Immunizations

Please check with your local Pharmacy.  Not all vaccines are available at all locations.  After verifying that your pharmacy has the vaccine you need in stock, save time by printing and completing the vaccine consent form below.  Bring it with you to the pharmacy along with your prescription insurance card, if applicable.

Flu

  • What is the flu?

    Influenza (the flu) is a contagious virus that spreads throughout the U.S. between October and May each year.  It is spread mostly by coughing, sneezing, and close contact.  The flu can strike quickly and last several days.  Common symptoms include fever/chills, sore throat, muscle aches, fatigue, cough, headache, and runny/stuffy nose.  Anyone can get the flu, though certain people including infants & children, people over 65, pregnant women, and people with weakened immune systems are at a higher risk for serious flu complications.  Each year thousands of people die from the flu and many more are hospitalized.  The best way to prevent the flu is by getting an annual flu shot.

  • Who needs the vaccine?

    The CDC recommends that all people 6 months of age and older receive an annual flu vaccine as long as they have no known contraindications.  This is especially important for young children, older people, and those with certain medical conditions.  

  • Flu Vaccine Consent Form

Pneumonia

Shingles

  • What is the Shingles?

    Shingles is a very painful rash, often with blisters, that usually occurs on one side of the face or body.  The rash lasts 2-4 weeks on average, but 1 out of 5 people experience severe nerve pain long after the rash clears up. Shingles is caused by the herpes zoster virus – the same virus that causes the chickenpox.  Anyone who has had the chickenpox can get shingles.  Shingles is more common in people age 50 and older than it is in younger people.  Those with weakened immune systems due to cancer or certain medications or chemotherapy are more susceptible to getting shingles.

  • Who needs the vaccine?

    The shingles vaccine is currently recommended for people age 60 and up.  However, the FDA has approved the vaccine beginning at age 50.  People who are pregnant, have weakened immune systems, or are allergic to gelatin, neomycin, or any other component of the vaccine should not receive the shingles vaccine.  Those with an acute illness and fever of 101.3° or higher should hold off getting the vaccine until they recover.   

  • Vaccine Consent Form

Tetanus, Diphtheria (Td)

  • What is Tetanus and Diphtheria?

    Tetanus and Diphtheria, though not common in the U.S., can both lead to severe complications in those affected.  Both are caused by bacteria.  Diphtheria spreads from person to person through secretions from coughing or sneezing, while tetanus-causing bacteria enters the body through cuts, scratches, or wounds.  Diphtheria can cause a thick coating to develop in the back of the throat leading to breathing problems, heart failure, paralysis, or death.  Tetanus, also known as lockjaw, causes painful muscle tightening and stiffness.  Tetanus kills about 1 out of every 10 people infected even with medical care.

  • Who needs the vaccine?

    The Td vaccine protects adolescents and adults.  A booster is recommended every 10 years, but it can also be given earlier after a severe burn or wound.  Another vaccine, Tdap, can be given in place of a single Td booster. Those with an allergy to any part of the vaccine, or those who have had a serious, life-threatening reaction after receiving a tetanus or diphtheria-containing vaccine, should not receive not get Td vaccine.  

  • Vaccine Consent Form

Tetanus, Diphtheria, Pertussis (Tdap)

  • What is Tetanus, Diphtheria, and Pertussis?

    Tetanus, Diphtheria, and Pertussis are very serious diseases.  The Tdap vaccine can help protect us from all 3.  Tetanus, also known as lockjaw, causes painful muscle tightening and stiffness.  Tetanus kills about 1 out of every 10 people infected even with medical care.  Diphtheria can cause a thick coating to develop in the back of the throat leading to breathing problems, heart failure, paralysis, or death.  Pertussis (whooping cough) can cause severe coughing spells which can cause difficulty breathing, vomiting, and disturbed sleep.  These diseases are all caused by bacteria.  Diphtheria and Pertussis both spread from person to person through secretions from coughing or sneezing, while tetanus-causing bacteria enters the body through cuts, scratches, or wounds.  

  • Who needs the vaccine?
    • Tdap vaccine can protect adolescents and adults from tetanus, diphtheria, and pertussis. One dose of Tdap is routinely given at age 11 or 12.  People who did not get Tdap at that age should get it as soon as possible.  Tdap is especially important for health care professionals and anyone having close contact with a baby younger than 12 months. Pregnant women should get a dose of Tdap during every pregnancy, to protect the newborn from pertussis.  Infants are most at risk for severe, life-threatening complications from pertussis.  Tdap can also be given in place of a single Td vaccine, serving as a tetantus-booster.
    • Those with an allergy to any part of the vaccine, or those who have had a serious, life-threatening reaction after receiving a vaccine containing tetanus,  diphtheria, or pertussis, should not receive not get Tdap vaccine.  Anyone who had coma or long repeated seizures within 7 days after a childhood dose of DTP or DTaP, or a previous dose of Tdap, should not get Tdap, unless a cause other than the vaccine was found.  They can still get Td.
  • Vaccine Consent Form

Hepatitis A

  • What is Hepatitis A?

    Hepatitis A is a serious liver disease caused by the Hepatitis A Virus (HAV).  It is usually spread by close personal contact, but can also be transmitted by drinking water or eating food containing HAV.  Symptoms of Hepatitis A include jaundice (yellow skin or eyes, dark urine), flu-like illness, and severe stomach pains and diarrhea in children.

