Adult Immunisation

ADULT IMMUNISATION

Background Information:
In Singapore, most immunisations for children up to 18 years old are covered under the National Childhood Immunisation Programme. For adults, there is no programme or schedule and immunisations are often left to their individual doctors to recommend. Many adults are not even aware that there are vaccines indicated in their age group or risk group.

Epidemiology:
As mentioned, the lack of awareness and minimal public health emphasis for adult immunisation has resulted in low uptake for vaccination even in high risk groups eg. elderly patients (those older than 65 years) and those with concurrent chronic diseases. In contrast to childhood vaccinations in Singapore which has achieved close to 100% coverage, adults have remained a largely unvaccinated group. There is a huge gap and opportunity to improve health in adults by immunisation throughout life.

Clinical
Immunisation is the most effective way to prevent infectious diseases and their sequelae. Immunsations can be divided into the following categories:

  1. Routine: These are vaccinations that are given commonly to prevent common diseases of public health importance eg. Mumps, measles, rubella, tetanus, diphtheria, pertussis, hepatitis B, etc. They are administered to all children born in Singapore and adults should take boosters to maintain their immunity eg tetanus booster every 10 years.
  2. Required:These are required for entry to certain countries as regulated by the International Health Regulations (IHR), WHO (World Health Organisation) Yellow Fever vaccination is required for entry into certain countries and for re-entry into Singapore after travel to a yellow fever endemic country. Vaccinations against meningitis and influenza are requirements for travel to Mecca for Haj or Umrah.
  3. Recommended:These are vaccines that are indicated for travel to countries endemic for certain diseases eg. Japanese B encephalitis, Typhoid, Rabies, Hepatitis A, etc. Another group of recommended vaccines are for individuals with certain medical conditions that puts them at high risk to specific infections eg. elderly, chronic medical conditions like diabetes, heart and lung problems, splenectomy patients, transplant patients, healthcare workers, HIV infected patients, etc.

Post Exposure Vaccination as “Treatment”
Vaccines can sometimes be used to protect non-immune persons against certain diseases after exposure but this has to be done as soon as possible eg. Chickenpox, hepatitis exposure, rabies post exposure. In addition, there is passive immunization with antibodies injection for “instant’’ protection after rabies, chickenpox and hepatitis exposure for certain high risk situations.

Points to Note:
Vaccines need to be taken at least 2 weeks before antibodies can be formed to give any protection. Some vaccinations need to be given over a course of 3 weeks or even one month before it is effective. For example, yellow fever vaccine certificate is only valid 10 days after the vaccination because that is the minimal interval before protective antibodies are formed.

Vaccines are recommended for adults on the following basis:

  1. Age
  2. Prior vaccination status/history
  3. Health condition
  4. Lifestyle
  5. Occupation
  6. Travel destination

Other than specific travel vaccines, the common vaccinations in adults are against the following micro-organisms:

  1. Influenza
  2. Hepatitis A and B
  3. Diphtheria Tetanus and Pertussis (Tdap)
  4. Pneumococcal
  5. Varicella and Herpes Zoster
  6. Human Papilloma Virus

You should see your family physician or contact our clinics for a review on which adult vaccinations will be most appropriate for you and your family members.

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