H1N1 Consent Letter download
H1N1 Consent Form download
"What you need to know" download
Posted October 23, 2009
As you may have heard, a new influenza virus, called the
2009 H1N1 influenza virus, was first identified in the United States in late
April 2009. The virus has caused
illness ranging from mild to severe, including hospitalizations and deaths in
adults and children. Many children have gotten 2009 H1N1 infection and there
have been large outbreaks in some schools across the country. The Centers for
Disease Control and Prevention’s (CDC) Advisory Committee on Immunization
Practices has recommended that children and young adults aged 6 months through
24 years be vaccinated against 2009 H1N1 as soon as the vaccine is
available. Other groups
recommended to get the first doses of 2009 H1N1 influenza vaccine are:
People who live with or care for children younger than 6 months of age
Health care providers and emergency medical services workers
People ages 25 through 64
years who have underlying chronic medical conditions that may complicate flu
symptoms, such as HIV, diabetes, or heart or lung disease (including asthma).
Vaccination is the best way to protect your child from this
potentially serious disease. The
Greater Sullivan County Public Health Network, in conjunction with the Lake
Sunapee Visiting Nurse’s Association and Hospice, are working with your child’s
school to give the 2009 H1N1 influenza vaccine to children at school. We will hold vaccination clinics
beginning this fall, and your child’s school will let you know the specific
dates once vaccine is on hand. Children 9 AND UNDER are expected to need
two doses of vaccine spaced about 3-4 weeks apart. There will be no cost to you or the
school district for this vaccine. Parents should be checking the DISTRICT
website which will be updated as soon as dates are available.
The “Vaccine Consent Form” included in this mailing allows
you to either accept or refuse the vaccination for your child. If you refuse, the vaccination will not
be given to your child. To accept
the vaccination, you can read the “WHAT YOU NEED TO KNOW” flyer included with
this letter about the disease and the vaccine. You must then sign and date the included consent form to
accept vaccination for your child and return it to the school. If you accept vaccination, the vaccine
will be given to your child when it is on hand. School staff will let you know when the vaccination clinic
will take place about one week before.
If, at any time, you change your mind about having your child
vaccinated, you must contact your child’s school nurse, who will send you
another “Vaccine Consent Form” for you to complete again indicating your
change. Giving consent early will
ensure that your child is ready to receive the vaccine as soon as it is on
Please realize there are two other ways you may be able to
get your child vaccinated for the H1N1 virus. Your child’s health care provider can answer your questions
about the 2009 H1N1 influenza virus, will be able to give your child the seasonal
influenza vaccine and may be able to give your child the 2009 H1N1
vaccine. You may also be able to
get your child vaccinated at one of the regional “Points of Distribution” (POD)
that will be set up around the state.
As soon as we know the dates, times and locations of these regional
PODs, we will send that information home to you.
If you have any questions about the vaccine, for general
public health related questions, including H1N1, please call 603-271-4496 (8:30
AM - 4:30 PM regular business days), or 603 –271 –5300, or 1-800-852-33345 ext.
5300 after hours. You may also
look for information on the NH Department of Health and Human Services website
at www.dhhs.state.nh.us. Please also visit the CDC’s 2009 H1N1
influenza web sites at http://www.cdc.gov/h1n1flu/
for more information especially for parents.
If you have any questions about the school vaccination
clinics, please contact your child’s school nurse.
Archived H1N1 Information
Last Modified on 7/12/2011 11:58:04 AM