Vaccination in Singapore

Addendum (25/05/2008): Have changed the compulsory and optional headings to recommended and enhanced regimes. Many thanks to angrydoctor for pointing it out.

While blog-surfing, J. was surprised to notice there’s a pretty vocal antivaccine movement in the West. “Antivaccine” because J. can’t figure out if they’re talking about thimerosal, symptoms suggestive of autistic spectrum disorder (ASD) in kids with mitochondrial disorders and whatnot except that ‘vaccines are bad, they cause autism’.

Anyway, J. thought he’d comment on a couple of things that people might have misconceptions about, and talk about what he’s learnt about the vaccination schedule in Singapore.

More information can be obtained on the National Immunisation Registry.

Vaccination Schedule:
Recommended

  • Bacillus Calmette-Guerin (BCG:to prevent miliary tuberculosis) – At birth
  • Hepatitis B – At birth, 1 month, 6 months
  • Diphtheria, Pertussis, Tetanus – 3, 4, 5 months, booster at 18 months (diphteria, tetanus only) booster at 10-12 years
  • Oral polio vaccine (Sabin) – 3, 4, 5 months, booster at 18 months, 6-7 years, 10-12 years
  • Measles, Mumps, Rubella (MMR) – 15 months, booster at 6-7 years

Enhanced -

  • Haemophilus influenza type b (Hib) – 3, 4, 5 months
  • Varicella zoster (chicken pox) – 15 months ( 13 years 2 doses)
  • Pneumococcal vaccine – Prevnar less than 2 years, Pneumovax after 2 years
  • Hepatitis A – non-schedule, 3 doses beginning at least 4 weeks before travel and um, if you really like half-cooked shellfish
  • Meningococcus – Single dose tetravalent, especially for pilgrims going on the Haj

Now, onwards to questions!

[start]
People say that autism rates have gone up when vaccine rates have gone up! Does this mean I shouldn’t get my children vaccinated?!

Well, somewhat of a moot point since in Singapore the MMR and DPT/DT are legally required, but it’s not true! You see, correlation does not equate causation. Pirate counts have gone down and global temperatures have gone up! Coincidence… or… the lack of pirates causes global warming? Oil prices have gone up and infant mortality has come down! Coincidence… or… we should raise oil prices through the roof so less kids will die?

Also, there’s been no good studies at all that correlates vaccines with autism. However, there have been good studies to show that vaccines decrease childhood mortality and morbidity, have helped control diseases and are generally safe. In the light of existing evidence, please, vaccinate your child.

Polio has been eradicated, did my baby really need three doses of the polio vaccine before he was 18 months old?

Yes, yes he does. Poliomyelitis was eradicated because of a comprehensive vaccination program. Transmissable diseases usually have a number needed to treat (NNT) to stop prevention. The more highly transmissable, the higher the percentage of people required to be immune. As such, polio is controlled because almost everyone is vaccinated. There’s no reason to allow polio to have a resurgence in our community.

I understand that around 90% of kids vaccinated gain the immunity the first time they get a shot. Why am I not given the option of testing to see if he even needs more than one done of a vaccine?

That is not true either. The efficacy of vaccines like polio vaccine and DPT/PT require that the dosing be complete in order to get >90% immunisation. Certainly, certain vaccinations like varicella-zoster or meningococcus only require one dose.

The required vaccine schedule should be limited to highly transmissible, deadly public epidemic-type diseases like polio, not lifestyle diseases like Hep B or HPV, or childhood diseases like chickenpox that are largely harmless.

Well, in Singapore, Hepatitis B is endemic with vertical (mother-child) transmission being the most common mode of transmission. It’s an easily preventable disease (vaccination!) with a huge problem in the form of liver cirrhosis and liver cancer, of which it’s a more common cause than alcohol. HBV can be transmitted sexually or through blood which is why healthcare professionals in Singapore are all vaccinated (with boosters if the childhood dose is insufficient).

Human papillomavirus (HPV) is a sexually transmitted disease that is the main risk factor for cervical and anal cancer. The high-risk subtypes, at least, the rest cause warts. Note, however, that unless one is very confident that one’s child will never have sex in their lifetime, it’s good to have an option of vaccination. That said, in Singapore HPV vaccination has not caught on because the subtypes present in Singapore might not be almost all Types 16/18 (the ones being vaccinated against), it doesn’t absolve the need for Pap smears and it’s really, really expensive.

If J. had a choice, he’s rather have been immunised against varicella when he was younger instead of having to sleep in his cousin’s room (he had chicken pox) so that he could catch it young. There’s a condition called zoster, caused by reactivation of varicella-zoster virus, which presents with painful vesicles along a dermatomal distribution. This occurs in people who have gotten chicken pox before. Painful, and preventable.
[end]

Anyway, J. hopes this helps clear up some misconceptions about vaccination. That said, he’s only a lowly medical student and not some infectious diseases guru, so please, peruse the National Immunisation Registry for more information.

