Year 10 immunisation consent form

If you have any questions regarding the Secondary School Immunisation program, you can email or call 9581 4870

What is the National Immunisation Program?

The National Immunisation Program schedule sets out free vaccinations for children, school programs, adults, Aboriginal and Torres Strait Islander peoples and other people at risk. As part of the program, free vaccines are recommended for adolescents aged 15 to 16 years or in Year 10 of secondary school. Free catch-up vaccination is available up to 20 years of age.

How to complete the form

Read the information provided.

Complete the Vaccine consent section for each vaccine program and sign or type your name if consenting Yes or No

Return the consent sections even if you do not want your child to be vaccinated.

Contact your local council for more information. See the Further information section

Meningococcal ACWY

Meningococcal disease is caused by bacteria. Although meningococcal disease is uncommon, it can become very serious, very quickly. About 10 per cent of people carry meningococcal bacteria in their throat without becoming unwell. These people are known as ‘carriers’. Meningococcal bacteria are passed from person to person by regular, close, prolonged household and intimate contact. Adolescents are at increased risk of meningococcal disease and more likely to spread the disease to others.

Invasive meningococcal disease occurs when these bacteria enter the blood stream to cause septicaemia (infection in the blood, also known as ‘bacteraemia’) or meningitis, (inflammation of the membrane covering of the brain). Death can occur in up to 10 per cent of cases. Occasionally, severe infection can also occur in the joints, throat, lungs or intestines.

There are different strains (serogroups) of meningococcal bacteria known by letters of the alphabet, including meningococcal A, B, C, W and Y. In recent years some of these meningococcal strains have increased across Australia.

Meningococcal B vaccination is strongly recommended for adolescents aged 15 to 19 years. Meningococcal B vaccination is available on prescription and this can be discussed with your doctor.

Meningococcal ACWY vaccine

The Meningococcal ACWY vaccine, Nimenrix®, is a four-in-one combined vaccine for protection against meningococcal A, C, W, Y strains. Studies have shown that this vaccine can provide up to 97 per cent immunity in adolescents. Meningococcal ACWY vaccination programs have been implemented in adolescents in the UK since 2015 and recommended in the US since 2005.

The vaccine does not contain any live bacteria and cannot cause meningococcal disease. The meningococcal ACWY vaccine will boost adolescents with the C strain they had as a baby and protect against the A, W and Y strains.

How is the vaccine given?

The Meningococcal ACWY vaccination is a single injection administered into the upper arm.

Possible side effects of meningococcal ACWY vaccine

Most side effects are minor and quickly disappear. If the following reactions occur, it will be soon after vaccination.

Common side effects

  • mild temperature
  • headache
  • dizziness
  • loss of appetite
  • pain, redness and swelling at the injection site
  • fainting may occur up to 30 minutes after any vaccination.

If mild reactions do occur, the side effects can be reduced by:

  • drinking extra fluids and not over-dressing if the person has a fever
  • taking paracetamol and placing a cold, wet cloth on the sore injection site.

Extremely rare side effects

  • severe allergic reaction.

In the event of a severe allergic reaction, immediate medical attention will be provided. If reactions are severe or persistent, or if you are worried, contact your doctor or hospital.

Pre-immunisation checklist

Before you or your child is immunised, tell your doctor or nurse if any of the following apply to your child:

  • is unwell on the day of immunisation (temperature over 38.5°C)
  • has any severe allergies
  • has had a severe reaction to any vaccine
  • is pregnant.

After vaccination wait at the place of vaccination a minimum of 15 minutes.

Further information

If you require further advice or information, please contact your local council immunisation service or local doctor. 

Better Health Channel

Australian Government Department of Health

Translating and interpreting service call 131 450

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