Adolescents & Adults

Adolescents & Adults
Do you know which adult vaccines you may need?

Vaccines are recommended for all adults based on factors such as:1

  • Age
  • Travel
  • Occupation
  • Medical history
  • Vaccination history

The Ministry of Health of Singapore established the National Adult Immunisation Schedule on 1
November 2017 that comprises of 7 types of vaccines that protect against 11 diseases including:2

  • Influenza
  • Pneumococcal (PCV 13/PPSV23)
  • Human Papillomavirus (HPV2/HPV4)
  • Tetanus, Diphtheria and Pertussis (Tdap)
  • Measles, Mumps and Rubella (MMR)
  • Hepatitis B
  • Varicella

Apart from the vaccines above, you may also need other vaccines depending on your age or other factors.1

Read on to learn more about the diseases and talk to your doctor about which vaccines are appropriate for you.

Recommended vaccines for the Adult
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  • Influenza
    influenza
    DISEASE:
    • Influenza (flu) is a contagious disease caused by influenza viruses.3
    • There are 4 strains of flu virus circulating. Ask your healthcare provider on how to stay protected from the 4 flu viruses.4

    TRANSMISSION:
    • Respiratory droplets when people with flu cough, sneeze or talk.5
    • Touching a surface or object that has flu virus on it and then touching your own mouth, nose, or possibly your eyes.5
    • Singapore has year-round influenza activity and has had variable peak activity in some years. Due to undefined peak of disease activity, the Ministry of Health in Singapore issues advisories once or twice a year when new vaccines with a change in formulation are released.6

    SIGNS AND SYMPTOMS:7
    chart influenza adult


    RECOMMENDATIONS:
    The recommended population groups are
    • Persons aged 65 years and older2,8
    • Adults who have chronic medical condition such as diabetes mellitus, asthma and heart disease2,8
    • Adults who have required regular medical follow-up or hospitalization during the preceding year due to renal, neurologic, hepatic or hematologic disorders8
    • Persons who are immunocompromised2,8
    • Women at all stages of pregnancy2,8
    • Persons aged 18 years and receiving long-term aspirin therapy2
    • Persons receiving intermediate and long-term care (ILTC) services2,8
    • Healthcare personnel8
    • Persons who are morbidly obese8
    • Household contacts and caregivers of children younger than 5 years of age, adults 50 years of age or older8

  • Tetanus, diphtheria and pertussis (Tdap)
    Tetanus, diphtheria and pertussis (Tdap)
    DISEASE:

    Tetanus or lockjaw is an infection caused by the Clostridium tetani bacteria. A poison (toxin) is produced when the bacteria invades the body, causing painful muscle contractions.9

    Diphtheria is an infection caused by the bacterium Corynebacterium diphtheria which leads to the development of a thick covering in the back of the throat.10

    Pertussis or whooping cough is a highly contagious infection of the lungs and airways by the bacteria Bordetella pertussis. It is characterised by severe coughing spells that may end in a "whoop" sound.11

    TRANSMISSION:

    Spores of tetanus bacteria from the environment, including soil, dust, and manure develop into bacteria when they enter the body through broken skin, usually through injuries from contaminated objects. These include:12

    • Wounds contaminated with dirt, faeces, or saliva
    • Wounds caused by an object puncturing the skin (puncture wounds), like a nail or needle
    • Burns
    • Crush injuries
    • Injuries with dead tissue

    Diphtheria is transmitted through respiratory droplets, like from coughing or sneezing or by touching a surface or object that has the bacteria on it.13

    Pertussis is transmitted through respiratory droplets:14

    • When an infected person sneezes or coughs
    • When you come into direct contact with respiratory secretions

    SIGNS AND SYMPTOMS:

    Tetanus infection can lead to serious health problems. Symptoms of tetanus include:15

    • Jaw cramping
    • Sudden, involuntary muscle tightening (muscle spasms) — often in the stomach
    • Trouble swallowing
    • Jerking or staring (seizures)
    • Changes in blood pressure and heart rate

    Tetanus can also cause serious health problems such as:

    • Involuntary tightening of the vocal cords (laryngospasm)
    • Broken bones/fractures
    • Blockage of the main artery of the lung or one of its branches by a blood clot (pulmonary embolism)
    • Pneumonia
    • Breathing difficulty, possibly leading to death (1 to 2 in 10 cases are fatal)

    The bacteria that cause diphtheria can get into and attach to the lining of the respiratory system. When this happens, the bacteria produces a poison (toxin) that can cause:16

    • Weakness
    • Sore throat
    • Fever
    • Swollen glands in the neck
    • Difficulty breathing and swallowing

    The majority of adults with pertussis will experience these complications. Some of the common complications include:17

    • Weight loss
    • Loss of bladder control
    • Passing out
    • Rib fractures from severe coughing

    Pertussis can further lead to:18

    • Pneumonia (lung infection)
    • Seizure

    RECOMMENDATIONS:

