Your baby and immunisation

Infants and children face many potential dangers from various infectious diseases in the first few years of their lives. One of the major contributing factors to improvement in child health is the availability of vaccines. All parents want the best for their children. Children who fall sick often miss out on learning opportunities and playtime and can affect their overall growth and development.

Here is a list of common vaccines that are available in Singapore for children:
BCG (Bacillus Calmette-Guérin)
Disease(s) it prevents: It is a vaccine against tuberculosis that is prepared from a strain of the attenuated (weakened) live bovine tuberculosis bacillus that has lost its virulence in humans.

Number of doses: 1

When it should be given and comments: Soon after birth, usually before baby is discharged from hospital.

Single dose needed.

HBV (Hepatitis B Vaccine)
Disease(s) it prevents: Hepatitis B virus is transmitted through contact with blood and other body fluids of an infected person. Newborn can be infected if the mother is a Hepatitis B carrier. Rates of new infection and acute disease are highest among adults, but chronic infection is more likely to occur in persons infected as infants or young children.

Chronically infected persons are at increased lifetime risk for liver hardening (cirrhosis) and liver cancer and also serve as the main reservoir for continued HBV transmission.  Hence Hepatitis B vaccination remains a very effective way in preventing liver cirrhosis and cancer.

Number of doses: 3

When it should be given and comments: First dose is usually given soon after birth, before baby is discharged from hospital.

2nd and 3rd doses can be given as part of the combination vaccine (6-in-1, see below).

For baby born to a mother who is a Hepatitis carrier, the 2nd dose should be given at 1 month old and the 3rd dose can be given as a combination vaccine (6-in-1) at 6-month-old.

Re-vaccination may be necessary if blood test done between 9-12 months old does not show adequate antibody level in the baby.

DTPa-IPV/HiB/HBV (Diphtheria, Tetanus, Pertussis, Poliomyelitis, Haemophilus influenza Type B and Hepatitis B, also known as 6-in-1)
Disease(s) it prevents: All these infections are potentially life-threatening.

Diphtheria: It affects the throat and is spread by respiratory droplets. It is often complicated by toxic damage to the heart and peripheral nerves. It is fatal in 5-10% of the patients, even if properly treated.

Tetanus: It is caused by the neurotoxin produced by the bacteria that grow in dirty wounds. This results in muscle spasms, especially of the jaw, causing difficulty in breathing. Generalized seizures may follow with death eventually ensues.

Pertussis (Whooping Cough): It is a disease of the respiratory tract. The baby will have coughing spells that may last for 4-8 weeks and may end up in death.

Poliomyelitis: It is caused by poliovirus via the faecal-oral route. Children get the infection when they ingest contaminated food or drink. Poor environmental hygiene is a risk factor. The virus attacks the nerves, resulting in a crippling condition.

Haemophilus influenza type B: It is spread by respiratory droplets and causes severe pneumonia, meningitis, ear infection and other serious infections.  It is most common in children under 5 years old.

Hepatitis B: see above

Number of doses: 3

When it should be given and comments:  Minimum age is 6 weeks old.

Generally, it is given at 2, 4 and 6 months old although slight variations is common according to doctors’ preference.

Primary course of 3 doses is to be completed by 6 months preferably

DTPa-IPV/HiB (Diphtheria, Tetanus, Pertussis, Poliomyelitis, Haemophilus influenza Type B, also known as 5-in-1)
Disease(s) it prevents: See above

Number of doses: 1

When it should be given and comments: This is usually given as a booster to the 6-in-1 at 18 months of age.

In a baby who has opted to give the HBV separately, this 5-in-1 vaccine is given at 3, 4 and 5 months of age.

Prevenar 13™
Disease(s) it prevents: Pneumococcal diseases: It is a group of serious infections that affects children under 5 years old. It is most prevalent under the age of 2 years in Singapore. The bacterium is often carried in the nose and throat of healthy adults and children. It is transmitted via respiratory droplets and can cause meningitis, severe pneumonia, middle ear infection and blood infection. These infections can develop and progress quickly to fatality.

Number of doses: 3 + 1

When it should be given and comments:  3 doses should be given before the first birthday.

A single booster dose is given after 12 months old with a minimum interval of 8 weeks from the previous dose.

Catch-up vaccination schedule
Catch-up vaccination is recommended for all children who are previously unimmunised in the following categories:

• Previously unvaccinated children between 7-12 months of age: 2 doses for the primary series and 1 booster dose (at 12-24 months of age) should be given. The recommended interval between first and second dose is 8 weeks, with a minimum interval of 4 weeks. The minimum interval between second dose of the primary series and the booster dose is 8 weeks.

