My Child & I: Vaccination – Part IV

In Parts I, II and III, we’ve learnt about vaccines, how they work and what vaccine series and boosters are. In this section, we’re going to look more in detail regarding the particular vaccines you should be giving your child.

Part IV: Vaccine Recommendations  & the Law

How do I know what vaccines I should get for my child?

Identifying what vaccines should be given to your child can be a major challenge indeed. Recommendations for vaccines change from year to year, and vaccines against new diseases are being developed all the time. Keeping abreast of all this information and choosing the best vaccination for your child can be a very daunting task indeed.

When it comes to the question of what vaccines are important for your child, I think the best approach is to identify:

  1. The mandatory vaccinations your child must receive

  2. Vaccinations that are strongly recommended for all children (may vary with age)

  3. Vaccines that are good in certain situations ( during outbreaks or for travelling to certain countries etc)

While this does help better identify the right vaccines for your child, there may still be a lot of information to process. Speaking to a physician familiar with vaccinations  may help clarify your doubts as well as provide you with a more streamlined approach to vaccinating your child.

What are the mandatory vaccinations my child must have?

Mandatory vaccinations differ from region to region. Most countries will have a set of vaccinations that all children must receive . In Singapore, it is mandated by law that all children must be vaccinated against Diptheria and Measles.

What vaccinations are good for my child?

This is a harder question to answer. Fortunately there is some help. As a rule, most countries develop their own recommended vaccine schedule, drawing input from various resources as well as expert advice from healthcare professionals. In that light, the Singapore Government has its developed its own recommended vaccine schedule. This is routinely updated and published on the HPB (Health Promotion Board) portal. The vaccine schedule is also found in health booklets issued to all newborn children in Singapore. However, they tend to fall out of date. Do check with your doctor for updates and changes to recommendations.

 Here’s a list of diseases commonly covered in the Singapore vaccine schedule:

  1. Tuberculosis

      • Bacterial illness endemic in many parts of the world, including Singapore. Spread by prolonged contact with patients with respiratory illness.

      • Children tend to develop extrapulmonary TB. Sites of infection can include brain linings or lymph nodes.

      • Vaccine is commonly referred to as BCG; given to all newborns in Singapore.

      • Children aged 6-59 months receiving their first dose must undergo skin testing first.

  1. Diptheria

    • Mandated by law

    • Infection produces respiratory illness and may cause cardiac complications.

    • Generally combined with Pertussis & Tetanus (3 in 1). Newer variations include protection against:

      1. Polio (4 in 1)

      2. Polio + HiB (Hemophilus influenza B) (5 in 1/Penta)

      3. Polio +HiB + Hepatitis B (6 in 1/Hexa)

  1. Pertussis @ Whooping cough

    • Highly contagious respiratory illness.

    • May progress to pneumonia, encephalopathy, seizures and death.

    • Generally given in combination with Diptheria & Tetanus.

  1. Tetanus

    • Infections sustained by deep wounds & cuts

    • Causes muscle spasms leading to characteristic lockjaw appearance. Spasms may be severe enough to break bones.

    • Usually combined with Diptheria & Pertussis. Adults who have completed vaccination series may receive isolated tetanus toxoid instead.

  1. Polio

    • Highly contagious viral disease. Largely eradicated thanks to global vaccination programs.

    • 1% of infected may develop paralysis, including of the respiratory muscles.

    • Comes as oral drops (OPV) or an injectable formulation (IPV). Current Singapore recommendations is to use IPV for the primary series (usually as a combination vaccine).

  1. Measles

    • Mandated by law

    • Virus spread by the respiratory system; highly contagious.

    • Presents with high fever followed by characteristic rash.

    • Complications may include bronchitis and (usually fatal) panencephalitis.

    • Usually combined with Mumps & Rubella (MMR). Newer variation includes Chickenpox -Varicella (MMRV).

