Corporate June 2015

WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTÉ

INTERNATIONAL CERTIFICATE OF VACCINATION OR PROPHYLAXIS

RÉGLEMENT SANITAIRE INTERNATIONAL (2005)

INTERNATIONAL HEALTH REGULATIONS (2005)

CERTIFICAT INTERNATIONAL DE VACCINATION OU DE PROPHYLAXIE

Issued to Delivré á

Passport No. or Travel Document No. Numéro de passeport ou de la piéce justificative NOT VALID AS PROOF OF IDENTITY

THE CHECKLIST TO AVOID BEING ON THE SICK LIST Consult your Travel Doctor-TMVC Ensure your vaccinations are up to date Always carry your Travel Doctor-TMVC Medical Kit Take out travel insurance Avoid mosquitoes, flies and other biting insects Don’t go near or touch local animals Eat & drink safely boil it, peel it, cook it… or forget it!

Make sure you have adequate supplies of your regular prescription medications Respect local laws & customs Take anti-malarial pills if necessary Apply sunscreen regularly While travelling, follow the preventative health advice in The Travel Doctor-TMVC Health Guide for International Travellers Visit www.Smartraveller.gov.au when planning your holiday and before departing to register your travel plans Have a check-up on return if you’ve been sick or injured 3.67

No. of days lost

>4 4 3 2 1

Did you know around 18% of travellers lose at least 1 day of their trip to illness, with almost 4% losing 4 or more days of their trip?

0.69 3.21 4.36 5.96

TOTAL (at least 1 day lost) 17.89 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

% of travellers Source: The Travel Doctor-TMVC Welcome Home Survey

2

TH BU

Busi

Ensu and Mak your Ensu the e Seek prio Ensu Alwa Doct Mak expe obta Noti whil Requ expe Inter is so

avellers

THE BEST PRACTICE BUSINESS TRAVEL CHECKLIST

Business travellers should also be aware of the following

Ensure you have complied with your employer’s travel policy and administrative requirements Make sure your travel plans and contact details are known to your manager and next of kin prior to departure Ensure you have travel insurance and that you are familiar with the emergency contact details Seek a travel health consultation with The Travel Doctor-TMVC prior to departure as per company procedures Ensure your vaccinations are up to date prior to departure Always carry your Travellers’ Medical Kit provided by The Travel Doctor-TMVC Make sure your passport is valid at least six months past your expected return date and ensure any relevant visas have been obtained Notify your employer of any reportable incident that occurs while on overseas business Request support from your HR team or manager should you experience any difficulties as a result of overseas travel.

International travel can be stressful and psychological support is sometimes required

18

3

INTERNATIONAL CERTIFICATE* OF VACCINATION OR PROPHYLAXIS

CERTIF VACCIN

This is to certify that [name]

Nous certifions que [nom]

date of b ne(e) le

nationality

national

whose signature follows

has on t

et de nationalité dont la signature suit

documen

a éte vacc

against [name of disease or condition] contre: (nom de la maladie ou de l’affection)

in accordance with the International Health Regulations. conformément au Règlement sanitaire international.

VACCINE OR PROPHYLAXIS VACCIN OU AGENT PROPHYLACTIQUE

DATE DATE

SIGNATURE AND PROFESSIONAL STATUS OF SUPERVISING CLINICIAN SIGNATURE ET TITRE DU CLINICIEN RESPONSABLE

MANU AND B OF VAC OR PR

FABRIC VACCIN PROPHY NUMÉR

1.

2.

*REQUIREMENTS FOR VALIDITY OF CERTIFICATE ON PAGE 20 4

* VOIR LES

IONAL

CIEN

CERTIFICAT* INTERNATIONAL DE VACCINATION OU DE PROPHYLAXIE

date of birth ne(e) le

sex

sexe

national identification document, if applicable

has on the date indicated been vaccinated or received prophylaxis

document d’identification national, le cas échéant

a éte vacciné(e) ou a reçu des agents prophylactiques à la date indiqé

MANUFACTURER AND BATCH NO. OF VACCINE OR PROPHYLAXIS FABRICANT DU VACCIN OU DE L’AGENT PROPHYLACTIQUE ET NUMÉRO DU LOT

CERTIFICATE VALID FROM: UNTIL:

OFFICIAL STAMP OF ADMINISTERING CENTRE

CERTIFICAT VALABLE À PARTIR DU: JUSQU’ AU:

CACHET OFFICIEL DU CENTRE HABILITÉ

* VOIR LES CONDITIONS DE VALIDIEÉ À LA PAGE 20 5

INTERNATIONAL CERTIFICATE* OF VACCINATION OR PROPHYLAXIS VACCINE OR PROPHYLAXIS VACCIN OU AGENT PROPHYLACTIQUE

DATE DATE

SIGNATURE AND PROFESSIONAL STATUS OF SUPERVISING CLINICIAN SIGNATURE ET TITRE DU CLINICIEN RESPONSABLE

CERTIF VACCIN

MANU AND B OF VAC OR PR

FABRIC VACCIN PROPHY NUMÉR

3.