    The recommended population groups are

    • Pregnant Women2,8
    • Persons aged ≥11 years who have not received Tdap vaccine or for whom vaccine status is unknown should receive a dose of Tdap followed by tetanus and diphtheria toxoids (Td) booster doses every 10 years thereafter8
    • Adults with an unknown or incomplete history of completing a three dose primary vaccination series with Td-containing vaccines should begin or complete a primary vaccination series including a single Tdap dose8
    • Tdap can also be used in management of a tetanus-prone wound8

  • Measles, Mumps, & Rubella (MMR)
    DISEASE:

    Measles, mumps and rubella are highly contagious and can have serious, potentially fatal complications.19

    TRANSMISSION:

    Measles spreads through the air when an infected person coughs or sneezes. Since the virus can stay in the air for up to 2 hours after an infected person was there, anyone can get infected by sharing the space the infected person was in previously. Highly contagious, measles can infect up to 90% of the people around the infected person if they are not protected.20

    Mumps spreads through direct contact with saliva or respiratory droplets from the mouth, nose, or throat. An infected person can spread the virus by:21

    • Coughing, sneezing, or talking
    • Sharing items that may have saliva on them, such as water bottles or cups
    • Participating in close-contact activities with others
    • Touching objects or surfaces with unwashed hands that are then touched by others

    Rubella spreads when an infected person coughs or sneezes. It can also be transmitted by an expectant mother to her developing baby.22

    SIGNS AND SYMPTOMS:

    Measles symptoms appear 7 to 14 days after contact with the virus and rashes develop 3 to 5 days after the first symptoms. Measles typically begins with:23

    • High fever (may spike to more than 40°C)
    • Cough
    • Runny nose
    • Red, watery eyes (conjunctivitis)

    2-3 days after symptoms begin:

    • Tiny white spots (Koplik spots) appear inside the mouth

    3-5 days after symptoms begin:

    • Rash break out
    • High fever (may spike to more than 40°C)

    Mumps cause puffy cheeks and tender, swollen jaw due to swollen salivary glands under the ears on one or both sides, often referred to as parotitis. The first few symptoms that begin a few days before parotitis include:24

    • Fever
    • Headache
    • Muscle aches
    • Tiredness
    • Loss of appetite

    Rubella is generally mild in adults. The symptoms include:25

    • Low-grade fever
    • Sore throat
    • Rash
    • Headache
    • Pink eye

    RECOMMENDATIONS:

    The recommended population groups are

    • Adults who have never been vaccinated or do not have evidence of immunity to all three diseases2,8
    • Adults who were vaccinated with only one dose of MMR during childhood8
    • Students in postsecondary educational institutions8
    • Workers in a healthcare facility or persons who come into contact with individuals at high risk of disease8
    • Adults who plan to travel internationally8

  • Hepatitis B
    Hepatitis B
    DISEASE:26

    Hepatitis B is a liver infection caused by the Hepatitis B virus (HBV). For some, hepatitis B is an acute, or short-term, illness but for others, it can become a long-term, chronic infection.

    TRANSMISSION:27

    Hepatitis B is transmitted through activities that involve percutaneous (i.e., puncture through the skin) or mucosal contact with infectious blood or body fluids. Other transmissions include:

    • Sex with an infected partner
    • Injection drug use
    • Birth to an infected mother
    • Contact with blood or open sores of an infected person
    • Needle sticks or sharp instrument exposures
    • Sharing items such as razors or toothbrushes with an infected person

    SIGNS AND SYMPTOMS:27

    When present, signs and symptoms of acute Hepatitis B infections can include:

    • Fever
    • Fatigue
    • Loss of appetite
    • Nausea
    • Vomiting
    • Abdominal pain
    • Dark urine
    • Clay-colored bowel movements
    • Joint pain
    • Jaundice

    Most persons with chronic HBV infection are asymptomatic and have no evidence of liver disease. Others develop:

    • Chronic hepatitis (elevation of AST/ALT)
    • Cirrhosis
    • Hepatocellular carcinoma (a type of liver cancer)

    RECOMMENDATIONS:

    The recommended population groups are individuals seeking protection from hepatitis B virus infection2,8 and persons with any of the following indications:

    • Sexually active persons with multiple partners; persons seeking evaluation or treatment for a sexually transmitted disease (STD); men who have sex with men8
    • Injection drug users8
    • Healthcare personnel and public safety workers (e.g. chronic haemodialysis patients facilities, correctional facilities, STD treatment facilities, drug abuse treatment and prevention facilities)8
    • Persons with chronic medical conditions (e.g. diabetes, end stage renal disease, chronic liver disease)8
    • HIV infection8
    • Household members and sex partners of hepatitis B surface antigen–positive persons8
    • Clients and staff members of institutions for persons with developmental disabilities8
    • International travellers to hepatitis B endemic regions8

  • Chickenpox
    Chickenpox
    DISEASE:28

    Chickenpox, a highly contagious disease caused by the varicella-zoster virus (VZV) can be serious, especially in babies, adolescents, adults, pregnant women, and people with a weakened immune system.

