Infants & Children

Immunisation is an important way to protect your child from certain life-threatening diseases.1

The recommended National Childhood Immunisation Schedule2 provided by the Ministry of Health, Singapore is as follows1:

m: month
y: year
D: dose
B: booster

BCG: Bacillus Calmette-Guérin
Hep B: Hepatitis B
DTaP: Diphtheria, tetanus and acellular pertussis (paediatric)
Tdap: Tetanus, reduced diphtheria and acellular pertussis
IPV: Inactivated poliovirus
Hib: Haemophilus influenzae type b
PCV: Pneumococcal conjugate
PSV: Pneumococcal polysaccharide
MMR: Measles, mumps and rubella
VAR: Varicella
HPV: Human papillomavirus
INF: Influenza

Footnotes

  • D1, D2, D3: Dose 1, dose 2, dose 3
  • B1, B2: Booster 1, booster 2
  • 10-11, 12-13, 13-14 years: Primary 5, Secondary 1, Secondary 2 (Tdap, IPV, HPV (for females) and MMR (as catch-up) vaccines are provided as part of Health Promotion Board’s school-based vaccination programme)
  • HepB: Doses 2 and 3 are recommended to be given as part of the 6-in-1 vaccine at 2 and 6 months, respectively.
  • MMR: Only the dose 2 is recommended to be given as part of the MMRV vaccine.
     

Optional Schedules:

  • Hep B and DTaP-containing combination vaccines: When a hepatitis B vaccine is given at birth, after a 3-dose primary vaccination of a 6-in-1, either a 6-in-1 or a 5-in-1 vaccine can be administered as the booster dose in 18 months.a (Note: only two doses of 6-in-1 vaccine will be subsidised in the NCIS)
  • PCV 13: Alternative schedule of a total of 4 doses at 2,4,6, & 12-15 months could be given.b (Note: only three doses of PCV will be subsidised in the NCIS)

a. Singapore Paediatric Society. Childhood Immunisation Schedule – Hep B. Available at here. Last accessed Jul 2020.
b. CDC. Vaccine (Shot) for Pneumococcal Disease. Available at here. Last accessed Jul 2020.

Disclaimer: This schedule is meant to serve as a discussion guide. Please consult your doctor for more information on any of these vaccines.
# 2 doses administered >1 month apart are recommended for children <9 years receiving influenza vaccine for the first time.
^ Number of doses depends on the child's age and/or vaccine brand.
* Rotavirus vaccine is an oral vaccine.
 

Recommended vaccines for Infants & Children

    DISEASE:10
    Tuberculosis (TB) is a disease caused by a bacterium called Mycobacterium tuberculosis.

    TRANSMISSION:10
    TB is spread through the air when an infected person coughs or sneezes. People nearby may breathe in these bacteria and become infected.

    SIGNS AND SYMPTOMS:11

    • Coughing

    • Fever

    • Fatigue

    • Night sweats

    • Weight loss

    POSSIBLE COMPLICATIONS:11

    • Spinal pain
    • Joint damage
    • Liver or kidney problems
    • Heart disorders
    • Meningitis (swelling of the membranes that cover the brain)

    Without treatment, TB can be fatal.

    DISEASE:12
    Hepatitis B     is a contagious liver disease that results from infection with the hepatitis B virus.

    TRANSMISSION:13
    Hepatitis B spreads through blood or other body fluids that contain small amounts of blood of an infected person. Babies and children can get hepatitis B in the following ways:

    • At birth from their infected mother
    • By touching open cuts or sores of an infected person
    • Through sharing toothbrushes or other personal items used by an infected person
    • Unlike hepatitis A, it is not spread routinely through food or water.

    SIGNS AND SYMPTOMS:13
    Adults and children over the age of 5 years are more likely to have symptoms. Symptoms include:

    • Fever
    • Nausea
    • Loss of appetite
    • Abdominal pain
    • Vomiting
    • Clay-coloured bowel
    • Dark urine movements
    • Joint pain
    • Jaundice (yellow colour in the skin or the eyes)
    • Fatigue

    POSSIBLE COMPLICATIONS:13

    • Chronic hepatitis
    • Cirrhosis
    • Liver failure

    DISEASE:14
    Diphtheria, tetanus, and pertussis (DTaP) are serious diseases caused by bacteria.

