Staff Vaccination Requirement Form Required VaccinesPolio* Polio* If you were vaccinated against polio as a child but have never had a polio booster dose as an adult, you should get this booster dose. Adults need only one polio booster dose in their lives. Date (if known) MM slash DD slash YYYY Measles or MMR** Measles or MMR * (Measles, Mump and Rubella). 1-2 dosesDate (if known) MM slash DD slash YYYY Tdap Tdap (Tetanus, diphtheria, pertussis/ Td (Tetanus-diphtheria) Tetanus. A booster every 10 years *Tdap: if you did not receive it when you were an adolescent Date (if known) MM slash DD slash YYYY Recommended VaccinesAnnual Flu Annual Flu (influenza) Date (if known) MM slash DD slash YYYY Hepatitis A** Hepatitis A * – 2 dosesDate (if known) MM slash DD slash YYYY Hepatitis B** Hepatitis B * – 3 dosesDate (if known) MM slash DD slash YYYY Varicella (Chicken-pox)* or Shingles* Varicella (Chicken-pox)* or Shingles *Singles vaccines for healthy adults 50 years old or over *If you had chicken-pox no need the vaccine Date (if known) MM slash DD slash YYYY Typhoid Typhoid One dose. A booster is required every 2 years as the vaccine loses effectiveness over timeDate (if known) MM slash DD slash YYYY Rabies* Rabies* – 3 dosesDate (if known) MM slash DD slash YYYY Japanese Encephalitis* Japanese Encephalitis* 1-2 doses depending of the vaccine manufacturer Date (if known) MM slash DD slash YYYY JapaYellow Fever* Yellow Fever* – 1 doseDate (if known) MM slash DD slash YYYY Based on recommendations from the Center for Disease Control and Prevention (CDC) verified* I verify that my required vaccinations are up to date now or will be before arriving in Myanmar. I understand that it is a requirement of employment to have updated vaccinations. Name:* Email:* Signature*Date MM slash DD slash YYYY Additional fnformation can be found at https://wwwnc.cdc.gov/travel/destinations/traveler/none/burma https://www.cdc.gov/vaccines/adults/index.html, https://www.cdc.gov/vaccines/adults/rec-vac/index.html and https://www.iamat.org/country/myanmar-burma/risk/routine-immunizations