预防接种证-英文.doc

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1、wordScraping the coat, input the code to inquire true and falseFor China Mobile, sending short message 9500024 to inquireShenyang Center for Disease Control and PreventionSupervised by Liaoning Anti-fake CenterNoticeVaccines uniformly provided by Shenyang Center for Diseases Control and Prevention a

2、re pasted with special supply identification, and please check in the process of vaccination. Vaccinate by the Certificate, SafekeepingThis certificate is uniformly made by Shenyang Center for Disease Control and Prevention, and is distributed for free. Shenyang Immunization RecordShenyang Center fo

3、r Disease Control and Prevention 11 / 11Bacillus Calmette Guerin vaccine has been vaccinated, the infant shall be reviewed on the first Monday when the infant was born for 4 monthsGuide to Parents1. According to the regulations of Article XII of “Law on the Prevention and Control of Infectious Disea

4、ses of Peoples Republic of China and “The State Implements Immunization Certificate System, our city will uniformly use Shenyang Immunization Record. 2. Immunization record is the effective proof for children to receive vaccination according to the law. When the newborn is born, the parents or guard

5、ians shall timely apply to transact the immunization procedures to the delivery unit or immunization medial health unit. 3. For each immunization of the children, the parents or guardians shall hold this certificate to vaccinate for children in designated location, vaccination outpatient clinic, vac

6、cination station, or village health center. 4. Children can enroll in a nursery, kindergarten, school, or going abroad by this certificate. If the children do not have this certificate or do not vaccinate according to this certificate, they must re-register this certificate and re-vaccinate, otherwi

7、se the formalities will not be transacted5. When the household registrations of the children are migrated or live in new regions away from home, the parents or guardians shall hold this certificate to transact the immigration formalities in the designated location, vaccination outpatient clinic, vac

8、cination station, or village health center, and returning to the place original residence to transact the emigration formalities6. This certificate shall be kept well. If the certificate is damaged or lost, the parents or guardians shall apply re-issuance to the local region or or village health cen

9、ter. 7. After vaccination, the children may have slight fever, local pain or red and swollen, which are the normal reaction and can fade within 3 days. If there are abnormal conditions after vaccination, please timely report to the vaccination unit and go to medical unit to receive symptomatic treat

10、ment8. When the relevant departments examine the vaccination work, the parents or guardians shall show this certificate for inspection. When the infant was born for a month, two or three hepatitis B vaccines shall be injected on Tuesday or Thursday of the first week at outpatient clinic of registere

11、d residences location.Shenyang Center for Disease Control and PreventionNo.: SZ-0504Name of Child: Qianhao Yu Sex: Male Date of Birth: March 15, 2005 Weight of Birth: 3,500g Address:Residence Address: County / District Street / VillagePlace of Work / School Tel: Juveniles who are under the age of 16

12、 should fill the following informationParents name: father: Zhiqun Yu Mother: Jing LuWorking Unit: Farther Mother Telephone No.: Farther Mother Date of removal: Year Month DayAddress of removalCounty / DistrictWhether insurance or not Date of issue: March 25, 2005 The issuing Authority (Seal): Sheny

13、ang Huanggu Central HospitalVaccination Public BoardName of vaccinesDiseases that can preventsVaccinated populationPrice of vaccinationBacillus Calmette Guerin vaccineTuberculosisNewbornFreeHepatitis B vaccine5ug)Hepatitis BNewborn 0, 1 and 6 monthsFreePoliomyelitis vaccinePoliomyelitis2, 3, 4 month

14、s, 1.52 years old, 4 years oldFreeMeasles Attenuated Live VaccineMeasles8 months, 1.5-2 years old, 6 years oldFreePertussis-Diphtheria-Tetanus triple vaccinePertussis, diphtheria, tetanus3, 4, 5months, 1.5-2 years oldFree, acellular pertussis diphtheria tetanus vaccine shall be paid.Tetanus-diphther

15、ia bined VaccineDiphtheria, tetanus6 years oldFreeEpidemic encephalitis BvaccineEpidemic encephalitis B2 vaccinations at early period of 6 months -1.5 years old are no need; separately intensify once at 2 years old and 6 years oldFree,but Vero cells epidemic encephalitis B shall be paid.Group A Meni

16、ngococcal polysaccharide vaccineEpidemic cerebrospinal meningitis (Group A)Separately vaccinate once at 1, 2, 4 and 6 years oldFreeGroup A+C Meningococcal polysaccharide vaccineEpidemic cerebrospinal meningitis (Group A+C)Above 2 years oldSelf-pay (including insurance)Hepatitis B vaccine10ug)Hepatit

