Travel and Vaccine

Travel and Vaccination Clinic
Mandatory Vaccines
Your Travel Medical Kit
Adult Vaccine Schedules
Child’s Vaccine Schedules
Vaccinations for Children
National Childhood Immunisation Schedule (wef Jan 2008)
Find Out More About Yellow Fever
ANNEX 1
Countries1 with risk of yellow fever transmission2 and countries requiring yellow fever vaccination
ANNEX 2
International Health Regulations

Travel and Vaccination Clinic

‘International travel can pose various risks to health, depending on the characteristics of both the traveller and the travel.’ WHO International travel and health report – 2008 Edition

Vaccination is a very safe and effective way of preventing certain infectious diseases.

Plan before you travel. Discuss your itinerary with our doctors and let us advice you on your vaccine requirements. See us at least 4 weeks before your travel date to allow sufficient time for optimal immunization schedules to be completed.

Mandatory Vaccines

Yellow Fever Vaccine

Mandatory for travelers going to or coming from certain countries in Sub-Saharan Africa and South America.

Yellow Fever Vaccination Certificate

Source: Singapore Immigration and Checkpoints Authority Website.

For entry into Singapore, a valid yellow fever vaccination certificate is required from travellers (over one year of age) who, within the preceding six days have been in or have passed through any country endemic for yellow fever.

The International Certificate of Vaccination for yellow fever is considered valid 10 days after vaccination. The certificate is for a period of 10 years.

Countries endemic for yellow fever are as follows:

Angola

Argentina

Benin

Bolivia

Brazil

Burkina Faso

Burundi

Cameroon

Central African Republic

Chad

Colombia

Congo

Cote d’lvoire

Democratic Republic of Congo

Ecuador

Equatorial Guinea

Ethiopia

French Guyana

Gabon

Gambia

Ghana

Guinea

Guinea-Bissau

Guyana

Kenya

Liberia

Mali

Mauritania

Niger

Nigeria

Panama

Paraguay

Peru

Rwanda

Senegal

Sierra Leone

Sudan

Suriname

Togo

Trinidad & Tobago

Uganda

Venezuela

Meningococcus Vaccine & Polio Vaccine

Mandatory for pilgrims to Saudi Arabia.

Your Travel Medical Kit

A medical kit is an absolute necessity for international travelers. The contents of the kit may vary depending on your specific needs, destination, quality of accommodation and assess to quality medical care.

Please remember that self-medication is not a substitute for proper medical care. Please seek medical attention as soon as possible especially if your symptoms do not improve.

These are some medicines that you might find useful to have in your travel medical kit. Recommended doses are for healthy adults. Please consult us for dosing in children, elderly and persons with chronic illnesses. Please do not take any drug that you have a known allergy to.

Paracetamol 500mg
  • For fever and pain.
  • Take 2 tablets 4 times a day.
  • Do not exceed 8 tablets a day.

 

Antacids
  • For gastritis.
  • Take 2 tablets 4 times a day.
  • Do not exceed 12 tablets a day.
  • May cause constipation or diarrhea.

 

Anti-Diarrhea Agents (eg Lomotil)
  • For diarrhea.
  • Take 1 tablet 3 times a day.

 

Oral Rehydration Salts
  • For replacing essential salts and fluids in the event of severe vomiting or diarrhea.
  • Dissolve 1 sachet in clean water and consume hourly.

 

Decongestant / Anti-Histamines
  • For blocked, stuffy or runny nose.
  • Take 1 tablet every morning.

 

Anti-Vomiting Agents
  • For vomiting and motion sickness.
  • Take 1 tablet 3 times a day.
  • To prevent motion sickness, take 1 tablet at least 30 minutes before travel.

 

Anti-Biotic (Ciprofloxacin)
  • This is a broad spectrum anti-biotic that is useful for traveler’s diarrhea, dysentery, cholera, urine tract infection and skin and soft tissue infections.
  • Take 2 tablets 2 times a day for 5 days.
  • Stop if you develop a rash.

 

Anti-Malaria Agents (Malarone)
  • Take 1 tablet one day before departure.
  • Take 1 tablet once every day while you are traveling.
  • Take 1 tablet everyday for a week after you have returned.

 

Insect Repellant (Anti-Mosquito Patch)
  • Attach the patch onto your skin or on clothes.
  • Each patch lasts up to 12 hours.

