Hepatitis B and Meningococcal Vaccination Programs for Grade 7 Students

Transcription

1 Hepatitis B and Meningococcal Vaccination Programs for Grade 7 Students The Ministry of Health and Long-Term Care provides Hepatitis B vaccine and Menactra vaccine free to all grade 7 students in Ontario. Important points: Your child s participation is voluntary. Although no vaccine is 100% effective, getting vaccinated is the best way to gain protection against these serious diseases. Choosing not to get vaccinated increases your risk of disease. Without vaccination, it is recommended that you understand how each disease is spread and take the appropriate measures to help reduce your child s risk. Many different careers, school programs, and workplaces require proof of these immunizations. School-based immunization clinics are held in the Fall and Spring for Hep B and Winter for Meningococcal. Hepatitis B vaccine for Grade 7 students is a 2-dose program, using either the RecombivaxHB ( or Engerix B ( vaccine. The 1 st dose is given in the Fall and the 2 nd dose is given in the Spring. Both doses must be received in order to be protected. If your child has previously received Hepatitis B vaccine or Twinrix vaccine (a combined Hepatitis A/Hepatitis B vaccine), record this information on the consent form. Menactra ( is a conjugated vaccine which provides long-term protection against 4 types of meningitis (A, C, Y and W-135). If your child has received Menactra already, they will not need it again. If your child has previously received the meningococcal C conjugate vaccine, it is highly recommended they still participate in the Grade 7 Menactra program, to provide them with a boost of C and broader protection against A, Y and W-135. It is very important that Public Health has information about past vaccinations for Hepatitis B and meningitis, in order to determine if participation in the Grade 7 vaccination program is appropriate. If unsure of your child s vaccination history, check with your doctor. A record of vaccination will be provided to your child. Keep this information with your child s Immunization Record (yellow card). For more information, please contact: Leeds, Grenville & Lanark District Health Unit, Vaccine Preventable Disease Program or

2 Frequently Asked Questions What is Hepatitis B Disease? It is an infection of the liver caused by the Hepatitis B virus. It can permanently damage the liver. The liver is needed to digest food and remove water and toxins from the body. The disease can cause tiredness, fever, loss of appetite, and sometimes jaundice (yellow skin and eyes). Most people get well, but about 10% can carry the virus for life and keep infecting other people. Some people will continue to have liver problems for the rest of their lives. Serious liver disease can lead to liver cancer and death. How is Hepatitis B Disease spread? Blood and body fluids of an infected person, usually by unprotected sexual contact. Sharing used needles, body/ear piercing or tattooing with infected equipment. An infected mother can spread the infection to her child at birth. What is Meningococcal Disease? It is a serious bacterial infection caused by Neisseria meningitidis. It can cause an infection in the bloodstream and/or the lining covering the brain and spinal cord. There are many types (serogroups) of this bacteria. Outbreaks have been mostly due to serogroup C, although types Y and W-135 are becoming more common in Canada. The earliest signs are fever, drowsiness, reduced consciousness and irritability. Other signs include severe headache, vomiting, stiffness, and neck pain. In many cases, red spots appear on the skin and do not disappear when pressed. 1 in 20 cases will result in death, even with treatment. 1 in 20 who survive, will have brain damage. How is Meningococcal Disease spread? The bacteria are common and can live in the back of the nose and throat, without making them sick. It is spread from an infected person to others through direct contact such as kissing, coughing and sneezing. It can also be spread through saliva (spit) when sharing items such as cigarettes, lipstick, food or drinks, cups, water bottles, cans, drinking straws, toothbrushes, toys, mouth guards and musical instruments with mouthpieces. Who should NOT receive Hepatitis B and Menactra vaccines? You have a history of severe reactions to vaccinations in the past. If you have a fever or anything more serious than a minor cold (delay the immunization until you are feeling well). You have an active neurological disorder such as Guillain-Barre Syndrome. For Hepatitis B vaccine: severe allergies to yeast, latex, aluminum, formaldehyde or Thimerosal. For Menactra vaccine: severe allergies to tetanus toxoid, latex, sodium phosphate and sodium chloride; females who are pregnant and/or breastfeeding will need to speak with a doctor first. What are the side effects of these vaccines? As with any vaccination, side effects can occur. The most common side effects are headache, redness, swelling and pain at the injection site, tiredness, and low grade fever. Serious side effects are rare, but if difficulty breathing, hives, or swelling of the throat occurs, call your health care provide or go to the nearest emergency room. Separate this information sheet from the consent and keep for future reference. Fill out consent form and return it to the school

