Protect against measles, mumps and rubella - consent form - NIP8902
School consent form for parents and guardians, which explains about vaccination against mumps, measles and rubella (MMR), including information for parents and guardians.
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The full resource:
Aotearoa New Zealand is at very high risk of a measles outbreak. There’s a risk of getting measles if you have not had 2 vaccinations, or have not already had measles.
The measles, mumps and rubella (MMR) vaccine is FREE for all children in New Zealand, and all adults over the age of 18 years who are eligible for free healthcare in New Zealand.
This form has two sections
- Information about immunisation
- A consent form for you to fill out and return to school.
What does the vaccination protect you from?
Measles is a is a very infectious virus. Before immunisation was introduced, nearly all children caught measles. Measles causes a rash, high fever, runny nose, cough and sore watery eyes. Severe cases can result in pneumonia, encephalitis (swelling in the brain), diarrhoea and rarely, death.
Mumps is caused by a virus and is spread through the air. Mumps causes fever, headache and swelling of the glands around the face. In males mumps can cause
swelling of the testicles and in rare cases, infertility. Mumps can also cause meningitis and encephalitis (swelling in the brain).
Unimmunised children exposed to measles or mumps need to be kept home from school.
Rubella is usually a mild, viral illness. It causes a rash, fever and swollen glands in children. It is extremely dangerous for pregnant women because it can cause deafness, blindness and brain damage in an unborn baby.
Immunisation is your best protection
The measles (MMR) vaccine we use in New Zealand is Priorix. This vaccine protects against measles, mumps, and rubella.
Priorix is a live vaccine. Live vaccines contain bacteria or viruses that have been weakened so that they cannot cause disease. This small amount of virus or bacteria stimulates an immune response. The vaccine works by causing the body to make antibodies that fight these diseases.
There is no ‘measles only’ vaccine available in New Zealand. It is not possible to separate these diseases out of the vaccine.
The vaccination is given as an injection in the upper arm. For best protection against measles 2 doses of the MMR vaccine are needed at least 4 weeks apart.
MMR immunisation is also available FREE from family doctors, some pharmacists, and local health centres.
How effective is the vaccine?
Two doses of MMR will protect 99% of people against measles and rubella, and around 85% of people from mumps.
A small number of people who are immunised may still become ill. If that happens, they usually get a milder illness than people who have not been immunised.
Who needs to be vaccinated?
If you’re not sure whether your rangatahi (young person) has had two doses of MMR, it's still recommended they get vaccinated. There are no additional safety concerns with having extra doses.
Most rangatahi will have been given at least one dose of MMR in early childhood. However, changes to the Immunisation Schedule in 2001 and less effective reminder systems in previous years mean that many rangatahi are not fully protected.
If you have come from overseas, including the Pacific Islands, you may have had different vaccines that may not protect you against measles, mumps and rubella.
If you’re not sure that they are fully immunised, check their Well Child/Tamariki Ora/ Plunket book or contact their medical centre/healthcare provider to make sure they have had BOTH doses of the MMR vaccine.
If your rangatahi haven’t had both doses, or you’re not sure, play it safe and get them immunised.
Who shouldn’t be immunised?
There are very few people who shouldn’t be immunised. Talk to their doctor, vaccinator or healthcare provider before signing this form if your child:
- has had a serious reaction to a vaccine in the past
- is being treated for cancer or other severe illness
- has had a blood transfusion or other blood products in the last year.
MMR immunisation is not recommended during pregnancy.
Side effects and reactions
Like most medicines, vaccines can sometimes cause reactions. These are usually mild, and not everyone will get them. Mild reactions are normal and shows that your child's immune system is responding to the vaccine.
What you may feel
What can help
Swelling and pain at the injection site (hard and sore to touch)
Nausea (feeling sick)
Headache, aches and pains
Place a cold, wet cloth, or ice pack where the injection was given. Leave it on for a short time.
Do not rub the injection site.
Mild rash (between 6 and 12 days after immunisation)
High fever (over 39°C – between 6 and 12 days after immunisation)
Swollen glands in the cheeks, neck, or under the jaw
Temporary joint pain
Rest and drink plenty of fluids.
Give paracetamol or ibuprofen for relief of significant discomfort or high fever as instructed by your vaccinator or healthcare provider.
Removing layers of clothing can help reduce fever.
A very rare side effect is bruise-like spots that appear 15 days to 6 weeks after immunisation.
This is mild, and usually goes away within 6 months.
Serious allergic reactions (known as anaphylaxis) are extremely rare. Only about 1 in 1 million people will experience this.
The vaccinator is well-trained and knows what to look for and can treat an allergic reaction quickly if it happens.
Serious allergic reactions normally happen soon after the vaccine has been given. This is why people need to wait for up to 20 minutes after immunisation.
Tips to prepare for vaccination
- Eating before and after will make you less likely to feel faint or dizzy.
- Wear a loose shirt with short sleeves so the vaccinator can easily access the upper arm.
- Tell the vaccinating team if you are feeling scared or anxious. They can help you with this.
- Take things easy after the immunisation as your arm might be a bit sore.
The Health and Disability Commissioner's Code of Rights applies to all consumers using a health or disability service in New Zealand.
Schools may have provided some information such as students’ names, room numbers, dates of birth, addresses and ethnicities. Your school should have notified you before doing so. This information, together with the information you provide on the school consent form, is used to help administer this immunisation programme.
Information from the consent form and details of each immunisation given or declined will be recorded on a patient management system held by your health district and some of it will be passed to the Aotearoa Immunisation Register.
Patient management systems are used by health districts to record health information. The Aotearoa Immunisation Register is a national database for recording all immunisations given to all people in New Zealand.
The information on the consent form, the patient management systems and the Aotearoa Immunisation Register is protected by the Health Information Privacy Code. Only authorised health professionals will see, use, or change it. However, you may see your child’s information and correct any details. If you would like to do so, contact your vaccinator or doctor or health centre.
Vaccinators will use the information on the consent form, the patient management system and the Aotearoa Immunisation Register:
- to contact your doctor or health centre if they need to check which immunisations your child has already been given
- if your child has any health concerns
- to help assess this immunisation programme and plan future programmes, or
- to refer your child to their health provider or another local health provider for the immunisation if they missed it at school.
Information that does not identify individuals may be used for research purposes or to plan new services.
For more information about school roll sharing, privacy and the use of information, see your health district’s privacy policies. If you have any questions about privacy, you can email firstname.lastname@example.org or contact the Privacy Commissioner’s free helpline on 0800 803 909.
If you have any questions about the Aotearoa Immunisation Register or would like to request a copy of your immunisation details held in the Aotearoa Immunisation Register please speak to your healthcare provider or contact email@example.com
Where can I get more information?
Speak to the vaccinator, your doctor or healthcare provider.
- Visit immunise.health.nz/MMR for more information about these immunisations, or
- immunise.health.nz for general information about immunisation.
The vaccinator's contact details are on the front of this form. Contact them directly if you need help or more information to fill out this form.
Detailed information on the MMR vaccine is published on the Medsafe website:
- for technical information about the vaccine, search www.medsafe.govt.nz for 'MMR' or 'Priorix'