11.0 Specialized and Annual Immunization Protocols (in … · 2016. 11. 10. · Nursing mothers. It is not known whether FluMist is excreted in human milk. Severe asthma (defined

11.0 Specialized and Annual Immunization Protocols (in alphabetic order) • Influenza

o FluMist® Quadrivalent Vaccine (nasal spray)

o Fluzonel® Quadrivalent Vaccine (IM injectable) o Appendix A - Influenza Vaccine Algorithm o Appendix B - Seasonal Influenza Vaccine Information Sheet for

Healthcare Providers o FluMist® Quadrivalent Fact Sheets o FluMist® Quadrivalent Consents o Fluzone® Quadrivalent Fact Sheets o Fluzone® Quadrivalent Consents

Nunavut Immunization Manual (October 2014) Page 1 of 1

Influenza Immunization Protocol for FluMist® Quadrivalent

Purpose Provide information and guidance for the Influenza Immunization Program in Nunavut.

Objective To reduce morbidity and mortality secondary to influenza infection.

Indication Annual immunization against influenza caused by the specific strains of the influenza virus contained in the vaccine.

Eligibility Use for ages 2 –17 years

See Appendix A – Influenza Vaccine Algorithm

Product FluMist® Quadrivalent

Vaccine Type Quadrivalent, live attenuated (for more information see references)

Vaccine components

Egg protein, Gentamicin

Gelatin hydrosylate, sucrose, arginine

Monosodium glutamate

Formats available Prefilled single use glass sprayer

Manufacturer MedImmune, LLC – Distributed by AstraZeneca Canada

Administration Intranasal spray

Dose Series 0.2 mL (0.1 mL in each nostril)

Booster Dose Children 6 months to less than 9 years old who have never had influenza vaccine should receive 2 doses, a minimum of 4 weeks apart.

Vaccine interchangeability

FluMist® Quadrivalent and Fluzone® Quadrivalent are interchangeable for children 2 –17 years.

Contraindications

0 to less than 24 months old

Pregnancy

Nursing mothers. It is not known whether FluMist is excreted in human milk.

Severe asthma (defined as currently on inhaled or oral glucocorticosteroids or active wheezing).

Medically attended wheezing in the 7 days prior to presenting for vaccination.

Individuals 2–17 years of age currently taking aspirin or aspirin-containing medication.

Immune compromised or close contact anticipated with persons with severe immune compromise (e.g. bone marrow transplant recipients requiring isolation) in next 2 weeks.

Those taking antiviral medications e.g. oseltamivir or zanamivir (do not administer FluMist® until 48 hours after antiviral medications are stopped).

Anaphylactic reaction to a previous dose of influenza vaccine or to any of the vaccine components, i.e. eggs, gentamicin, gelatin, arginine. Egg allergies.

An apparent allergic reaction to the vaccine or any other symptoms (e.g. throat constriction, difficulty swallowing) that raises concern regarding the safety of re-immunization.

Severe lower respiratory symptoms (wheeze, chest tightness, difficulty breathing) within 24 Influenza Immunization Protocol for FluMist Quadrivalent (revised October 2015) Page 1 of 3

hours of influenza vaccine. Serious acute febrile illness. Those with mild non-serious febrile illness (e.g. mild upper respiratory tract infection) can be given influenza vaccine.

Guillain-Barré syndrome (GBS) within 6 weeks of a previous influenza vaccine

Precautions and Additional Notes

Vaccine is given annually from age 2 until 17 years old.

A tuberculin skin test (TST) can be placed on the same day or deferred by at least 4 weeks from the date of vaccine.

NACI recommends that LAIV be given together with, or at any time before or after the administration of any other live attenuated or inactivated vaccine.

Do not withhold vaccination with FluMist® Q because of a runny stuffy nose as long as the nasal mucosa can be visualized. If the nasal cavity is totally occluded with a mucous plug, delay immunization with FluMist® Q or consider Fluzone® Q.

Vaccine Supply and Distribution

Review section on vaccine ordering in the Policy and Procedure section of the Nunavut Drug Formulary.

Storage

Store in monitored vaccine refrigerator between 2°C and 8°C. Protect from light. DO NOT FREEZE. Freezing destroys the active components of the vaccine. Segregate damaged product keeping the cold chain protocol and inform Regional Communicable Disease Coordinator (RCDC) and regional pharmacy.

Consent Consent forms must be reviewed and signed by the client or parent/guardian prior to vaccination.

Anaphylaxis Review the principles of the emergency management of anaphylaxis in the Nunavut Immunization Manual Section 3 (3.7). Further information can be found in : Anaphylaxis: Initial Management in Non-Hospital Settings, in the Canadian Immunization Guide

Side Effects Most common reactions, nasal congestion/rhinorrhea.

Reportable Adverse Events/Side Effects

Report all serious adverse events requiring medical attention, unusual/unexpected events, or medication errors to RCDC. Review section 3.5 in the Nunavut Immunization Manual.

Vaccine Coverage and Reporting

Under Development

Documentation All immunizations given should be documented on the chart, personal immunization record, and electronic record (where applicable).

Materials and Resources

All protocols and materials are available on the DH website (www.gov.nu.ca/health) Nunavut Communicable Disease and Surveillance Manual: Influenza Public Health Protocol Public Service Announcement: Preventing Influenza Public Service Announcement: Seasonal Influenza in your Community FluMist Quadrivalent Fact Sheet FluMist Quadrivalent Consent Form Fluzone Quadrivalent Fact Sheet Fluzone Quadrivalent Consent Form

References 1. FluMist® Quadrivalent. Product Monograph. AstraZeneca Canada. May 2015. 2. Public Health Agency of Canada. Canadian Immunization Guide – Evergreen Edition

Influenza Immunization Protocol for FluMist Quadrivalent (revised October 2015) Page 2 of 3

http://www.phac-aspc.gc.ca/publicat/cig-gci/p02-03-eng.php


(2012). Available at: http://www.phac-aspc.gc.ca/publicat/cig-gci/index-eng.php 3. Public Health Agency of Canada. An Advisory Committee Statement (ACS). National Advisory Committee on Immunization (NACI), Canadian Immunization Guide Chapter on Influenza and statement on Seasonal Influenza Vaccine for 2015-2016. July 2015.Statement on Seasonal Influenza Vaccine for 2015-2016 - Public Health Agency of Canada

Influenza Immunization Protocol for FluMist Quadrivalent (revised October 2015) Page 3 of 3

http://www.phac-aspc.gc.ca/publicat/cig-gci/index-eng.php

http://www.phac-aspc.gc.ca/naci-ccni/flu-2015-grippe-eng.php


Influenza Immunization Protocol for Fluzone® Quadrivalent

Purpose Provide information and guidance for the Influenza Immunization Program in Nunavut.

Objective To reduce morbidity and mortality secondary to Influenza infection.

Indication Annual immunization against Influenza caused by the specific strains of the influenza virus contained in the vaccine.

Eligibility Use for 6 to less than 24 months and older than 17 years old.

May be used for ages 2–17 when FluMist® Q is contraindicated or unavailable. However, FluMist® Q is the first choice for ages 2–17 years.

See Appendix A - Influenza Vaccine Algorithm

Product FluZone® Quadrivalent

Vaccine Type Quadrivalent Inactivated – split virus (for more information see references)

Vaccine components

Egg protein, Thimerosal, Triton®X-100

Formaldehyde, sodium phosphate, sucrose, isotonic sodium chloride solution

Formats available 5 mL vials holding 10 x 0.5 mL doses

Manufacturer Sanofi Pasteur

Administration Intramuscular (IM) in the anterolateral thigh (vastus lateralis) in infants < 1 year of age and in the deltoid muscle for children ≥ 1 year of age with adequate muscle mass and adults.

Dose Series Intramuscular (IM) 0.5 mL (usually given into the deltoid)

Booster Dose Children 6 months to less than 9 years who have never had influenza vaccine should receive 2 doses, a minimum of 4 weeks apart.

Vaccine interchangeability

FluMist® Quadrivalent and FluZone® Quadrivalent are interchangeable for children 2-17 years old.

Contraindications

Less than 6 months old.

Anaphylactic reaction to a previous dose of influenza vaccine or to any of the vaccine components, i.e. thimerosal.

An apparent allergic reaction to the vaccine or any other symptoms (e.g. throat constriction, difficulty swallowing) that raise concern regarding the safety of re-immunization.

Severe lower respiratory symptoms (wheeze, chest tightness, difficulty breathing) within 24 hours of influenza vaccine.

Oculorespiratory syndrome (ORS) with lower respiratory tract symptoms following prior flu vaccination, do not vaccinate without expert review. Those who experienced ORS (bilateral red eyes, cough, sore throat, hoarseness, facial swelling) without lower respiratory symptoms may be safely re-immunized with influenza vaccine

Serious acute febrile illness. Those with mild non-serious febrile illness (e.g. mild upper respiratory tract infection) can be given influenza vaccine.

Guillain-Barré syndrome (GBS) within 6 weeks of a previous influenza vaccine.

Precautions and The National Advisory Committee on Immunization (NACI) has concluded that egg

Influenza Immunization Protocol for Fluzone Quadrivalent (October 2015) Page 1 of 3

Additional Notes allergic individuals may be vaccinated against influenza using Quadrivalent Influenza Vaccine (QIV) without a prior influenza vaccine skin test and with the full dose in any setting where vaccines are routinely administered.

Vaccine is given annually from 6 months to two years old and from older than 17 years into adulthood.

May be given at the same time as other inactivated or live vaccines.

Don’t draw up vaccine until ready to use.

After a vial is punctured it must be used within 28 days. Date all opened vials.

NACI states that influenza vaccination is recommended for pregnant women.

NACI states that influenza vaccination is considered safe for breastfeeding women.

Take the opportunity to simultaneously immunize, unimmunized adults over 50 years old with pneumococcal polysaccharide vaccine (Pneumovax 23).

Vaccine Supply and Distribution

Review section on vaccine ordering in the Policy and Procedure section of the Nunavut Drug Formulary.

Storage

Store in monitored vaccine refrigerator between 2°C and 8°C.

Protect from light.

DO NOT FREEZE. Freezing destroys the active components of the vaccine. Segregate damaged product keeping the cold chain protocol and inform RCDC and regional pharmacy.

Consent Consent forms must be reviewed and signed by the client or parent/guardian prior to vaccination.

Anaphylaxis Review the principles of the emergency management of anaphylaxis in the Nunavut Immunization Manual Section 3 (3.7). Further information can be found in : Anaphylaxis: Initial Management in Non-Hospital Settings, in the Canadian Immunization Guide.

Side Effects Injection site: pain, redness at injection site.

Systemic: fever, fatigue, headache and myalgia.

Reportable Adverse Events/Side Effects

Report all serious adverse events requiring medical attention, unusual/unexpected events, or medication errors to RCDC. Review section 3.5 in the Nunavut Immunization Manual.

Vaccine coverage and Reporting

Under development.

Documentation All immunizations given should be documented on the chart, personal immunization record, and electronic record (where applicable).

Materials and Resources

All protocols and materials are available on the DH website (www.gov.nu.ca/health) Nunavut Communicable Disease and Surveillance Manual: Influenza Public Health Protocol Nunavut Immunization Manual Public Service Announcement: Preventing Influenza Public Service Announcement: Seasonal Influenza in your Community Fluzone Quadrivalent Fact Sheet Fluzone Quadrivalent Consent Form



FluMist Quadrivalent Fact Sheet FluMist Quadrivalent Form

References 1. FLUZONE® Quadrivalent. Product Monograph. Sanofi Pasteur. May 2015. 2. Public Health Agency of Canada. Canadian Immunization Guide – Evergreen Edition (2012). Available at: http://www.phac-aspc.gc.ca/publicat/cig-gci/index-eng.php 3. Public Health Agency of Canada. An Advisory Committee Statement (ACS). National Advisory Committee on Immunization (NACI), Canadian Immunization Guide Chapter on Influenza and statement on Seasonal Influenza Vaccine for 2015-2016. July 2015.http://www.phac-aspc.gc.ca/naci-ccni/flu-2015-grippe-eng.php


http://www.phac-aspc.gc.ca/publicat/cig-gci/index-eng.php


Appendix A Influenza Vaccine Algorithm

This chart outlines the influenza immunization process for the Influenza season. Additional information is provided below where noted.

1. FluMist® Quadrivalent (FluMist® Q) is the recommended vaccine for 2 to 17 years old in Nunavut during the influenza season. Review the Seasonal Influenza Vaccine (FluMist® Quadrivalent) Consent Form.

2. If FluMist® Quadrivalent is contraindicated or unavailable, consider inactivated influenza vaccine (by IM injection) and review the Seasonal Influenza Vaccine (Fluzone® Quadrivalent (Fluzone® Q)) Consent Form. Refer to Appendix B - Seasonal Influenza Vaccine Information Sheet for Healthcare Providers in Nunavut for details on contraindications and precautions for FluMist® Quadrivalent.

3. Refer to Appendix B - Seasonal Influenza Vaccine Information Sheet for Healthcare Providers in Nunavut for details on contraindications and precautions for Fluzone® Quadrivalent.

