SB 277 - Vaccines and Personal Belief Waivers

SB 277 – What does it mean for your practice and your patients?
 
Governor Jerry Brown signed SB 277 into law on June 30th, 2015 and the legislation went into effect on January 1, 2016. Personal belief exemptions were no longer obtainable after January 1, 2016. We have reviewed the language of the bill and here is our current understanding.
 
Personal belief and religious exemption waivers may have been obtainable until December 31, 2015. NDs with a supervising MD/DO were able to sign personal belief exemptions after educating patients on the risks and benefits of immunizations and communicable diseases, but they no longer can.
 
Children with a signed exemption in preschool on January 1, 2016 were not required to get any vaccines until they entered kindergarten. They must now have all doses of required vaccines to enter kindergarten.
 
Children with a signed exemption in kindergarten-sixth grade on January 1, 2016 were not required to get any vaccines until they entered 7th grade. They must now have all required vaccines to enter 7th grade. However, it is not clear if all doses of Hep B are required before 7th grade.
 
In addition to the entrance to kindergarten and 7th grade, if a student changes schools, they are required to show proof of the vaccinations.

Children with a signed exemption in seventh-twelfth grade on January 1, 2016 were not required to get any vaccines.
 
Children who are homeschooled or are enrolled in online public school are not required to be vaccinated. A home school may include multiple families.
 
Children who have individualized education programs (children with certain disabilities) are not subject to this law.
 
The required vaccines are TDaP, MMR, Polio, Hib, Hep B and Varicella. (Pneumovax, Rotavirus, Flu vaccines, Hep A and HPV are not required.)
 
There is no specific requirement as to when the vaccines must be given (e.g. it is not mandated that Hep B be given at birth). Delayed schedules are possible, although the timing may be difficult if the child is attending preschool.

SB 277 does not state anything about titers. If a child presents with blood work showing positive titers to a condition that is required to be vaccinated against by SB 277, it is up to the discretion of the MD/DO whether they feel this qualifies for a "medical exemption."
 
No new personal belief or religious exemption waivers can be accepted after January 1, 2016. Only medical exemptions are allowed. NDs CANNOT write for medical exemptions. The CNDA worked hard to amend SB 277 to allow NDs to write for medical exemptions (as we did with personal belief exemptions in AB 2109) but were unable to get that to happen. Only MDs and DOs can write for medical exemptions. The guidelines are strict but rely on the doctor’s judgment. In the past, medical exemptions were allowed if the patient had already had the disease in question or had an immune compromising condition. The doctor is allowed to take family history into consideration. The CDC has a list of what they consider to be reasons for medical exemptions. Exemptions can be permanent or temporary. Please do not comment on SB 277 without consulting the CNDA.