17、is BAll the populationSelf-payHepatitis B hyper-immune globulinHepatitis BNewborn, accidentally infected population, pregnant of hepatitis B virus carrierSelf-payHepatitis A vaccineHepatitis AAbove 1 years old Self-payLive Attenuated Varicella vaccineVaricella, herpes zosterAdult / 6-13 years old /

18、2-5 years old childrenSelf-payHaemophilus Influenzae type B vaccineChildren pneumonia, meningitis caused by Haemophilus Influenzae type B, etc.2 months - 5 years oldSelf-pay23-valent pneumococcal polysaccharide vaccinePneumonia, meningitis, otitis media, etc. caused by pneumococcusVaccinate 3 times

19、for 6 months old (2 months, 3 months and 4 months); vaccinate 2 times for 6 months old - 1 yearold; vaccinate once for 1 yearold to 5 years oldSelf-payVaccine by lysis of influenza virusInfluenza, etc.caused by influenza virus Vaccinate once at 5 years oldSelf-payInfluenza vaccine cleavage vaccineMe

20、asles, rubella, mumpsAbove 2 years oldSelf-payMeasles and rubellabivalent vaccineMeasles, rubellaAbove 6 months oldSelf-payMeasles, mumpsbivalentvaccineMeasles, mumpsAbove 1 years oldSelf-payAttenuated live rubella vaccineRubellaAbove 1 years oldSelf-payBivalent live vaccine capsule of dysenteryBaci

21、llary dysenteryAbove 8 months oldSelf-payLive oral rotavirus vaccineInfantile rotavirus diarrheaAbove 1 years oldSelf-payNotes: The charge vaccines uniformly distributed by Shenyang Center for Disease Control and Prevention are pasted with uniform mark, persons who are vaccinated should pay attentio

22、n to check.The injection cost is RMB 2.0 (LJF (2003) No. 35), and RMB 0.9 will be collected for self-destruction syringe if needed. Informed Consent Form for Vaccination Program Immune VaccineCategory of VaccinesContraindicationReactionHepatitis B vaccinePersons who suffer from hepatitis, fever, acu

23、te or chronic disease, serious skin eczema, preterm low body weight, serious viscera deformity and allergic history are forbidden to use this vaccine.Slight reaction, a few people will have blush and induration in the position of vaccine injection, and will fade away in 2-3 days. There is generally

24、no whole body reaction, and very few persons will appear chilly or low fever, and individual is reported to have urticarial. Poliomyelitis vaccine1. Persons who have immunodeficiency or are in the period of accepting the therapy of immunosuppressant is forbidden to get vaccinated. 2. Persons who are

25、 allergic to milk or milk products are forbidden to get vaccinated.3. Persons who have fever or diarrhea (defecate more than 4 times a day) or suffer from acute infectious disease is forbidden to get vaccinated. Only very few infants will have transient diarrhea after being vaccinated, and will self

26、-cure. Measles vaccinePersons who have serious diseases, fever or allergic history (especially who are allergic to eggs) are forbidden to get vaccinated. There is no reaction in partial body after rejection. A few persons may have fever, and generally will not exceed 2 days, and someone will have sp

27、oradicrash.Pertussis-diphtheria-tetanus triple vaccine1. Persons who have epilepsy, nervous system disease or convulsions history are forbidden to get vaccinated.2. Persons who have acute infectious disease (including rehabilitation stage) or fever are postponed to get vaccinated. 1. Local part may

28、appear red, pain and tickle or low fever, fatigue, headache, etc. Generally, there is no need of special treatments, and the symptoms will fade spontaneously. 2. Aseptic suppuration3. If reaction of the whole body is severe, the persons who get vaccinated shall go to hospital for diagnosis and treat

29、ment. 4. Diphtheria, tetanus and acellular pertussis bined vaccine: the whole body reaction or local reaction is very slight.Epidemic meningitis vaccine1. Persons who have nervous system disease and mental disease are forbidden to get vaccinated. 2. Persons who have serious disease, such as kidney d

30、isease, heart disease, active tuberculosis, etc. are forbidden to get vaccinated.3. Persons who have acute infectious disease and feverare forbidden to get vaccinated.After rejection, the reaction is alight, and a few people have short-time fever, which often happens at 6 8 hours after vaccination.