9 responses to this post.

  1. There is an error in your post (and it is a common misconception even amongst doctors).

    The vaccines which you listed as ‘compulsory’ are actually just ‘recommended’. They form the ‘standard’ vaccination programme under our national vaccination programme, while the ‘optional’ ones are part of the ‘enhanced’ programme.

    The difference between the standard and enhanced programme , according to the NIR site you linked to is this:

    “Basic immunisation (except for hepatitis B) are provided free at polyclinics. However, optional immunisation for chickenpox, meningitis (Haemophilus influenzae type b – Hib) and hepatitis A are available at a fee.”

    There are reasons why some vaccines are listed as standard and thus subsidised, while others are not, although the MOH does review the evidence are amend the schedules accordingly.

    It is not against the law to refuse consent for your child to be vaccinated, except for the Diptheria and Measles vaccine (just Measles alone, not MMR, although I am not sure if monvalent Measles vaccine is available in Singapore).

    The relevant laws are found in the Infectious Diseases Act, and the compulsory vaccines listed under the Fourth Schedule of that Act.

    In practice, ‘policing’ of this law takes place when parents apply for their children to enroll in schools, when (again from the NRI site):

    “the school authorities will check your child’s immunisation certificates to see if he or she has completed all the immunisations”.

    Since it is compulsory for parents to make their children attend national primary schools under the Compulsory Education Act, this sort of ensures that the immunisation record of all children are checked.

    I am personally not aware of any instance where parents have been charged with failing to vaccinate their children (although I have read of cases of parents being charged for not enrolling their children in national primary schools).

    Reply

  2. My fellow on Orkut shared this link with me and I’m not dissapointed at all that I came to your blog.

    Reply

  3. Posted by TreZ on April 3, 2011 at 7:14 pm

    Hmm..just curious, If one had lost one’s vaccine records, can a blood test verify one immunity and which boosters are needed ? Thanks !

    Reply

  4. Posted by Anonymous on April 3, 2011 at 11:30 pm

    I’m sorry but this post is full of misconceptions and reflects a lack of knowledge and understanding of issues surrounding vaccinations. I hope not many parents make decisions regarding their children’s vaccination based on it.

    Reply

  5. Posted by Jason on June 27, 2011 at 6:02 am

    This has got be the most disgusting article I have ever read. I have never seen so much blatantly incorrect information, listed as undisputed fact or at minimum “disputed” (correlation does not prove causation). I hope that this has been done in ignorance, but I am sure it has been done intentionally, and for that, I hope your soul pays dearly for endangering and ultimately bringing harm unto otherwise healthy babies.

    First, the most blatant lie in your propaganda hit piece – “Polio was eradicated by the vaccination regimen.”

    This is an entirely false, and completely misleading statement. By the time the vaccines were introduced, the prevalence of Polio had declined by 95% due to better sanitation and cleanliness standards. So as you would say “correlation does not prove causation”, as in, just because polio had 95% eradicated, and then they introduced a vaccine that was supposed to prevent it, doesn’t meant the vaccine did. In fact, according to the statistics, and the graphs plotted with data-points, if no vaccine had of been introduced, Polio would have been 99% eradicated by the 60’s.

    Furthermore, a new study has illustrated the blatant correlation between infant mortality and the amount of vaccinations a nation gives. Ironically, after having the lowest infant mortality rate for decades, the US now has the worst infant mortality rate in the developed worth (34th of 34), and wouldn’t you know it – they give the most vaccines to their children (26). Full study can be found http://www.scribd.com/doc/54772978/Infant-Mortality-Rates-Regress-w-Higher-No-of-Vaccine-Doses

    Now the final nail in the genocide program known as “vaccinations”, is the fact that children’s immune system is not fully developed till AGE 4! Why would you attack an incomplete immune system over and over again, with not just a live virus, but toxic adjuvants and preservative including Mercury?

    If you want a HEALTHY, HAPPY, baby, breastfeed your child, and don’t attack his incomplete immune system with viruses, chemicals and lethal heavy metals.

    Reply

  6. Posted by curious on December 12, 2011 at 2:44 pm

    You mentioned that “Well, in Singapore, Hepatitis B is endemic with vertical (mother-child) transmission being the most common mode of transmission. ”

    If that is the case, if the mother does not have Hepatitis B, then what is the necessasity of vaccinating the infant?

    Reply

  7. Posted by Tay Lian Hwa on January 28, 2012 at 9:06 am

    Hepatitis B causes liver cirrhosis (liver damage)and may cause liver cancer. Immunising your child protects him from Hepatitis B which is sexually transmitted and through possible common sharing of toothbrushes or shavers.

    Reply

    • But many things cause liver cancer too. Why are healthcare officials not looking at ways of educating public? For example, reducing or abstaining from alcohol. Abstaining from frequent intake of seafood etc? Never drink phosphoric acid or aspartame-laden drinks, etc?

      Reply

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