YELLOW FEVER VACCINATION App. Date : Drs Baird, Gilmore, Campbell & Reid Bangor Health Centre Newtownards Road Bangor BT20 4LD Ph 028 91515200 ( fax 028 91515296)
We are a designated Yel ow Fever Vaccination centre and have been approached by one of your patients who require Yel ow Fever vaccination. As we do not have access to their medical records, we would be grateful if you could take a few minutes to complete this form which your patient must bringwith them to their vaccination appointment. This is for safety reasons to ensure that there is no medical contraindication to them having the vaccine Yel ow fever is a serious viral haemorrhagic il ness passed to humans by the bite of an infected mosquito. There is no specific treatment and many people who get yel ow fever will die from it, so immunisation and prevention of mosquito bites are essential for travel ers to an endemic zone Yel ow Fever vaccine has been used for more than 50 years, works wel and lasts for about ten years. Vaccination should be carried out at least ten days before travel to al ow immunity to develop and for the International Certificate of Vaccination to become valid. Most people do not have problems, but certain groups of people should not get the vaccine. Revaccination is not required before 10 years. Who should not get vaccine? Yel ow fever vaccine is a LIVE vaccine so any contraindications to a live vaccine apply as wel as the fol owing
Patients who have had a confirmed anaphylactic reaction to a previous dose of yel ow fever vaccine or any component of the vaccine ( e.g. polymixin, neomycin )
Patients who have a confirmed anaphylactic reaction to egg
Any patient whose immune system is compromised by illness or medication eg within 6 months of chemo or radiotherapy, recent bone or organ transplant, high dose steroids, any other immunosuppressant drugs such as methotrexate, azathiaprine etc,
Patients with a disorder of thymus gland eg myasthenia gravis, thymoma, removal thymus,
Reactions to Yel ow fever vaccine are not common and usual y mild with soreness at the injection site, myalgia, headache and low grade fever being the most likely Rarely severe reactions occur and can affect the nervous system ( meningitis or encephalitis) or multi-organ failure ( risk 1:200,000) There is a higher risk of these reactions in those over 60 years of age ( 5:200,000) We wil discuss these risks with each patient Patients Name ………………………………………………………………. Date of any previous YF vaccination : …………… Address ……………………………………………………………….
DOB ………………………………………………………………. I have examined this patient’s record and find no contraindication to them having yel ow fever vaccine Signed :……………………………………………………. (General Practitioner) Date: ……………………………
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YELLOW FEVER VACCINATION App. Date :