31、Local is flush and the pressure pain, and will gradually fade after vaccinationEpidemicencephalitis B vaccinePersons who have fever, acute infectious disease, otitis media, heart, kidney, liver disease, active tuberculosis, allergic history or convulsions history are forbidden to get vaccinated; per

32、sons who have promised immune system or are accepting immunosuppressive therapy are forbidden to get vaccinated. After rejection, generally there is no reaction, and a very few persons will have local flush, sometimes have fever, rash, allergic shock, angioedema, etc. Informed Consent Form for Vacci

33、nation Program Immune Vaccine (1)1. HIB: hemophilus influenzae B conjugate vaccine 2. Hepatitis A vaccinePreventable diseases: infectious diseases caused byhemophilus influenzae B (meningitis, pneumonia,septicemia, phlegmon, arthritis, epiglottitis, etc.)Preventable diseases: Hepatitis AContraindica

34、tion1. Allergic people who are known to be allergic with some content of the vaccine, especially to tetanus toxoid, or allergic with inoculation of previous vaccine.2. The inoculation shall be delayed during active stage of fever or acute diseases, especially infectious diseases or chronic diseases.

35、3. Normal reactions of immunization that can be reduced byimmunosuppressive therapy andimmunodeficiency.Hepatitis A inactivationHepatitis A attenuationContraindication1. Patients who have Hepatitis and other serious diseases.2. Patients of febrile diseases shall delay the inoculation. 3. People who

36、are known to be allergy for any content of the vaccine.1. People who are not feeling good and the body temperature is over 37.5 .2. People who have acute infectious disease or other serious diseases.3. People who suffer from idiopathic and acquired immune deficiency.4. People who are receivingimmuno

37、suppressive therapy.5. Pregnant women and people of allergic constitution.Possible reactions after inoculation1. Partial reactions of injection positions: pain, rubefaction or inflammation. In general, this partial reaction is early-stage, transient and slight, and sometimes atypical rash can be obs

38、erved.2. Extremely unusual cases may appear edema of lower extremity, along with cyanosis or transient purpura. This reaction usually appears within the first few hours after inoculation, and usually quickly disappears spontaneously without any sequela; there are usually no symptoms of disease and r

39、espiratory system, and this occasion often appears during simultaneous inoculation with other vaccines.3. Unusual allergy reaction cases may appear in face or throat; rubella alike rash, pruritus and edema.4. Systematic symptoms: fever (usually lower than 39), and enhanced excitability and crying ap

40、pear more often. Possible reactions after inoculation1. Partial side reactions are usually pain, and sometimes red & swollen, and indurate.2. Systematic side reactions include headache, fever, nausea, etc. The duration is usually less than 24 hours, and can relieve by self.3. The expectant treatment

41、 shall be made in time for allergy reaction.No partial or systematic untoward effect after inoculation of Hepatitis A attenuation inactivation vaccine.Protective effect95%Signature of visiting doctor: Date: Signature of visiting doctor: Date:Signature of parent (s): Date: Signature of parent (s): Da

42、te:Informed Consent Form for Vaccination Program Immune Vaccine (2)3. MMR vaccine 4. Chicken pox attenuation and inactivation vaccinePreventable diseases: measles, mumps, rubella.Preventable diseases: water mark herpes zoster.ContraindicationPeople who have serious diseases, acute and chronic infect

43、ion, fever or allergic history with eggs shall not inoculate.Pregnant women are forbidden to use, fertile women who inoculate shall avoid pregnancy within 3 months after inoculation.DomesticImportedContraindication1. People who have serious diseases and fever shall delay the inoculation.2. People wh

44、o have allergy history and pregnant women shall be forbidden to use.3. Patients ofleukemia, tumor, immunodeficiency, etc. shall use with caution under doctors guidance.1. Same with other vaccine, people who have acute serious fever diseases shall delay the inoculation, however, for healthy people, s

45、light infection is not immune contraindication.2. People whose total lymphocyte is less than 1200 / mm3 or proved to lack cellular immune function shall be forbidden to use.3. People who are known as hypersensitive with neomycin shall be forbidden to use, but people who have contact dermatitis with

46、neomycin are not included in the contraindication.4. Forbidden to use in pregnancy duration.Possible reactions after inoculation1. Within 6 to 11 days, few children may appear transient fever reaction or slight rash which will automatically relieve less than 2 days.2. Adult women occasionally appear

47、 slight arthralgia, and need no special treatment normally. Expectant treatment can be made when necessary.Possible reactions after inoculation1. Usually no side reaction after injection, occasionally with slight partial reaction.2. Rarely seen slight or medium fever, transient eruption for less than 3 days. Expectant treatment can be made when necessary.1. Healthy people: prehensive reactogenicity of all th