    TRANSMISSION:
    Diphtheria and pertussis spread from person to person.15,16

    Tetanus does not spread from person to person but the bacteria are usually found in soil, dust, and manure and enter the body through breaks in the skin – usually cuts or puncture wounds caused by contaminated objects.17

    SIGNS AND SYMPTOMS:14

    • Diphtheria causes a thick covering in the back of the throat.
    • Tetanus (lockjaw) causes painful tightening of the muscles, usually all over the body.
    • Pertussis is a highly contagious respiratory tract infection. Coughs may eventually turn more serious, particularly in infants.

    POSSIBLE COMPLICATIONS:

    • Diphtheria can lead to breathing problems, paralysis, heart failure and even death.14
    • Tetanus can lead to “locking” of the jaw so the victim cannot open his mouth or swallow.14
    • Pertussis can lead to pneumonia, seizures, brain damage and death.18

    DISEASE:19
    Poliomyelitis (polio) is a highly infectious disease caused by a virus that invades the nervous system.

    TRANSMISSION:19
    Humans are the only known reservoir of poliovirus. The virus lives in an infected person’s throat and intestines. It spreads through contact with the faeces (stool) of an infected person and less commonly through droplets from a sneeze or cough.

    SIGNS AND SYMPTOMS:19
    Most people who get infected with poliovirus will not have any visible symptoms. About 1 out of 4 people with poliovirus infection will have flu-like symptoms that may include:

    • Sore throat
    • Fever
    • Tiredness
    • Nausea
    • Headache
    • Stomach pain

    A smaller proportion of people with poliovirus infection will develop other more serious symptoms that affect the brain and spinal cord.

    POSSIBLE COMPLICATIONS:19

    • Life-long paralysis

    Even children who seem to fully recover can develop these complications as adults, 15 – 40 years later:

    • New muscle pain
    • Weakness
    • Paralysis

    DISEASE:20
    Haemophilus influenzae type b (Hib) is a bacterium that can cause a severe infection, occurring mostly in infants and children younger than five years of age.

    TRANSMISSION:20
    The germs spread from person to person by direct contact or through respiratory droplets from coughing and sneezing.

    SIGNS AND SYMPTOMS:20
    Symptoms will depend on the type of illness and may include:

    • Fever
    • Headache
    • Stiff neck
    • Vomiting
    • Coughing
    • Breathing difficulties
    • Tender skin
    • Swelling
    • Redness in a joint
    • Ear pain

    POSSIBLE COMPLICATIONS:20

    • Pneumonia (lung infection)
    • Bacteraemia (bloodstream infection)
    • Meningitis (infection of the covering of the brain and spinal cord)

    DISEASE:21
    Pneumococcal disease is an infection caused by the Streptococcus pneumoniae bacterium. Infection can result in pneumonia, infection of the blood (bacteraemia/sepsis), middle-ear infection (otitis media) or bacterial meningitis.

    TRANSMISSION:22
    Pneumococcal disease spreads when an infected person coughs or sneezes. Some children may not even feel sick but they could have the bacteria in their noses and throats. These children can still spread pneumococcal disease.

    SIGNS AND SYMPTOMS:22
    There are different types of pneumococcal disease. Symptoms depend on the part of the body it affects.

    Pneumococcal pneumonia causes:

    • Fever or chills
    • Cough
    • Chest pain
    • Rapid breathing or difficulty breathing

    Pneumococcal meningitis causes:

    • Stiff neck or headache
    • High fever
    • Increased pain from bight lights
    • Confusion

    Blood infection causes:

    • Fever
    • Chills
    • Low alertness

    POSSIBLE COMPLICATIONS:22

    • Brain damage
    • Disabilities like hearing loss, or loss of arms or legs
    • Death

    DISEASE:23
    Measles, mumps and rubella (MMR) are viral diseases that can have serious consequences.

    TRANSMISSION:23
    Diseases spread from person to person.

