Yellow Fever Vaccine Form - Red Hill Doctors Surgery：黄热病疫苗形式-红山医生手术

Yellow Fever Vaccine Form - Red Hill Doctors Surgery：黄热病疫苗形式-红山医生手术 Red Hill Doctors Surgery 11 Windsor Rd, Red Hill 4059 Ph: 61 7 3369 2444 Fax: 61 7 3369 2035 www.redhilldoctorssurgery.mydrsurgery.com.au Yellow Fever Viral haemorrhagic fever characterised by fever, jaundice and bleeding, transmitted by infected mosquitoes. The case fatality rate is >60% in adults who are not immune. Several different species of the aedea and haemgogus (South America) mosquitoes transmit the yellow fever virus. Vaccination is safe, effective and lasts for 10 years. It is a legal requirement for travellers coming from countries with infected areas even if only in transit through these countries. Australians returning from endemic areas who have not been vaccinated can be quarantined. Available only at accredited practices, vaccination has a number of strict requirements for example it should not be given if the traveller is allergic to eggs or neomucin, under the of 9 months, immune deficient or pregnant. Other live vaccines can be given at the same time as Yellow Fever. Otherwise, there should be at least 4 weeks separating any other live vaccines, such as Cholera or Measles. An International Certificate of Vaccination, valid from 10 days following vaccination, is given at the time of vaccination and required to be carried by the traveller while overseas. Avoidance of Mosquito bites is advised Prevention: 1. Take personal protective measures against mosquitoes 2. Mosquito repellent containing DEET (30% concentration is generally adequate) should be worn and sleeping in air-conditioned or well-screened rooms are recommended. 3. Important to reduce the amount of skin exposure when outdoors by wearing socks, long pants and long-sleeved shirts. 4. Not to wear purfumes/scents or dark colours as mosquitoes are attracted to those colours. 5. When applying a repellent containing DEET on children, do so with care – some evidence of a potential for neurological side effects associated with overdoses. 6. If travelling in rural areas – advised to carry along a portable mosquito net impregnated with permethrin (a mosquito repellent/insecticide) and soak their clothing in permethrin as well. Patient Consent Dr ________________________ has informed and explained the statistics, prevention and side effects associated with Yellow Fever vaccination. I_______________________ understand the risks in both being vaccinated and not being vaccinated against Yellow Fever. Therefore I do/do not give permission to be vaccinated against Yellow Fever Patient Signature:_____________________________ Date: _____________ Red Hill Doctors Surgery 11 Windsor Rd, Red Hill 4059 Ph: 61 7 3369 2444 Fax: 61 7 3369 2035 www.redhilldoctorssurgery.mydrsurgery.com.au Yellow Fever Information and Consent form Consulting Doctor's name : Date: , A Yellow Fever vaccine certificate is needed for travel in/out of some countries , 200 000 cases of Yellow Fever are estimated to occur yearly on this planet , There is no known treatment to cure the disease. , The fatality rate from the disease is reported as 10-50% , Deaths from Yellow Fever disease have occurred in unvaccinated tourists. Over 300 million doses of vaccine have been given over 60 years Yellow Fever vaccine is safe and highly effective vaccine against this deadly disease. Australians receive about 24 000 doses per year. Serious side effects are extremely rare, however the risks of the vaccination are: Mild Side Effects , Most people will get a slight sore arm , 2-10% may feel tired, headache, muscle aches, fever for 24 hours starting 3-9 days after the vaccine , 1% need to curtail regular activities More Serious Side Effect , 1 in 130 000 will get immediate hypersensitivity – rash, itching, faint or asthma – this is why you need to wait 30 minutes in the clinic , 0.09-2.5 million will get inflammation of multiple organs eg lungs, kidney, liver, spleen, skin, blood stream , 1 in 8 million will get encephalitis (inflammation of the brain) , There have been a few deaths reported from the more serious side effects of the Yellow Fever vaccine – expected frequency is one death in Australia every 16 years. , The risk of serious side effects increases with age – compared with persons 15-44 years - 3.3 times mire risk for persons 45-65 years - 8.95 times more risk for persons 65 years and over , The following may increase your risk of reacting badly to the Yellow Fever Vaccine. It is important you notify the staff member if any of the following apply to you: 1. Are you allergic to eggs? 2. Have you had a reaction to any vaccine before? 3. Could you have HIV positive of have AIDS? 4. Do you suffer a serious weakness of the immune system? 5. Do you have cancer or take drugs to control this? 6. Do you have any major liver or kidney disease? 7. Have you had your thymus removed? 8. Are you currently taking steroid drugs or cortisone? (The following are NOT a problem: recent injections into a joint, steroid asthma puffers and prednisone under 20mgs per day) 9. WOMEN ONLY – Could you be pregnant now or in the next two weeks? You need to wait in the clinic for 30 minutes after the vaccine Please notify staff immediately if you feel anything unusual during this time, especially: WARM ITCHY FAINT SHORT OF BREATH Red Hill Doctors Surgery 11 Windsor Rd, Red Hill 4059 Ph: 61 7 3369 2444 Fax: 61 7 3369 2035 www.redhilldoctorssurgery.mydrsurgery.com.au RHDS T:T:\PRACTICE MANUAL\PRACTICE ADMINISTRATION\RECEPTION\DOCUMENT TEMPLATES