Section 9 Appendices - Government of Newfoundland and Labrador

Newfoundland and Labrador 

Immunization Manual 

Section 9 

Appendices 

Appendix A: Vaccine Abbreviations ................................................................................ 2 

Appendix B: Coverage Rate Report Forms for Newfoundland Labrador Immunization 

Programs ........................................................................................................................ 3 

Appendix C: CRMS Documentation of Immunization ...................................................... 8 

Appendix D: Latex Allergies and Immunization ............................................................... 9 

Appendix E: Adverse Events Following Immunization Reporting Form ..........................11 

Appendix F: User Guide: Report of Adverse Events Following Immunization (AEFI) .....12 

Appendix G: Management of Anaphylaxis in the Non-Hospital Setting (Poster) .............13 

Appendix H: Vaccine Information for Immunization Program .........................................14 

Appendix I: Self Directed Learning Module on Immunization ........................................15 

Appendix J: Requisition for Biological Preparations .......................................................32 

Appendix K: Biological Preparations Return Report (Wastage) .....................................33 

Appendix L: Temperature Monitoring Form ...................................................................34 

1

Immunization Manual – NL September 2013 

Appendix A: Vaccine Abbreviations 

http://www.phac-aspc.gc.ca/publicat/cig-gci/app-anneng.php 

Appendices 2


Appendix B: Coverage Rate Report Forms for 

Newfoundland Labrador Immunization Programs 

Region _____________________ 

Birth Year ___________________ 

Coverage Rates Report 1 

Immunization Status at age 2 years 

Report due March 31 st of each year 

Number of two year olds with active files (Child Health Cards or CRMS and not 

moved from region) in the region with that birth year ___________________ 

Date Reported _______________ 

# Children 

who have 

received 

Percentage 

DTaP/IPV/Hib 

4 doses 

Pneumococcal 

4 doses 

MMR 

2 doses 

1 dose 2 dose 

Varicella 

1 dose 

Men-C 

1 dose 

Birth Year Immunization status at age 2 

2010 Due March 31,2013 

2011 Due March 31,2014** 

2012 Due March 31,2015 

2013 Due March 31,2016 

2014 Due March 31,2017 

** Need New Coverage form to capture MMRV in 2014 

Comments 




Immunization status at Kindergarten 

Report due December 31 st of each year 

Region ___________________________ 

Kindergarten Enrolment ______________ (includes home schooled children) 

School Year ________________________ 

Date Reported_______________________ 

# Children 

who have 

received 

Percentage 

DTaP/IPV/ 

Hib 

4 doses 

DTaP/ 

IPV or 

Tdap- 

IPV 

Pneumococcal 

3 or 4 

doses 

MMR 

2 doses 

1 st 

dose 

2 nd 

dose 

Varicella 

1 dose 

Men-C 

1 dose 

Comments 




Immunization status for Men-C-ACYW135 Grade 4 

Region _______________________ 

Report due June 30 th of each year 

School Year ___________________ (should include home schooled children) 

Birth Year _____________________ 

Date Reported___________________ 

Men-C-ACYW135 

# students # children who have 

eligible** received 

**Eligible includes children in grade 4 who have not already received a dose of Men-C- 

ACYW135 

Comments 




Immunization status for Human Papillomavirus (HPV) vaccine Grade 6 

Females only 

Region _______________________ 


School Year ___________________ (should include home schooled children) 

Date Reported____________________ 

# students 

eligible * 

HPV 

Dose # 1 

# children 

who have 

received 

# students 

eligible* 

HPV 

Dose # 2 

# children 

who have 

received 

# students 

eligible* 

HPV 

Dose # 3 

# children who 

have received 

Percentage 

* Eligible includes children in grade 6 who have not already received a series of HPV 

vaccine. 

Comments 



Region_______________________ 

School Year ___________________ 


Immunization status for Tdap Grade 9 


Grade 9 enrolment______________ (should include home schooled children) 

Date Reported__________________ 

# Students eligible 

Tdap 

# Of students 

vaccinated 

Percentage% 

Comments 

_______________________________________________________________________ 

_______________________________________________________________________ 

_______________________________________________________________________ 

_______________________________________________________________________ 



Appendix C: Client Referral Management System 

(CRMS) Documentation of Immunization 

All regional health authorities must use CRMS to capture primary immunizations, school 

immunizations, adult immunizations and vaccines that have been administered in 

relation to communicable disease control. Please see the guidelines for documentation 

in CRMS that have been developed by the regional health authorities where the client 

resides for specifics. 