  1. Mumps

    • Highly contagious, spread by respiratory secretions.

    • Complications commonly include oophritis/orchitis (swelling of ovaries/testes) possibly leading to infertility, and rarely fatal encephalitis.

    • Usually combined with Measles & Rubella.

  1. Rubella @German Measles

    • Virus spread by respiratory secretions. Causes symptoms suggestive to Measles but generally milder.

    • Though death is rare, pregnant mothers who are infected are at risk of miscarriage (~20%) as well as a series of incurable illnesses for the fetus (congenital rubella syndrome).

    • Usually combined with Measles & Mumps.

  2. Hepatitis B

    • Virus causing liver infection. Prevalent in many regions, including Singapore.

    • Vertical transmission (mother to child) possible.

    • Disease may cause chronic liver disease and progress to liver cancer.

    • Standalone vaccine available. May also be found in the 6 in 1 vaccine or in combination with Hepatitis A vaccine.

  3. Pneumococcus

    • Bacterial infection spread by the respiratory secretions.

    • Infection may cause sinusitis, middle ear infections, pneumonia, bacteremia or meningitis.

    • Complications and death are most common in the very young and very old. Patients younger than 2 also tend to be the most commonly infected .

  4. Hemophilus influenza B (HiB)

    • Bacterial infection spread by respiratory secretions

    • Common cause of childhood meningitis (prior to vaccination program).

    • Standalone vaccine available. May also be found in 5 in 1 vaccine.

  5. Human Papilloma Virus (HPV)

    • Causes genital warts. Certain high risk strains (16,18) have been identified as risks for cervical cancer.

    • Two vaccine variants available:

      1. Cervarix: Protective against high risk cancer strains of HPV.

      2. Gardasil: Protects against high risk cancer strains as well as common strains associated with genital warts.

    • Currently recommended for females aged 9-26.

    • Gardasil also recommended in males 9-26 to prevent genital warts and minimise transmission of high risk strains to females.

What are other vaccines that are good to have?

Most of the time, following the routine vaccine schedule should be sufficient to ensure your child’s good health. Adjunct vaccinations you may wish to consider may include cover against:

  • Varicella @ Chickenpox

  • Influenza (to be taken annually)

  • Rotavirus

  • Hepatitis A

Occasionally, travel to other countries may require you to be vaccinated against certain diseases. For example, patients undergoing pilgrimage to Mecca are required to be vaccinated against Meningococcus. Common considerations for vaccinations during travels include:

  • Meningococcus

  • Rabies

  • Typhoid

  • Japanese Encephalitis

amongst others. The US Centre for Disease Control (CDC) portal has a useful tool to help plan your vaccinations.

From time to time, there may be outbreaks of infectious diseases that may require vaccinations to minimize disease spread. The H1N1 saga in 2008/9 is one such example. In such circumstances you may be alerted by your doctor or by Governmental press releases regarding vaccine recommendations as well details regarding mass vaccination programmes.

In sum

Vaccinations may be a pain (literally!) but their benefits far outweigh their temporary inconveniences. Thanks to vaccinations and vaccine programs, we have greatly improved the safety and well-being of our children. Smallpox, once a global threat now no longer exists and even polio, which was a scrouge just a generation ago has now been largely eradicated.

Most vaccines are given in childhood to promote long lasting immunity as well as to protect one of our most vulnerable populations from deadly illnesses. While vaccine recommendations may vary from region to region, all agree that vaccines are of vital importance and they feature prominently in all child health programs.

The challenge is to identify what vaccine would be best for your child. Regional guidelines like Singapore’s vaccine schedule  help parents with the selection of appropriate vaccines. International vaccination guides like those published by the World Health Organization (WHO) and the US Centre for Disease Control (CDC)  may be useful sources of additional information.

Vaccinating your child may look to be a daunting challenge but there’s always help available. Speak to your doctor to find our more. Get your child the protection they deserve.


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