SB 792
Page 2
SENATE RULES COMMITTEEOffice of Senate Floor Analyses
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UNFINISHED BUSINESS
Bill No: SB 792
Author: Mendoza (D)
Amended: 9/4/15
Vote: 21
SENATE HEALTH COMMITTEE: 8-0, 4/15/15
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Pan, Roth, Wolk
NO VOTE RECORDED: Nielsen
SENATE HUMAN SERVICES COMMITTEE: 3-0, 4/28/15
AYES: McGuire, Berryhill, Hancock
NO VOTE RECORDED: Liu, Nguyen
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
SENATE FLOOR: 34-3, 5/22/15
AYES: Allen, Bates, Beall, Berryhill, Block, Cannella, De León, Gaines, Galgiani, Hall, Hancock, Hernandez, Hertzberg, Hill, Hueso, Jackson, Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell, Monning, Nguyen, Nielsen, Pan, Pavley, Roth, Runner, Stone, Vidak, Wieckowski, Wolk
NOES: Anderson, Moorlach, Morrell
NO VOTE RECORDED: Fuller, Huff
ASSEMBLY FLOOR: 60-16, 9/08/15 - See last page for vote
SUBJECT: Day care facilities: immunizations: exemptions
SOURCE: Health Officers Association of California
DIGEST: This bill prohibits, commencing September 1, 2016, a person from being employed or volunteering at a day care center or a day care home if he or she has not been immunized against influenza, pertussis, and measles.
Assembly Amendments add volunteers to those individuals that are required to be immunized; narrow the required vaccines to influenza, pertussis, and measles; add a 30-day grace period for required immunizations; require day care centers to maintain documentation of the required immunizations or exemptions, as specified; specify that a violation of this bill would not be subject to a crime; and, make other technical, clarifying changes.
ANALYSIS:
Existing law:
1) Permits a person to be hired as a teacher in a day care center if he or she is 18 years or older and meets certain educational requirements.
2) Requires family day care homes for children to apply to the Department of Social Services (DSS) for a license and requires applicants to file an application on forms furnished by DSS, as specified, and to include specified documentation related to finances, fire safety, employee fingerprints, and tuberculosis clearance.
3) Prohibits the governing authority of a school or other institution from unconditionally admitting any person as a pupil of private or public elementary or secondary schools, child care centers, day nurseries, nursery schools, family day care homes, or development centers, unless, prior to first admission to that institution, he or she has been fully immunized against diphtheria, haemophilus influenzae type b (Hib), measles, mumps, pertussis, poliomyelitis, rubella, tetanus, hepatitis b (except after 7th grade), and chickenpox, as specified.
4) Permits the Department of Public Health (DPH) to add to this list any other disease deemed appropriate, taking into consideration the recommendations of the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics (AAP) Committee on Infectious Diseases.
5) Waives the above immunization requirements if the parent or guardian files with the governing authority a written statement by a licensed physician to the effect that the physical condition of the child or medical circumstances relating to the child are such that immunization is not considered safe. Requires the statement to indicate the specific nature and probable duration of the medical condition or circumstances that contraindicate immunization.
6) Waives the above immunization requirements if the parent or guardian or adult who has assumed responsibility for the child's care and custody, or the person seeking admission, if an emancipated minor, files a letter with the governing authority stating that the immunization is contrary to his or her beliefs (commonly referred to as a “personal belief exemption” or “PBE.”)
7) Requires a separate form prescribed by DPH to accompany a PBE. Requires the form to include:
a) A signed attestation from a health care practitioner that indicates that the parent or guardian of the person who is subject to the immunization requirements, the adult who has assumed responsibility for the care and custody of the person, or the person if an emancipated minor, was provided with information regarding the benefits and risks of the immunization and the health risks of the communicable diseases listed above to the person and to the community. Requires the attestation to be signed within six months of the date when the person first becomes subject to the immunization requirement for which the PBE is being sought.
b) A written statement signed by the parent or guardian of the person who is subject to the immunization requirements, the adult who has assumed responsibility for the care and custody of the person, or the person if an emancipated minor, that indicates that the signer has received the information provided by the health care practitioner pursuant to a) above. Requires the statement to be signed within six months of the date when the person first becomes subject to the immunization requirements.