Client presents for influenza immunization

Ages 2–17 years old1 Ages 6 - 23 months and older than 17 years. May be used for 2-17 years if FluMist® Q

contraindicated

Review FluMist® Q consent form

FluMist® Q eligible

Administer FluMist® Q

FluMist® Q2 contraindicated or

Review Fluzone® Q consent form

Fluzone® Q eligible

Administer Fluzone® Q

Fluzone® Q contraindicated3

Educate about personal protective measures (hand hygiene, etc.). Encourage

others in the household to be immunized in order to

protect this person

Influenza – Algorithm (Revised October 2015)

Appendix B

Seasonal Influenza Vaccine Information Sheet for Healthcare Providers in Nunavut Product name FluMist® Quadrivalent Fluzone® Quadrivalent Product Characteristics Live Attenuated Influenza Vaccine (LAIV-Q) Quadrivalent Inactivated Vaccine (QIV) Manufacturer AstraZeneca Sanofi Pasteur Inc. Vaccine type Live attenuated Inactivated – split virus Route Intranasal spray IM Dose & site 0.2 mL (0.1 mL in each nostril) 0.5 mL (given into the deltoid or anterolateral thigh)

Authorized ages for use in Nunavut Ages 2 - 17 years old

6 to less than 24 months and older than 17 years. *May be used for ages 2 – 17 years when FluMist® Quadrivalent is contraindicated or unavailable

Formats available Prefilled single use glass sprayer 5 mL multidose vial Thimerosal No Yes Antibiotics (trace) Gentamicin None Clinically relevant non-medical ingredients

Egg protein; Gelatin hydrosylate; Sucrose; Arginine Egg protein; Formaldehyde; Sodium deoxycholate; Sucrose

Pediatric considerations

Children 6 months to less than 9 years of age receiving influenza vaccine for the first time require 2 doses, 4 weeks apart. Those who have previously received 1 or more doses only require 1 dose per season

Children 6 months to less than 9 years of age receiving influenza vaccine for the first time require 2 doses, 4 weeks apart. Those who have previously received 1 or more doses only require 1 dose per season

Child with runny/stuffy nose

Proceed with FluMist® Q as long as nasal mucosa can be visualized. If nasal cavity is occluded, delay FluMist® Q or consider Fluzone® Q

Proceed to vaccinate if meets the remaining criteria and consent has been obtained from caregiver

Simultaneous administration with other vaccines

May be given at the same time as other inactivated or live vaccines. However, after administration of a live vaccine (such as FluMist® Q), at least 4 weeks should pass before another live vaccine is administered

May be given at the same time as other inactivated or live vaccines

Simultaneous administration with TST

A TST can be placed on the same day as FluMist® Q , or deferred for at least 4 weeks from day of vaccine No effect on the timing of a TST

Vaccine interchangeability FluMist® Q and Fluzone® Q are interchangeable *

Contraindications – do not vaccinate

-Less than 24 months -Pregnancy - Nursing mothers. It is not known whether FluMist is excreted in human milk. -Anaphylactic reaction to a previous dose or vaccine components i.e. eggs, gentamicin, gelatin, arginine NOTE: Do not vaccinate those with egg allergy -Serious acute febrile illness -Guillain Barré (GBS) within 6 weeks of a previous influenza vaccine -Individuals with severe asthma (defined as currently on inhaled or oral glucocorticosteroids or active wheezing) OR those with medically attended wheezing in the 7 days prior to vaccination -Individuals 2-17 years currently receiving aspirin or aspirin-containing medication -Immune compromised -Close contact with persons with severe immune compromising conditions (e.g. bone marrow transplant recipients requiring isolation) -Individuals taking antiviral medications e.g. oseltamivir (Tamiflu) or zanamivir

-Anaphylactic reaction to a previous dose or to any of the vaccine components i.e. thimerosal, formaldehyde, neomycin -Severe lower respiratory symptoms (wheeze, chest tightness, difficulty breathing) within 24 hours of influenza vaccination, an apparent allergic reaction to the vaccine or any other symptoms (e.g. throat constriction, difficulty swallowing) that raise concern regarding the safety of re-immunization -ORS with lower respiratory tract symptoms -Serious acute febrile illness -Guillain Barré (GBS) within 6 weeks of a previous influenza vaccine NOTE: NACI has concluded that egg allergic individuals may be vaccinated against influenza using QIV without a prior influenza vaccine skin test and with the full dose in any setting where vaccines are routinely administered.

Contact the RCDC with questions not addressed here

Influenza – Public Health Protocol (Revised October 2015)

ᐋᓐᓂᐊᖃᕐᓇᙱᑦᑐᓕᕆᔨᒃᑯᑦ

ᓱᓕᔪᑦ ᑎᑎᕋᖅᓯᒪᔪᑦ

Flumist Quadrivalent Vaccine Fact Sheet - Inuktitut - August 2015

FluMist® - ᑯᐊᑦᕆᕙᓚᓐ − ᓱᕐᓗᒃᑯᑦ ᑎᒻᒥᒃᑳᕈᑎ ᓄᕙᓗᐊᒌᒃᑯᑎ

ᓄᕙᓐᓇᖅᑐᖅ ᑭᓲᖕᒪ? ᓄᕙᓐᓇᖅᑐᖅ ᐊᐃᑦᑑᑕᐅᔪᓐᓇᖅᑐᖅ ᐋᓐᓂᐊᖑᓪᓗᓂ ᓄᕙᓐᓇᐅᑉ ᖁᐱᕐᕈᐊᕐᔪᖏᓐᓂ ᐃᓅᓕᓴᒐᒃᓴᐅᙱᑦᑐᓂᑦ. ᓯᐊᒻᒪᑉᐸᓪᓕᐊᓲᖅ ᖁᐃᖅᓱᕐᓂᒃᑯᑦ, ᑕᒋᐅᖃᑦᑕᕐᓂᒃᑯᑦ ᑲᒃᑭᒃᑯᓪᓘᓐᓃᑦ.

ᐋᓐᓂᐊᓂᕐᒧᑦ ᓇᓗᓇᐃᖅᑕᐅᔾᔪᑎᖏᑦ ᐃᓚᖃᖅᑐᑦ: ᐆᑎᕐᓇᕐᓂᕐᒥᑦ, ᖁᐃᖅᓱᓂᕐᒥᑦ, ᓂᕆᔪᒪᑦᑎᐊᙱᓐᓂᕐᒥᑦ, ᓴᐅᓂᙳᓂᕐᒥᑦ, ᐃᒡᒋᐊᖁᕐᓗᓂᕐᒥᑦ ᐊᒃᓱᐊᓗᓪᓗ ᑕᖃᓯᒪᓂᕐᒥᑦ.

ᐃᓄᐃᑦ ᓄᕙᓕᒐᔪᖃᑦᑕᖅᑐᑦ ᓄᕕᐱᐅᓪᓗ ᒪᐃᓗ ᐊᑯᓐᓂᖏᓐᓂ, ᑭᓯᐊᓂ ᓄᕙᒡᔪᐊᕐᓇᖅ ᓴᙱᓂᖅᓴᐅᓲᖑᓪᓗᓂ ᔮᓐᓄᐊᕆᒥ ᕖᕝᕗᐊᕆᒥᓪᓘᓐᓃᑦ.

ᑭᓇ ᐋᓐᓂᓕᕇᒃᑯᓯᖅᑕᐅᔪᓐᓇᕐᒪᑦ? ᓱᕈᓰᑦ ᓄᓇᕗᒻᒥ ᐅᑭᐅᖃᖅᑐᑦ 2-ᓂᒃ 17-ᓄᑦ ᓱᕐᓗᒃᑯᑦ ᑎᒻᒥᒃᑳᖅᑕᐅᔪᓐᓇᖅᑐᑦ ᑖᔅᓱᒧᖓ FluMist® -ᖑᓂᕋᖅᑕᐅᔪᒧᑦ.

ᓱᕈᓰᑦ 9ᓂᒃ ᑐᖔᓂ ᐅᑭᐅᖃᖅᑐᖅ, ᓯᕗᓕᖅᐹᒥ ᓄᕙᓗᐊᒌᒃᑯᓯᖅᑕᐅᔪᑦ, ᒪᕐᕈᐃᖅᓱᖅᑕᐅᓪᓗᐊᖅᑐᑦ, ᐱᓇᓱᐊᕈᓰᑦ ᑎᓴᒪᓂ ᐅᖓᓯᒌᑦᑐᓂ, ᓴᐳᔾᔭᐅᓂᕐᒧᑦ.

FluMist® -ᖑᓂᕋᖅᑕᐅᔪᖅ ᐆᒻᒪᓪᓗᓂ, ᓴᙲᓪᓕᒋᐊᖅᓯᒪᓪᓗᑎ ᖁᐱᕐᕈᐊᕐᔪᐃᑦ ᐃᓅᓕᓴᒐᒃᓴᐅᒐᑎ ᐋᓐᓂᐊᓕᕇᒃᑯᑎᐅᓪᓗᓂ. ᓱᕐᓗᒃᑯᑦ ᑎᒻᒥᒃᑳᖅᑕᐅᓲᖑᓪᓗᓂ.

ᑭᓲᖕᒪᑕ ᐃᑲᔫᑎᖏᑦ ᐋᓐᓂᐊᓕᕇᒃᑯᑎᐅᑉ? ᓄᓇᕗᒻᒥᐅᓂᑦ ᓴᐳᔾᔨᓲᖑᖕᒪᑦ ᖃᓂᒪᓂᐊᖏᒻᒪᑕ ᓄᕙᒡᔪᐊᕐᓇᖅᑐᒥ.

ᓄᓇᓕᖕᒥ ᓴᐳᔾᔨᓲᖑᖕᒪᑦ ᑕᐃᒃᑯᐊᓗ ᐊᑦᑕᕐᓇᖅᑐᒦᓐᓂᖅᓴᐅᔪᑦ ᐊᑲᐅᙱᓕᐅᕈᑎᖃᕐᓂᕐᒥᑦ ᓄᕙᒡᔪᐊᕐᓇᖅᑐᒥ.

ᓄᕙᒡᔪᐊᕐᓂᖅ ᐋᓐᓂᐊᕕᖕᒥᑦ ᐃᓂᓪᓚᖓᔾᔪᑕᐅᓕᕈᓐᓇᕐᒪᑦ ᑐᖁᔾᔪᑕᐅᓗᓂᓘᓐᓃᑦ, ᐱᓗᐊᖅᑐᒥᑦ ᑕᐃᒃᑯᐊ ᐊᑦᑕᕐᓇᖅᑐᒦᑦᑐᑦ.

ᓱᕐᓗᒃᑯᑦ ᑎᒻᒥᒃᑳᕉᑎ Flumist® -ᖑᓂᕋᖅᑕᐅᔪᖅ ᐊᑦᑕᕐᓇᙱᓛ? ᐄ. ᑎᒻᒥᒃᑳᕐᕕᐅᓚᐅᖅᑐᓂ ᖃᓄᐃᑕᐅᒐᔪᖃᑦᑕᖅᑐᑦ ᑲᒃᑭᓕᑲᑕᓪᓗᓂ, ᓂᕆᒍᒪᑦᑎᐊᙱᓐᓂᖅ, ᓴᙲᓐᓂᖅ, ᓂᐊᖁᙳᓂᖅ, ᓄᑭᒃᑯᑦ ᐋᓐᓂᐊᕐᓂᖅ ᐆᑎᕐᓇᕐᓗᓂᓗ. ᑕᒪᓐᓇ ᑕᐃᒪᐃᒐᔪᕈᑕᐅᓲᖅ ᐋᓐᓂᐊᓕᕇᒃᑯᑎᒧᑦ ᓇᓗᓇᐃᖅᓯᓪᓗᓂᓗ ᑎᒦᑦ ᓴᓇᕙᓪᓕᐊᓂᖓᓂ ᖁᐱᕐᕈᐊᕐᔪᖕᓂᑦ ᑐᖁᓴᐅᑎᓂᑦ ᐋᓐᓂᐊᖑᔪᒧᑦ. ᐃᓛᓐᓂᒃᑯᑦ ᐅᕕᓂᕐᓗᒃᑐᖃᓲᖅ ᓱᕐᓗᒃᑯᓪᓘᓐᓃᑦ ᐊᐅᓕᕐᓗᓂ. ᐃᓄᒋᐊᒃᑐᑦ ᖃᓄᐃᔾᔪᑎᖃᖅᐸᙱᑦᑐᑦ ᐋᓐᓂᐊᓕᕇᒃᑯᑎᒧᑦ.

ᐋᓐᓂᐊᓕᕆᒃᑯᑎᓕᒫᓄᑦ, ᐃᓛᓐᓂᓚᐅᓱᖔᓗᒃ ᓈᒻᒪᒃᓴᖅᑐᖃᙱᑦᑐᒻᒪᕆᐅᔪᓐᓇᖅᑐᖅ ᑕᐃᔭᐅᓲᖑᓪᓗᓂ ᓈᒻᒪᒃᓴᙱᕐᔪᐊᕐᓂᖅ. ᓈᒻᒪᒃᓴᙱᕐᔪᐊᕐᓗᓂ ᓴᖅᑭᓲᖅ ᐱᖑᔭᐅᓗᓂ, ᐊᒥᕐᓘᓗᓂ, ᖃᓂᒃᑯᑦ ᐳᓪᓕᕐᓂᖃᕐᓗᓂ, ᐊᓂᖅᓵᖅᑐᑦᑎᐊᕈᓐᓇᙱᓪᓗᓂ. ᑕᐃᒪᐃᖃᑦᑕᖅᑐᑦ ᑕᐃᒪᐃᒐᔪᒃᑐᑦ 15 ᒥᓂᑦᓯᓂ ᐊᓂᒍᓚᐅᙱᓐᓂᖏᓐᓂ ᐋᓐᓂᐊᓕᕇᒃᑯᓯᖅᑕᐅᓯᒪᓕᖅᐸᑦ. ᐅᑕᖅᑭᒋᐊᖃᖅᐳᑎᑦ 15 ᒥᓂᑦᓯᓄᑦ ᖃᓄᐃᑦᑐᑐᐃᓐᓇᕐᒧᑦ ᐋᓐᓂᐊᓕᕇᒃᑯᓯᖅᑕᐅᒍᕕᑦ ᑲᐴᑎᒧᑦ. ᓈᒻᒪᒃᓴᙱᕐᔪᐊᕐᓂᖅ ᑲᒪᒋᔭᐅᔪᓐᓇᖅᑐᖅ ᐋᓐᓂᐊᓕᕆᔨᐅᔪᖅ ᐃᓕᓐᓂᐊᖅᓯᒪᑦᑎᐊᖅᑐᖅ ᑲᒪᑦᑎᐊᓂᕐᒥᑦ.

ᑭᓇ ᐅᖃᖃᑎᖃᕆᐊᖃᖅᐸ ᐋᓐᓂᐊᓕᕆᔨᒥᑦ ᐋᓐᓂᐊᓕᕇᒃᑯᓯᖅᑕᐅᓚᐅᙱᓐᓂᖓᓂ? ᐋᓐᓂᐊᓕᕆᔨᒥᑦ ᐅᖃᖃᑎᖃᕐᓗᑎᑦ ᕿᑐᕐᖓᐃᑦ ᓇᓕᐊᓐᓂᑐᐃᓐᓇᖅ ᐊᑐᕐᓂᑰᑉᐸᑦ:

• ᑎᒥᖓ ᓈᒻᒪᒃᓴᙱᑦᑐᖅ ᒪᓐᓂᓂ, ᔭᓐᑕᒪᐃᓯᓐ-ᖑᓂᕋᖅᑐᒧ, ᔨᐊᓚᑎᓐᒧ ᐋᕐᔩᓂᓐᒧᓪᓘᓐᓃᑦ.

