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Today D-M-Y
To determine whether you are eligible to participate in this study we would like to ask you a few personal questions including questions about your age, where you were born, previous vaccinations and medical history. The answers you give will be kept confidential.
Do you agree to the collection of your personal information for screening purposes?
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Yes No
Thank you for your interest, the screening process will not continue
Email
(Please ensure you regularly use this email, as all AVIRS related information will be sent here)
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*Twilio Compatible Mobile. Enter as a number only. Replace the leading zero with 61 for compatibility with sending SMS survey invitations, e.g. 0412 123 123 must be entered as 61412123123
Are you between 18 and 35 years old?
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Yes No
D-M-Y
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You are ineligible for this study (under 18 or over 35 years old). Thank you for your interest
Have you ever had the Yellow Fever vaccination?
In Australia, the Yellow Fever vaccine is not routinely given as part of the National Immunisation Program. It is however recommended for people aged ≥9 months who are travelling to an area with a risk of yellow fever virus transmission such as tropical and subtropical regions of Africa and South America. If you have travelled to these parts of the world it is likely that you would have been recommended to have this vaccine. See the Australian immunisation handbook for yellow fever for further information. *
No Yes Unsure
Have you ever had any vaccinations for the purpose of travelling to Central/South America or Africa?
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No Yes
Have you ever had Yellow Fever in the past?
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No Yes
Have you ever had the BCG vaccine for Tuberculosis (TB)?
In Australia, the BCG vaccine has not been routinely given as part of the National Immunisation Program since 1985, however it is widely administered at birth or in early-life in other countries worldwide and in selected circumstances in Australia for individuals with an increased risk of TB exposure. See the Australian immunisation handbook for tuberculosis for further information. *
No Yes Unsure
What is your country of birth?
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Have you ever had TB in the past?
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No Yes
Have you ever knowingly been in close contact with someone who has TB?
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No Yes
Have you worked or lived in any of the following countries for periods of more than 3 months?
Afghanistan
Eswatini (Swaziland)
Malawi
Romania
Algeria
Ethiopia
Malaysia
Russian Federation
Angola
Fiji
Mali
Rwanda
Azerbaijan
Gabon
Marshall Islands
Sao Tome and Principe
Bangladesh
Gambia
Mauritania
Senegal
Benin
Georgia
Micronesia
Sierra Leone
Bhutan
Ghana
Moldova
Singapore
Bolivia
Greenland
Mongolia
Solomon Islands
Botswana
Guinea
Morocco
Somalia
Brazil
Guinea-Bissau
Mozambique
South Africa
Brunei Darussalam
Guyana
Myanmar (Burma)
South Sudan
Burkina Faso
Haiti
Namibia
Sri Lanka
Burundi
Hong Kong (SAR of China)
Nauru
Sudan
Cambodia
India
Nepal
Tajikistan
Cameroon
Indonesia
Nicaragua
Tanzania
Central African Republic
Kazakhstan
Niger
Thailand
Chad
Kenya
Nigeria
Timor-Leste (East Timor)
China (excluding SARs)
Kiribati
Niue
Turkmenistan
Colombia
Korea, People's Rep (North)
Northern Mariana Islands
Tuvalu
Congo
Korea, Republic of (South)
Pakistan
Uganda
Congo, Democratic Republic
Kyrgyzstan
Palau
Ukraine
Cote d'Ivoire
Lao
Panama
Uzbekistan
Djibouti
Lesotho
Papua New Guinea
Venezuela
Dominican Republic
Liberia
Paraguay
Viet Nam
Ecuador
Libya
Peru
Yemen
El Salvador
Macau (SAR of China)
Philippines
Zambia
Equatorial Guinea
Madagascar
Qatar
Zimbabwe
Eritrea
Have you worked or lived in any of the following countries for periods of more than 3 months?
Afghanistan
Eswatini (Swaziland)
Malawi
Romania
Algeria
Ethiopia
Malaysia
Russian Federation
Angola
Fiji
Mali
Rwanda
Azerbaijan
Gabon
Marshall Islands
Sao Tome and Principe
Bangladesh
Gambia
Mauritania
Senegal
Benin
Georgia
Micronesia
Sierra Leone
Bhutan
Ghana
Moldova
Singapore
Bolivia
Greenland
Mongolia
Solomon Islands
Botswana
Guinea
Morocco
Somalia
Brazil
Guinea-Bissau
Mozambique
South Africa
Brunei Darussalam
Guyana
Myanmar (Burma)
South Sudan
Burkina Faso
Haiti
Namibia
Sri Lanka
Burundi
Hong Kong (SAR of China)
Nauru
Sudan
Cambodia
India
Nepal
Tajikistan
Cameroon
Indonesia
Nicaragua
Tanzania
Central African Republic
Kazakhstan
Niger
Thailand
Chad
Kenya
Nigeria
Timor-Leste (East Timor)
China (excluding SARs)
Kiribati
Niue
Turkmenistan
Colombia
Korea, People's Rep (North)
Northern Mariana Islands
Tuvalu
Congo
Korea, Republic of (South)
Pakistan
Uganda
Congo, Democratic Republic
Kyrgyzstan
Palau
Ukraine
Cote d'Ivoire
Lao
Panama
Uzbekistan
Djibouti
Lesotho
Papua New Guinea
Venezuela
Dominican Republic
Liberia
Paraguay
Viet Nam
Ecuador
Libya
Peru
Yemen
El Salvador
Macau (SAR of China)
Philippines
Zambia
Equatorial Guinea
Madagascar
Qatar
Zimbabwe
Eritrea
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No Yes
Have you ever been involved in the care of patients with TB?
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No Yes
Have you been screened in Australia for TB?
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No Yes
Have you had any vaccinations in the last 4 weeks?
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No Yes
Do you have any of the following medical conditions?
- Chronic renal disease
- Thymus disease (e.g. myasthenia gravis, thymoma, thymectomy, DiGeorge syndrome)
- HIV infection
- Cancer
- Autoimmune disease
No Yes
Are you currently on antibiotics or have taken any in the last month?
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No Yes
Are you currently taking any of the following?
- Steroids, by tablet or injection
- Other medications that suppress the immune system
- Chemotherapy
- Other prescription medication
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No Yes
Have you ever had Guillian-Barre syndrome?
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No Yes
Have you ever had a severe allergic reaction to a vaccine (e.g. anaphylaxis) or antibiotics?
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No Yes
Please list the reaction
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Do you have any moderate or severe skin diseases currently affecting the skin of your upper arm (e.g. eczema, psoriasis etc.)?
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No Yes
Do you have tattoos that mostly or completely cover one or both of your upper arms?
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No Yes
Are you pregnant or could you be pregnant or planning to be pregnant in the next 12 months?
(A pregnancy test can be provided as discretely as possible at the screening visit)
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No Yes Unsure
Are you currently breast feeding?
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No Yes
How did you hear about AVIRS?
Is the participant eligible for this study?
0 - Incomplete eligibility entry
1 - Yes
2 - Yes - BCG only
3 - No
4 - No - possible LTBI - go to IGRA testing
5 - Refer to study team for clarification
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You have not answered all the eligibility questions. Please make sure all questions have been answered to determine your eligibility.
You are eligible to participate in AVIRS, study staff will be in contact shortly
Thank you for your interest, you are ineligible and unable to proceed with the study