8) Permits a child for whom the requirement has been waived, whenever there is good cause to believe that he or she has been exposed to one of the specified communicable diseases, to be temporarily excluded from the school or institution until the local health officer is satisfied that the child is no longer at risk of developing the disease.
This bill:
1) Prohibits, commencing September 1, 2016, a person from being employed or being a volunteer at a day care center or a day care home if he or she has not been immunized against influenza, pertussis, and measles. Requires an employee or volunteer to receive an influenza vaccination between August 1 and December 1 of each year.
2) Permits a person, if he or she meets all other requirements for employment or volunteering, as applicable, but needs additional time to obtain and provide his or her immunization records, to be employed or volunteer conditionally for a maximum of 30 days upon signing and submitting a written statement attesting that he or she has been immunized as required.
3) Exempts a person from this requirement if the person:
a) Submits a written statement from a licensed physician declaring that because of the person’s physical condition or medical circumstances, immunization is not safe;
b) Submits a written statement from a licensed physician providing that the person has evidence of current immunity to influenza, pertussis, and measles; or
c) Submits a written declaration that he or she has declined the influenza vaccination.
d) Was hired after December 1 of the previous year and before August 1 of the current year. Specifies that this exemption applies only to the influenza vaccine during the first year of employment or volunteering.
4) Requires the day care center to maintain documentation of the required immunizations or exemptions from immunization, in the person’s personnel record that is maintained by the day care center.
5) Places the immunization requirement above on day care teachers. Requires any person hired as a day care teacher to present evidence of a current tuberculosis clearance.
6) Requires, as a condition of licensing by DSS commencing September 1, 2016, family day care home applicants to provide evidence of current immunity pursuant to 1) above for the applicant and any other person who provides care and supervision to the children.
7) Specifies that a violation of this bill would not be subject to a crime.
Comments:
1) Author’s statement. According to the author, children in day care settings have close, intimate contact with each other and with the staff who work there. Many of these children are too young to be fully immunized against potentially serious communicable diseases. Children who are too young to be vaccinated rely on those around them to be immunized to prevent the spread of disease (community immunity). This bill will protect children in day care by requiring those who care for them to maintain immunity. Some diseases, such as the flu, cause only a relative inconvenience to healthy adults. However, this same disease can require hospitalization and perhaps even be fatal in an infant or an individual with a suppressed immune system. Other diseases in the ACIP schedule include very serious conditions, formerly under control, that have resurfaced in recent years, including pertussis and measles. By requiring vaccination for pre-school workers, vulnerable children will be “cocooned” from potentially serious illness, and day care centers will be a safe and healthy place for our little ones to learn and play.
2) Immunizations. According to the CDC, vaccines contain the same antigens or parts of antigens that cause diseases, but the antigens in vaccines are either killed or greatly weakened. Vaccine antigens are not strong enough to cause disease, but they are strong enough to make the immune system produce antibodies against them. Memory cells prevent re-infection when they encounter that disease again in the future. Vaccines are responsible for the control of many infectious diseases that were once common around the world, including polio, measles, diphtheria, pertussis (whooping cough), rubella (German measles), mumps, tetanus, and Hib. Vaccines eradicated smallpox, one of the most devastating diseases in history. Over the years, vaccines have prevented countless cases of infectious diseases and saved literally millions of lives. Vaccine-preventable diseases have a costly impact, resulting in doctor's visits, hospitalizations, and premature deaths. Sick children can also cause parents to lose time from work. CDC recommends routine vaccination to prevent 17 vaccine-preventable diseases that occur in infants, children, adolescents, or adults.
3) ACIP. The ACIP consists of 15 experts who are voting members and are responsible for making vaccine recommendations. The Secretary of the U.S. Department of Health and Human Services selects these members after an application, interview, and nomination process. Fourteen of the members have expertise in vaccinology, immunology, pediatrics, internal medicine, nursing, family medicine, virology, public health, infectious diseases, and/or preventive medicine; one member is a consumer representative who provides perspectives on the social and community aspects of vaccination. ACIP develops written recommendations for the routine administration of vaccines to pediatric and adult populations, along with schedules regarding the appropriate periodicity, dosage, and contraindications applicable to the vaccines and is the only entity within the federal government which makes such recommendations. The overall goals of ACIP are to provide advice to assist in reducing the incidence of vaccine-preventable diseases and to increase the safe usage of vaccines and related biological products.