• ᑭᖑᓂᐊᓂ ᓈᒻᒪᒃᓴᕐᔪᐊᓚᐅᙱᑉᐸᑦ ᐋᓐᓂᐊᓕᕆᒃᑯᑎᒥ. • ᐋᔅᐳᕆᓐᑐᖃᑦᑕᖅᐸᑦ ᒫᓐᓇᐅᔪᖅ ᐊᓯᓂᓘᓐᓃᑦ ᐄᔭᒐᕐᒥ ᐋᔅᐳᕆᓐ-

ᖃᖅᑐᒥᑦ. • ᐊᒃᓱᐊᓗᒃ ᐊᓂᕐᓂᑭᔭᑦᑐᖅ ᐅᕝᕙᓘᓐᓃᑦ ᐊᓂᕐᓂᑭᔾᔭᐃᑯᑎᒥ

ᐄᔭᒐᒃᑐᖅ (ᓂᐅᕆᐊᓖᑦ). • ᓴᙲᓪᓕᓯᒪᔪᒥᑦ ᑎᒥᖓ ᐊᓐᓇᐅᒪᔾᔪᑎᖃᖅᐸᑦ -

ᐋᓐᓂᐊᓂᕐᒧᓪᓘᓐᓃᑦ ᐄᔭᒐᖃᑦᑕᕐᓂᕐᒧᓪᓘᓐᓃᑦ ᓴᙲᓪᓕᑦᑎᕆᔪᒥᑦ ᑎᒥᐊᑕ ᐊᓐᓇᐅᒪᔾᔪᑎᖏᓐᓂ.

• ᖃᓂᒋᔭᖃᒐᔪᓲᖅ ᐃᓄᖕᒥᑦ ᓴᙲᓪᓕᓯᒪᔪᓂᑦ ᐊᓐᓇᐅᒪᔾᔪᑎᖃᖅᑐᒥᑦ.

• ᒫᓐᓇᐅᔪᖅ ᖁᐱᕐᕈᐊᕐᔪᖕᓄᑦ ᐃᓅᓕᓴᒐᒃᓴᐅᙱᑦᑐᓄᑦ ᐄᔭᒐᖃᑦᑕᖅᐸᑦ, ᓲᕐᓗ ᑖᒥᕗᓘᒥ.

• ᓇᔾᔨᔪᖅ/ᓯᖓᐃᔪᖅ.

ᐊᑦᑕᕐᓇᕐᓂᖓ ᑭᓲᖕᒪ ᓄᕙᒡᔪᐊᕐᓇᒧᑦ ᐋᓐᓂᐊᓕᕇᒃᑯᓯᖅᑕᐅᙱᓪᓗᓂ?

ᓇᓚᐅᑦᑖᖅᑕᐅᓯᒪᔪᖅ 4000-ᖏᓐᓂ 8000-ᖏᓐᓄ ᑲᓇᑕᒥᐅᑦ ᑐᖁᕙᒃᑐᑦ ᐊᕐᕌᒍᑕᒫᑦ ᓄᕙᒡᔪᐊᕐᓂᕐᒧᑦ. ᐊᒥᓱᒃᑲᓐᓃᑦ ᐋᓐᓂᐊᓕᖃᑦᑕᖅᑐᑦ ᑲᒪᒋᔭᐅᑦᑎᐊᕆᐊᖃᓲᖑᓪᓗᑎ ᐋᓐᓂᐊᕕᓐᓂ. ᕿᑐᕐᖓᕆᔭᐅᑦ ᓄᓇᓖᓪᓗ ᓴᐳᑎᓯᒪᒃᑭᑦ ᑖᔅᓱᒪᙵ ᓄᖅᑲᖓᑎᒐᒃᓴᐅᔪᒥᑦ ᐋᓐᓂᐊᒥᑦ.

Flumist® -ᒧ ᐋᓐᓂᐊᓕᕇᒃᑯᓯᖅᑕᐅᓚᐅᖅᑐᓂ ᑲᒪᑦᑎᐊᕐᓂᖅ

• ᐆᑎᕐᓇᓗᐊᖅᑕᐃᓕᒪᓂᕐᒧᑦ ᐊᒻᒪ ᐋᓐᓂᐊᓗᐊᖅᑕᐃᓕᒪᓂᕐᒧᑦ ᒪᐃᓗᐊᖅᑕᐃᓕᒪᓂᕐᒧᓪᓘᓐᓃᑦ, ᐋᓐᓂᐊᕐᓇᙱᑦᑐᒥᑦ ᐆᑎᕐᓇᔾᔭᐃᑯᑎᒥᑦ ᐄᓯᓗᑎᑦ (ᑕᐃᓚᓈ (ᓂᐊᖁᖅᓯᐅᑎ), ᑕᒻᐳᕋ (ᐆᑎᕐᓇᖅᑐᖅᓯᐅᑎ) ᐅᕝᕙᓘᓐᓃᑦ ᐋᓐᓂᐊᕐᓇᙱᑦᑐᒥᑦ ᐳᓪᓕᕐᓇᙱᑦᑐᒥᑦ (ᐋᑦᕕᐅᓪ, ᒨᑦᕆᓐ).ᓱᕈᓯᕐᓄᑦ, ᐋᓐᓂᐊᓕᕆᔨᐅᑉ ᖃᓄᑎᒋ ᐄᓯᖁᑉᐸᒍ ᒪᓕᑦᑎᐊᕐᓗᒍ ᐅᕝᕙᓘᓐᓃᑦ ᐴᖓᓂ ᑎᑎᕋᖅᓯᒪᔪᖅ ᒪᓕᑦᑎᐊᕐᓗᒍ.

• ᐋᔅᐳᕆᓐ ᑐᓂᔭᐅᙱᓪᓗᓂ ᑭᓇᑐᐃᓐᓇᕐᒧᑦ 20 ᑐᖔᓂ ᐅᑭᐅᓕᒻᒧᑦ ᐊᑦᑕᕐᓇᕐᓂᖓ ᕋᐃᔅ ᐋᓐᓂᐊᕈᑕᐅᓂᕋᖅᑐᖅ ᐱᔾᔪᑕᐅᓗᓂ, ᖃᕌᓴᕐᒧᑦ ᐱᐅᔪᓐᓃᕈᑕᐅᔪᓐᓇᕐᒪᑦ ᑐᖁᔾᔪᑕᐅᓗᓂᓗ

• ᖃᓄᐃᓕᔾᔪᑎᖃᓪᓚᕆᒃᑯᕕᑦ ᓲᕐᓗ ᖃᓂᒃᑯᑦ/ᖃᖓᓯᓈᒃᑯᑦ, ᐱᖑᔭᓐᓂᖅ ᐅᕝᕙᓘᓐᓃᑦ ᖀᖅᓱᓕᕈᕕᑦ ᑐᐊᕕᕐᓇᖅᑐᒃᑯᕕᓕᐊᕐᓗᑎᑦ ᐋᓐᓂᐊᕕᓕᐊᑲᐅᑎᒋᓗᑎᓘᓐᓃᑦ.

• ᐊᐱᖅᑯᑎᖃᕈᕕᑦ, ᐃᓱᒫᓘᑎᖃᕈᕕᓪᓘᓐᓃᑦ ᖃᓄᐃᓕᕈᑕᐅᔪᒥᑦ ᐋᓐᓂᐊᓕᕇᒃᑯᑎᒧᑦ, ᐋᓐᓂᐊᓕᕆᔨᒥᑦ ᐅᖃᖃᑎᖃᕐᓗᑎᑦ.

Please fill in OR addressograph/affix label: Last Name: _______________________________ First Name: _______________________________ Sex (M/F): ________________________________ DOB (dd/mm/yyyy): ________________________ Chart #: __________________________________ Age: ___________________________________ Community of Residence: __________________

ᓄᕙᓗᐊᕇᒃᑯᑎ ᑲᐱᔭᐅᓂᕐᒧᑦ ᐊᖏᕈᑎ ᑕᑕᑎᕆᐊᓕᒃ

(FLUMIST® Quadrivalent ᓱᕐᓗᒃᑯᑦ ᑎᒻᒥᑳᕈᑎ ᐊᕐᕌᒍᓕᓐᓄᑦ 2-ᒥ 17-ᒧ ) ᑲᐱᔭᐅᓂᐊᖅᑐᒧᑦ, ᑭᐅᖑᐊᑕᖅᓯᓐᓇᑭᒃ:

1 ᖃᓂᒪᕖᑦ ᐅᓪᓗᒥ? ᐄ ᐋᒡᒐ

2

ᑲᐱᔭᐅᓚᐅᖅᑎᓪᓗᑎᑦ ᑭᖑᓂᖓᒍᑦ ᒪᑯᓂᖓ ᓈᒻᒪᙱᓪᓕᐅᕈᑎᑲᑲᑦᑕᖅᑎᒪᓂᑯᕖᑦ (ᑎᑎᖅᓯᕕᒋᒃᑭᑦ ᐊᑑᑎᓯᒪᔭᑎᑦ): ᐱᑕᖃᖏᑦᑐᖅ

ᐊᓂᖅᑎᕆᓪᓗᑎᑦ ᓱᕕᖅᓱᖅᓱᑎᑦ ᓴᕝᕕᒃᑯᓪᓘᓐᓃᑦ ᓱᑲᖓᓂᖅ ᐄ ᐋᒡᒐ ᐱᔭᕆᐊᑐᑦᓴᕐᓂᖅ ᐊᓂᖅᓵᖅᑐᕈᓐᓇᐃᓕᐅᖅᑲᓂᖅ ᐄᒋᐊᕐᓕᕐᒥᓪᓘᓐᓃᑦ ᐄ ᐋᒡᒐ ᐅᕕᓂᕐᓗᓐᓂᖅ ᐄ ᐋᒡᒐ ᐋᓐᓂᐊᕕᒻᒥᑦ ᐅᓂᖅᓯᒪᔭᕆᐊᖃᕐᓂᖅ ᐄ ᐋᒡᒐ ᐊᓐᓇᐅᒪᔾᔪᑎᓪᓗᖅᑐᖅ ᐄ ᐋᒡᒐ ᐳᕐᓕᓐᓂᖅ ᑲᐱᒋᔭᐅᕕᕕᓂᖓᒍᑦ ᐄ ᐋᒡᒐ ᐊᓯᖏᑦ ᑎᒥᒃᑯᑦ ᓈᒻᒪᙱᓕᐅᕈᑎᕐᔪᐊᑦ ᐄ ᐋᒡᒐ (ᓇᓗᓇᐃᕐᓗᒋᑦ): ___________________________________________

3 ᑎᒦᑦ ᓈᒻᒪᑦᓴᖏᓐᓂᖃᖅᑳ (ᑎᑎᖅᓯᕕᒋᒃᑭᑦ ᐊᑑᑭᓯᒪᔭᑎᑦ)

ᒪᓐᓃᑦ ᐄ ᐋᒡᒐ ᒪᒥᓴᐅᑎ (ᔨᐊᓐᓇᒦᓴᓐ) ᐄ ᐋᒡᒐ ᔭᓕᑕᓐ ᐄ ᐋᒡᒐ ᐋᖅᔨᓇᐃᓐ ᐄ ᐋᒡᒐ

4 ᐊᓂᖅᑎᕆᓪᓗᑎᑦ ᓱᕕᖅᓱᖅᑭᑦ ᒫᓐᓇ ᖃᐅᔨᓴᖅᑕᐅᓯᒪᕕᓪᓘᓐᓃᑦ ᐋᓐᓂᐊᓯᐅᖅᑎᒧᑦ ᐅᓪᓗᐃᑦ 7 ᓱᕕᖅᓱᕐᓂᕐᒧᑦ? ᐄ ᐋᒡᒐ

5 ᐊᓂᕐᓂᑭᔭᖃᑦᑕᖅᓯᒪᕖᑦ (ᓇᓗᓇᐃᖅᑕᐅᓯᒪᔪᖅ ᒫᓐᓇ ᐅᖃᐅᓯᒃᑯᑦ ᓂᐅᖅᑐᒐᕐᒥᓪᓘᓐᓃᑦ ᐊᓂᕐᓂᑭᔭᕐᓂᕐᒧᑦ ᒫᓐᓇᓘᓐᓃᑦ ᓱᕕᖅᓱᓂᕐᒧᑦ)? ᐊᖏᕈᕕᑦ ᓇᓗᓇᐃᖅᓯᒋᑦ: ______________________________________________________ ᐄ ᐋᒡᒐ

6 ᒫᓐᓇᐅᔪᖅ ᐋᔅᐳᓐᑐᖃᑦᑕᖅᑮᑦ ᐃᓗᐊᖅᓴᐅᑎᑐᖃᑦᑕᖅᑭᓪᓘᓐᓃᑦ ᐱᑕᓕᓐᓂᑦ ᐋᔅᐳᓐᓂᑦ? ᐄ ᐋᒡᒐ

7 ᐊᓐᓇᐅᒪᔾᔪᑎᖃᑦᓯᐊᖏᓪᓚᑏᑦ ᐱᑎᑕᐅᖃᑦᑕᖅᑭᓪᓘᓐᓃᑦ ᑳᓐᓱᖃᕐᓂᕐᒧᑦ ᐃᓗᐊᖅᓴᐅᑎᓂᑦ? ᐊᖏᕈᕕᑦ, ᓇᓗᓇᐃᕐᓗᒋᑦ____ ᐄ ᐋᒡᒐ

8 ᖃᓂᒋᔭᖃᖅᓯᒪᕖᑦ ᐊᓐᓇᐅᒪᔾᔪᑎᖃᑦᓯᐊᖏᑦᑐᒥᑦ ᐱᑎᑕᐅᖃᑦᑕᖅᑐᒥᓪᓘᓐᓃᑦ ᑳᓐᓱᖃᕐᓂᕐᒧᑦ ᐃᓗᐊᖅᓴᐅᑎᓂᑦ? ᐊᖏᕈᕕᑦ, ᓇᓗᓇᐃᕐᓗᒋᑦ____________________________________________ ᐄ ᐋᒡᒐ

9 ᓇᔾᔨᕖᑦ ᓇᔾᔨᑐᐃᓐᓇᕆᐊᖃᖅᑭᓪᓘᓐᓃᑦ? ᐄ ᐋᒡᒐ

ᐊᖏᖅᑐᒥᓂᐅᒍᕕᑦ ᖁᓛᓐᓃᑦᑐᒧᑦ, ᐅᖃᖃᑎᖃᖑᐊᑕᖅᓯᓐᓇᕆᑦ ᐋᓐᓂᐊᓯᐅᖅᑎᒥᑦ

_________________________________________________________________________________________________ ᑎᑎᕋᕐᓗᒍ ᐊᑏᑦ ᐊᑎᓕᐅᖅᕕᖓ ᐱᔨᑦᓯᕋᖅᑕᐅᔫᑉ ᐊᖓᔪᖅᑳᕆᔭᐅᔪᓪᓘᓐᓃᑦ/ᒪᓕᒐᖅᑎᒍᑦ ᑲᒪᔨᖓ ᐅᓪᓗᖓ (ᐅᓗᖅ/ᑕᖅᑭᖅ/ᐊᕐᕌᒍᖓ) ᐱᐊᕋᐃᑦ ᐊᕐᕌᒍᓖᑦ 2-ᒥ 9−ᖑᖏᑦᑐᐃᓪᓗ, ᑲᐱᔭᐅᓚᐅᖅᓯᒪᖏᑐᐊᐸᑦ ᓄᕙᓗᐊᕇᒃᑯᑎᒧᑦ, ᒪᕐᕈᐊᖅᑎ ᑎᒻᒥᑳᖅᕕᐅᒋᐊᖃᕋᔭᖅᑐᖅ, ᐱᓇᓱᐊᕈᓯᓐᓄᑦ ᓯᑕᒪᓄᑦ. ᑕᐃᒪᐃᖏᑉᐸᑦ ᑎᒥᑳᖅᕕᐅᒐᔭᖅᑐᖅ ᐊᑕᐅᓯᐊᕐᓗᓂ.

