get vaccinated. In the United States,
the recommended pertussis vaccine for infants and children is
called DTaP, which is a combination vaccine that protects
against three diseases: diphtheria; tetanus; and, pertussis.
For maximum protection against pertussis, children need five
DTaP shots. The first three shots are given at two, four, and
six months of age. The fourth shot is given between 15 and 18
months of age, and a fifth shot is given before a child enters
school, at four to six years of age. Parents can also help
protect infants by keeping them away as much as possible from
anyone who has cold symptoms or is coughing. Vaccine
protection for pertussis, tetanus, and diphtheria fades with
time. Before 2005, the only booster available contained
protection against tetanus and diphtheria, and was recommended
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for teens and adults once every 10 years. There are boosters
for pre-teens, teens and adults that contain protection
against tetanus, diphtheria, and pertussis. It is recommended
that pre-teens going to the doctor for their regular check-up
at age 11 or 12 years get a dose, and teens who did not get
this vaccine at the 11- or 12-year-old check-up get vaccinated
at their next visit. Adults who did not get the booster as a
pre-teen or teen should get a dose. Pregnant women who had not
previously received the booster shot should get one postpartum
before leaving the hospital or birthing center. Adults 65
years and older (grandparents, child care providers, and
healthcare providers) who have close contact with infants
should get vaccinated.
5)EXISTING DPH EDUCATIONAL MATERIALS . According to DPH, the
department has voluntarily developed materials on all diseases
prevented by routine immunization in keeping with its mission
of preventing such diseases, including pertussis, measles, and
influenza. In addition, DPH is required under state law to
develop information about meningococcal disease. The DPH
Website includes information on recommended vaccines and the
timing of those vaccines.
6)VACCINE INFORMATION STATEMENTS . Vaccine Information
Statements (VISs) are information sheets produced by the CDC
that explain the benefits and risks of a vaccine to adult
vaccine recipients and the parents or legal representatives of
children. Federal law requires that VISs be handed out
whenever certain vaccinations are given. There are VISs for
24 individual vaccines (including DTaP) and one combined VIS
for six vaccines given to infants/children.
7)PATIENT HANDOUTS . Hospitals are required to provide
information regarding a number of things to maternity patients
prior to discharge. According to information provided by the
California Hospital Association, maternity patients are
provided with information related to advance directives,
breastfeeding, charity care and discount payment policies,
child car seats, confidentiality, continuing health care
requirements following discharge, grievances processes, HIV,
length of stay requirements, midwives, newborn hearing
screening, patient rights and responsibilities, shaken baby
syndrome, and sudden infant death syndrome (SIDS).
8)PREVIOUS LEGISLATION . AB 354 (Arambula), Chapter 434,
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Statutes of 2010, permits DPH to update vaccination
requirements for children entering schools and child care
facilities and adds AAFP to the list of entities whose
recommendations DPH must consider when updating the list of
required vaccinations.
AB 2580 (Arambula) of 2008 was similar to AB 354, but would
also have required pupils entering the seventh grade to be
fully immunized against pertussis by receiving any necessary
adolescent booster immunization. AB 2580 was held on the
Senate Appropriations Committee suspense file.
9)SUPPORT . Sanofi-Pasteur, the sponsor of this bill, state that
this bill is an attempt to protect and education mothers of
newborn infants while in the hospital against a very serious
disease. The California State PTA writes that they support
programs to raise public awareness of the necessity for
sufficient immunizations against whooping cough and other
contagious diseases.
10)POLICY CONCERNS . It appears that CDC and DPH already
generate and post on their respective websites information
related to pertussis. Additionally, there does not seem to be
any barrier to hospitals providing information about pertussis
to parents of newborns under existing law. Further, in
response to the pertussis outbreak last year the Legislature
approved AB 354, which had the effect of allowing DPH to
require pertussis booster vaccines for students prior to the
start of the seventh grade. It does not appear that, as
currently drafted, this bill will increase immunization rates
among new mothers and infants, which is the stated intent of
the author, nor that the bill is necessary given recent
measures approved by the Legislature.
REGISTERED SUPPORT / OPPOSITION :
Support
Sanofi-Pasteur (sponsor)
California State PTA
Opposition
None on file.
AB 1192
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Analysis Prepared by : Melanie Moreno / HEALTH / (916)
319-2097