Appendix D: Latex Allergies and Immunization 

To address concerns regarding latex allergies and immunization the following 

documentation has been collected: 

Documentation from manufacturers 

Individuals identified as high risk 

Suggested guidelines for immunizing a person with latex allergies 

Screening questions to ask when using a product with latex content 

Individuals identified as high risk for latex allergies: 

Those with spina bifida 

Those with myelodysplasia or complex congenital anomalies 

Those who have frequent contact with natural latex products and have 

experienced allergy type reactions 

Those with a history of anaphylactic reactions of “unknown origin” during surgery 

Those who have food allergies to avocados, kiwi, bananas, chestnuts, tomato or 

apples 

Guidelines for immunizing a person with latex allergy: 

Ampules of vaccine do not contain latex 

Use an alternate product, latex free if one is available 

Inject vaccine immediately after drawing up 

Screening questions to ask when using a latex containing product: 

Do you have any allergies? 

Do you have an allergy to avocados, kiwi, bananas, chestnuts, tomato or apples? 

Do you have spina bifida? 

Do you have a history of rash, hives, eye irritation, rhinitis (runny nose) or 

asthmatic symptoms after handing latex gloves, balloons, condoms or other latex 

items? 

Do you have any medical problems? 

Do your lips swell if you blow up a balloon? 

Have you had surgery, if yes how many? 

Do you frequently come in contact with rubber products in your workplace? 

If the answer to any of these questions is yes: 

Inquire whether allergy testing has been done and did it include latex 

If status is unknown check with the parent or family doctor 

If the person is allergic to latex, use latex guidelines 

If further information is unavailable refer to MOH 



Latex Content of commonly used Vaccine Closures 

Vaccine/product Trade Name Manufacturer Closure 

Content 

DaPT-IPV-Hib Pediacel Sanofi No latex 

DaPT-IPV Quadracel Sanofi No latex 

MMR/diluent Priorix (vial 

only) 

Comments/alternate 

GSK No latex Diluent in prefilled 

syringe contains 

latex 

MMR/diluent MMRII Merck No latex 

MMRV/diluent Priorix-Tetra GSK No latex 

Pneu-C-10 Synflorix GSK Prefilled 

syringe 

contains latex, 

vial does not 

Pneu-C-13 Prevnar Wyeth No latex 

Varicella Varilrix GSK No latex Diluent in prefilled 

syringe contains 

latex 

Varicella Varilrix Merck No latex 

Men-C Mengugate C Merck No latex 

HB Recombivax Merck Latex Use Energix 

HB Energix GSK No latex 

HPV Gardasil Merck No latex 

Flu Fluviral GSK No latex 

Flu Vaxigrip Sanofi No latex 

Pneu-P-23 

Pneumovax- 

23 

Merck 

No latex 

Tubersol 5TU 

Sanofi No latex 

PPD 

HAHB Twinrix GSK Latex Prefilled syringe 

contains latex 

HA 

Havrix (vial 

only) 

GSK No latex Prefilled syringe 


HA Vaqta Merck Latex Use Havrix 

Typh-l Typhium Vi Sanofi No latex 

Tdap Boostrix GSK Latex Use Adacel as it 

does not contain 

latex 

Men-P-ACWY Menomune Sanofi Latex 

Men-C- 

ACYW135 

Menactra Sanofi No Latex 

Hib ACT-HIB Sanofi No latex 

Td Td Absorbed Sanofi No latex Multi-dose vial 


IPV Imovax-Polio Sanofi No latex 

Td-IPV 

Td Polio- 

Absorbed 

Sanofi 

No latex 



Appendix E: Adverse Events Following Immunization 

Reporting Form 

http://www.phac-aspc.gc.ca/im/aefi-form-eng.php 



Appendix F: User Guide: Report of Adverse Events 

Following Immunization (AEFI) 

http://www.phac-aspc.gc.ca/im/aefi_guide/index-eng.php 



Appendix G: Management of Anaphylaxis in the Non- 

Hospital Setting (Poster) 

1. Administer epinephrine promptly*, subcutaneously or intramuscularly in the limb 

opposite the site of injection. Use the arm if both legs have been used as injection 

sites during the current visit. 