Ages 2 and less than 9 years old

Dose Date Time Dose Route Vaccine Lot Number Signature & Designation

1 ______/______/______ dd mm yyyy 0.2

mL Nasal Spray

(0.1 mL in each ᐋᒡᒐstril)

FLUMIST® QIV

2 ______/______/______ dd mm yyyy 0.2

mL Nasal Spray

(0.1 mL in each ᐋᒡᒐstril)

FLUMIST® QIV

ᐊᖏᕈᑎ ᐆᒧᖓ FLUMIST® Quadrivalent: ᐅᖃᓕᒫᖅᓯᒪᔭᒃᑲ ᐱᓯᒪᑦᓱᒍᓘᓐᓃᑦ FLUMIST® Quadrivalent ᓱᓕᓪᓗᑎᒃ ᑎᑎᕋᖅᓯᒪᔪᑦ ᓇᓗᓇᐃᖅᑕᐃᓯᒪᔪᑦ ᐅᕙᓐᓄᑦ. ᐱᕕᖃᖅᑎᑕᐅᓯᒪᔪᖓ ᐊᐱᖅᑯᑎᓂᑦ ᐊᐱᖅᓱᕈᓐᓇᓂᕐᒥᑦ ᑭᐅᔭᐅᑦᓱᑎᓪᓗ ᓈᒻᒪᒋᔭᒃᑯᑦ. ᑐᑭᓯᓯᒪᔪᖓ ᐃᑲᔫᑎᓂᑦ ᐊᑦᑕᕐᓇᖅᑐᒦᒍᓐᓇᕐᓂᖓᓄᓪᓘᓐᓃᑦ ᑲᐱᔭᐅᓂᖅ. ᐊᖏᖅᑐᖓ FLUMIST® Quadrivalen-ᒥ ᐱᑎᑕᐅᒍᒪᓂᖓᓄᑦ ᐆᓇ: ᕿᑐᕐᖓᕋ, ᐸᖅᑭᔭᓐᓄᑦ ᐅᕙᓐᓄᓪᓘᓐᓃᑦ

FLUMIST® Quadrivalent Consent Form – Inuktitut (revised August 2015)

Department of Health

Fact Sheet

Flumist Quadrivalent Vaccine Fact Sheet - English - August 2015

FluMist® Quadrivalent - Nasal Spray Influenza Vaccine

What is Influenza (flu)? Influenza (flu) is a contagious disease caused by the influenza virus. It spreads through coughing, sneezing or nasal fluids.

Symptoms include: fever, cough, loss of appetite, muscle aches, sore throat and feeling very tired.

People usually get the flu between November and May, but flu season most often peaks in January or February.

Who can receive the vaccine? Children in Nunavut aged 2 - 17 can receive FluMist®

Children younger than 9 years old, getting the vaccine for the first time, should get 2 doses, at least 4 weeks apart, to be protected.

FluMist® is a live, weakened virus vaccine. It is given as a spray in the nose.

What are benefits of the vaccine? It protects Nunavummiut from getting sick with Influenza.

It protects the community and those most at risk of complications from influenza.

Influenza can lead to hospitalization and even death, especially for those at highest risk.

Is Flumist® safe? Yes. The most common side effects are runny nose, reduced appetite, weakness, headache, muscle aches and fever. This is a normal reaction to the vaccine and indicates that your body is making antibodies to the disease. Occasionally it can cause a rash or nose bleed. Many people have no side effects at all from the vaccine.

With all vaccines, there is a very rare chance of a severe allergic reaction called anaphylaxis. Anaphylaxis appears as hives, rash, swelling of the mouth, difficulty breathing. This type of reaction typically occurs within 15 minutes of receiving a vaccine. It is recommended you stay in the clinic for 15 minutes after getting any vaccine. Anaphylaxis can be treated and your healthcare provider is trained to treat it.

Who should talk with their healthcare provider before getting the vaccine? Tell your health care provider if your child has any of the following:

• Allergy to eggs, gentamycin, gelatin or arginine. • A previous serious reaction to any vaccine. • Are currently taking aspirin or any medicine with

aspirin in it. • Severe asthma or is currently on asthma

medication (puffers). • A weakened immune system – either a medical

condition or is taking medication that weakens the immune system.

• Is regularly in close contact with somebody who has a weakened immune system.

• Is currently taking antiviral medication, such as Tamiflu or.

• Is currently pregnant.

What is the risk of not getting the Influenza vaccine? It is estimated that 4000 – 8000 Canadians die each year from Influenza. Many more become sick and need special care in the hospital. Protect your child and the community from this preventable disease.

Flumist® Vaccine After Care

• To control fever and relieve muscle aches, you can take Acetaminophen (Tylenol, Tempra) or Ibuprofen (Advil, Motrin). For children, give the amount recommended by your health care provider or on the bottle.

• Aspirin (ASA) should NOT be given to anyone under 20 years of age due to the risk of Reye Syndrome, which can cause permanent brain damage and death.

• If you experience any serious side effects such as swelling of the mouth/lips, hives or seizures please visit your emergency department or health center immediately.

• If you have any questions, or are concerned about a reaction from the vaccine, talk with your health care provider.


Seasonal Influenza Vaccine Consent Form (FLUMIST® Quadrivalent Nasal Spray for ages 2 to 17 Year Olds)

For the person receiving the vaccine, please answer: 1 Are you sick today? Yes No

2

Have you ever experienced any of the following after an influenza vaccine (please all that apply): None

Wheezing or chest tightness Yes No Difficulty breathing or swallowing Yes No Rash Yes No Hospitalization Yes No Guillain-Barré Syndrome Yes No Swelling beyond the injection site Yes No Other severe reaction Yes No (specify): ___________________________________________

3 Are you allergic to (please all that apply) :

Eggs Yes No Gentamicin Yes No Gelatin Yes No Arginine Yes No

4 Are you currently wheezing or have been assessed by a healthcare provider in the last 7 days for wheezing? Yes No

5 Do you have a history of severe asthma (defined as currently on oral or inhaled medicine for asthma or current active wheezing)? If yes, specify: ______________________________________________________ Yes No

6 Are you currently taking aspirin or any medications containing aspirin? Yes No

7 Are you immune compromised or receiving cancer treatment? If yes, specify:__________________________ Yes No

8 Are you in close contact with someone who is immune compromised or receiving cancer treatment? If yes, specify:______________________________________________ Yes No

9 Are you pregnant or is there a chance you might be pregnant? Yes No

If you Yes to any above, please discuss with nurse

_________________________________________________________________________________________________ Print Name Signature of Client or Parent/Legal Guardian Date (dd/mm/yyyy) Children between the ages of 2 and less than 9 years old, who have never been immunized against influenza, require 2 doses, 4 weeks apart. Otherwise only one dose is required.



1 ______/______/______ dd mm yyyy 0.2

mL Nasal Spray

(0.1 mL in each nostril) FLUMIST® QIV

2 ______/______/______ dd mm yyyy 0.2

mL Nasal Spray

(0.1 mL in each nostril) FLUMIST® QIV

CONSENT FOR FLUMIST® Quadrivalent: I have read or had the FLUMIST® Quadrivalent Fact Sheet explained to me. I have had a chance to ask questions which were answered to my satisfaction. I understand the benefits and risks of the vaccine. I consent to FLUMIST® Quadrivalent being given to: My Child, My Ward or Myself

FLUMIST® Quadrivalent Consent Form – English (revised August 2015)

Munaqhiliqiyitkut

Kangiqhidjutit

Flumist Quadrivalent Vaccine Fact Sheet - Inuinnaqtun - August 2015

FluMistmik Quadrivalent nguyuq– Qingaqmun Havautihaq Qalalaqinnarhigaangat Kapukhiqniq

Hunaukman Qalalaqinnartuq? Qalalaqinnartuq hiamitiqtaaqtuq aanniarut qalalaqinnartuq qalaqtuigaangat, tagyugaangat, qingnaqnin kuhiqtainaligaangat.

Ilitugidjutiit ilauqaqtun: kidjakhutik, qalainalikhutik, niriumayuiqhutik, niqqaitlu ullugiahulikhugit, igiakliulikhutik, unaguhuinalikhutiklu.

Inuit annialaqivaktun uuminga Hikutirviangugaangat Qiqiayaqluarviangugaangatlu, kihimi qalaktuiluaqpaktun Ubluqtuhirviangugaangat Idjirurviamiluuniit.

Kitkun pigiaqaqtun kapukhiqnirnik? Nuttaqqat Nunavunmi ukiuqaqtun 2nik 17mun pigiaqaqtun FluMistmik.

Nuttaqqat avatqungitun nainik ukiunik, kapuqhigiangat hivulliqpaaqmik, kapuqhiqtauyukhat malruiqtuqhutik, taima 4nik havainirnik avatqutkaaqlugu, munagiyauyaangat.

FluMistngit innuyut, hakuiktitivaktuq aanniarutingnik. Tuniyauvaktun hikigaqtuqtutun qingakkut.

Hunauyut pidjutikhat kapukhirnikkut? Munagidjutikhaqaqtuq Nunavunmiunun aanniaqnaitumik qalaliqinirmin

Munaqtihimaaqtuq nunalaanun tapkungalu ayungnautiqaluaqtun qalaliqinirmin.

Qalaqlungniq aanniaqyuaqnaqtuq ilaani aanniaqvingmungaqtitivaktuq huiqtitivakhunilu, tapkunungaluaq aanniaqtaaqtunuanut.

Tamna Flumistngit qayangnaituq? Hii. Naunaitqiaq ayungnautikhangit imaatun itun kuhiqtalaqivaktuq qinngat, niriyumahuiqhutik, hakuikhutik, niqqaingit hayulaqivaktun, kidjakhutiklu. Taimailinniaqtun kapuqhiruvit taima timit havakyualikman havautikharnik timingnun piyaagiangat aanniarutingnik. Ilaani

uvinirlungnahitivaktuq aulaqitivakhunilu qingakkut. Amigiaqtun inuit ayungnautiqangitun kapuqhiqnirmin.

Tamainik kapuqhirninin, ayungnautiqaluangitun inuuhirnun taivagaat anaphylaxis-mik. Anaphylaxis-ngit naunairutiqaqpaktuq muqpanuatun itutun uvinirlungnirpaktun, kilaalaqivakhutik, puvipkakhutik qanirmun, anirniqlukhutiklu. Imiailigaigumik 15nik minutemi kapuqhirnirmin. Ihumaliugiikhimayuq taima munarhitkunni itukhauyut 15nik minutesnik kapuqhigiigumik. Tamna Anaphylaxis-mik inuk atuligumi munagiyaugiaqaqtun talvani munarhitkuni ayuigiikhimayut hanaqiyaangat taimailigaiqagumi.

Kina uqagiaqaqtuq munarhinun kapuqhiqtinanik? Uqallautilugu munarhitkun ayungnautiqaqqa nuttaran iihigigaangat ukuninga titiraqhimayut ataaani:

• Ayungnautiqaqtun maningnik, gentamycin-nik, gelatin-nik, arginine-niklu. • Ayungnautiqaqpaktuq kingulirmin kapukhirnirmin. • Havautituqtuq aspirinmik havautituqtuqlu aspirin-qaqtunik. • Aningnirliqtuqaqtunik havautitugumiklu aningniryumirnikkut (anirhautikhat). • Hakuikhimayuq timimingni havautituliurutmi – havautitugiaqagumi havautituqtuqluuniit hakuiyaqhaiyuq timimingni havautituliurutmi. • Ilauqatigihimaaqatigiyait inungnik hakuiyagiikhimaayumik timimingni havautituliurunmini. • Qalakhiutiqaqtunik havautituqtuq, taimaitunik Tamiflu-mik. • Hiingaiyaqtuq. Hunauva ayungnautigiyaingit kapuqhingitkumi qalaliqinaitumik kapuutingnik? Nallautiqhimayuq taima 4 tausinik 8 tausinikluuniit kanaitiangit inungnik tuquvaktun ukiuk tamaat qalaliqinirmin. Amigiatun aannialaqivaktun piqaqpaktunlu ikayukharnik aanniarvingmni. Munagilugu nuttaran nunalaangitlu uuminga ihuaqhagiaqaqtunik aanniarutmin.

Flumistmin Kapuqhirniq Munagidjutikhaq

• Munagiyaangat kidjaumaninga aniqnaiqyumigiangat niqqaingit, havautituqtitigiaqaqtan, ullugianaitkutikharnik (Tylenol-mik, Tempra-mikluuniit) ullugianaiyautikharnikluuniit havautmik (Advil-mik, Motrin-mikluuniit). Nuttaqqanut, tunilugit havautitugiaqaqtainik munarhinin atuquyainik havautiminluuniit.

• Havautit Aspirin-ngit (ASA) tuniyakhaungitun inungnun ukiuqangitunik 20nik taima ayungnautiqaqniaqmanik imaitumik aanniarutmik Reye Syndrome-mik, taima qillaminuaq hunngiyainiaqtun qaritaqmun huigiaqaqtunluuniit.

• Akuktauguvit ayungnautingnik taimaitunik puvipkaknirnik qanirmun/umilrungnunlu, uvinirlingnikmik, qiqhiyunikluuniit, upautilugit amigaqhutigiaqaqtunik aanniaqviit munarhitkunluuniit qillaminuaq.

