Answers to 8 of Your Questions about Childhood Vaccinations

1. What are vaccines and how do they work?

Simply put, vaccines can be defined as safe biological preparations derived from germs that cause disease. Vaccination is the act of introducing a vaccine into a person’s body. The vaccine stimulates the immune system to produce antibodies against a specific disease. Vaccination is the most effective and safe way to prevent infectious diseases. It not only lowers a person’s risk of infection but also reduces transmission rates. Many dangerous and lethal diseases, such as smallpox, have been completely eradicated with immunisation, saving millions of lives.

2. Why is childhood vaccination necessary?

Young children are especially prone to being exposed to different germs from the places they visit and people they interact with daily. As their immune systems are not fully developed, they are more vulnerable than adults to many infections, some of which can be fatal. Vaccination helps to pre-emptively boost the child’s immune system by allowing the body to respond faster in the event of infection, fighting off the disease before it can cause serious complications.

3. Are vaccines safe for children?

Vaccines are generally safe. Like all medicines, vaccines have side effects, but they are usually minor. Some of the common side effects include fever, arm soreness and redness at injection site. Severe side effects are possible but exceedingly rare. Your child is far less likely to be harmed by the vaccine than the disease itself. In Singapore, the Ministry of Health (MOH) constantly monitoring the side effect profiles of the recommended vaccines to ensure that strict international standards are adhered to.

There are some common misconceptions that parents have with regard to certain childhood vaccines. For example, there are claims that the DTaP (Diphtheria, Tetanus, Pertussis) vaccine causes Sudden Infant Death Syndrome (SIDS). Studies were conducted in the 1980s to investigate these claims. The outcome of the studies unanimously showed that the number of deaths from SIDS occurring around the time of DTaP vaccination could reasonably attributed to chance rather than any causal factors.

The fear of the Measles, Mumps and Rubella (MMR) vaccine causing autism originated from a paper published in The Lancet in 1997. The article suggested that there may be a causal link between the MMR vaccine and autism. This claim was taken seriously, and many studies were conducted to investigate the hypothesis. None of the subsequent studies found a causal relationship between autism or autistic disorders and MMR vaccine. A more likely explanation for the claim is that the signs of developmental issues in children tend to become more obvious around 18 months. This coincides with the second dose of MMR, leading some to incorrectly inconclude that the MMR vaccine is linked to autism in children.

Another common misconception is of egg allergy being a contraindication to the MMR and influenza vaccines. While the MMR vaccine is grown in fibroblast cells of chick embryos, it does not contain any egg element. Hence it is safe to administer the MMR vaccine to a child with egg allergy.

On the other hand, influenza vaccines are commonly made from an egg-based manufacturing process. Based on World Health Organisation (WHO) recommendations, the influenza vaccination is safe for the majority of children with egg allergies. Children with a history of life-threatening allergic reactions to egg are advised to take the flu vaccine in a medical facility that can provide prompt treatment to potential severe reactions.

4. Are vaccines effective?

No vaccine guarantees 100% protection. Most childhood vaccines are effective in 85 to 95% of the recipients. There is a small percentage of children who will not mount an immunity after their vaccination. Therefore, high vaccination coverage is important to maintain herd immunity. This will prevent the disease from re-entering the population, protecting those who remain vulnerable to the disease.

5. Why are some vaccines combined with others?

Combination vaccines work by combining multiple vaccines into one single vaccine shot. The use of combination vaccines is very common in Singapore. Some examples of combination vaccines are the 5-in-1 (combining the DTaP, polio vaccines and Haemophilus Influenzae type b (Hib) antigens) and 6-in-1 (combining the DTaP, polio, Haemophilus Influenzae type b (Hib) antigens and Hepatitis B vaccines).

Some parents are worried about combination vaccines causing more side effects. However, studies have shown that there is it is not dangerous to give multiple vaccines to a child at the same time. The advantages of combination vaccines include fewer injections, lesser frequency of discomfort, fewer clinic visits and higher compliance rates. This also means that your child will receive the immunisation in a timely manner, giving them the maximum amount of protection during the first few vulnerable months of their lives.

6. What vaccinations does my child need?

In Singapore, there is a set of age-appropriate vaccinations (from birth to 17 years old) called the Singapore National Childhood Immunisation Schedule (NCIS) recommended by the Expert Committee on Immunisation (ECI) and MOH as a standard of care to protect children against infectious diseases.

From 1^st November 2020, the NCIS has expanded from covering vaccinations against 12 diseases to a total of 14 diseases namely tuberculosis, diphtheria, tetanus, pertussis, hepatitis B, poliovirus, Haemophilus influenzae type b, measles, mumps, rubella, pneumococcal disease, influenza, human papillomavirus and varicella.

To find out what vaccines your child needs and the recommended schedule for these vaccinations, please refer to the following table:

Discovering the range of vaccines available for your child can seem overwhelming at first, especially if one is a new parent. However, this schedule can be a useful tool for parents to refer to to ensure that their children are on schedule for their vaccinations. It is important to note that under the Infectious Disease Act, measles and diphtheria are two compulsory vaccinations in Singapore. The rest of the vaccines are highly encouraged.

7. What should I do if my child misses a vaccine?

Do not worry if your child misses a vaccination or has fallen behind the vaccination schedule. Most of the time, it is never too late to catch up without having to repeat earlier vaccinations. Do contact your family doctor to discuss how you can get your child up to date with their immunisations.

8. Are my child’s vaccinations subsidised?

From 1 November 2020, all children who are Singapore citizens and permanent residents will be given a higher subsidy for the nationally-recommended vaccines. No out-of-pocket payment is required when children have their 5-in-1, 6-in-1, Hepatitis B, MMR, influenza, Oral Poliovirus (OPV), Pneumococcal Conjugate (PCV10), PCV13, Pneumococcal polysaccharide (PPSV23), Tdap-IPV, Tdap, and varicella (chickenpox) vaccines administered at a CHAS General Practice clinic.

Do not overlook the importance of vaccinating your child

Vaccines are a safe, effective and proven way of keeping your child safe from various infections and diseases. The importance of childhood vaccinations cannot be overstated. Should you have concerns about the suitability of certain vaccines for your child, a discussion with your paediatrician will support you in making the right decisions.