    TRANSMISSION:29

    The virus spreads from people with chickenpox to others who have never had the disease or never been vaccinated, mainly through close contact.

    A person with chickenpox is contagious beginning 1 to 2 days before rash onset until all the chickenpox lesions have crusted. Vaccinated people who get chickenpox may develop lesions that do not crust over. These people are considered contagious until no new lesions have appeared for 24 hours.

    SIGNS AND SYMPTOMS:

    It causes:30

    • Rash
    • Fluid-filled blisters
    • Fever
    • Tiredness
    • Loss of appetite
    • Headache

    And can lead to:31

    • Bacterial infections of the skin
    • Pneumonia
    • Infection or inflammation of the brain
    • Bleeding problems (hemorrhagic complications)
    • Bloodstream infections
    • Dehydration
    • Death

    RECOMMENDATIONS:

    The recommended population groups are

    • All adults without evidence of immunity to varicella2,8,32
    • Vaccination should be emphasised for those who work in healthcare settings, or have close contact with persons at high risk for severe disease or are at high risk for exposure or transmission8

  • Meningococcal disease
    Meningococcal disease
    DISEASE:33

    Meningococcal disease is caused by the bacterium Neisseria meningitidis.

    Meningococcal meningitis causes inflammation affecting the brain and spinal cord.

    TRANSMISSION:34

    It is transmitted through respiratory droplets and close contact (e.g. coughing or kissing).

    SIGNS AND SYMPTOMS:35

    The most common symptoms include:

    • Fever
    • Headache
    • Stiff neck

    Additional symptoms include:

    • Nausea
    • Vomiting
    • Photophobia (eyes more sensitive to light)
    • Altered mental status (confusion)

    Later symptoms of meningitis can be very severe, e.g. seizures.36

    POSSIBLE COMPLICATIONS:37

    Even with antibiotic treatment, 10 to 15 in 100 people infected with meningococcal disease will die. About 11 to 19 in 100 survivors will have long-term disabilities, such as loss of limb(s), deafness, nervous system problems, or brain damage.

    RECOMMENDATIONS:

    The recommended populations are:

    • Adults with damaged spleen or had their spleen removed8,38
    • Microbiologist who is routinely exposed to the bacteria8,38
    • Persons travelling to or residing in countries where the disease is common8,38
    • Persons at risk because of a meningococcal disease outbreak8,38
    • First-year college student living in a dorm38
    • Military recruits38

  • Pneumococcal disease
    DISEASE:39

    Pneumococcal disease is caused by the bacterium Streptococcus pneumoniae.

    TRANSMISSION:40

    Pneumococcal disease is transmitted through coughing, sneezing or contact with respiratory secretions of an infected person.

    SIGNS AND SYMPTOMS:41

    The symptoms of pneumococcal disease vary depending on the site of infection.

    PNEUMONIA:
    • Fever and chills
    • Cough
    • Rapid or difficulty breathing
    • Chest pain

    Older adults with pneumococcal pneumonia may experience confusion or low alertness, rather than the more common symptoms listed above.

    MENINGITIS:
    • Fever
    • Stiff neck
    • Confusion
    • Photophobia (visual sensitivity to light)

    BACTEREMIA:
    • Fever
    • Chills
    • Low alertness

    POSSIBLE COMPLICATIONS:41

    Pneumococcal disease can lead to serious infections of:

    • The lungs (pneumonia)
    • The blood (bacteremia/sepsis)
    • The lining of the brain (meningitis)

    Doctors consider some pneumococcal infections to be “invasive.” Invasive disease means that germs invade parts of the body that are normally free from germs.

    Most pneumococcal infections are mild. However, some can be deadly or result in long-term problems, such as brain damage or hearing loss.

    RECOMMENDATIONS:

    According to the Singapore National Adult Immunisation Schedule, the recommended population groups for pneumococcal vaccination are as follows:

    • Persons aged 65 years or older2
    • Persons aged 18 years and older with chronic illnesses such as chronic lung, heart, kidney or liver diseases and diabetes mellitus2
    • Persons who are immunocompromised or with other medical conditions (Persons with cochlear implants or cerebrospinal fluid leaks; persons with damaged spleen)2

  • Human papillomavirus (HPV)
    family
    DISEASE:42

    Human papillomavirus (HPV) is associated with cervical, vaginal and vulvar cancers in women, anal and throat cancers in both men and women and penile cancer in men.

    TRANSMISSION:43

    It is transmitted through sexual and skin-to-skin genital contact.

    RECOMMENDATIONS:

    Adult female2,8 and male8 up to age of 26 years old.

    Vaccination is not a substitute for cervical cancer screening.

    This vaccine does not protect against all HPV types that can cause cervical cancer. Women should still get regular Pap tests.




References:
  1. CDC. Do You Know Which Adult Vaccines You Might Need? Available at here. Last accessed Sep 2019.
  2. Ministry of Health Singapore. National Adult Immunisation Schedule. Available at here. Last accessed Sep 2019.
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