Table 1 

AGE 

Epinephrine Dose by Age 

DOSE (1:1000 epinephrine) 

2-6 months 0.07 mL 

7 months to 11 months Between 0.07 mL. and 0.10 mL 

12 to 17 months 0.10 mL 

18 months to 4 years 0.15 mL 

5 years 0.20 mL 

6-9 years 0.30 mL 

10-13 years 0.40 mL 

14 years and older 0.50 mL 

2. Call for assistance - transport to an emergency medical facility 

3. Place person in recumbent position with legs elevated. 

4. Initiate Cardio Pulmonary Resuscitation (CPR), if required 

5. Administer ONE dose diphenhydramine HCl (Benadryl ®) ** as an adjunct to 

epinephrine immunization. This is given deep IM in a limb not used for initial 

immunization/injection 

Table 2 BENADRYL ® Dose by Age 

AGE Injected 50mg /mL Oral or injected 

Less than 2 years 0.25 mL 12.5 mg 

2 - 4 years 0.50 mL 25 mg 

5 - 11 years 0.50-1.00 mL 25-50 mg 

12 years and over 1.00 mL 50 mg 

6. Repeat epinephrine at 5 minute intervals, if no improvement after initial dose. 

May be repeated twice (total of 3 doses) 

Emergency Telephone Number ___________________________ 

*Speedy intervention with epinephrine is of paramount importance; failure to use epinephrine promptly is more 

dangerous than using it improperly 

** Some RHA may include an oral dose of Benadryl ® for the treatment of the conscious patients. (See CIG for 

rationale) 

NOTE: In the event of an anaphylactic type reaction all events must be charted and the nursing manager and 

Communicable Disease Nurse/Coordinator should be notified as soon as possible 



Appendix H: Vaccine Information for Immunization 

Program 

http://www.health.gov.nl.ca/health/publichealth/cdc/imm 

unizations.html 



Appendix I: Self Directed Learning Module on 

Immunization 

Self Directed Learning Module on Immunization 

Goal: 

To provide an ongoing, standardized educational process that will guide health 

practitioners’ immunization practise in accordance with policies and procedures outlined 

in the Newfoundland and Labrador Immunization Manual and the Canadian 

Immunization Guide. 

Objectives: 

On completion of the immunization educational process, the participant will be able to: 

Define terms related to immunization and immunity. 

1. Demonstrate proper vaccine handling and storage. 

2. Provide adequate information to clients that will enable them to make an 

informed decision. 

3. Demonstrate knowledge of the current Newfoundland and Labrador routine 

immunization schedule. 

4. Demonstrate knowledge of vaccines used in terms of: 

recommended indication, route, site and dosage 

common side effects 

adverse effects 

contraindications 

risks/benefits 

patient education (i.e.: what to do if person being vaccinated experiences an 

adverse event or common side effect) 

administration technique 

Resources: 

1. Newfoundland and Labrador Department of Health and Community Services, 

Immunization Manual. December 2011 

2. National Advisory Committee on Immunization.(2012) Canadian Immunization 

(Evergreen Edition).Ottawa ON http://www.phac-aspc.gc.ca/publicat/ciggci/index-eng.php 

3. Control of Communicable Disease Manual.19 th ed. 2008 Heymann. APHA. 

4. Manufacturers’ product monograph inserts. 

5. Your Child’s Best Shot. A Parent’s Guide to Vaccination, 3 rd ed. 2006. Gold, R. 

Canadian Paediatric Society 

6. Websites: http://www.immunize.cpha.ca 

http://www.health.gov.nl.ca/health/publichealth/cdc/health_pro_info.html#immunization 



Self-Directed Learning Module on Immunization 

Guidelines for the Practitioner 

1. To become knowledgeable in the field of immunization you will need to 

successfully complete i) this written self-directed immunization learning module; 

and ii) a supervised immunization experience; and iii) orientation session with the 

Communicable Disease Control Nurse (CDCN) 

2. You will direct your own learning experience with the goal of reaching or 

maintaining competence in immunization. Feel free to use any resource: books, 

journals, colleges, to assist you in completing the module. It is recommended 

that you refer to the most current edition of the Newfoundland and Labrador 

Immunization Manual and the Canadian Immunization Guide. All resources will 

be provided to you by your manager. 