• Apiqutiqaguvit, ihumaaluutiqaguvitluuniit akuktaurutingnin kapuqhirnirmin, uqaqqatigilugit munarhitkut.


Qalalaqinnarhigaangat Influenza-mut Kapurhiqniq Angirut Titiraq (FLUMIST® Quadrivalent Qingaqmut havautihaq ukiulingnut malrungnik 17-mut)

Inungmut kapurhirnikkut, kiulugit: 1 Aanniaqqit ublumi? Hii Imannaq

2

Ayuqhautiqaqpakpit influenza-qnaittumik kapuqhiqtaugaangat (Titiqlugit tamaita atuqtauvaktuta): Piisak

Aniqhaagiami ayurhaliqqat, hatqanga mihiknaqhipluni Hii Imannaq Ayurhaliqtuq anirhaagiami iigiamiluuniit Hii Imannaq Kapurhiqninnga pupillaktuq Hii Imannaq Aanniarvilidjutaukpat Hii Imannaq Guillain-Barré-mik Aaniaqarumi Hii Imannaq Puvipkaqtuq kapurhiqninngani Hii Imannaq Allnik qayangnaqtunik mihingnaqqa Hii Imannaq (naunaiglugu): ___________________________________________

3 Hapkuninnga pilimaitpit (titiqlugit atuqtauvaktuta) :

Manninik Hii Imannaq Gentamicin-mik Hii Imannaq Gelatin-mik Hii Imannaq Arginine-mik Hii Imannaq

4 Anirhaagiami ayurhaliqqat ihivriuqtauva munarhimit 7nik ublunik anirhaagutiminut ayurhautigiyaanik? Hii Imannaq

5 Ayurhautigiviuk anirhaariami ayurhautigiinaqtaanik (naunaiqhimayuq qangitigut anirhaarutikkulluuniit ayurhautigiyaaminut anirhaagiami ublumiluuniit anirhaagiami ayurhautigiyamiknik)? Angiruvit,naunaiglugu: __________________________________ Hii Imannaq

6 Havautituliqqit aspirin-mik atlanikluuniit havautituliqqa piqaqtumik aspirin-mik? Hii Imannaq

7 Naamagivauk pipkaiyumik piliqqalluuniit kaansamut ihuarhaitjutinganik? Angiruvit, naunaiglugu:_________________ Hii Imannaq

8 Ilauva inungmut naamagiyauyuq pipkaiyumik piliqqalluuniit kaansamut ihuarhaitjutinganik? Angiruvit, naunaiglugu:________________________________________ Hii Imannaq

9 Hingaiyauliqqit, uvaluunniit hingaiyaulirnahugivit? Hii Imannaq

Titikhiguvit Angiruvit nallianik, uqadjavutit munaqhimut

_________________________________________________________________________________________________ Taiguaqnaqtumik titiraqlugu atiit Sainiutinga Kapurhirahuap Angayuqqaangaluunit/Munaqtingaluuniit (pittaaqqat Ublua (dd/mm/yyyy) Nutarauva ukiulik 2mit 9mut kapurhiqhimaittuq influenza-qnait, kapurhiqtukhaugaluaq malruknik, 4 hitamanik Santinguraikpat. atauhiinaqmik kapurhiqtukhaugaluaq.


Kapurhiqninnga Ublua Time Kapurhiqninnga Qaffinik Kapurhiqniq Lot Nappa Atiliurvia & Munaqtipluniit

1 ______/______/______ dd mm yyyy 0.2 mL

Qingaqmut (0.1 mL

qingangnut) FLUMIST® QIV

2 ______/______/______ dd mm yyyy 0.2 mL

Qingaqmut (0.1 mL

qingangnut) FLUMIST® QIV

ANGIRUT HAVAUTIMUT FLUMIST® Quadrivalent: Tairuktatka havautituqhimayunga FLUMIST® Quadrivalent Kangikhidjutikhaq kangiqhipkaktauyunga. naunaiqtitauyuq uvamnut. Apirhiplungalu apirhigiamni kiuyauyutlu uvamnut nakuuyumik. Ilihimayunnga ikayuutingit ayurhautingillu kapurhiniqmut. Angiqtunnga FLUMIST® Quadrivalent tuniyauyukhaq: Nutaramnut, Munariyamnut Uvamnut

FLUMIST® Quadrivalent Consent Form – Inuinnaqtun (revised August 2015)

Ministère de la Santé

Feuille de renseignements

Flumist Quadrivalent Vaccine Fact Sheet - French – August 2015

Vaccin antigrippal nasal FluMist® Quadrivalent Qu’est-ce que la grippe? La grippe est une maladie contagieuse causée par le virus de la grippe qui se propage par la toux, les éternuements ou les sécrétions nasales.

Les symptômes sont les suivants : fièvre, toux, perte d’appétit, douleurs musculaires, mal de gorge et fatigue.

La grippe circule en tout temps de novembre à mai, mais atteint habituellement des pics en janvier et février.

Qui peut se faire vacciner? Les enfants du Nunavut âgés de 2 à 17 ans peuvent recevoir le vaccin antigrippal nasal FluMist®.

Les enfants de moins de 9 ans qui reçoivent le vaccin pour la première fois ont besoin de 2 doses, à au moins 4 semaines d’intervalle, afin d’être protégés.

Le FluMist® est un vaccin vivant contenant un virus affaibli. Il est administré par vaporisateur nasal.

Quels sont les avantages du vaccin? Il protège les Nunavummiut contre la grippe. Il protège la collectivité et les personnes à risque de complications en raison de la grippe.

La grippe peut entraîner l’hospitalisation et même la mort pour les personnes les plus à risque.

Le vaccin antigrippal Flumist® est-il sécuritaire? Oui. Les effets secondaires les plus communs sont l’écoulement nasal, la perte d’appétit, des maux de tête, des douleurs musculaires et de la fièvre. Il s’agit d’une réaction normale au vaccin qui indique que votre corps développe des anticorps à la maladie. Occasionnellement, le vaccin peut provoquer une éruption cutanée ou un saignement de nez. Beaucoup de gens de ressentent aucun effet secondaire.

Il est très rare qu’une grave réaction allergique appelée anaphylaxie se produise. Voici les principaux symptômes d’anaphylaxie : urticaire, éruption cutanée, enflure de la bouche, difficultés respiratoires. Ce type de réactions se produit habituellement dans les 15 minutes suivant la vaccination. Il est donc recommandé de rester à la clinique au moins 15 minutes après la vaccination. L’anaphylaxie se traite et votre professionnel de la santé est formé pour la traiter.

Qui devrait consulter un professionnel de la santé avant de recevoir le vaccin antigrippal? Veuillez le dire à votre professionnel de la santé si votre enfant présente l’une des conditions suivantes :

• Allergie aux œufs, à la gentamicine, à la gélatine ou à l’arginine;

• Réaction sérieuse antérieure à tout autre vaccin; • Prise actuelle d’aspirine ou d’un médicament

contenant de l’aspirine; • Antécédent d’asthme grave ou prise actuelle de

médicament contre l’asthme (inhalateur); • Système immunitaire affaibli en raison d’une

condition médicale ou de la prise de médicaments affaiblissant le système immunitaire;

• Contact étroit fréquent avec des personnes ayant un système immunitaire affaibli;

• Prise actuelle d’un médicament comme le Tamiflu; • Votre fille est enceinte.

Quel est le risque de ne pas recevoir le vaccin antigrippal? On estime que de 4 000 à 8 000 Canadiens meurent chaque année de la grippe. Plusieurs personnes atteintes ont besoin de soins spéciaux à l’hôpital. Protégez-vous, et protégez vos enfants et la collectivité contre cette maladie évitable.

Soins parfois requis après le vaccin antigrippal Flumist®

• Pour contrôler la fièvre et soulager un endolorissement ou des douleurs musculaires, vous pouvez prendre de l’acétaminophène (Tylénol, Tempra) ou de l’ibuprofène (Advil, Motrin). Dans le cas des enfants, veuillez donner la quantité recommandée par votre fournisseur de soins de santé ou sur la bouteille.

• Il ne faut PAS donner d’aspirine (ASA) à des personnes de moins de vingt ans en raison des risques de syndrome de Reye qui peut causer des lésions permanentes au cerveau et même la mort.

• Si vous éprouvez des effets secondaires graves comme l’enflure de la bouche ou des lèvres, de l’urticaire ou des convulsions, rendez-vous immédiatement à l’urgence ou au centre de santé de votre collectivité.

• Si vous avez des questions ou des préoccupations concernant une réaction au vaccin, veuillez en parler avec votre fournisseur de soins de santé.


Formulaire d’autorisation

pour l’administration du vaccin contre la grippe saisonnière (Vaporisateur nasal quadrivalent FLUMIST® pour les 2 à 17 ans)

S’adresse à la personne recevant le vaccin, veuillez répondre aux questions suivantes : 1 Êtes-vous malade aujourd’hui ? Oui Non

2

Avez-vous déjà ressenti les effets suivants à la suite de l’administration d’un vaccin contre la grippe ? (veuillez toute case pertinente) : Aucun

Respiration sifflante ou serrement dans la poitrine Oui Non Difficulté à respirer ou à avaler Oui Non Éruption cutanée Oui Non Hospitalisation Oui Non Syndrome de Guillain-Barré Syndrome Oui Non Enflure ailleurs qu’au point d’injection Oui Non Autre réaction sévère Oui Non (Précisez): __________________________________

3 Êtes-vous allergique à ? (veuillez toute case pertinente) :

Oeufs Oui Non Gentamicine Oui Non Gélatine Oui Non Arginine Oui Non

4 Votre respiration est-elle sifflante en ce moment ou avez-vous été examiné par un professionnel de la santé pour une respiration sifflante au cours des 7 derniers jours ? Oui Non

5 Avez-vous un historique d’asthme sévère (c.-à-d. prenez-vous un médicament oral ou respiratoire pour l’asthme ou une respiration sifflante ?) Si oui, veuillez préciser : _______________________________________________ Oui Non

6 Prenez-vous actuellement de l’aspirine ou un médicament contenant de l’aspirine ? Oui Non

7 Votre système immunitaire est-il affaibli ou suivez-vous un traitement contre le cancer ? Si oui, veuillez préciser : Oui Non

8 Êtes-vous en contact rapproché avec une personne dont le système immunitaire est affaibli ou qui reçoit un traitement contre le cancer ? Si oui, veuillez préciser : ______________________________________________ Oui Non

9 Êtes-vous enceinte ou existe-t-il une chance que vous le soyez ? Oui Non

Si vous avez Oui à l’une ou l’autre des cases ci-devant, veuillez discuter avec l’infirmier/ère. _________________________________________________________________________________________________ Nom en lettres moulées Signature du client, du parent ou tuteur Date (jj/mm/aaaa) Les enfants âgés entre 2 ans et de moins de 9 ans qui n’ont jamais été immunisés contre la grippe saisonnière doivent recevoir 2 doses à 4 semaines d’intervalles. Sinon, une seule dose est requise.


Dose Date Heure Dose Route Vaccin No de lot Signature & désignation

1 ______/______/______ jj mm aaaa 0.2

ml Vaporisateur nasal

(0.1 ml par narine) QIV FLUMIST®

2 ______/______/______ jj mm aaaa 0.2

ml Vaporisateur nasal

(0.1 ml par narine) QIV FLUMIST®

CONSENTEMENT POUR LE Quadrivalent FLUMIST® : J’ai lu ou quelqu’un m’a expliqué le contenu de la fiche d’information du quadrivalent FLUMIST®. J’ai eu l’occasion de poser des questions et les réponses se sont avérées satisfaisantes. Je comprends les avantages et les risques du vaccin. Je consens à ce que le quadrivalent FLUMIST® soit administré à : mon enfant, la personne sous ma tutelle ou moi-même

FLUMIST® Quadrivalent Consent Form – French (revised August 2015)

ᐋᓐᓂᐊᖃᕐᓇᖏᑦᑐᓕᕆᔨᒃᑯᑦ

ᓱᓕᔪᑦ ᑎᑎᕋᖅᓯᒪᔪᑦ

Fluzone Quadrivalent Vaccine Fact Sheet - Inuktitut – August 2015

ᓄᕙᓗᐊᕐᓂᕐᒧᑦ ᑲᐱᔭᐅᓂᖅ

ᓄᕙᓗᐊᕐᓂᕐᒧᑦ ᑲᐱᔭᐅᓂᖅ (ᓄᕙᒃ)? ᓄᕙᖕᓂᖅ ᐊᒃᑐᕐᓇᖅᑑᕗᖅ ᓱᖃᐃᒻᒪᑦ ᒪᒥᓐᓇᖏᒻᒪᑦ. ᐅᒃᑐᖅᑕᐅᓇᖅᐳᖅ ᖁᐃᖅᓱᓇᖅᑐᒃᑯᑦ, ᑕᒋᐊᓂᒃᑯᑦ ᐅᕝᕙᓘᓐᓃᒃ ᑲᒃᑭᒃᑯᓘᓂ.

ᐋᓐᓂᐊᖑᕗᑦ: ᐆᑎᕐᓇᕐᓂᖅ, ᖁᐃᖅᓱᕐᓂᖅ, ᓂᕆᒍᒪᖏᓐᓂᖅ, ᓄᑭᕐᓗᖕᓂᖅ, ᐃᒡᒋᐊᕐᓗᖕᓂᖅ ᐊᒻᒪ ᑕᖃᓗᐊᕐᓂᖅ.

ᓄᕙᒐᔪᒃᐳᑦ ᐊᑯᓐᓂᐊᓂᒃ ᓄᕕᑉᐱᕆ ᒪᐃᒥᓪᓗ, ᑭᓯᐊᓂᒃ ᓄᕙᒐᔪᖕᓂᖅᓴᐅᕗᑦ ᔭᓐᓄᐊᕆ ᕖᕝᕗᐊᕆᒥᓪᓗ.

ᑭᓇ ᑲᐱᔭᐅᔪᓐᓇᖅᐸ? ᑭᓇᑐᐃᓐᓇᖅ ᑕᖅᑭᓂᒃ 6−ᓂᒃ ᐅᑭᐅᖃᖅᑐᖅ ᑲᐱᔭᐅᔪᓐᓇᖅᑐᖅ ᓄᕙᖕᒧᑦ.