4.

5.

6.

7.

*REQUIREMENTS FOR VALIDITY OF CERTIFICATE ON PAGE 20 6

* VOIR LES

IONAL

CIEN

CERTIFICAT* INTERNATIONAL DE VACCINATION OU DE PROPHYLAXIE MANUFACTURER AND BATCH NO. OF VACCINE OR PROPHYLAXIS FABRICANT DU VACCIN OU DE L’AGENT PROPHYLACTIQUE ET NUMÉRO DU LOT

CERTIFICATE VALID FROM: UNTIL:

OFFICIAL STAMP OF ADMINISTERING CENTRE

CERTIFICAT VALABLE À PARTIR DU: JUSQU’ AU:

CACHET OFFICIEL DU CENTRE HABILITÉ

* VOIR LES CONDITIONS DE VALIDIEÉ À LA PAGE 20 7

OTHER VACCINATIONS AUTRES VACCINATIONS DISEASE TARGETED MALADIE VISÉE

DATE DATE

MANUFACTURER, BRAND NAME AND BATCH NO. OF VACCINE

NEXT B (DATE)

FABRICANT DU VACCIN, MARQUE ET NUMÉRO DU LOT

PROCHA (DATE):

8

S

NAME NE

NEXT BOOSTER (DATE)

UE ET

PROCHAIN RAPPEL (DATE):

OFFICIAL STAMP AND SIGNATURE CACHET OFFÌCIEL ET SIGNATURE

9

OTHER VACCINATIONS AUTRES VACCINATIONS DISEASE TARGETED MALADIE VISÉE

DATE DATE

MANUFACTURER, BRAND NAME AND BATCH NO. OF VACCINE

NEXT B (DATE)

FABRICANT DU VACCIN, MARQUE ET NUMÉRO DU LOT

PROCHA (DATE):

10

S

NAME NE

NEXT BOOSTER (DATE)

UE ET

PROCHAIN RAPPEL (DATE):

OFFICIAL STAMP AND SIGNATURE CACHET OFFÌCIEL ET SIGNATURE

11

OTHER VACCINATIONS AUTRES VACCINATIONS DISEASE TARGETED MALADIE VISÉE

DATE DATE

MANUFACTURER, BRAND NAME AND BATCH NO. OF VACCINE

NEXT B (DATE)

FABRICANT DU VACCIN, MARQUE ET NUMÉRO DU LOT

PROCHA (DATE):

12

S

NAME NE

NEXT BOOSTER (DATE)

UE ET

PROCHAIN RAPPEL (DATE):

OFFICIAL STAMP AND SIGNATURE CACHET OFFÌCIEL ET SIGNATURE

13

RABIES PRE-EXPOSURE DATE

NATURE OF VACCINE

DOSE IM OR ID

RABIES

BATCH

POST E

Rabies can be fatal if animal exposure is not treated immediately and precisely.

Be extremely wary of unqualified people telling you to wait and see. There have been cases of persons dying of rabies while the biting animal still appears well.

If you are bitten or scratched or licked by an animal, especially if behaving unusually, it is vital you: 1. Thoroughly cleanse the wound with soap and water. Encourage limited bleeding, do not stitch. Apply alcohol.

2. Seek medical advice as soon as possible. Try to obtain Human Diploid Cell Vaccine (HDCV). Other safe vaccines include Rabipur, Verorab, Lyssavac and Imovax Rabies Vero.

3. If you have been preimmunised you need two doses of the vaccine to boost your antibodies. You do not require additional rabies immunoglobulin (HRIG).

4. If you have not been pre immunised, you require a course of 5 injections of Human Diploid Cell Vaccine (HDCV). These vaccines are given in the arm. As the vaccine takes a little while to start working, in addition to the vaccine you require an injection of Human Rabies Immune Globulin (HRIG) 20IU per kg body weight to protect you from the disease while the vaccine takes effect. In order to be properly effective, half of the HRIG must be injected into the bite site.