3. Complete the module prior to meeting with the Communicable Disease Control 

Nurse for orientation on immunization. When you are finished, hand in or send 

your completed module to the CDCN at least two days prior to your scheduled 

orientation time. 

4. The NL Immunization Manual found at 

http://www.health.gov.nl.ca/health/publichealth/cdc/health_pro_info.html#immuni 

zation contains the provincial and regional policies and procedures for 

immunization, therefore, it is important to carefully read and become familiar with 

this resource. 

5. The module will be corrected by the CDCN (or nurse manager) and reviewed 

with you at the orientation session. 

6. Remember, there is no grade or pass/fail designation awarded to this module. 

Instead, all questions must be answered completely and must follow 

Newfoundland and Labrador immunization policy. 



Self-Directed Learning Module on Immunization 

Questions 

Please answer ALL questions in the space provided. If additional space is needed, 

please write on the back making sure the answer is well indicated. Please be brief but 

complete with your answers. 

1. What are the true contraindications for all vaccines? 

2. What is meant by immunization precautions? 

3. What are the characteristics of an “ideal vaccine”? 

4. What are the five characteristics of a valid consent for immunization? 

5. Before administering inactivated vaccines and/or live attenuated 

vaccines, what would you discuss with the client in terms of benefits, 

reactions and instructions if a reaction were to occur? 

Vaccine A. Benefits B. Reactions C. Instructions 

Inactivated 

Vaccines 

Live 

vaccines 



6. What documentation, charting and reporting requirements are needed when an 

adverse event following immunization occurs? 

7. What instructions would you give the parent/guardian for management of 

common side effects post immunization? 

8. Live vaccines are not recommended in which circumstances: 

A. Pregnancy 

B. Hypersensitivity to eggs 

C. Immunocompromised 

D. Previous anaphylactic reaction to the vaccine 

E. A C & D. 

9. What is the difference in the diphtheria component between DTaP-IPV and Td 

vaccines? 

10. What is the best source for up to date information on vaccines regarding 

dosage? 

A. Immunization Manual 

B. Internet site 

C. Product monograph supplied with the vaccine 

11. The term “cold chain” refers to: 

A. the distribution for vaccines 

B. how it is ensured that vaccines arrive at their final destination with their 

immunogenic properties intact 

C. storage for vaccines 

D. maintaining the temperature of vaccines between 2C and 8C 

E. All of the above 

12. Check () the following True (T) or False (F): 

When a cold chain break has occurred: 

A. The nurse will notify the vaccine coordinator. 

___T ___F 

B. If it is known that the power outage will last less than two hours, the vaccines 

can remain in the refrigerator; the door should not be opened. 

___T ___F 



C. If due to a witnessed power outage, the vaccine coordinator or designate will 

take the vaccines out of the refrigerator and destroy them. 

___T ___F 

13. How frequently should one monitor temperature in any vaccine 

storage unit? 

14. Of the following, circle those which are accurate when referring to a 

refrigerator that is used to store vaccines: 

A. The temperature within it must be maintained between 0 and 8 degrees 

Celsius. 

B. Food and beverages can be stored in the vaccine refrigerator. 

C. The procedures to be followed in the event of refrigerator failure are posted on 

it. 

D. Bottles of water can be placed on any empty shelves and in the door spaces. 

E. The refrigerator can be located in the coffee room so everyone can use it. 

F. It must contain a maximum-minimum thermometer. 

G. The refrigerator is checked regularly to determine if the temperature within it is 

optimal. 

H. It meets the approved Provincial Immunization Policy 

15. Check () the following True (T) or False (F): 

Refrigerators used to store vaccines shall: 

A. be maintained at a temperature between 2 and 8C 

___T ___F 

B. be defrosted when 1 cm. of ice builds up in the freezer section 

___T ___F 

C. contain water bottles in order to maintain a more constant temperature in the 

event of a power failure 

___T ___F 

16. When vaccine has been exposed to temperatures outside the recommended 

range, we should: 

A. Use the vaccine if it has been exposed for less than two hours 

B. Consult the appropriate manufacturer(s) and destroy the vaccine 

C. Place the vaccine in a container labelled “do not use”, place at proper 

temperature and notify the vaccine coordinator in your region or the provincial 

Office and await further direction. 