ᓱᕈᓰᑦ 9−ᓂᒃ ᐅᑭᐅᖃᖅᑐᖅ ᑐᖔᓂᒃ, ᓯᕗᓪᓕᕐᐹᒥᒃ ᑲᐱᔭᐅᔪᓐᓇᖅᑐᖅ, ᒪᕐᕈᐃᖅᓱᕐᓗᒍ ᐃᓗᓕᖃᖅᑐᒥᒃ, ᑎᓴᒪᓂᒃ ᐱᓇᓱᐊᕈᓰᑦ ᖃᖏᖅᑎᓪᓗᒍ, ᓴᐳᑎᔭᐅᔪᓐᓇᖅᐳᖅ.

ᓄᓇᕗᒥᑦ ᓱᕈᓰᑦ ᐅᑭᐅᖃᖅᑐᑦ 2-ᒥᑦ 17-ᒧᑦ ᓱᕐᓗᒃᑯᑦ ᑎᖕᒥᑳᕐᕕᐅᔪᓐᓇᖅᑐᑦ ᑕᐃᔭᐅᓪᓗᓂ FluMist® −ᒥᑦ ᑕᑯᓗᒍ ᑖᓐᓇ ᓇᓗᓇᐃᓯᒪᔾᔪᑎᒦᑦᑐᖅ ᕿᑐᕐᖓᑦ ᐊᔪᖏᑦᑐᖅ.

ᑭᓱ ᐃᑲᔫᑎᔪᓐᓇᖅᐸ ᑲᐱᔭᐅᓗᓂ? ᓄᓇᕗᒥᐅᓄᑦ ᓴᐳᑎᔭᐅᔪᓐᓇᖅᐳᑦ ᓄᕙᓕᖁᓇᒋᑦ.

ᓄᓇᓕᖕᓂᒃ ᓴᐳᒻᒥᔪᓐᓇᖅᐳᑦ ᑖᒃᑯᐊᓗ ᐊᑦᑕᕐᓇᖅᑐᒦᑦᑐᑦ ᓄᕙᒡᔪᐊᕐᓂᕐᒧᑦ.

ᓄᕙᒡᔪᐊᕐᓂᕐᒧᑦ ᐋᓐᓂᐊᕕᓕᐅᕈᑎᐅᖃᑦᑕᖅᐳᖅ ᑐᖁᔾᔪᑎᐅᔪᓐᓇᖅᖢᓂᓗ, ᐱᓗᐊᖅᑐᒥᒃ ᑖᒃᑯᐊ ᐊᑦᑕᕐᓇᖅᑐᒦᕐᔪᐊᖅᑐᓄᑦ.

ᑭᓇᖕᒪᑦ Fluzone QIA ᐊᑦᑕᕐᓇᖅᐹ? ᐄ. ᐊᑦᑕᕐᓇᕐᓂᖅᐹᖑᕗᑦ ᐋᓐᓂᐊᖅᖢᑎᒃ ᐊᐅᐸᖅᓯᕙᒃᖢᑎᒡᓗ ᓇᐅᒃᑯᑦ ᑲᐱᔭᐅᓚᐅᕐᓂᕐᒥᓂᒃ. ᐆᑎᕐᓇᒐᔪᒃᐳᑦ, ᐅᐃᕐᖓᖅᖢᑎᒃ, ᓂᐊᖁᓂᖅ ᐅᕝᕙᓘᓐᓃᑦ ᓄᑭᕐᓗᖕᓂᖅ. ᑖᓐᓇ ᑲᐱᔭᐅᓂᖅ ᑕᐃᒪᐃᒐᔪᒃᑐᖅ ᐊᑦᑕᕐᓇᖅᐹ ®

QIA?

ᐄ, ᑲᐱᔭᐅᕝᕕᒋᓚᐅᖅᑕᖓᓂᒃ ᐊᒃᑐᖅᑕᐅᒐᔪᒃᑐᑦ ᐋᓐᓂᐊᖅᖢᑎᑦ, ᐊᐅᐸᖅᓯᒡᓗᑎᓪᓗ. ᐃᓛᓐᓂᒃᑯᑦ ᐅᑎᕐᓇᖅᓯᓇᖅᑐᑦ, ᑕᖃᑲᑕᓕᖅᖢᑎᒃ, ᓂᐊᖁᙳᓪᓕᑎᓪᓗᒍ, ᓄᑭᕐᓗᓕᖅᖢᑎᒡᓘᓐᓃᑦ. ᑕᐃᒪᐃᒐᔪᒃᐳᑦ ᑲᐱᔭᐅᔭᕇᖅᑐᓄᑦ ᐊᒻᒪ ᐋᓐᓂᐊᒧᑦ ᑎᒦᑦ ᐅᓇᑕᐅᑎᓕᐅᖅᑐᖅ. ᑲᐱᔭᐅᔪᑦ ᖃᓄᐃᓕᒐᔪᖏᑦᑑᒐᓗᐊᑦ ᐃᓄᐃᑦ.

ᑲᐱᔭᐅᔪᓕᒫᑦ ᑎᒥᒧᑦ ᓈᒻᒪᒋᔭᐅᒐᔪᖏᑉᐳᑦ ᑕᐃᔭᐃᓗᑎᒃ ᐊᓇᐱᓚᒃᓯ. ᐊᓇᐱᓚᒃᓯ ᓴᖅᑭᒐᔪᒃᐳᑦ, ᐱᖑᔭᓕᖅᖢᑎᒃ, ᐊᒥᕐᓗᓕᖢᑎᒃ, ᖃᓂᕐᓗᓕᖅᖢᑎᒃ, ᐊᓂᖅᑎᕆᒐᓕᖅᖢᑎᒡᓗ. ᑕᐃᒪᐃᒐᔪᒃᐳᑦ 15 ᒥᓇᒥᑦ ᑲᐱᔭᐅᔭᕇᖅᓯᒪᓕᖅᑎᓪᓗᒋᑦ. ᖃᖓᑐᐃᓐᓇᒃᑯᑦ ᑲᐱᔭᐅᔭᕇᖅᓯᒪᓕᖅᑎᓪᓗᒋᑦ ᐋᓐᓂᐊᕕᖕᒥᖏᓐᓇᖁᔭᐅᓯᐅᖑᕗᑦ 15-ᒥᓇᒥᒃ ᑲᐱᔭᐅᔭᕇᖅᓯᓕᖅᑎᓪᓗᒋᑦ. ᐊᓇᐱᓚᒃᓯ ᐃᓅᓕᓴᖅᑕᐅᔪᓐᓇᖅᑐᖅ ᐊᒻᒪ ᐋᓐᓂᐊᓲᖅᑎ ᐃᓕᓐᓂᐊᖅᑎᑕᐅᓯᒪᕗᖅ ᑲᒪᒋᔭᕆᐊᒃᓴᖓᓂᒃ.

ᑲᐱᔭᐅᓚᐅᖅᑎᓐᓇᒋᑦ ᐋᓐᓂᐊᓲᖅᑎ ᐊᐱᕆᔭᐅᔭᕆᐊᖃᖅᑐᖅ? ᐋᓐᓂᐊᓲᖅᑎ ᐅᖃᐅᑎᓪᓗᒍ ᕿᑐᕐᖓᑦ ᐃᕝᕕᓘᓐᓃᑦ ᐅᑯᓂᖓ ᐃᒪᓐᓇᐃᓕᓐᓂᕈᓂ:

• ᑎᒦᑦ ᐱᐅᒃᓴᕈᓐᓃᖅᐸᑦ ᑎᒥᕈᓴᓪ, ᕗᒪᑐᕼᐃᑦ, ᑎᕆᑕᓐ® X-100 ᐅᕝᕙᓘᓐᓃᑦ ᓇᓕᐊᖕᓂᑐᐃᓐᓇᖅ ᑲᐱᔭᐅᔪᖃᖅᑎᓪᓗᒍ.

• ᓯᕗᓂᐊᓂᑦ ᑎᒥᑦ ᐱᐅᒃᓴᖏᕐᔪᐊᓂᕈᓂ ᑲᐱᔭᐅᑎᓪᓗᑎᑦ. • ᖃᓄᑐᐃᓐᓇᖅ ᐊᐅᓕᕐᓂᕈᕕᑦ. • ᕗᐃᓚᐃᓐ ᐋᓐᓂᐊᖅ (ᒋᐱᓴ –ᐱᕋᓪᐃᑎᒃᒧᑦ ᐋᓐᓂᐊᕐᔪᐊᓕᕈᓂ) ᓯᕗᓂᐊᓂ

ᓄᕙᔾᔭᐃᑯᑎᒧᑦ ᑲᐱᔭᐅᓐᓂᕈᓂ ᐱᓇᓱᐊᕈᓯᕐᓂᒃ 6-ᓂᒃ. • ᐆᑎᕐᓇᕐᔪᐊᓕᕈᕕᑦ.

ᑭᓱ ᐊᑦᑕᕐᓇᕐᔪᐊᕋᔭᖏᑉᐸ ᓄᕙᒡᔪᐊᒧᑦ ᑲᐱᔭᐅᓂᖅ? 400−800−ᓗᐊᖑᕗᑦ ᑲᓇᑕᒥᐅᑕᑦ ᑐᖁᖃᑦᑕᖅᑐᑦ ᐊᕐᕌᒍᑕᒫᖅ ᓄᕙᕐᔪᐊᒧᑦ. ᐅᓄᖅᑐᑦ ᖃᓂᒻᒪᖃᑦᑕᖅᐳᑦ ᑲᒪᒋᔭᐅᔭᕆᐊᖃᓕᖅᖢᑎᒡᓗ ᐋᓐᓂᐊᕕᖕᒥᑦ. ᐃᒥᓂᒃ ᓴᐳᑎᓯᒪᒋᑦ, ᕿᑐᕐᖓᑦ ᓄᓇᓯᓪᓗ ᑕᔅᓱᒥᖓ ᐋᓐᓂᐊᖅᑕᖁᓇᒋᑦ.

ᑲᐱᔭᐅᔭᕇᖅᑎᓪᓗᑎᒃ ᑲᒪᒋᔭᐅᓂᖅ

• ᐃᓅᓕᓴᕋᓱᓕᕐᓂᕈᕕᑦ ᐆᑎᕐᓇᕐᓗᑎᑦ ᓄᑭᕐᓗᒃᑯᕕᓪᓗ ᐃᒃᐱᖕᓇᐃᕐᓗᑎᓂᕐᓗᑎᒡᓗ, ᐊᓯᑕᒥᓄᐸᓐ (ᑕᐃᓕᓅ, ᑕᒻᐳᕋ) ᐅᕝᕙᓘᓐᓃᑦ ᐃᐳᕈᕕᓐ (ᐋᕕᐅ, ᒨᑐᕋᓐ). ᓱᕈᓯᕐᓄᑦ, ᐋᓐᓂᐊᓲᖅᑎᒧᑦ ᖃᓄᑎᒋ ᖃᐃᑦᑎᒐᔭᕐᒪᖔᑦ ᐃᓗᓕᖓᓂᒡᓘᓐᓃᑦ.

• ᐋᔅᐳᕋᓐ (ASA) ᑐᓂᔭᐅᒋᐊᖃᖏᑦᑐᖅ 20−ᓂᒃ ᐊᕐᕌᒍᓖᑦ ᑐᖔᓂ ᐊᑦᑕᕐᓇᕐᓂᖓᓄᑦ ᕋᐃ ᐋᓐᓂᐊᖅ, ᖃᕋᓴᕐᒧᑦ ᐱᐅᔪᓐᓂᑲᐅᑎᒋᓇᕐᒪᑦ ᐊᒻᒪ ᑐᖁᔾᔪᑕᐅᔪᓐᓇᖅᖢᓂ.

• ᐃᒃᐱᖕᓇᐃᕐᔪᐊᓕᕐᓂᕈᕕᑦ ᓲᕐᓗ ᖃᓂᕐᓗᒡᓗᑎᑦ, ᖃᓂᒃᑯᑦ, ᐱᖑᔭᓕᕐᓂᕈᕕᑦ ᐅᕝᕙᓘᓐᓃᑦ ᖀᖅᓱᕐᓗᑎᒃ ᑐᐊᕕᕐᓇᖅᑐᒃᑯᕕᖕᒧᐊᕐᓗᑎᒃ ᐅᕝᕙᓘᓐᓃᑦ ᐋᓐᓂᐊᕕᖕᒧᓪᓘᓐᓃᑦ.

• ᐊᐱᖅᑯᑎᖃᑐᐊᕈᕕᑦ, ᐅᕝᕙᓘᓐᓃᑦ ᐃᓱᒫᓗᒃᑯᕕᓘᓐᓃᑦ ᑲᐱᔭᐅᖃᐅᔭᕐᓄᑦ ᖃᓄᐃᓕᑳᓪᓚᒡᓗᑎᑦ, ᐋᓐᓂᐊᓲᖅᑎᒧᑦ ᐅᖃᓪᓚᖃᑎᖃᕐᓗᑎᒃ.

