Influenza Vaccine Consent Form - City Of Ottawa (Page 3 of 3) in pdf

Influenza Facts

Who should not get the influenza vaccine?

Influenza, commonly known as “the flu”, infects 10 to 20%

The following persons should not get the flu vaccine:

of Canadians every year. Having the flu can result in

• Infants under 6 months of age

missing work and/or school, visits to the doctor or

• Anyone who has a severe allergy to eggs

emergency room, increased hospitalizations for pneumonia,

and deaths. The Ontario Ministry of Health and Long Term

• Anyone allergic to Triton

X-100, neomycin, thimerosal

Care provides free flu vaccine for all those over 6 months of

or formaldehyde (for Vaxigrip

)

age who live, work or attend school in Ontario.

• Anyone allergic to chicken proteins, neomycin,

kanamycin, formaldehyde, polysorbate 80 or CTAB

Influenza is a serious respiratory disease caused by a virus.

(cetyltrimethylammonium bromide) (for Agriflu

)

It spreads easily through coughing and sneezing. It can also

• Anyone allergic to formaldehyde, sodium deoxycholate,

spread through direct contact with surfaces contaminated by

sucrose and thimerosal (for Fluviral

)

the flu virus. While some symptoms may be cold-like, the

• Anyone who has had a serious allergic reaction to a

flu can be far more serious, causing fever, chills, cough,

previous dose of the flu vaccine

sore throat, headache and body aches. Although the fever

may go away on the second or third day of illness, it may

• Anyone who is ill and has a fever, until he/she is feeling

take up to six weeks to feel better. Most people recover

better

fully, but the flu can lead to more serious illnesses such as

pneumonia. Complications are more common in young

In addition to the above, the following persons will not be

children, the elderly and those who have chronic medical

given the flu vaccine at a clinic and will be referred to

conditions.

their physician:

• Anyone with a history of Guillain-Barré Syndrome

The Influenza Vaccine

within 6 weeks of a previous flu vaccine

In order to provide the most effective protection, the vaccine

• Anyone with a history of Oculo-Respiratory Syndrome

must contain part of the virus itself, but the virus used is

following receipt of seasonal flu vaccine, where it was

dead and cannot give you the flu. Each year the content of

severe enough to result in hospitalization

the flu vaccine is changed by the World Health

Organization (WHO) to protect against the strains that are

What are the possible side effects of the influenza vaccine?

expected to circulate across the world. The 2012-2013

Most people have no reactions to the vaccine, or mild

seasonal influenza vaccines can protect against the

reactions that last 1-3 days such as:

equivalent strains of A/California/7/2009(H1N1)pdm09-

like, A/Victoria/361/2011 (H3N2)-like, and B/

• Soreness, redness and swelling at the injection site

Wisconsin/1/2010-like flu viruses.

• Low grade fever, headache and muscle aches; extra rest,

) will

plenty of fluids and acetaminophen (e.g. Tylenol

With a good match between the vaccine and the circulating

help ease these symptoms.

strain, the vaccine is 80% effective in preventing influenza

infection in healthy adults. For children, the vaccine is about

Severe side effects and allergic reactions are very rare.

60-80% effective in preventing the influenza. The vaccine is

Oculorespiratory syndrome (ORS) is an unusual side effect

somewhat less effective in preventing influenza in the

reported in past years, causing red eyes and/or swelling of the

elderly. However, the vaccine can prevent pneumonia,

face and/or coughing, wheezing or difficult breathing.

hospitalization and death seniors.

Guillain-Barré Syndrome (GBS) is a rare condition that can

result in weakness and paralysis of the body's muscles. It most

Each year you need to receive the new vaccine to be

commonly occurs after infection but in rare cases can also

effectively protected against the flu. Protection from the

occur after some vaccines. GBS may be associated with

vaccine is achieved two weeks after the injection and may

influenza vaccine in about 1 per million recipients.

last six months or longer. For those who receive the vaccine

At the time of year that the vaccine is given, many viruses are

and still get the flu, it is usually milder than it would have

making people sick. Infection with these viruses may be

been without the vaccine. Children less than nine (9) years

mistaken for a reaction to the flu vaccine.

of age need two (2) doses of seasonal flu vaccine, given at

least four (4) weeks apart, if they haven’t had a seasonal flu

vaccine before. The flu vaccine is considered safe during

pregnancy and breastfeeding.

Influenza Vaccine Consent Form - City Of Ottawa Page 3

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