 

Sun-block (at least SPF 30)
  • Apply to sun exposed areas concentrating on the face and neck.
  • Avoid contact with eyes.
  • Re-apply regularly especially if you are sweating profusely or are going swimming.

 

Laxative
  • Dissolve 1 sachet in clean water and consume 3 times a day.

 

Dressing Set (Antiseptic Ointment, Bandages, Gauze and Tape)
  • Wash wounds under clean running water.
  • Apply Antiseptic Ointment and then cover with a clean gauze.
  • Wrap the area with a clean bandage and tape the bandage securely.
  • See a doctor as soon as possible.

Adult Vaccine Schedules

Please refer to the Child’s Vaccine schedule for ages below the age stated under each vaccine

Vaccine Against Sequence Duration of Protection
Twinrix
16 years old and above
Hepatitis A+B Rapid1st shot
2nd shot – day 7
3rd shot – day 21
4th shot- 1 yearStandard1st shot
2nd shot – month 1
3rd shot – month 6
10 years10 years
Engerix-B Adult
20 years old and above
Hepatitis B Rapid1st shot
2nd shot – day 7
3rd shot – day 21
4th shot- 1 yearStandard1st shot
2nd shot – month 1
3rd shot – month 6
10 years10 years
Havrix Adult
19 years old and above
Hepatitis A 1st shot
2nd shot – month 6
10 years
Dukoral
7 years old and above
Cholera and E. Coli (Traveller’s Diarrhea) 1st drink
2nd drink – day 7
2 years
Typherix
2 years old and above
Salmonella (Typhoid Fever) 1 shot only 3 years
Fluarix
9 years old and above
Influenza 1 shot only 1 year
Boostrix
4 years old and above
Tetanus, Diphtheria and Pertussis 1 shot only 10 years
Mencevax
2 years old and above
Meningococcus
NB. For travelers to Middle East or community living (eg dormitory)
1 shot only 10 years
Varilrix
13 years old and above
Varicella (Chickenpox) 1st shot
2nd shot – week 6
Life
Japanese Encephalitis
3 years old and above
Japanese Encephalitis
NB. For travelers to rural/jungle Southeast Asia
1st shot
2nd shot – day 7
3rd shot – day 28
4 years
Stamaril
6 months old and above
Yellow Fever
NB. For travelers to South America or Sub-Saharan Africa
1 shot only 10 years
Malarone
40 kg and above of body weight
Malaria Pills to be taken everyday starting 1 day before entering and stopping 7 days after leaving the endemic area As long as taking the pills
Cervarix HPV Virus
(Cervical Cancer)
1st shot
2nd shot – month 1
3rd shot – month 6
At least 5.5 years
Need for booster is being studied

Child’s Vaccine Schedules

Please refer to the Adult’s Vaccine schedule for ages above the age stated under each vaccine

Vaccine Against Sequence Duration of Protection
Twinrix
1 to 15 years old
Hepatitis A+B 1st shot
2nd shot – month 6
10 years
Engerix-B Ped
0 to 19 years old
Hepatitis B 1st shot
2nd shot – month 1
3rd shot – month 6
10 years
Havrix Junior
1 to 18 years old
Hepatitis A 1st shot
2nd shot – month 6
10 years
Dukoral
2 to 6 years old
Cholera and E. Coli (Traveller’s Diarrhea) 1st drink
2nd drink – day 7
3rd drink – day 14
2 years
Typherix
2 years old and above
Salmonella (Typhoid Fever) 1 shot only 3 years
Fluarix
6 months to 8 years old
Influenza 1st shot
2nd shot – week 4
1 year
Boostrix
4 years old and above
Tetanus, Diphtheria and Pertussis 1 shot only 10 years
Mencevax
2 years old and above
Meningococcus
NB. For travelers to Middle East or community living (eg dormitory)
1 shot only 10 years
Varilrix
1 to 12 years old
Varicella (Chickenpox) 1 shot only Life
Japanese Encephalitis (reduced dose)
0 to 3 years old
Japanese Encephalitis
NB. For travelers to rural/jungle Southeast Asia
1st shot
2nd shot – day 7
3rd shot – day 28
4 years
Stamaril
6 months old and above
Yellow Fever
NB. For travelers to South America or Sub-Saharan Africa
1 shot only 10 years
Malarone
11 to 20kg – ¼ pill
21 to 30kg – ½ pill
31 to 40 kg – ¾ pill
Malaria Pills to be taken everyday starting 1 day before entering and stopping 7 days after leaving the endemic area As long as taking the pills

 

Vaccinations for Children

Vaccinations serve to prevent illness and disease by stimulating the production of antibodies in us. This is especially useful for illnesses with no good cure, or for those which tend to spread very rapidly amongst our community.