    SIGNS AND SYMPTOMS:23
    Measles virus causes symptoms that include:

    • Fever
    • Rash
    • Runny nose
    • Cough
    • Red, watery eyes

    Rubella virus causes:

    • Fever
    • Rash
    • Headache
    • Sore throat
    • Red, itchy eyes

    POSSIBLE COMPLICATIONS:23
    Measles:

    • Ear infection
    • Diarrhoea
    • Pneumonia
    • Brain damage (rare)
    • Death (rare)

    Mumps:

    • Swelling of the testicles or ovaries
    • Deafness
    • Inflammation of the brain and/or tissue covering the brain and spinal cord (encephalitis/meningitis)
    • Death (very rare)

    Rubella can cause arthritis in up to half of teenage and adult women. If a woman gets rubella while she is pregnant, she could have a miscarriage or her baby could be born with serious birth defects.

    POSSIBLE COMPLICATIONS:19

    • Life-long paralysis

    Even children who seem to fully recover can develop these complications as adults, 15 – 40 years later:

    • New muscle pain
    • Weakness
    • Paralysis

    DISEASE:24
    Human papillomavirus (HPV) is the most common viral infection of the reproductive tract. HPV infections usually clear up without any intervention. A small proportion of infections with certain types of HPV can persist and progress to cancer. Cervical cancer is by far the most common HPV-related disease.

    TRANSMISSION:24
    HPV is mainly transmitted through sexual contact.

    SIGNS AND SYMPTOMS:24
    The majority of HPV infections do not cause symptoms or disease and resolve spontaneously.

    POSSIBLE COMPLICATIONS:24
    It takes 15 to 20 years for cervical cancer to develop in women with normal immune systems.
    It can take only 5 to 10 years in women with weakened immune systems, such as those with untreated HIV infection

    DISEASE:25
    Chickenpox (Varicella) is a common childhood disease. It is usually mild but it can be serious, especially in young infants and adults.

    TRANSMISSION:25
    Chickenpox is highly contagious. It spreads from person to person by direct contact or by droplets from an infected person when he coughs or sneezes. It can also spread indirectly through articles freshly soiled by droplets or fluid from the blisters of an infected person

    SIGNS AND SYMPTOMS:25
    An infected person usually has a fever, together with red spots on the body and face. The spots appear over a few days and progress to blisters which eventually burst, dry up and form crusts before healing. These spots are usually itchy and may leave scars when scratched.

    POSSIBLE COMPLICATIONS:25

    • Skin infection
    • Dehydration
    • Brain damage from encephalitis
    • Pneumonia

    DISEASE:3
    Older children, adolescents and adults infected by hepatitis A often feel sick and symptoms can last for up to 6 months. There is no specific treatment for hepatitis A.3

    TRANSMISSION:3
    Hepatitis A virus is found in the stool of a person who has the virus. It spreads:

    • through contaminated items such as toys and door knobs
    • by consuming food and drinks contaminated with the virus
    • by person-to-person contact e.g. hand-to-mouth transmission after changing diaper of an infected infant

    SIGNS AND SYMPTOMS:3
    The symptoms may include the following:

    • Fever
    • Loss of appetite
    • Tiredness
    • Stomach pain
    • Vomiting
    • Dark urine
    • Yellow skin and eyes

    POSSIBLE COMPLICATIONS:26
    Most people do not have lasting liver damage. In rare cases, hepatitis A can cause liver failure and death. This is more common in older people and in people with other liver diseases.

    DISEASE:27
    Flu (short for influenza) is an illness caused by influenza viruses. Flu viruses infect the nose, upper airways, throat and lungs. Flu spreads easily and can cause serious illness, especially for children younger than 5 years old, older people, pregnant women and people with certain chronic medical conditions like asthma and diabetes. Children (especially those younger than 2 years old) are more likely to be hospitalised due to flu.

    TRANSMISSION:28
    Flu spreads when infected people talk, cough or sneeze and droplets with virus in them land in the mouths or noses of people nearby. People can spread flu to others from one day before they have symptoms to 5 – 7 days after they get sick. This period can be longer for children and people who are very sick.

    SIGNS AND SYMPTOMS:27

    • Fever (not everyone with the flu has a fever) or feeling feverish/chills
    • Cough
    • Sore throat
    • Muscle aches
    • Headache
    • Tiredness

    Some children with flu will vomit or have diarrhoea.

