HEPATITIS B WAIVER

We strongly recommend this vaccine, but it is not mandatory. Therefore, you may sign and submit a waiver for this vaccine which will remove your hold.
**In the event of an outbreak, exempted students will be excluded from all on-campus activities until specified by the County Health Department.**

HEPATITIS B INFORMATION & VACCINATION WAIVER

Hepatitis B is a serious infectious disease caused by a virus that attacks the liver. The hepatitis B virus (HBV) can cause life-long infection that may lead to cirrhosis (scarring) of the liver, liver cancer, liver failure, or death. There is no cure for hepatitis B, but the infection can be prevented by vaccination.

Symptoms of the Disease
Symptoms of hepatitis B can resemble the flu and may include fever, loss of appetite, low energy, joint pain, cramping, or nausea and vomiting, as well as jaundice (yellow skin or eyes). However, in about 50 percent of cases, hepatitis B causes no symptoms and some of these become chronic carriers who are able to transmit the disease to others.

Transmission of the Disease
Hepatitis B is contagious and spreads when the blood or other body fluids of a person with the virus are absorbed into an individual’s blood stream. The hepatitis B virus can live in all body fluids of an infected person, including blood, saliva, semen, and vaginal fluids. It can enter the body through cuts, tears, or abrasions in the skin and through mucous membranes of the mouth, vagina, anus, and eyes. Hepatitis B can be transmitted through sexual contact; by sharing razors, toothbrushes, shared needles for drug injection, or by getting a tattoo or body piercing using non-sterile instruments or needles.

Risk Factors for Hepatitis B
Anyone who comes in contact with the blood or body fluids of an infected person is at risk for hepatitis B. Certain behaviors can increase the risk, including unprotected sex (vaginal, anal, and oral); contact sports (sports during which players may be exposed to each other’s blood or saliva); getting a tattoo or body piercing; sharing items such as razors, earrings, and toothbrushes; sharing injection drug paraphernalia; travel abroad to areas where the disease is widespread; health care and other occupations that involve exposure to infected blood or body fluids; and household contact with someone with chronic infection

Vaccination Recommendations for College Students
A vaccine is available to help protect against hepatitis B. The U.S. Centers for Disease Control and Prevention (CDC) recommends vaccination of everyone age 18 and under, and anyone at high risk for hepatitis B. The American College Health Association (ACHA) recommends that all college students be vaccinated and the National Collegiate Athletic Association (NCAA) recommends that all student athletes be vaccinated. The hepatitis B vaccine is safe and effective. You cannot get the disease from the vaccine. The most common side effect of the vaccine is soreness at the site of the injection. Vaccination requires a series of three shots over a six-month period. After that, a booster shot is usually not necessary. The vaccine is effective in protecting over 96 percent of those who complete the three-dose vaccination series.

Other Forms of Prevention
In addition to vaccination, people can modify their behavior by using condoms during sex and avoiding tattooing and body piercing with non-sterile instruments or techniques. One also can avoid sharing needles, razors, or toothbrushes.

For more information about Hepatitis B and other infectious diseases:
To learn more about hepatitis B and other infectious diseases, as well as available vaccines, please contact your physician or visit the CDC web and/or the FIU Student Health Services web site at: studenthealth.fiu.edu.
HEPATITIS B WAIVER
Today's Date: Today's Date: / MM / DD YYYY
Student Name: Student Name: First Last
Panther ID:
Date of Birth: Date of Birth: / MM / DD YYYY
Email:
WAIVER OF LIABILITY:
I have read the information above pertaining to hepatitis B. I understand the risks involved and I decline to receive the hepatitis B vaccine.

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I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Name of Parent/Legal guardian, if under 18 years of age: Name of Parent/Legal guardian, if under 18 years of age: First Last
Signature of parent/legal guardian, if under 18 years of age:

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Clear

Full Name
Parent/Legal guardian Government Issued ID:
Please Upload a Valid Government Issued Picture ID of Parent/Legal guardian, if under 18 years of age.

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