Screening Questions for Hepatitis A and B Vaccination
Screening Questions
Are you moderately or
severely sick today?
Vaccinate
today if all
boxes in
shaded area
are checked
□ No
Action, if answers “yes”
If yes, defer until well.
Mild illnesses (such as upper respiratory infections or diarrhea)
are NOT contraindications to vaccination. Do not withhold
vaccination if a person is taking antibiotics.
If yes: History of anaphylactic reaction such as hives (urticaria),
wheezing or difficulty breathing, or circulatory collapse or shock
(not fainting) from a previous dose of vaccine or vaccine
component is a contraindication for further doses.
Local reactions (e.g., a red eye following instillation of ophthalmic
solution) are not contraindications.
Are you allergic to yeast,
neomycin or any vaccine?
□ No
If allergic to Alum,
Havrix, Recombivax, Engerix B, & Twinrix are contraindicated
If allergic to 2-phenoxyethanol,
Havrix & Twinrix are contraindicated
If allergic to neomycin,
Havrix & Twinrix are contraindicated
If allergic to yeast,
Recombivax, Engerix B & Twinrix are contraindicated
Have you ever had a serious
reaction after receiving a
vaccination?
Females only:
Are you pregnant?
□ No
If yes: History of anaphylactic reaction such as hives (urticaria),
wheezing or difficulty breathing, or circulatory collapse or shock
(not fainting) from a previous dose of proposed vaccine or
vaccine component is a contraindication for further doses.
□ No
If yes: Advise pregnant women that there are no studies in
pregnant women, but based on the vaccines being inactivated
(not live attenuated vaccines), theoretically, there should not be a
risk of adverse events to the fetus and data from women
vaccinated by accident does not indicate a problem. Pregnant
women who actually get hep B disease pose serious problems to
the fetus so the risk benefit favors hep B vacccination for highrisk pregnant women and probably favors hep A vaccination too.
DRAFT
Hep Vax Screen
LASD 8.29.08