    POSSIBLE COMPLICATIONS:27

    • Pneumonia (lung infection)
    • Dehydration
    • Worsening of long-term medical conditions, like asthma and diabetes

    DISEASE:33
    Meningococcal disease is caused by the bacterium Neisseria meningitidis. The disease is often severe and can be deadly.29

    The invasive form of meningococcal disease can take one’s life in just 24 hours.30

    Doctors treat meningococcal disease with antibiotics but quick medical attention is extremely important. Keeping up to date with recommended vaccines is the best defense against meningococcal disease.29

    TRANSMISSION:31
    Meningococcal bacteria is spread by sharing respiratory and throat secretions (saliva/spit) for example, coughing, kissing or lengthy contact.

    SIGNS AND SYMPTOMS:32
    Flu-like symptoms or sudden onset of:

    • Fever
    • Headache
    • Stiff neck

    It will often also cause:

    • Nausea
    • Vomiting
    • Rash
    • Confusion
    • Increased sensitivity to light

    POSSIBLE COMPLICATIONS:33

    • Meningococcal meningitis (infection of the thin lining that surrounds the brain and spinal cord)
    • Meningococcal septicaemia (infection of the bloodstream)
    • Up to 1 in 5 survivors will suffer disabilities, nervous system problems or brain damage

    DISEASE:6
    Rotavirus causes severe diarrhoea and vomiting. It affects mostly babies and young children. Diarrhoea and vomiting can lead to serious dehydration

    TRANSMISSION:6
    Rotavirus spreads easily. The virus is in the stool of people who are infected and can be easily spread via contaminated hands and objects, such as toys.

    SIGNS AND SYMPTOMS:6

    • Fever
    • Watery diarrhoea
    • Vomiting
    • Stomach pain

    POSSIBLE COMPLICATIONS:6
    Rotavirus infection in infants and young children can lead to severe diarrhoea and dehydration. The dehydration may be severe and some children need an IV (needle in their vein) in the hospital to replace lost fluids.

    DISEASE:34
    Typhoid fever is an infection caused by Salmonella typhi. Infections are usually associated with travel to countries where these diseases are endemic and limited number of cases are local transmissions.

    TRANSMISSION:34
    It is transmitted through contaminated food and water.

    SIGNS AND SYMPTOMS:35
    Early symptoms include:

    • Fever
    • Headache
    • Weakness and fatigue
    • Muscle aches
    • Dry cough
    • Weight loss
    • Abdominal pain
    • Diarrhoea or constipation
    • Rash
    • Swollen abdomen

    As the disease progresses, patients develop:

    • High fever
    • Profound tiredness
    • Delirium

    POSSIBLE COMPLICATIONS:34
    The most serious complication of typhoid fever is intestinal bleeding or perforation. A perforated intestine occurs when your intestine or bowel develops a hole, causing intestinal contents to leak into the abdominal cavity and triggering severe abdominal pain, nausea, vomiting and bloodstream infection.

    DISEASE:36
    Japanese encephalitis (JE) is a potentially severe disease and is among the most important cause of viral encephalitis in Asia, especially in rural and suburban areas. JE is primarily a disease of children, but all age groups are affected.

    TRANSMISSION:37
    The virus is found in pigs and birds, and is passed to mosquitoes when they bite infected animals. It cannot be spread from person to person.

    SIGNS AND SYMPTOMS:36
    It takes 5 to 15 days after the bite of an infected mosquito to develop the following symptoms:

    • Fever
    • Chills
    • Headache
    • Fatigue
    • Nausea
    • Vomiting

    The disease can progress to inflammation of the brain (encephalitis) and is often accompanied by seizures. Coma and paralysis may occur in some cases.

    POSSIBLE COMPLICATIONS:38

    • 30% of patients do not survive
    • Of those who survive, 20%–30% suffer permanent intellectual, behavioural or neurological problems such as paralysis, recurrent seizures or the inability to speak

References:

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  2. Ministry of Health, Singapore. Nationally Recommended Vaccines. Available at here. Last accessed Jul 2020.
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