ᑕᑕᑎᕐᓗᒍ ᐅᕝᕙᓘᓐᓃᑦ ᑐᕌᕈᑕ ᐊᔾᔨᙳᐊᖅ ᑎᑎᖅᓯᒪᔭᖓᓗ ᓇᓗᓇᐃᒃᑯᑕ: ᐊᑎᕈᓯᐊᖅ: _______________________________

ᐊᑎᖅ: _______________________________ (ᐊᕐᓇᖅ/ᐊᖑᑦ): ________________________________

ᐃᓅᕕᐊ (ᐅᓪᓗᖅ/ᑕᖅᑭᖅ/ᐊᕐᕉᒍᐊ): ________________________ ᑎᑎᖅᑳ #: __________________________________ ᐅᑭᐅᖓ: ___________________________________

ᓄᓇᖓ: __________________

ᐊᕐᕌᒍᑕᒫᖅ ᓄᕙᓗᐊᕐᓂᕐᒧᑦ ᐊᖏᕈᑎᒥᒃ ᑕᑕᑎᒐᒃᓴᖅ

ᑲᐱᔭᐅᓂᖅ ᓄᕙᓗᐊᔾᔭᐃᑯᑎᒥᒃ ᐋᓐᓂᐊᕇᒃᑯᓯᖅᑕᐅᓯᒪᓂᕐᒧᑦ)

ᑲᐱᔭᐅᔪᒧᑦ ᑭᐅᔭᐅᔭᕆᐊᓖᑦ:

1 ᐅᓪᓗᒥ ᖃᓂᒪᕖᑦ? ᐄ ᐋᒃᑲ

2

ᐅᑯᓂᖓ ᓄᕙᓗᐊᔾᔭᐃᒃᑯᑎᒧᑦ ᑲᐱᔭᐅᓚᐅᖅᓯᒪᕖᑦ (ᑕᑕᑎᖅᑕᐃᓐᓇᕆᓗᒋᑦ ): ᐃᒪᓐᓇᐃᓚᐅᖅᓯᒪᖏᑦᑐᖓ

ᐊᓂᖅᑎᕆᒐᖃᑦᑕᖅᐲᑦ ᐅᕝᕙᓘᓐᓃᑦ ᐄᓯᔪᓐᓇᐃᓕᖃᑦᑕᖅᐲᑦ ᐄ ᐋᒃᑲ ᓄᕙᖅᐸᓪᓕᐊᖃᑦᑕᖅᐲᑦ ᐅᕝᕙᓘᓐᓃᑦ ᓴᒡᕖᑦ ᒥᑭᒃᓕᑳᓪᓚᖃᑦᑕᖅᐹ ᐄ ᐋᒃᑲ ᖃᓂᕐᓗᒃᐲᑦ ᐅᕝᕙᓘᓐᓃᑦ ᐃᒡᒋᐊᕐᓗᒃᐱᑦ ᐄ ᐋᒃᑲ ᐋᓐᓂᐊᕕᖕᒨᖅᑕᐅᓚᐅᖅᐲᑦ ᐄ ᐋᒃᑲ Guillain-Barré Syndrome ᐄ ᐋᒃᑲ ᐊᓯᖏᓪᓗ ᐃᒃᐱᖕᓇᐃᕐᔪᐊᖅᖢᑎᑦ ᐄ ᐋᒃᑲ ________________________________________________________________(ᓇᓗᓇᐃᕐᓗᒍ): _________________________________

3 ᐊᐅᑲᑕᖃᑦᑕᖅᐲᑦ? ᐄ ᐋᒃᑲ ᐊᐅᖕᓄᑦ ᒥᒃᖠᐊᕈᑎᖃᖅᐲᑦ? ᐄ ᐋᒃᑲ

4 ᐄᔭᒐᕐᓄᑦ ᐱᐅᒃᓴᖏᑉᐲᑦ (ᑕᑕᑎᖅᑕᐃᓐᓇᕆᓗᒋᑦ ):

ᑎᒥᕉ ᐄ ᐋᒃᑲ ᕗᒪᑎᓐᕼᐊᑕ ᐄ ᐋᒃᑲ ᑎᕆᐅᑕᓐ X100 ᐄ ᐋᒃᑲ ᓇᓕᐊᖕᓂᑐᐃᓐᓇᖅ ᖁᓛᓂᑦᑐᒥᒃ ᑎᑎᕋᕈᕕᐅᒃ ᐃᒪᓐᓇ ᐋᓐᓂᐊᓲᖅᑎᒧᑦ ᐅᖃᖃᑎᖃᕆᑦ.

_________________________________________________________________________________________________ ᐊᑎᓕᐅᕐᓗᑎᑦ ᐊᑎᓕᐅᕈᓯᐊ ᐋᓐᓂᐊᕕᓕᐊᖅᑐᒧᑦ ᐅᕝᕙᓘᓐᓃᑦ ᐊᖓᔪᖅᑳᕆᔭᐅᔪᒧᑦ/ᐸᖅᑭᔨᒧᑦ ᐅᓪᓗᖅ (ᐅᓪᓗᖅ/ᑕᖅᑭᖅ/ᐊᕐᕌᒍᑦ) ᓱᕈᓰᑦ ᐊᑲᓐᓂᖓᓂᒃ ᐅᑭᐅᓖᑦ 2 ᐊᒻᒪ 9 ᑐᖔᓂᒃ, ᑲᐱᔭᐅᓚᐅᖅᓯᒪᖏᑦᑐᒥᒃ ᓄᕙᓗᐊᕐᓂᕐᒧᑦ, ᒪᕐᕈᐃᖅᓱᕐᓗᒍ ᐃᓚᖃᕐᓗᓂ, ᑎᓴᒪᓂᒃ ᐱᓇᓱᐊᕈᓰᖕᓂᒃ ᖄᖏᐅᑎᒃᐸᑦ. ᐄᖑᑲᓪᓚᒃᐸᑦ ᐊᑕᐅᓯᕐᒥᑦ ᐱᖁᔭᐅᓯᒪᕗᑦ.

ᑕᖅᑭᓂᒃ 4−ᓂᒃ ᐅᑭᐅᖃᓚᐅᖏᑦᑐᑦ ᓱᓕ

ᐃᓗᓕᖏᑦ ᐅᓪᓗᐊ ᐃᑲᕋ ᐃᓗᓕᖏᑦ ᓇᐅᒃᑯᑦ ᑲᐴᑎ ᓇᓕᖃᖓᑕ ᓈᓴᐅᑕ ᐊᑎᕈᓯᐊ ᓇᒦᓂᖓᓗ

1 ______/______/______

ᐅᓪᓗᖅ ᑕᖅᑭᖅ ᐊᕐᕌᒍᑦ 0.5 mL IM ᓄᕙᒡᔪᐊᕐᓇᖅᑐᒥᑦ

ᑲᐴᑎ

2 ______/______/______ ᐅᓪᓗᖅ ᑕᖅᑭᖅ ᐊᕐᕌᒍᑦ 0.5mL IM

ᓄᕙᒡᔪᐊᕐᓇᖅᑐᒥᑦ ᑲᐴᑎ

ᐊᖏᕈᑎ ᑲᐱᔭᐅᓗᓂ ᓄᕙᓗᐊᔾᔭᐃᑯᑎᕐᒥᑦ: ᐅᖃᓕᒫᖃᐅᕙᕋ ᓇᓗᓇᐃᖅᓯᒪᔮᓂᒡᓘᓐᓃᑦ ᓄᕙᓗᐊᔾᔭᐃᑯᑎᒥᒃ ᑲᐱᔭᐅᓂᖅ. ᐊᐱᕆᔪᓐᓇᖅᓯᖃᐅᕗᖓ ᑭᐅᔭᑦᑎᐊᖅᖢᑎᒃ. ᑐᑭᓯᕗᖓ ᑲᐱᔭᐅᒍᒪᑦ ᐃᑲᔫᑎᐅᔪᓐᓇᖅᑐᖅ ᐊᑦᑕᕐᓇᑐᐃᓐᓇᕆᐊᖃᖅᖢᓂᒡᓗ. ᐅᖁᔨᕗᖓ ᓄᕙᓗᐊᔾᔭᐃᑯᑎᒥᒃ ᐆᒧᖓ: ᕿᑐᕐᖓᓄᑦ, ᐸᐸᑕᕐᓂᒃ ᐅᕝᕙᓘᓐᓃᑦ ᐅᕙᖓ

FLUZONE® Quadrivalent Consent Form – Inuktitut (revised August 2015)

Department of Health

Fact Sheet

Fluzone Quadrivalent Vaccine Fact Sheet - English - August 2015

® Fluzone® Quadrivalent Influenza Vaccine

What is Influenza (flu)? Influenza (flu) is a contagious disease caused by the influenza virus. It spreads through coughing, sneezing or nasal fluids.

Symptoms include: fever, cough, loss of appetite, muscle aches, sore throat and feeling very tired.

People usually get the flu between November and May, but flu season most often peaks in January or February.

Who can receive the vaccine? Anyone over 6 months of age should be vaccinated against the flu.

Children younger than 9 years old, getting the vaccine for the first time, should get 2 doses, at least 4 weeks apart, to be protected.

Children in Nunavut aged 2-17 can receive a nasal spray vaccine called FluMist® - see the FluMist® fact sheet to see if your child is eligible.

What are benefits of the vaccine? It protects Nunavummiut from getting sick with Influenza.

It protects the community and those most at risk of complications from influenza.

Influenza can lead to hospitalization and even death, especially for those at highest risk.

Is Fluzone® QIV safe? Yes. The most common side effects are pain and redness at the injection site. Occasionally it can cause fever, tiredness, headache or sore muscles. This is a

normal reaction to the vaccine and indicates that your body is making antibodies to the disease. Many people have no side effects at all from the vaccine.

With all vaccines, there is a very rare chance of a severe allergic reaction called anaphylaxis. Anaphylaxis appears as hives, rash, swelling of the mouth, difficulty breathing. This type of reaction typically occurs within 15 minutes of receiving a vaccine. It is recommended you stay in the clinic for 15 minutes after getting any vaccine. Anaphylaxis can be treated and your healthcare provider is trained to treat it.

Who should talk with their healthcare provider before getting the vaccine? Tell your health care provider if you or your child has any of the following:

• Allergy to thimerosal, formaldehyde, Triton® X-100 or any ingredient of the vaccine.

• A previous serious reaction to any vaccine. • Any condition that makes you bleed more. • Guillain-Barre Syndrome (GBS – a severe

paralytic illness) within 6 weeks of a previous flu vaccine.

• A serious illness with fever.

What is the risk of not getting the Influenza vaccine? It is estimated that 4000 – 8000 Canadians die each year from Influenza. Many more become sick and need special care in the hospital. Protect yourself, your children and the community from this preventable disease.

Fluviral® Vaccine After Care

• To control fever and relieve soreness or muscle aches, you can take Acetaminophen (Tylenol, Tempra) or Ibuprofen (Advil, Motrin). For children, give the amount recommended by your health care provider or on the bottle.

• Aspirin (ASA) should NOT be given to anyone under 20 years of age due to the risk of Reye Syndrome, which can cause permanent brain damage and death.

• If you experience any serious side effects such as swelling of the mouth/lips, hives or seizures please visit your emergency department or health center immediately.

• If you have any questions, or are concerned about a reaction from the vaccine, talk with your health care provider.


Seasonal Influenza Vaccine Consent Form (FLUZONE® Quadrivalent (QIV) for IM injection)

For the person receiving the vaccine, please answer: 1 Are you sick today? Yes No

2

Have you ever experienced any of the following after an influenza vaccine (please all that apply): None

Wheezing or chest tightness Yes No Difficulty breathing or swallowing Yes No Swelling of the mouth or throat Yes No Hospitalization Yes No Guillain-Barré Syndrome Yes No Other severe reaction Yes No (specify): _________________________________

3 Do you have bleeding problems? Yes No Do you take blood thinners? Yes No

4 Are you allergic to (please all that apply) :

Thimerosal Yes No Formaldehyde Yes No Triton® X100 Yes No If you Yes to any above, please discuss with nurse.

_________________________________________________________________________________________________ Print Name Signature of Client or Parent/Legal Guardian Date (dd/mm/yyyy) Children between the ages of 2 and less than 9 years old, who have never been immunized against influenza, require 2 doses, 4 weeks apart. Otherwise only one dose is required.

Ages > 6 months


1 ______/______/______ dd mm yyyy 0.5 mL IM FLUZONE® QIV

2 ______/______/______ dd mm yyyy 0.5mL IM FLUZONE® QIV

CONSENT FOR FLUZONE® Quadrivalent: I have read or had the FLUZONE® Quadrivalent Fact Sheet explained to me. I have had a chance to ask questions which were answered to my satisfaction. I understand the benefits and risks of the vaccine. I consent to FLUZONE® Quadrivalent being given to: My Child, My Ward or Myself

FLUZONE® Quadrivalent Consent Form – English (revised August 2015)

Munarhiliqiyikkut

Kangiqhidjutit

Fluzone Quadrivalent Vaccine Fact Sheet - Inuinnaqtun - September 2015

Fluzone® Quadrivalent Influenza-mik Kapukhiqniq Hunaungman Influenza-mik? Influenza-mik hiamitiqtaaqtuq aanniarut Influenza-mik qalaqtuigaangat, tagyugaangat, qingnaqnin kuhiqtainaligaangat.


Inuit annialaqivaktun uuminga Tarium Hikutirvia Qiqaiyarluarvia, kihimi flu-paktun Ubluqtuhivia uvanillu Idjirurvia.

Kitkun pigiaqaqtun kapukhiqnirnik? Inuit kituliqaak inuuqaqtun avatqukhunik siksinik tatqikhiutingnik kapuqhigiaqaqtun flu-mit.

Nutaqqat nukakhiit nainik ukiunik, kapuqhiktut hivulliqpaamik, kapuqhiqtauyukhat malruiqtuqhutik, taima 4nik havainirnik avatqutkaaqlugu, munagiyauyarangat.

Nutaqqat Nunavunmi ukiuqaqtun 2nik 17mun pigiaqaqtun Fluzone Quadrivalent.- takulugu tamna Fluzone Quadrivalent kangiqhidjutikhaq titiraq pigiaqagumi nuttaran.

Hunauyut pidjutikhat kapukhirnikkut? Munaridjutikhaqaqtuq Nunavunmiunun aanniaqnaitumik Influenza-min

Munaqhihimaaqtuq nunalaanun tapkunungalu ayungnautiqaluaqtun Influenza-min.

Influenza aanniaryuaqnaqtuq ilaani aanniaqvingmungaqtitivaktuq huiqtitivakhunilu, tapkunungaluaq aanniaqtaaqtunuanut

Tamna Fluzone® QIV qayangnaituq? Hii. Naunaitqiaq ayungnautikhangit imaatun itun kuhiqtalaqivaktuq qinngat, niriyumahuiqhutik, hakuikhutik, niqqaingit hayulaqivaktun, kidjakhutiklu.

Taimailinniaqtun kapuqhiruvit taima timit havakyualikman havautikharnik timingnun piyarangat aanniarutingnik. Ilaani uvinirlungnahitivaktuq aulaqitivakhunilu qingakkut. Amiriyariaqaqtun inuit ayungnautiqangitun kapuqhiqnirmin.

Tamainik kapuqhirninin, ayungnautiqaluangitun inuuhirnun taivagaat anaphylaxis-mik. Anaphylaxis-ngit naunairutiqaqpaktuq muqpanuatun itutun uvinirlungnirpaktun, kilaalaqivakhutik, puvipkakhutik qanirmun, anirniqlukhutiklu. Imailivaktut 15nik minutemi kapuqhirnirmin. Ihumaliugiikhimayuq taima munaqhitkunni itukhauyut 15nik minutesnik kapuqhigiigumik. Tamna Anaphylaxis-mik inuk atuligumi munagiyaugiaqaqtun talvani munaqhitkuni ayuigiikhimayut hanaqiyaangat taimailigaiqagumi.

Kina uqagiaqaqtuq munaqhinun kapuqhiqtinanik? Uqallautilugu munaqhitkun ayungnautiqaqqa ilvit nuttaran iihigigaangat ukuninga titiraqhimayut atani:

• Ayungnautiqaqtunut, thimerosal-nik, formaldehyde-nik, Triton® X-100-nik taimaituqaqqan havautingni kapuutingni.