Successful mass vaccination programmes can benefit even those in the community who fail to get vaccinated by reducing the incidence of the illness within the community.

In Singapore, measles and diphtheria vaccinations are required BY LAW. While the other vaccines on the National Immunization Programme ( NIP ) are not compulsory, parents and caretakers are strongly encouraged to adhere to the recommended vaccinations for your child’s own protection. Singapore’s National Childhood Immunization schedule can be found here.

While not officially incorporated into the NIP, we would like to encourage parents to consider providing the following vaccines for their children:

  • Rotavirus vaccine ( oral ) at 2 months and 4 months of age.
  • Seasonal Influenza every year from 6 months of age to 2 years of age.
  • Chicken Pox ( Varicella ) vaccine, given after 12 months of age. To reduce the number of injections given to your child, this can be combined with the MMR vaccine at 13 months
  • Human Papillomavirus ( HPV ) vaccine which reduces the risk of Cervical Cancer, for girls at 9 to 10 years of age.

Although mild coughs and colds should not stop you from bringing your child for scheduled vaccinations, do inform the clinic and the doctor if your child is feeling unwell.

In addition, please highlight to the doctor if your child has/had:

  • Fever, with or without other symptoms
  • Allergic reactions to any previous vaccines or medications, or egg allergy.
  • A history of other medical problems, such as cancer, leukemia, SLE or uncontrolled epilepsy.
  • Missed any previous doses of vaccines, which may require ‘catch-up’ vaccinations.

After the vaccinations, some of the common reactions include:

  • Redness, soreness or induration ( hardening ) around the injection site
  • Fever
  • Irritability
  • Mild rashes

If you child experiences these symptoms, using a topical cream to sooth the injection site or some Paracetemol syrup to control the fever may be useful. In very rare circumstances, if your child throws a fit ( seizure ) or becomes extremely lethargic or if  the fever does not settle within 1 to 2 days, please bring your child to the nearest clinic or hospital for review.

Some of the National Immunization schedules for other parts of the world can be found at:

National Childhood Immunisation Schedule (wef Jan 2008)

Age Standard Schedule Common Schedule Alternative Schedule
At Birth BCG Hepatitis B BCG Hepatitis B BCG Hepatitis B
1 mth Hepatitis B Hepatitis B
2 mth 6 in 1 (DPT, HiB, Polio, HepB)
3 mth DPT Polio 5 in 1 (DPT, HiB, Polio)
4 mth DPT Polio 5 in 1 (DPT, HiB, Polio) 6 in 1 (DPT, HiB, Polio, HepB)
5 mth DPT Polio 5 in 1 (DPT, HiB, Polio)
6 mth Hepatitis B Hepatitis B 6 in 1 (DPT, HiB, Polio, HepB)
1-2 yrs MMR 15 mth – MMR 15 mth – MMR
18 mth DPT Polio 5 in 1 DPT, HiB, Polio 5 in 1 DPT, HiB, Polio
6-7 yrs MMR Polio MMR Polio MMR Polio
10-11 yrs DT Polio DT Polio DT Polio

 

Optional Vaccines
1. Pneumococcus
2. Haemophilus Influenza
3. Rotavirus 4. Menigococcal
5. Varicella
6. Hepatitis A

NB
1. All above schedules are approved and accepted by the Ministry of Health (MOH).
2. Standard Schedule is the schedule as set out by MOH.
3. Common Schedule is the schedule that the majority of children are on.
4. Alternative Schedule is gaining popularity due to the fewer number of injections.

Find Out More About Yellow Fever

Yellow fever is a serious and frequently fatal viral disease transmitted by mosquitoes.

Vaccination against yellow fever is required from any person who is going to or coming from or has passed through any country which is wholly or partly endemic for yellow fever. (Please see below for the list of countries)

Image of map: Global Distribution of Yellow Fever, 1996Yellow fever vaccination can only be given at designated Yellow Fever Vaccination Centers and travelers will be issued with a WHO International Certificate of Vaccination. Robertson Medical Practice is an approved Vaccination Center for Yellow Fever.

