Procedures for Yellow Fever Vaccination Centres in Canada

Image - Example of a completed Certificate of Medical Contraindication to Vaccination

Text equivalent of the Example of a completed Certificate of Medical Contraindication to Vaccination

FRONT PAGE:

Title: CERTIFICATE OF MEDICAL CONTRAINDICATION TO VACCINATION

Issued to:

Josephine Doe (1)

On the inner pages, the health care provider must complete all fields appropriately.

INSIDE PAGES:

CERTIFICATE OF MEDICAL CONTRAINDICATION TO VACCINATION

This is to certify that (name):

Josephine Doe (2)

Date of birth:

12 March 1970 (3)

Sex

F(4)

Nationality:

Canadian (5)

National identification document, if applicable:

Passport (6)

Whose signature follows :

Josephine Doe (7)

Cannot be vaccinated against (name of disease or condition):

Yellow fever (8)

because of the following reasons:

Severe allergy to eggs (9)

Contraindicated vaccine:

Yellow fever (10)

Date:

15 August 2007 (11)

Signature and professional status of supervising clinician:

John Smith R.N. (12)

Medical contraindication valid from:
Until:

25 August 2007"
30 November 2007 (13)

Official stamp of the administering centre:

Official stamps are provided to Yellow Fever Vaccination Centres. There are three lines on the stamp:
Line 1, "YFVC/CVFJ"; Line 2 displays the identification number assigned to the Yellow Fever Vaccination Centre. The number contains the code of the province where the site is located, followed by a unique 4-digit number (e.g. XX-1000); Line 3: "CANADA". (14)

BACK PAGE:

A country where the vectors of yellow fever are present, may require a traveller coming from an area where the World Health Organization has determined that a risk of yellow fever transmission is present to be quarantined:

if the traveller is unable to produce a valid certificate of vaccination against yellow fever.
Until the certificate becomes valid, or;
Until a period of not more than six days, from the date of last possible exposure to infection, has elapsed. Should the travellers not be quarantined, they may be required to report any feverish or other symptoms to the competent authority and be placed under surveillance.

If a health care practitioner is of the opinion that the vaccination against yellow fever is contraindicated on medical grounds, the health care practitioner should provide the person with reasons, written in English or French, underlying that opinion, which the authorities on arrival should take into account. The health care practitioner should inform the traveller of any risk associated with non-vaccination and provide information regarding protection from yellow fever vectors.