5. Inform your Doctor on your return home.

14

HRIG 1. 0 2. 3 3. 7 4. 14 5. 28 6. 0

cisely. e have s well. g

BATCH NO.

PHYSICIAN’S SIGNATURE SIGNATURE DU MEDECIN

POST EXPOSURE HRIG 1. 0 2. 3

Cell c and

3. 7

oost your ). s of m. As ne you r kg body n order site.

4. 14 5. 28 6. 0

15

The following table outlines the usual duration of protection once the vaccination course is complete. For some vaccines, the duration of protection is uncertain.

VACCINE

DURATION OF PROTECTION

Chickenpox

No booster required after recommended schedule

Cholera (oral)

VACCIN

Mening

Pneum

Polio

Booster at 2 years

Q Feve Diphtheria

At least 10 years

Hepatitis A

Booster at after 6 months for probable lifelong immunity

Hepatitis B

No booster required after recommended schedule. Antibody check for high risk individuals

Rabies

Influenza

1 year

Japanese B Encephalitis

Booster at 2 years (Jespect) Booster at 5 years (Imojev, consider booster at 12 months for those <18 years of age)

Tetanu

Typhoi

Typhoi

Measles, Mumps, Rubella

No booster required after recommended schedule 16

Whoop (Pertu

Yellow

FOR SPEC

ce the n of

dy

ider

VACCINE

DURATION OF PROTECTION

Meningococcal Diseases

3 years (polysaccharide) At least 3 years (conjugate)

Pneumonia

5 years

Polio

Single adult booster only if needed

Q Fever

Lifelong

Rabies

Routine boosters not required. Boost at 2 years if in special high risk groups.

Tetanus

10 years, with a booster if a tetanus-prone wound occurs after more than 5 years

Typhoid (Injectable)

3 years

Typhoid (Oral)

3 years for 3 doses, 5 years for 4 doses

Whooping Cough (Pertussis)

Immunity starts to wane after 3-5 years

Yellow Fever

At least 10 years (Certificate valid for 10 years)

FOR SPECIFIC DETAIL CONSULT THE PRODUCT INFORMATION 17

CERTIFICATE OF VACCINATION

PERS

MENINGOCOCCAL A, C, W AND Y REQUIRED VACCINE FOR HAJJ PILGRIMS

BLOOD

NAME

G6PD A

has been vaccinated against meningococcal meningitis A, C, W & Y

ALLER

Y W C A Y W C A Y W C A DATE

SEROL

Y W C A

HEPAT

DOCTOR’S SIGNATURE & NAME (BLOCK CAPITALS)

HEP B

MEASL

MUMP

RUBEL

VARICE

18

PERSONAL MEDICAL INFORMATION PHYSICIAN’S SIGNATURE BLOOD GROUP

G6PD ACTIVITY

&Y

ALLERGIES & SENSITIVITIES

SEROLOGY

DATE DETECTED

HEPATITIS A ANTIBODIES HEP B SURFACE AB MEASLES ANTIBODIES MUMPS ANTIBODIES RUBELLA ANTIBODIES VARICELLA ANTIBODIES

19

TITRE

PHYSICIAN’S SIGNATURE

INTERNATIONAL CERTIFICATE OF VACCINATION OF PROPHYLAXIS

NOTE

REQUIREMENTS FOR VALIDITY

CHOLE

This certificate is valid only if the vaccine or prophylaxis used has been approved by the World Health Organization.

The requ was rem vaccinat provided other va

This certificate must be signed in the hand of the clinician, who shall be a medical practitioner or other authorised health worker supervising the administration of the vaccine or prophylaxis. The certificate must also bear the official stamp to the administering centre, however, this shall not be an accepted substitute for the signature.

Any amendment of the certificate, or erasure, or failure to complete any part of it, may render it invalid.

The validity of this certificate shall extend until the date indicated for the particular vaccination or prophylaxis. The certificate shall be fully completed in English or in French. The certificate may also be completed in another language in the same document in addition to either English or French.

NOTES The only disease specifically designated in the International Health Regulations (2005) for which proof of vaccination or prophylaxis may be required as a condition of entry to a State Party, is yellow fever.

When administering the vaccine, the clinician must write â&#x20AC;&#x153;Yellow Feverâ&#x20AC;? in the space provided on this certificate.