• Previously unvaccinated children between 12 to 23 months of age: 2 doses of PCV should be given with a minimum interval of 8 weeks between doses.

Supplemental pneumococcal vaccination with PCV13 is recommended for children who have either started or completed pneumococcal vaccination with the 7-valent pneumococcal conjugate vaccine (PCV7). PCV13 contains seven serotypes included in PCV7 plus six additional serotypes.

Rotarix™
Disease(s) it prevents: Rotavirus: It is the most common cause of severe diarrhea and vomiting in infants and young children.  98% of all children are infected with rotavirus at least once by the age of 5 years. It is the leading cause of diarrhoeal hospitalization in Singapore.

Number of doses: 2

When it should be given and comments: This vaccine is given orally.

Minimum age is 6 weeks.

Maximum age for completion is 8 months.

Interval between the 2 doses is 8 weeks.

MMRV (Measles, Mumps, Rubella & Varicella/Chickenpox)
Disease(s) it prevents: Measles: It is the most contagious vaccine-preventable infection in humans.  It is spread by respiratory droplets. Symptoms include fever, cough, running nose and a rash.  Complications: Seizures, ear infection, pneumonia, brain infection and death.

Mumps: It is an inflammation of the salivary glands, which presents as swelling and pain over the angle of the jaws, with fever, headache and muscle ache. Complications: deafness, brain infection and sterility.

Rubella (German measles): It is spread by respiratory droplets but may also be present in urine and faeces. Children presents with fever and rash with swelling of the neck lymph nodes. If pregnant women catch the infection, it may result in birth defects.

Varicella (Chickenpox): It is a highly contagious infection that is spread via respiratory droplets and direct contact with the secretions from the blisters. Complications include pneumonia and brain damage.

Number of doses: 2 doses 3 months apart

When it should be given and comments: Measles vaccination is compulsory by law in Singapore.

From the 1st December 2011, the Ministry of Health has changed its recommendation to giving the first dose at 12 months old and the booster dose at 15 months old.

Do not give your child the vaccine if your child is allergic to eggs.

There is no scientific basis for any link between MMR and autism.
If you are giving your child Chickenpox vaccine separately, your child will need 2 doses, 3 months apart.

HAV
Disease(s) it prevents: Hepatitis A: It is an infection of the liver that is spread by ingesting contaminated food or drink. Children may present with fever, jaundice, headache and tiredness.

Number of doses: 2 doses 6-12 months apart  

When it should be given and comments: Minimum age is 1 year old

Influenza Vaccine
Disease(s) it prevents: Influenza: It is a viral infection that causes chills, fever, sore throat, muscle pains, severe headache, coughing and fatigue. It is often confused with the common cold, but influenza is a more severe disease.

Number of doses: 1 or 2#  

When it should be given and comments: Minimum age is 6 months old.

Vaccine is recommended annually for all children aged 6 months to <5 years and

children aged 6 months to <18 years in high-risk groups

#Previously unvaccinated children under the age of 9 years will require 2 doses given at least one month apart. Children 9 years and above will require a single dose of the vaccine.

The vaccine will not protect you against the common cold, even though some of the symptoms are similar to flu.

Do not give your child the vaccine if your child is allergic to eggs.

HPV Vaccine (Human Papillomavirus Vaccine)
Disease(s) it prevents: Human Papillomavirus (HPV) is a virus that can cause pre-cancerous and cancerous lesions in the cervix of the women¡¯s womb.  The vaccine is intended to protect females against these diseases, although the protection is only about

Number of doses: 3

When it should be given and comments: Recommended for females 9 to 26 years; three doses are required.

First dose: Chosen date

2nd dose: 1 month later

3rd dose: 6 months from first dose

Alternative schedule is 0, 2 and 6 months

Schedules of the various immunizations may defer slightly as preferred by different doctors. For more information, please speak to your doctors.

Common side effects of the vaccines include fever, irritability, loss of appetite and local swelling at injection sites. If your child has an underlying medical condition, please inform your doctor prior to the vaccination.

If your baby misses a dose of the vaccine, contact your doctor to arrange for the dose to be given as soon as possible. There is no need to re-start the whole schedule.

Publication of this article by courtesy of Dr Wong Chin Khoon, Paediatrician from SBCC Baby & Child Clinic at Central Plaza.