17. How can you tell if someone has fainted versus someone who is having an 

anaphylactic reaction? 



18. Mona, a 16 year old female, has just received a Tdap booster. She states that 

she is feeling faint, is pale and suddenly collapses. 

Check () the following True (T) or False (F): 

A. She is experiencing an anaphylactic reaction. 

___T ___F 

B. You should have her lie down and measure her BP, pulse and respirations. 

___T ___F 

C. The correct dosage of adrenalin to administer in the case of anaphylaxis 

is 0.5 ml. 

___T ___F 

D. In the event of an anaphylactic reaction, you should never administer 

CPR. 

___T ___F 

19. For the vaccines noted below describe the following: administration 

route; site; dosage and needle size that would be used for infants, 

children and adults: 

Answers: 

Infants 

Children 

Infants 

Adults 

Vaccine Route Injection 

Site 

MMRV 

DTaP-IPV 

Pneu-C-13 

Influenza 

Dosage 

NEEDLE 

Size & 

Length 

20. What are the key principles of risk communication? 

21. All of the following are principles of combination vaccines except? 

A. Combination vaccines do not need to be tested. 

B. Ideal combination vaccines are safe and effective as the single antigen. 

C. They should fit the current schedule, be easily stored & easy to administer. 

D. Helps to reduce the number of immunization 



22 . Give the recommended Newfoundland and Labrador schedule for a child 

who began immunization at birth 

. 

Routine immunization schedule for children beginning immunization in early infancy 

Age 

DTaP 

IPV 

Hib 

DTaP 

IPV 

Or 

Tdap- 

IPV 

VACCINE 

HB HPV MMRV MMR Tdap Inf 

Pneu- 

C-13 

Men C 

ACYW 135 

Men- 

C 

2 mos. 

4 mos. 

6 mos. 

6-23 mos. 

12 mos. 

18 mos. 

4 to 6 yrs. 

Grade 4 

Grade 6 

14 to 16 

yrs. 

Answer: 

DTaP-IPV-Hib Diphtheria,acellular pertussis, tetanus, polio, Haemophilus influenzae type b 

DTaP-IPV Diphtheria, acellular pertussis, tetanus, polio vaccine 

HB Hepatitis B vaccine 2 doses at 0, 4-6 mo beginning in school year 2012 

MMR 

Measles, mumps, rubella vaccine 

MMRV 

Measles, mumps, rubella,varicella vaccine 

Tdap 

Tetanus, diphtheria, acellular pertussis vaccine 

Tdap-IPV Tetanus, diphtheria, acellular pertussis vaccine, polio vaccine 

Inf 

Influenza 

Var 

Varicella vaccine 

Pneu-C-13 Pneumococcal conjugate 13 valent 

Men-C 

Meningococcal type C 

Men-C-ACYW 135 Meningococcal type A, C, Y&W 135 

HPV 

Human Papilloma virus 



23. In the following 4 scenarios, give the immunization schedule and the 

vaccines you would use to complete the child’s schedule to school entry. 

A. A healthy four-year-old child who has never been immunized. 

Immunization schedule for children < 7 years of age not immunized in early Infancy 

Timing DTaP-IPV Hib MMRV MMR Pneu-C-13 Men-C Tdap- 

IPV 

First visit 

2 months later 


6-12 months 

later 

* 4-6 years 

* 4-6 years can be omitted if fourth dose was given after the fourth birthday 

B. A healthy 13-month-old child who has never been immunized. 

Immunization schedule for children < 7 years of age not immunized in early infancy 


IPV 

First visit 



6-12 months 

later 

* 4-6 years 


C. A seven-month-old infant who received two doses of DTaP-IPV-Hib and 

Pneu-C- 13 at two and four months of age 

Immunization schedule for children < 7 years of age not iimmunized in early infancy 


IPV 

First visit 



6-12 months 

later 

* 4-6 years 


D. A nine-month-old infant who received two doses of DTaP-IPV and Pneu- 

C-13 at two and four months of age. 



