Fillable Influenza Vaccination Consent Form (Page 2 of 2) in pdf

Influenza facts

Influenza, commonly known as “the flu”, infects 10 to 20% of Canadians every year. Having the flu can result in missing work and/or school, visits to

the doctor or emergency room, increased hospitalizations for pneumonia, and deaths. The Ontario Ministry of Health and Long Term Care provides

flu vaccine for all those over 6 months of age who live, work or attend school in Ontario.

Influenza is a serious respiratory disease caused by a virus. It spreads easily through coughing and sneezing. It can also spread through direct contact

with surfaces contaminated by the flu virus. While some symptoms may be cold-like, the flu can be far more serious, causing fever, chills, cough, sore

throat, headache and body aches. Although the fever may go away on the second or third day of illness, it may take up to six weeks to feel better.

Most people recover fully, but the flu can lead to more serious illnesses such as pneumonia. Complications are more common in young children, the

elderly and those who have chronic medical conditions.

The influenza vaccine

In order to provide the most effective protection, the vaccine must contain part of the virus itself, but the virus used is dead and cannot give you the

flu. Each year the content of the influenza vaccine is changed by the World Health Organization (WHO) to protect against the strains that are expected

to circulate across the world. The 2013-2014 seasonal influenza vaccines can protect against the equivalent strains of A/California/7/2009(H1N1)

pdm09-like, A/Victoria/361/2011 (H3N2)-like, and B/Massachusetts/2/2012-like flu viruses.

The vaccine is 50-80% effective in preventing influenza illness. Its effectiveness varies from year to year depending on different factors, including

how well the vaccine ‘matches’ the actual strains that are circulating in the community. The vaccine is somewhat less effective in preventing the flu

in the elderly. However, the vaccine does reduce hospitalizations and deaths in seniors and in adults with chronic health conditions.

Each year you need to receive the new vaccine to be effectively protected against the flu. Protection from the vaccine is achieved two weeks after

the injection and may last six months or longer. For those who receive the vaccine and still get the flu, it is usually milder than it would have been

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

Who should not get the influenza vaccine?

The following persons should not get the influenza vaccine:

Infants under 6 months of age

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Anyone allergic to Triton® X-100, neomycin, thimerosal or formaldehyde

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Anyone who has had a serious allergic reaction to a previous dose of the flu vaccine

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

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The following persons should consult a physician for advice prior to receiving the influenza vaccine:

Anyone with a history of Guillain-Barré Syndrome within 6 weeks of a previous flu vaccine

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Anyone with a history of severe Oculo-Respiratory Syndrome following receipt of seasonal flu vaccine

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Anyone who has a severe allergy to eggs

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What are the possible side effects of the influenza vaccine?

Most people have no reactions to the vaccine, or mild reactions that last 1-3 days such as:

Soreness, redness and swelling at the injection site

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Low grade fever, headache and muscle aches. Extra rest, plenty of fluids and acetaminophen (eg. Tylenol) will help ease these

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symptoms

Severe side effects and allergic reactions are very rare. Oculo-Respiratory syndrome (ORS) is an unusual side effect reported in past

years, causing red eyes and/or swelling of the face and/or coughing, wheezing or difficult breathing. Guillain-Barré Syndrome (GBS) is

a rare condition that can result in weakness and paralysis of the body’s muscles. It most commonly occurs after infection but in rare

cases can also occur after some vaccines. GBS may be associated with influenza vaccine in about 1 per million recipients.

At the time of year that the vaccine is given, many viruses are making people sick. Infection with these viruses may be mistaken for a

reaction to the flu vaccine.

Influenza Vaccination Consent Form Page 2

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