3 Grade 7 Hepatitis B and Meningococcal Vaccinations Consent Form Please Read Parent/Student Letter Before Filling Out Information Below. Student information (Please Print) Last Name: First Name: Sex: Male Female Ontario Health Card # Date of Birth: (yy/mm/dd) _/ / School Name: Teacher: Home Address: City: Postal Code: Home Phone # ( ) - Daytime Contact Phone # ( ) - Doctor: By providing doctor s name, you are authorizing Leeds, Grenville & Lanark District Health Unit to communicate immunization information to them if requested. Health History: Please " " in correct column below. Student's Health History Questions No Yes Any serious past or present medical problems? Any previous serious reaction(s) to any vaccines? Any known allergies? (food, drugs, latex, yeast, aluminum, formaldehyde, tetanus toxoid, other) Currently pregnant? Feeling well today?(complete on clinic day) Have you received any vaccinations for meningococcal disease in past? i.e. Menjugate, NeisVacC, Menomune, Menactra Have you received Hepatitis B vaccine or Twinrix (a combined Hep B/Hep A vaccine often received for travel) in the past? If yes, provide date(s)/name of vaccine(s) If yes, provide date(s)/name of vaccine(s) Consent or Refusal for Participation in Grade 7 Vaccination Programs I have read or had explained to me the information about these vaccines. I understand the benefits, side effects and risks. Any questions have been answered to my satisfaction. This consent is valid until completion of required doses unless notified by the parent. Provide consent for vaccination or refusal by placing X in the correct boxes below. Return form to school. Consent for Vaccination Place X Refusal Place X I want to get Hepatitis B Vaccine I DO NOT want Hepatitis B Vaccine I want to get Menactra Vaccine I DO NOT want Menactra Vaccine Parent/Legal Guardian Print Parent Name: The personal and/or personal health information collected by LGL HU staff is pursuant to the Health Protection and Promotion Act, 1990 (HPPA), The Municipal Freedom of Information Act, 1989 (MFIPPA), the Personal Health Infor mation Protection Act, 2004 (PHIPA) and will be used for the purpose of meeting client-identified needs and providing service. Questions about this collection should be directed to: Leeds Grenville & Lanark District Health Unit: 458 Laurier Blvd. Brockville, ON K6V 7A or

4 FOR NURSE'S USE ONLY: Hepatitis B Vaccine Administration Documentation Dose #1 Dose #2 Vaccine Name/Manufacturer: Recombivax HB/ Merck Frosst Engerix/GSK Vaccine Name /Manufacturer: Recombivax HB/ Merck Frosst Engerix/GSK Site: Deltoid left right Site: Deltoid left right Dosage: 1 ml Route: IM Dosage: 1 ml Route: IM Lot #: Lot #: Time: Time: Nurse Health History Reviewed Round #2 Nurse Menactra Vaccine Administration Documentation Vaccine Name: Menactra Manufacturer: Sanofi Pasteur Dosage: 0.5 ml Route: IM Site: deltoid: left right Lot #: Nurse Time: Absent Documentation Absent: Hep B Dose #1 Absent: Menactra Absent: Hep B Dose #2 NOTES:

5 Hepatitis B Vaccine Record Please do not detach from consent form This portion will be returned to you for your records after the two injections have been given Student s name: Received Hepatitis B Vaccine Dose #1 on: Received Hepatitis B Vaccine Dose #2 on: This information is being collected under the authority of the Immunization of School Pupils Act, R.S.O. 1990, c.i.1 and the Health Protection and Promotion Act, R.S.O. 1990, c.h.7 for the purpose of enabling the Medical Officer of Health for Leeds, Grenville & Lanark to maintain a record of immunization and for the provision of statistical data to the Ministry of Health and Long Term Care. This information will be retained, used, disclosed and disposed of in accordance with the Personal Health Information Protection Act, 2004, S.O. 2004, c. 3. This information may be shared with organizations such as Cancer Care Ontario for research and evaluation purposes. For more information, contact the Vaccine Preventable Diseases Program at the Leeds, Grenville & Lanark District Health Unit at Meningococcal Groups ACYW-135 Immunization Record Please do not detach from consent form This portion will be returned to you for your records after the injection is given Student s name: Received Meningococcal ACYW-135 Vaccine on: This information is being collected under the authority of the Immunization of School Pupils Act, R.S.O. 1990, c.i.1 and the Health Protection and Promotion Act, R.S.O. 1990, c.h.7 for the purpose of enabling the Medical Officer of Health for Leeds, Grenville & Lanark to maintain a record of immunization and for the provision of statistical data to the Ministry of Health and Long Term Care. This information will be retained, used, disclosed and disposed of in accordance with the Personal Health Information Protection Act, 2004, S.O. 2004, c. 3. This information may be shared with organizations such as Cancer Care Ontario for research and evaluation purposes. For more information, contact the Vaccine Preventable Diseases Program at the Leeds, Grenville & Lanark District Health Unit at