Live Vaccine Screening For Contraindications

#Live Vaccine Screening For Contraindications

Questions:

This section can be completed by the Health Care Provider/Patient/Guardian
Note for Patient/Guardian: If you are unsure about an answer, please leave it blank and discuss with your Health Care Provider

(-) Have you had a recent fever?
(-) Have you received any vaccines in the last month?
(-) Have you had a serious allergic reaction (such as anaphylaxis) to a previous dose of a vaccine?
(-) Have you had a serious allergic reaction to anything else, including egg?
(-) Have you ever had cancer, leukaemia, lymphoma, an organ, bone marrow transplant, stem cell therapy, or another health condition that weakens your immune system, including blood disorders, graft versus host disease or HIV/AIDS?
(-) In the past 12 months, have you been on any treatment for rheumatoid arthritis, multiple sclerosis, psoriasis, polymyositis, sarcoidosis, inflammatory bowel disease or other inflammatory conditions?
(-) In the last 12 months have you had any treatment that weakens your immune system such as oral prednisolone, or other steroids, anti-cancer drugs, biological therapy, radiotherapy, or chemotherapy?
(-) Do you live with someone who has a disease that lowers immunity (e.g. leukaemia, cancer, HIV/AIDS), or live with someone who is having treatment that lowers immunity (e.g. oral steroid medicines such as cortisone and prednisone, radiotherapy, chemotherapy) (Required advice for immunocompromised household contacts will vary)
(-) Have you been treated recently with oral antiviral medication such as Aciclovir for conditions such as herpes? (Relevant to varicella and zoster vaccines)
(-) Have you had an injection of immunoglobulin, or received any blood products or a whole blood transfusion within the past year? (Relevant to MMR and varicella vaccines)
(-) Have you ever had a thymus disorder of any kind?
(-) Is the patient under 12 months old or over 60 years old?
(-) Are you pregnant, planning a pregnancy or breastfeeding?

Outcome:

This section is to be completed by Health Care Providers ONLY (check relevant boxes)

(-) There are no contraindications to live vaccination. Discussion of side effects of vaccination has occurred and informed consent for vaccination obtained.
(-) Live vaccination is contraindicated.
(-) Live vaccination should be delayed.
    (-) until recovery from acute illness
   (-) until treatment is completed and for ?? months afterwards
    (-) until ??
(-) Specialist advice regarding immune status is required. Not for vaccination at this time.

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