Certain people are not fit to receive the Yellow Fever Vaccine. These include pregnant mothers, children under 6 months of age, travelers who are allergic to egg and travelers with a compromised immune system. Such travelers need to obtain a medical waiver prior to travel.

Yellow fever vaccine generally has few side effects; fewer than 5% of vaccinees develop mild headache, muscle pain, or other minor symptoms 5 to 10 days after vaccination. A single dose confers immunity for 10 years.

Africa
Central and South America
Angola
Benin
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Congo
Côte d’Ivoire
Democratic Republic of Congo
Equatorial Guinea
Ethiopia
Gabon
The Gambia
Ghana
Guinea
Guinea-Bissau
Kenya
Liberia
Mali
Mauritania
Niger
Nigeria
Rwanda
São Tomé and Principe
Senegal
Sierra Leone
Somalia
Sudan
Tanzania
Togo
Uganda
Argentina
Bolivia
Brazil1
Colombia
Ecuador
French Guiana
Guyana
Panama
Paraguay
Peru
Suriname
Trinidad and Tobago
Venezuela

ANNEX 1
Countries1 with risk of yellow fever transmission2 and countries requiring yellow fever vaccination

Country Countries with risk of yellow fever transmission Countries requiring yellow fever
vaccination for travellers coming from countries with risk of yellow fever transmission
Countries requiring yellow fever vaccination for travellers from all countries
Afghanistan Yes
Albania Yes
Algeria Yes
Angola  Yes Yes
Anguilla Yes
Antigua and Barbuda Yes
Argentina Yes
Australia Yes
Bahamas Yes
Bahrain Yes
Bangladesh Yes
Barbados Yes
Belize Yes
Benin Yes Yes
Bhutan Yes
Bolivia  Yes Yes
Botswana Yes
Brazil Yes Yes
Brunei Darussalam Yes
Burkina Faso Yes Yes
Burundi Yes Yes
Cambodia Yes
Cameroon  Yes Yes
Cape Verde Yes
Central African
Republic  Yes Yes
Chad Yes Yes
China Yes
Christmas Island Yes
Colombia Yes
Congo Yes Yes
Congo, Democratic
Republic of Yes Yes
Costa Rica Yes
Côte d’Ivoire Yes Yes
Djibouti Yes
Dominica Yes
Ecuador  Yes Yes
Egypt Yes
El Salvador Yes
Equatorial Guinea Yes Yes
Eritrea Yes
Ethiopia  Yes Yes
Fiji Yes
French Guyana Yes Yes
French Polynesia Yes
Gabon  Yes Yes
Gambia  Yes Yes
Ghana Yes Yes
Grenada Yes
Guadeloupe Yes
Guatemala Yes
Guinea Yes Yes
Guinea-Bissau Yes Yes
Guyana Yes Yes
Haiti Yes
Honduras Yes
India Yes
Indonesia Yes
Iran (Islamic Republic
of) Yes
Iraq Yes
Jamaica Yes
Jordan Yes
Kazakhstan Yes
Kenya  Yes Yes
Kiribati Yes
Korea, Democratic
People’s Republic of Yes
Lao People’s
Democratic Republic Yes
Lebanon Yes
Lesotho Yes
Liberia Yes Yes
Libyan Arab
Jamahiriya Yes
Madagascar Yes
Malawi Yes
Malaysia Yes
Maldives Yes
Mali  Yes Yes
Malta Yes
Mauritania Yes Yes
Mauritius Yes
Montserrat Yes
Mozambique Yes
Myanmar Yes
Namibia Yes
Nauru Yes
Nepal Yes
Netherlands Antilles Yes
New Caledonia Yes
Nicaragua Yes
Niger Yes Yes
Nigeria Yes Yes
Niue Yes
Oman Yes
Pakistan Yes
Palau Yes
Panama  Yes Yes
Papua New Guinea Yes
Paraguay Yes Yes
Peru Yes
Philippines Yes
Pitcairn Islands Yes
Portugal Yes
Reunion Yes
Rwanda  Yes Yes
Saint Helena Yes
Saint Kitts and Nevis Yes
Saint Lucia Yes
Saint Vincent and
the Grenadines Yes
Samoa Yes
Sao Tome and
Principe Yes Yes
Saudi Arabia Yes
Senegal Yes Yes
Seychelles Yes
Sierra Leone Yes Yes
Singapore Yes
Solomon Islands Yes
Somalia  Yes Yes
South Africa Yes
Sri Lanka Yes
Sudan Yes Yes
Suriname Yes Yes
Swaziland Yes
Syrian Arab Republic Yes
Thailand Yes
Timor Leste Yes
Togo Yes Yes
Tonga Yes
Trinidad and Tobago Yes Yes
Tunisia Yes
Uganda  Yes Yes
United Republic
of Tanzania Yes Yes
Uruguay Yes
Venezuela Yes
Viet Nam Yes
Yemen Yes
Zimbabwe Yes