Immunization schedule for children < 7 years of age not immunized in early Infancy 


IPV 

First visit 



6-12 months 

later 

* 4-6 years 


24. Steven is eight months old and is attending a Child Health Clinic. At six 

months of age, he received one dose of DaPT-IPV-Hib and Pneu-C-13. Steven 

is being breastfed, and his mother is two months pregnant. He looks well but 

is taking Amoxil. 

A) What are the contraindications to Steven receiving his immunization today? 

a. On antibiotics 

b. Household member pregnant 

c. Being breastfed 

d. None of the above 

B) What vaccines should be given to Steven today? 

a. DTaP-IPV- Hib, Pneu-C-13 

b. DT, Hib 

c. MMRV 

d. Var 

e. Men-C 

C) At what age should Steven return for his next immunization appointment? 

a. 12 months 

b. 9 months 

c. 10 months 

d. 15 months 

D) What vaccines should Steven receive then? 

a. DTaP-IPV- Hib 

b. DT, Hib 

c. MMR 

d. Var 

e. Men-C 

E) What vaccines will Steven receive at 12 months of age? 

a. DTaP-IPV-Hib, Pneu-C-13 

b. MMRV, Men-C, Pneu-C-13 

c. DaPT, OPV, Hep. B 

d. MMR, Hib 

F) What vaccines will Steven receive when he is 14-16 years of age? 



a. Tdap 

b. Td-P 

c. Td 

25. A preschool child has arrived at Child Health Clinic having previously 

received a complete primary series of DTaP-IPV-Hib (in infancy). You are 

informed that the child is allergic to dust, cats and several foods. What would 

you do regarding the MMRV injection that is overdue? 

26. Katelyn is 12 months old. She has previously received three doses of DTaP- 

IPV-Hib and two doses of Pneu-C-13 at the recommended ages. After the third 

dose of DTaP-IPV-Hib Katelyn had a fever of 105°F and a febrile seizure. Two 

months ago, she was exposed to measles and was given immune globulin. 

A) Does Katelyn have contraindications to any vaccines? 

a. Yes 

b. No 

B) If your answer to A was yes, which vaccine(s) would be contraindicated at this 

time? 

a. DTaP-IPV-Hib 

b. MMRV 

c. IPV 

d. Hep B 

C) What vaccine(s) should Katelyn receive today? 

a. DTaP-IPV-Hib, MMRV 

b. Men-C and Pneu-C-13 

c. Men-C only 

D) When should Katelyn return for immunization, and what vaccine(s) should she 

receive at that time? 

a. In two months for DT-P, Hib 

b. In two months for Hep B 

c. In three to 11 months for MMRV 

d. In two months for DTaP-IPV-Hib and MMRV 

27. A child received MMR two days ago and requires a Tuberculin Skin 

Test (TST) with PPD. What do you do and why? 

28. Elizabeth is seven weeks old and was born one month premature. 

Mom is breastfeeding her, and her father recently completed radiation 

and chemotherapy for Hodgkin’s. Her sister has epilepsy. 



A. Should Elizabeth be immunized today? 

a. Yes 

b. No 

B. Are there any contraindications? 

a. Yes, due to prematurity 

b. Yes, due to family history of epilepsy 

c. Yes, due to family member receiving chemotherapy 


e. All of the above 

C. What vaccines does Elizabeth need at two months of age? 

a. DTaP-IPV-Hib, Pneu-C 13 

b. DTaP-IPV-Hib 

c. None until three months because she is one month premature 

d. Not until she weighs 4500gms 

D. After the first immunization is given, when should she come back and 

what vaccines should she receive? 

a. In two months for DTaP-IPV-Hib and Pneu-C-13 

b. In two months for DTaP-IPV 

c. In one month for Hib 


29. Austin, Elizabeth’s brother, is three years old and has no documentation of 

his MMR or his fourth dose of DTaP-IPV-Hib. 