• Ayungnautiqaqpaktuq kingulirmin kapukhirnirmin. • Kinguniklu aulaqitaalaqiyaaqtunik. • Guillain-Barre Syndrome -qaqgumik (GBS –

inimikkut pilimaitkumik) taima siksinik havainirnik qalalaqiyunut kapuqhingnikkut.

• Aanniarutiqaqqan kidjaumarutiqagumik.

Hunauva ayungnautigiyaingit kapuqhingitkumi qalaliqinaitumik kapuutingnik? Nallautiqhimayuq taima 4 tausinik 8 tausinikluuniit Kanitianmiutat inungnik tuquvaktun ukiuk tamaat Influenza-min. Amigaitun aannialaqivaktun piqaqpaktunlu ikayukharnik aanniarvingmni. Munagilugu nuttaran nunalaangitlu uuminga ihuaqhagiaqaqtunik aanniarutmin.

Fluviralmin Kapuqhirniq Munagidjutikhaq

• Munagiyaangat kidjaumaninga aniqnaiqyumigiangat niqqaingit, havautituqtitigiaqaqtan, ullugianaitkutikharnik (Tylenol-mik, Tempra-mikluuniit) ullugianaiyautikharnikluuniit havautmik (Advil-mik, Motrin-mikluuniit). Nutaqqanut, tunilugit havautitugiaqaqtainik munaqhinin atuquyainik havautiminluuniit.

• Havautit Aspirin-ngit (ASA) tuniyakhaungitun inungnun ukiuqangitunik 20nik taima ayungnautiqaqniaqmanik imaitumik aanniarutmik Reye Syndrome-mik, taima qillaminuaq hunngiyainiaqtun qaritarmun huigiaqaqtunluuniit.

• Akuktauguvit ayungnautingnik taimaitunik puvipkaknirnik qanirmun/umilrungnunlu, uvinirlingnikmik, qiqhiyunikluuniit, upautilugit amigaqhutigiaqaqtunik aanniaqviit munaqhitkunluuniit qillaminuaq.

• Apiqqutikhaqaruvit, ihumaaluutiqaguvitluuniit akuktaurutingnin kapuqhirnirmin, uqaqqatigilugit munaqhitkut.

Munarhiliqiyikkut

Kangiqhidjutit

Fluzone Quadrivalent Vaccine Fact Sheet - Inuinnaqtun - September 2015

Fluzone® Quadrivalent Influenza-mik Kapukhiqniq Hunaungman Influenza-mik? Influenza-mik hiamitiqtaaqtuq aanniarut Influenza-mik qalaqtuigaangat, tagyugaangat, qingnaqnin kuhiqtainaligaangat.


Inuit annialaqivaktun uuminga Tarium Hikutirvia Qiqaiyarluarvia, kihimi flu-paktun Ubluqtuhivia uvanillu Idjirurvia.

Kitkun pigiaqaqtun kapukhiqnirnik? Inuit kituliqaak inuuqaqtun avatqukhunik siksinik tatqikhiutingnik kapuqhigiaqaqtun flu-mit.

Nutaqqat nukakhiit nainik ukiunik, kapuqhiktut hivulliqpaamik, kapuqhiqtauyukhat malruiqtuqhutik, taima 4nik havainirnik avatqutkaaqlugu, munagiyauyarangat.

Nutaqqat Nunavunmi ukiuqaqtun 2nik 17mun pigiaqaqtun Fluzone Quadrivalent.- takulugu tamna Fluzone Quadrivalent kangiqhidjutikhaq titiraq pigiaqagumi nuttaran.

Hunauyut pidjutikhat kapukhirnikkut? Munaridjutikhaqaqtuq Nunavunmiunun aanniaqnaitumik Influenza-min

Munaqhihimaaqtuq nunalaanun tapkunungalu ayungnautiqaluaqtun Influenza-min.

Influenza aanniaryuaqnaqtuq ilaani aanniaqvingmungaqtitivaktuq huiqtitivakhunilu, tapkunungaluaq aanniaqtaaqtunuanut

Tamna Fluzone® QIV qayangnaituq? Hii. Naunaitqiaq ayungnautikhangit imaatun itun kuhiqtalaqivaktuq qinngat, niriyumahuiqhutik, hakuikhutik, niqqaingit hayulaqivaktun, kidjakhutiklu.

Taimailinniaqtun kapuqhiruvit taima timit havakyualikman havautikharnik timingnun piyarangat aanniarutingnik. Ilaani uvinirlungnahitivaktuq aulaqitivakhunilu qingakkut. Amiriyariaqaqtun inuit ayungnautiqangitun kapuqhiqnirmin.

Tamainik kapuqhirninin, ayungnautiqaluangitun inuuhirnun taivagaat anaphylaxis-mik. Anaphylaxis-ngit naunairutiqaqpaktuq muqpanuatun itutun uvinirlungnirpaktun, kilaalaqivakhutik, puvipkakhutik qanirmun, anirniqlukhutiklu. Imailivaktut 15nik minutemi kapuqhirnirmin. Ihumaliugiikhimayuq taima munaqhitkunni itukhauyut 15nik minutesnik kapuqhigiigumik. Tamna Anaphylaxis-mik inuk atuligumi munagiyaugiaqaqtun talvani munaqhitkuni ayuigiikhimayut hanaqiyaangat taimailigaiqagumi.

Kina uqagiaqaqtuq munaqhinun kapuqhiqtinanik? Uqallautilugu munaqhitkun ayungnautiqaqqa ilvit nuttaran iihigigaangat ukuninga titiraqhimayut atani:

• Ayungnautiqaqtunut, thimerosal-nik, formaldehyde-nik, Triton® X-100-nik taimaituqaqqan havautingni kapuutingni.

• Ayungnautiqaqpaktuq kingulirmin kapukhirnirmin. • Kinguniklu aulaqitaalaqiyaaqtunik. • Guillain-Barre Syndrome -qaqgumik (GBS –

inimikkut pilimaitkumik) taima siksinik havainirnik qalalaqiyunut kapuqhingnikkut.

• Aanniarutiqaqqan kidjaumarutiqagumik.

Hunauva ayungnautigiyaingit kapuqhingitkumi qalaliqinaitumik kapuutingnik? Nallautiqhimayuq taima 4 tausinik 8 tausinikluuniit Kanitianmiutat inungnik tuquvaktun ukiuk tamaat Influenza-min. Amigaitun aannialaqivaktun piqaqpaktunlu ikayukharnik aanniarvingmni. Munagilugu nuttaran nunalaangitlu uuminga ihuaqhagiaqaqtunik aanniarutmin.

Fluviralmin Kapuqhirniq Munagidjutikhaq

• Munagiyaangat kidjaumaninga aniqnaiqyumigiangat niqqaingit, havautituqtitigiaqaqtan, ullugianaitkutikharnik (Tylenol-mik, Tempra-mikluuniit) ullugianaiyautikharnikluuniit havautmik (Advil-mik, Motrin-mikluuniit). Nutaqqanut, tunilugit havautitugiaqaqtainik munaqhinin atuquyainik havautiminluuniit.

• Havautit Aspirin-ngit (ASA) tuniyakhaungitun inungnun ukiuqangitunik 20nik taima ayungnautiqaqniaqmanik imaitumik aanniarutmik Reye Syndrome-mik, taima qillaminuaq hunngiyainiaqtun qaritarmun huigiaqaqtunluuniit.

• Akuktauguvit ayungnautingnik taimaitunik puvipkaknirnik qanirmun/umilrungnunlu, uvinirlingnikmik, qiqhiyunikluuniit, upautilugit amigaqhutigiaqaqtunik aanniaqviit munaqhitkunluuniit qillaminuaq.

• Apiqqutikhaqaruvit, ihumaaluutiqaguvitluuniit akuktaurutingnin kapuqhirnirmin, uqaqqatigilugit munaqhitkut.

Feuille de renseignements

Fluzone Quadrivalent Vaccine Fact Sheet - French – August 2015

Ministère de la Santé

Vaccin antigrippal Fluzone® Quadrivalent Qu’est-ce que la grippe? La grippe est une maladie contagieuse causée par le virus de la grippe qui se propage par la toux, les éternuements ou les sécrétions nasales. Les symptômes sont les suivants : fièvre, toux, perte d’appétit, douleurs musculaires, mal de gorge et fatigue. La grippe circule en tout temps de novembre à mai, mais atteint habituellement des pics en janvier et février. Qui peut se faire vacciner? Toute personne de 6 mois et plus devrait se faire vacciner contre la grippe.

Les enfants de moins de 9 ans qui reçoivent le vaccin pour la première fois ont besoin de 2 doses, à au moins 4 semaines d’intervalle, afin d’être protégés. Les enfants du Nunavut âgés de 2 à 17 ans peuvent recevoir un vaccin antigrippal administré à l’aide d’un vaporisateur nasal appelé FluMist® - veuillez consulter la fiche d’information sur le FluMist® si votre enfant est admissible.

Quels sont les avantages du vaccin? Il protège les Nunavummiut contre la grippe. Il protège la collectivité et les personnes à risque de complications en raison de la grippe. La grippe peut entraîner l’hospitalisation et même la mort pour les personnes les plus à risque.

Le vaccin antigrippal Fluzone® Quadrivalent est-il sécuritaire? Oui. Une certaine douleur et la présence d’une rougeur au site de l’injection sont les effets secondaires les plus fréquents. Certaines personnes peuvent ressentir de la fatigue, des maux de tête ou des douleurs musculaires. Il s’agit d’une réaction normale au vaccin qui indique que

votre corps développe des anticorps à la maladie. Beaucoup de gens ne ressentent aucun effet secondaire.

Il est très rare qu’une grave réaction allergique appelée anaphylaxie se produise. Voici les principaux symptômes d’anaphylaxie : urticaire, éruption cutanée, enflure de la bouche, difficultés respiratoires. Ce type de réactions se produit habituellement dans les 15 minutes suivant la vaccination. Il est donc recommandé de rester à la clinique au moins 15 minutes après la vaccination. L’anaphylaxie se traite et votre professionnel de la santé est formé pour la traiter.

Qui devrait consulter un professionnel de la santé avant de recevoir le vaccin antigrippal? Veuillez informer votre professionnel de la santé si vous présentez ou votre enfant présente l’une des conditions suivantes :

• Allergie au thimérosal, au formaldéhyde, au Triton® X-100 ou tout ingrédient du vaccin.

• Une réaction sérieuse antérieure à tout vaccin. • Toute condition qui vous fait saigner davantage. • Syndrome de Guillain-Barré (SGB – une

maladie paralytique grave) dans les six semaines suivant l’administration d’un vaccin antérieur contre la grippe.

• Une maladie grave accompagnée de fièvre.

Quel est le risque de ne pas recevoir le vaccin antigrippal? On estime que de 4 000 à 8 000 Canadiens meurent chaque année de la grippe. Plusieurs personnes atteintes ont besoin de soins spéciaux à l’hôpital. Protégez-vous, et protégez vos enfants et la collectivité contre cette maladie évitable.

Soins parfois requis après le vaccin antigrippal Fluzone® Quadrivalent

• Pour contrôler la fièvre et soulager un endolorissement ou des douleurs musculaires, vous pouvez prendre de l’acétaminophène (Tylénol, Tempra) ou de l’ibuprofène (Advil, Motrin). Dans le cas des enfants, veuillez donner la quantité recommandée par votre fournisseur de soins de santé ou sur la bouteille.

• Il ne faut PAS donner d’aspirine (ASA) à des personnes de moins de vingt ans en raison des risques de syndrome de Reye qui peut causer des lésions permanentes au cerveau et même la mort.

• Si vous éprouvez des effets secondaires graves comme l’enflure de la bouche ou des lèvres, de l’urticaire ou des convulsions, rendez-vous immédiatement à l’urgence ou au centre de santé de votre collectivité.

• Si vous avez des questions ou des préoccupations concernant une réaction au vaccin, veuillez en parler avec votre fournisseur de soins de santé.


Formulaire d’autorisation

pour l’administration du vaccin contre la grippe saisonnière (Quadrivalent FLUZONE® (QIV) pour injection IM)

S’adresse à la personne recevant le vaccin, veuillez répondre aux questions suivantes : 1 Are you sick today? Oui Non

2

Avez-vous déjà ressenti les effets suivants à la suite de l’administration d’un vaccin contre la grippe ? (veuillez toute case pertinente) : Aucun

Respiration sifflante ou serrement de poitrine Oui Non Difficulté à respirer ou à avaler Oui Non Enflure de la bouche ou de la gorge Oui Non Hospitalisation Oui Non Syndrome de Guillain-Barré Oui Non Autre réaction sévère Oui Non (veuillez préciser): _________________________________

3 Souffrez-vous de saignements ? Oui Non Prenez-vous des médicaments pour éclaircir le sang ? Oui Non

4 Êtes-vous allergique à ? (veuillez toute case pertinente) :

Thimérosal Oui Non Formaldéhyde Oui Non Triton® X100 Oui Non

Si vous avez Oui à l’une ou l’autre des cases ci-devant, veuillez discuter avec l’infirmier/ère. _________________________________________________________________________________________________ Nom en lettres moulées Signature du client, du parent ou tuteur Date (jj/mm/aaaa) Les enfants âgés entre 2 ans et de moins de 9 ans qui n’ont jamais été immunisés contre la grippe saisonnière doivent recevoir 2 doses à 4 semaines d’intervalles. Sinon, une seule dose est requise.

Âge > 6 mois

Dose Date Heure Dose Route Vaccin No de lot Signature & désignation

1 ______/______/______ jj mm aaaa 0.5 ml IM FLUZONE® QIV

2 ______/______/______ jj mm aaaa 0.5ml IM FLUZONE® QIV

CONSENTEMENT POUR LE quadrivalent FLUZONE®: J’ai lu ou quelqu’un m’a expliqué le contenu de la fiche d’information du quadrivalent FLUMIST®. J’ai eu l’occasion de poser des questions et les réponses se sont avérées satisfaisantes. Je comprends les avantages et les risques du vaccin. Je consens à ce que le quadrivalent FLUZONE® soit administré à :

mon enfant, la personne sous ma tutelle ou moi-même.

FLUZONE® Quadrivalent Consent Form – French (revised August 2015)

Documents

11.0 Specialized and Annual Immunization Protocols (in … · 2016. 11. 10. · Nursing mothers. It is not known whether FluMist is excreted in human milk. Severe asthma (defined