 

1 For the purpose of this publication, the term “country” covers countries, territories and areas.
2 Risk of yellow fever transmission is defined as either yellow fever has been reported currently or in the past plus presence of vectors and animal reservoirs that create a potential risk of infection and transmission.
* Either yellow fever has been reported or disease previously reported plus the presence of vectors and animal reservoirs create a potential risk of infection and transmission.

ANNEX 2
International Health Regulations

The spread of infectious diseases from one part of the world to another is not a new phenomenon, but in recent decades a number of factors have underscored the fact that infectious disease events in one country may be of potential concern for the entire world. These factors include: increased population movements, whether through tourism or migration or as a result of disasters; growth in international trade in food; biological, social and environmental changes linked with urbanization; deforestation; alterations in climate; and changes in methods of food processing, distribution and consumer habits. Consequently, the need for international cooperation in order to safeguard global health has become increasingly important.

The International Health Regulations (IHR), adopted in 1969, amended in 1973 and 19811 and completely revised in 20052 provide the legal framework for such international cooperation. The stated purpose of the Regulations is to prevent, protect against, control, and provide public health responses to, the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade.

Their main objectives are to ensure: (1) the appropriate application of routine, preventive measures (e.g. at ports and airports) and the use by all countries of internationally approved documents (e.g. vaccination certifi cates); (2) the notifi cation to WHO of all events that may constitute a public health emergency of international concern; and (3) the implementation of any temporary recommendations should the WHO Director-General have determined that such an emergency is occurring. In addition to its new notifi cation and reporting requirements, the IHR (2005) focus on the provision of support for affected states and the avoidance of stigma and unnecessary negative impact on international travel and trade.

1 International Health Regulations (1969): third annotated edition. Geneva, World Health Organization, 1983.
2 International Health Regulations (2005): http://www.who.int/ihr

The IHR (2005) entered into force on 15 June 2007. They take account of the present volume of international traffi c and trade and of current trends in the epidemiology of infectious diseases, as well as other emerging and re-emerging health risks.

The two specifi c applications of the IHR (2005) most likely to be encountered by travellers are the yellow fever vaccination requirements imposed by certain countries (see Chapter 6; country list) and the disinsection of aircraft to prevent importation of disease vectors (see Chapter 2).3

The vaccination requirements and the disinsection measures are intended to help prevent the international spread of diseases and, in the context of international travel, to do so with the minimum inconvenience to the traveller. This requires international collaboration in the detection and reduction or elimination of the sources of infection.

Ultimately, the risk of an infectious agent becoming established in a country is determined by the quality of the national epidemiological and public health capacities and, in particular, by day-to-day national health and disease surveillance activities and the ability to detect and implement prompt and effective control measures. The requirements for states to establish certain minimum capacities in this regard will, when implemented, provide increased security for visitors as well as for the resident population of the country.

3 Hardiman M., Wilder-Smith A. The revised international health regulations and their relevance to the travel medicine practitioner. Journal of Travel Medicine, 2007,
14(3):141—144.

advise


Need more advice?

Come down to Our Clinics for a discussion with Our Doctors, or call our clinics for more information:

1.) Robertson Walk  (+65 6238 7810)

2.) Bencoolen Street (+65 6884 4119)

3.) Novena Medical Centre (+65 6397 2095)

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About Dr. Tan
Dr. Tan graduated from the National University of Singapore in 2001. His residency was in the two largest public hospitals in Singapore; Tan Tock Seng Hospital and Singapore General Hospital.

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2 Comments

  1. I would like to know what are the possible allergic reactions to a Yellow Fever injection as my wife, daughter & I are visiting Brazil & Argentina in March 2012.

    Thank you

    • Hi sudesh,

      For Yellow Fever vaccinations we use Stamaril by Sanofi Pasteur. 16% of patients will get pain, redness, bruising and swelling at the injection site. Les than 10% of patients will get headaches, muscle aches, nausea, diarrhea or fever.

      rgds

      Dr Tan

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