A. Are there any contraindications? 

a. No pertussis due to family history of epilepsy 

b. No MMR due to family member receiving chemotherapy 

c. No contraindications 

B. What vaccines does Austin need? 

a. DTaP-IPV-Hib 

b. MMRV 

c. a and b 

d. DT-P, Hib 

C. Does he need a booster i.e. DTaP-IPV? 

a. Yes 

b. No 

D. When can he receive this fifth dose of DaPT-IPV? 

a. One year later 

b. Two years later 

c. Three years later 

d. Any of the above 

30. The following questions relate to administering tuberculin skin testing (TST): 

A. Which biological is used; what strength and dosage? 

B. What site? 



C. Which route? 

D. What type of syringe and needle? 

31. How do you read and record the results of a TST? How do you interpret the 

readings? 

32. It is December and a family with 2 young children (7 months and 2 ½ years) 

has moved back to Newfoundland and Labrador from Alberta. Paul, had 

chickenpox at 5 ½mos of age, he is now 7months old and is feeling well. He 

previously received DTaP-IPV-Hib, Pneu-C-13 and Men-C at two and four 

months of age. 

A. What vaccine(s) should Paul receive today? 

a) DTaP-IPV-Hib, Pneu-C-13, Men C and Influenza 

b) DTaP-IPV-Hib, Pneu-C-13 and Men C 

c) DTaP-IPV-Hib, Pneu-C-13 

d) DTaP-IPV-Hib and Influenza 

A. When should Paul return to clinic and what vaccine(s) should he receive? 

a) In 6 months for MMR, Var and Men C 

b) In 5 months for MMR and Men C 

c) In 5 months for MMRV, Men C and Pneu-C-13 

d) In 5 months for MMR 

e) In 6 months for MMR 

C. What would Paul’s remaining vaccine schedule look like? 

33. Paul’s sister Joy is 2 ½ years old; she was born in New Brunswick and moved 

with her parents to Alberta when she was 5 months old. She previously 

received: 

DTaP-IPV-Hib at 2, 4, 6, and 18 months 

Pneu-C-13 at 2, 4, 6 and 18 months 

Men C at 6 months 

HB at birth and 2 months 

MMR & Var at 12 months and MMR at18 months 

Influenza at 6 and 18 months 

D. What vaccine(s) should Joy receive today? 

a) None 

b) HB and Men C 

c) HB 

d) Men C 



e) HB, Men C and Influenza 

E. What would Joy’s remaining vaccine schedule look like? 

34. John has just returned from Halifax where he had a bone marrow 

transplant, what is the process for immunization? 

35. What should be recommended to a 26-year-old woman who is not immune to 

rubella? 

36. Mrs. B is a 60 year old woman with diabetes, she has called the local health 

unit to inquire about which vaccines she should receive this coming fall. 

Which immunizations should she offered? 

37. Who are the target population for pneumococcal polysaccharide immunization 

in NL? 

38. Who are the target population for inclusion in the high risk children’s 

pneumococcal conjugate vaccine program; primary series (4 doses 

versus 3) in NL? 

39. The following questions pertain to hepatitis B vaccine. 

A. Who is the target population for universal hepatitis B immunization? 

B. What are the current schedules? 

C. For prevention of hepatitis B in an infant born to a mother known prior to 

delivery to be a surface antigen carrier (HBsAg+) see CIG for information 

on HBIG administration. 

40. Your co-worker has experienced a needle stick injury. What should be 

done? 



41. The following questions pertain to Human Papillomavirus (HPV) 

vaccine. 

A. Who is the target population for universal HPV immunization? 

B. What is the current schedule? 

C. From what disease does this vaccine protect? 

42. What information should you record after completing immunization, and where would 

you record it? 

43. Hepatitis B infection can cause: 

A. No symptoms 

B. Death 

C. Chronic carrier state 

D. Cirrhosis and cancer of the liver 


44. The most severe complication of pertussis is: 

A. Death 

B. Brain damage 

C. Apnea 

D. Cough 

E. Hib 

45. Which disease can cause fetal abnormalities if a woman contracts it 

during the first three months of pregnancy? 

A. Measles 

B. Mumps 

C. Polio 

D. Rubella 

E. Hib 

46. How is tetanus transmitted? 

A. By direct, person-to-person contact 

B. By contact with airborne droplets 

C. Through a break in the skin 

D. By an insect bite 

E. By sexual contact 

47. Which of the following diseases is considered to be the most 

contagious? 