ACIP, along with AAP, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists, approved the 2015 Recommended Immunization Schedules for Persons Aged 0 Through 18 Years. Children under six are recommended to receive vaccines for: hepatitis b; rotavirus; diphtheria, tetanus, and pertussis (DTaP); Hib; pneumococcal; polio; influenza; measles, mumps, rubella (MMR); varicella; hepatitis a; and meningococcal.
4) California Vaccination Rates. According to an August 2014 DPH fact sheet, vaccination coverage in California is at or near all-time high levels. DPH states that the implementation of current vaccine requirements has been effective in maintaining greater than or equal to 92 % immunization coverage among children in licensed child care facilities and kindergartens. DPH would like immunization rates to be as close to 100 % as possible, and is using national Healthy People 2020 objectives as a benchmark to monitor progress. These objectives include: toddlers/pre-school: 90 % rate for four doses of DTaP, 3 or 4 doses of Hib vaccine, 3 doses of hepatitis b vaccine, 1 dose of MMR, 3 doses of polio vaccine, and one dose of varicella vaccine; kindergarteners: 95 % rate for 4 doses DTaP, 2 MMR, 3 polio vaccine, 3 hepatitis b vaccine, and 2 doses of varicella vaccine; and for 13 to 15 year olds: 80 % Tdap vaccination rate. The DPH Immunization Branch maintains data on its website related to vaccination rates and is searchable statewide and by school (kindergarten and seventh grade rates) and child care facility. This year, 89.4 % of the 434,922 children aged two to five years enrolled in reporting child care facilities received all required immunizations (4+ DTP, 3+ Polio, 1+ MMR, 1+ Hib, 3+ Hep B, and 1+ Vari or physician-documented varicella disease), a 0.1 % increase from the prior year. ‘Conditional’ entrants (children in process to be fully vaccinated but not yet having all required vaccinations), decreased by 0.1 % this past year. There were 2,734 (0.56 %) children with permanent medical exemptions (PMEs) and 12,981 (2.67 %) with PBEs. Children with PBEs decreased from 2.94 % this past year. For all facilities, immunization coverage was greater than or equal to 94 % for each vaccine this year.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No
According to Assembly Appropriations Committee, costs to the Department of Social Services (DSS), which licenses child care facilities, are expected to be minor and absorbable.
SUPPORT: (Verified 9/8/15)
Health Officers Association of California (source)
Alameda County Board of Supervisors
American Academy of Pediatrics, California
American Nurses Association\California
California Academy of Family Physicians
California Academy of Preventative Medicine
California Federation of Teachers
California Hospital Association
California Immunization Coalition
California Medical Association
California Primary Care Association
California Public Health Association-North
Child Care Law Center
Children Now
County Health Executives Association of California
First 5 California
Knowledge Universe
Los Angeles County Board of Supervisors
March of Dimes, California Chapter
National Association of Social Workers, California Chapter
Santa Clara County Board of Supervisors
OPPOSITION: (Verified 9/8/15)
Educate Operate
California Coalition for Health Choice
Your Family Your Choice
ASSEMBLY FLOOR: 60-16, 9/08/15
AYES: Alejo, Travis Allen, Baker, Bloom, Bonilla, Bonta, Brown, Burke, Calderon, Campos, Chang, Chau, Chiu, Chu, Cooley, Cooper, Dababneh, Daly, Dodd, Eggman, Frazier, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Hadley, Roger Hernández, Holden, Irwin, Jones-Sawyer, Kim, Lackey, Levine, Lopez, Low, Maienschein, McCarty, Medina, Mullin, Nazarian, O'Donnell, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Weber, Wood, Atkins
NOES: Achadjian, Brough, Dahle, Beth Gaines, Gallagher, Grove, Harper, Jones, Linder, Mathis, Mayes, Melendez, Obernolte, Patterson, Waldron, Wilk
NO VOTE RECORDED: Bigelow, Chávez, Olsen, Williams
Prepared by: Melanie Moreno / HEALTH /
9/8/15 19:34:35
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