  • Who needs the vaccine?

    People who should be routinely vaccinated against Hepatitis A include children between their first and second birthday, anyone traveling to an area/country with a high prevalence of HAV, and other ‘high risk’ individuals, including people who use street drugs or have chronic liver disease (see CDC website for full list of vaccine indications).

  • Vaccine Consent Form

Hepatitis B

  • What is Hepatitis B?

    Hepatitis B is a serious liver disease caused by the Hepatitis B Virus.  It infects thousands of people in the U.S. each year, and it is not uncommon to have 2,000 – 4,000 people die each year from cirrhosis or liver cancer caused by Hepatitis B.  The virus is easily spread through contact with the blood or other bodily fluids of an infected person.  People can also be infected from contact with a contaminated object, where the virus can live for up to 7 days.  Short term (acute) symptoms of Hepatitis B include loss of appetite, tiredness, jaundice (yellowing of eyes, skin), pain in muscles, joints, and stomach, diarrhea and vomiting.  Many people go on to develop chronic Hepatitis B infection, though not all have symptoms.  Whether symptomatic or not, chronic infection is still very serious and can lead to liver damage (cirrhosis), liver cancer, and even death.

  • Who needs the vaccine?

    Children should receive their first Hepatitis B vaccine at birth, followed by 2 more vaccinations – one between 1-2 months of age and the last between 6-18 months of age.  Anyone age 18 or younger who didn’t previously receive the vaccine should also be vaccinated.  All unvaccinated adults at risk of Hepatitis B infection should be vaccinated.  Some people considered ‘high risk’ include:

    • People who inject street drugs
    • People with chronic liver or kidney disease
    • People with jobs that expose them to human blood or other bodily fluids

    Please refer to the full list of high risk individuals on the CDC’s website or ask your pharmacist or doctor if you may be at risk.

  • Vaccine Consent Forms

HPV/Cervical Cancer

  • What is HPV?

    Genital human papillomavirus (HPV) is the most common sexually transmitted virus in the U.S.  More than half of sexually active men and women are infected with HPV at some point in their lives. Most HPV infections cause little to no symptoms and can go away on their own.  However, HPV can cause cervical cancer in women, which is the 2nd leading cause of cancer deaths among women in the world. HPV is also associated with several less common cancers in both women and men.  The HPV vaccine can prevent most cases of cervical cancer in women if given before exposure to the virus.  It can also prevent vaginal and vulvar cancer in females, and genital warts and anal cancer in both males and females.

  • Who needs the vaccine?

    The HPV vaccine is recommended for girls and boys age 11-12, though it can be given to females age 13-26 and males age 13-21 who have not completed the 3 dose series.

  • Vaccine Consent Form

Measles, Mumps, Rubella (MMR)

  • What is MMR?

    Measles, mumps, and rubella are serious diseases that were very common (especially among children) prior to vaccines.  These diseases are spread from person to person through the air.  You can easily catch them by being around someone who is already infected.

    • Measles virus causes rash, cough, runny nose, eye irritation and fever.  It can lead to ear infections, pneumonia, seizures, brain damage and death.
    • Mumps virus causes fever, headache, muscle pain, loss of appetite and swollen glands.  It can lead to deafness, meningitis, painful swelling of the testicles or ovaries, and rarely sterility.
    • Rubella virus (German measles) causes rash, arthritis (mostly in women), and mild fever.  If a woman gets rubella while she is pregnant, she could have a miscarriage or her baby could be born with birth defects. 
  • Who needs the vaccine?

    Children should get two doses of the MMR vaccine.  The first dose should be given between 12-15 months of age, with the second dose usually given between 4-6 years of age.  Generally, anyone 18 years of age or older who was born after 1956 should get at least one dose of MMR vaccine, unless they can show that they have either been vaccinated or had all three diseases.  Pregnant women should not get the MMR vaccine.  People with a suppressed immune system due to cancer, HIV, medications (steroids) or those who have had recent blood transfusion or another vaccine (within past 4 weeks) should not get the vaccine, or may need to delay the vaccine until later.

  • Vaccine Consent Form

Meningitis

  • What is Meningitis?

    Meningococcal disease (meningitis) is a serious illness caused by bacteria that infect the covering of the brain and spinal cord.  Anyone can get meningococcal disease, but it is most common in infants less than one year of age and people 16-23 years.  College freshman living in dorms are also at an increased risk.

    Over 1000 people in the U.S. get meningococcal disease every year.  Even when treated with antibiotics, 10-15% of these people die.

  • Who needs the vaccine?

    Adolescents 11-18 years of age should receive two doses of the MCV4 meningitis vaccine, with the first doses given at 11 or 12 years of age. 

    Other people at increased risk for meningococcal disease include:

    • college freshman living in dormitories
    • U.S. military recruits
    • laboratory personnel who are routinely exposed to meningococcal bacteria
    • travelers to certain countries
    • anyone who has damage to their spleen or has had their spleen removed
    • people with certain immune disorders
    • people exposed to the bacteria during an outbreak.
  • Vaccine Consent Form

To learn more about vaccine recommendations provided by the CDC, please visit http://www.cdc.gov/vaccines/