This same certificate will also be used in the event that these Regulations are amended or a recommendation is made under these Regulations by the World Health Organization to designate another disease.

20

YELLO

The inte yellow fe the Wor designa centre is

The valid beginnin a prophy prophyla

This cer or other official s

Any ame any part

SMALL

WHO de Smallpo

ATION

as been

shall be ising must r, this

plete

ed all be o be on to

alth s may ver. w

r ate

NOTE CHOLERA The requirement for an international certificate of cholera vaccination was removed from the International Health Regulations in 1973. If vaccination against cholera is performed it can be entered in the space provided for â&#x20AC;&#x2DC;Other vaccinationsâ&#x20AC;&#x2122; in this booklet, as is the case for other vaccinations.

YELLOW FEVER The international certificate of vaccination or prophylaxis against yellow fever is valid only if the vaccine used has been approved by the World Health Organization and if the vaccinating centre has been designated by the health administration for the territory in which that centre is situated.

The validity of this certificate shall extend for a period of ten years, beginning ten days after the date of vaccination or, in the event of a prophylaxis within such period of ten years, from the date of that prophylaxis.

This certificate must be signed in his own hand by a medical practitioner or other person authorised by the national health administration; his official stamp is not an accepted substitute for his signature.

Any amendment of this certificate, or erasure, or failure to complete any part of it, may render it invalid.

SMALLPOX WHO declared on 8 May 1980 that smallpox had been eradicated.

Smallpox vaccination is therefore no longer justified.

21

MEDICAL CONTRAINDICATION TO VACCINATION

INFOR

CONTRE-INDICATION MÉDICALE Á LA VACCINATION

1. The d the fo Exam 2. If vacc shoul autho 3. Vaccin WHO yellow health 4. Pleas travel

This is to certify that immunisation against Je soussigné(e) certifie que la vaccination contre

for Name of disease – Nom de la maladie)

pour

is medically (name of traveller – Nom du voyageur)

est médicalement

RENSE contraindicated because of the following conditions: contre-indiquée pour les raisons suivantes:

(Signature and address of physician) (Signature et adresse du medecin) 22

1. La date suivant Exemp 2. Si la va fournir frontièr 3. Les exi dans la sur le c disponi 4. Le méd d’une m

ATION

N

INFORMATION FOR PHYSICIANS 1. The dates of vaccination on each certificate are to be recorded in the following sequence: day, month, year – the month in letters.

Example: January 1, 2014 is written 1 January 2014.

2. If vaccination is contraindicated on medical grounds, the physician should provide the traveller with a written opinion which health authorities should take into account.

3. Vaccination certificate requirements of countries are published by WHO in “International Travel and Health”. Information on designate yellow fever vaccinating centres is available from local or national health offices.

4. Please be sure always to consider that your patient may have a travel-associated illness.

RENSEIGNEMENTS DESTINÉS AUX MEDECINS 1. L a date de la vaccination doit ètre porté sur les certificats dans l’orde suivant: jour, mois, anné - le mois étant indiqué en toutes lettres.

Exemple: 1st Janvier 2014.

2. S i la vaccination est contre-indiqée pour raison médicale, le médicin doit fournir par écrit au voyaguer un avis circonstancié, dont l’autorité sanitaire aux frontières doit tenir compte.

3. L es exigences des pays en matiére de vaccination sont publicées par l’OMS dans la brochure “Voyages Internationaux et santè”. Les renseignements sur le centres habilìtés à pratiquer la vaccination contre la fièvre jaune sont disponibles auprès des autorités sanitaires locales ou nationales.

4. L e médecin doit toujours tenir compte du fait que son patìent peut être atteint d’une maladie liée à un voyage.

hysician)

medecin) 23

THE TRAVEL DOCTOR-TMVC SPECIALISES IN PREPARING AND SUPPORTING BOTH HOLIDAY AND BUSINESS TRAVELLERS BY PROVIDING: • I ndividual medical advice on international health risks specific to your itinerary • Full medical assessments where appropriate • All vaccines and anti-malarial medications on-site • Specially designed traveller’s medical kits The Travel Doctor-TMVC has dedicated clinics in most major centres of Australia, and affiliated clinics in New Zealand and Thailand.

To contact your nearest Travel Doctor-TMVC clinic in Australia call 1300 658 844. Locations and contact details of Australian and international clinics can be found at www.traveldoctor.com.au

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