A. Mumps 

B. Measles 

C. Rubella 

D. Hepatitis B 

E. Polio 



48. Mumps is characterized by: 

A. Orchitis in postpubertal males 

B. Respiratory symptoms 

C. Swelling of one or more salivary glands 

D. Life-long immunity after lab-confirmed mumps disease 


49. Which of the following groups have the best sero-protection rates following 

immunization with HB? 

A. Children less than 2 years of age 

B. Children between the ages of 5 and 15 years 

C. People aged 20-29 years 

D. Peoples greater than 60 years of age 

50. Children in whom invasive Hib disease develops before 24 months of age 

should still receive vaccine as recommended. 

True or False? 

51. Pertussis vaccine is recommended for whom? 

A. Children greater than or equal to 2 months of age 

B. Adolescents 

C. Adults 

D. Persons who have had natural Pertussis infection 


52. Diphtheria is seen most often: 

A. during the summer months in Canada 

B. in infants of immune mothers 

C. in non-immunized children under 15 years of age 

D. in countries where mass immunization is carried out regularly 


53. Which of the following diseases can cause meningitis? 

A. Haemophilus influenzae type b 

B. Mumps 

C. Polio 

D. All of the above 

E. None of the above 

54. Rubella: 

A. is usually a mild disease 

B. can be confused with measles 

C. can occur without a rash 

D. can be complicated by arthritis 


55. People born before 1970 are considered to be immune to which of the 

following diseases: 

A. Pertussis 

B. Mumps 

C. Measles 

D. Polio 

E. None of the above 



56. The incubation period for hepatitis B can be: 

A. 45-180 days 

B. 60-90 days 

C. 6-9 months 

D. 2 weeks 


57. If a child has had varicella (chickenpox) prior to their first birthday the varicella 

immunization is not required. 

A. True 

B. False 

58. Which of the following are vaccine preventable diseases? 

A. Chickenpox 

B. West Nile virus infection 

C. Influenza 

D. Invasive Pneumococcal disease 

59. Once a vaccine has been drawn up into the syringe when should it be given? 

A. Within 90 minutes 

B. Within 24 hours 

C. As soon as possible 

60. The following is true about the Human Papillomavirus (HPV) vaccine: 

A. HPV vaccine is not licensed for use among males 

B. Vaccine ideally should be administered before potential exposure to HPV through 

sexual exposure 

C. HPV vaccine does not take the place of regular pap screening 

D. All of the above 



Checklist for Supervised Immunization Experience 

ACTIVITY 

Completed the Self Directed Learning 

Module 

Shared Vaccine Information with Client 

Assessment Prior to Immunization 

Discussed Risks and Benefits 

Obtained Informed Consent 

Washed Hands 

Vaccine Preparation - Sections 3 and 4 

Checked adrenalin/ benadryl dose 

and availability 

Vaccine selection 

Checked expiry date 

Dosage 

Reconstitution as required 

Choice of syringe, needle and site 

Sterile/aseptic technique 

Vaccine storage handling 

techniques 

Demonstrated Appropriate Vaccine 

Administration - Section 4 

Inspect vaccine 

Positioning, holding 

IM 

SC 

ID 

Disposal of needle and syringe 

Comfort measures 

 

Assessment post immunization 

Demonstrated Appropriate Documentation 

Section 1.4 

Client=s Record of Immunization 

Provide post-immunization info 

Provide record of immunization 

DATE 

COMPLETED 

COMMENTS 

Completion Date: _______________________ 

Signature: ____________________ 



Appendix J: Requisition for Biological Preparations 

http://www.health.gov.nl.ca/health/publichealth/cdc/Requisiti 

ons%20for%20Biological%20Preparations.pdf 



Appendix K: Report Form for Biological Products 

Wastage 

http://www.health.gov.nl.ca/health/publichealth/cdc/Biol 

ogical%20Preparations%20Return%20Report.pdf 



Appendix L: Temperature Monitoring Form 

http://www.health.gov.nl.ca/health/publichealth/cdc/Temperat 

ure%20Monitoring%20Log.pdf

Section 9 Appendices - Government of Newfoundland and Labrador

Create successful ePaper yourself

Delete template?

Save as template?