Mandatory Immunisations for Newborns in Singapore

13-01-2025

As parents, we’ve all heard about the importance of immunising our children against certain illnesses. Your child’s doctor would have also discussed why your little one should be vaccinated.

Almost all health professionals recommend immunising children, especially against common childhood diseases like chickenpox, mumps or rubella, because getting any of these diseases could ill your little one.

Organisations such as the Health Promotion Board (HPB), Singapore, and the World Health Organization (WHO) recommend childhood immunisations for many reasons. One of the primary reasons is that immunisation protects your little one against serious diseases that can have some pretty nasty complications by helping to strengthen a baby’s immune system.

Children Vaccination

Immunising your child through child vaccinations can help protect other children, too, especially if they are not immunised themselves for whatever reason. Also, if enough kids are vaccinated against a specific disease, the chances are that the condition may be eradicated. In Singapore, some immunisations are mandatory for all children, while others are optional.

The vaccinations currently required (guideline by MOH) to children in Singapore include:

BCG
Hepatitis B
Diphtheria
Tetanus
Pertussis (DTP)
Poliomyelitis (Oral Polio Vaccine)
Measles, Mumps, and Rubella (MMR)
Chicken Pox

Combination vaccines, such as the 5-in-1 and 6-in-1, are beneficial as they reduce the number of injections a child receives by combining protections against several diseases into a single shot.

Diphtheria and measles vaccinations are compulsory by law and are available for free at the local polyclinics.

Optional vaccines (Chickenpox, Influenza, Rotavirus, Hepatitis A, Meningococcal and Pneumococcal) are available with your child’s paediatrician. Haemophilus influenzae type b (Hib) is included in combination vaccines, providing protection against multiple diseases with fewer injections.

Keeping track of the childhood immunisation schedule can seem like a lot. We will discuss those immunisations in this article so you understand what to expect with and without certain immunisations.

A little child taking an injection from the doctor

Required Immunisations for Newborns: Childhood Immunisation Schedule

Health care has come a long way in taking preventative measures to ensure children receive the 1st dose of vaccinations, building the critical immune system to fight against deadly diseases.

BCG (Bacillus Calmette-Guerin)

Your baby will be given a weakened version of the BCG virus at birth. This jab protects your baby from tuberculosis (TB). Tuberculosis is a bacterial infection that affects the lungs, intestines, bones, kidneys, and brain. Untreated, it can cause severe spinal pain and stiffness. Long-term, tuberculosis leaves permanent damage to the lungs.

Hepatitis B Vaccine

The hepatitis B vaccine is given to your little one in 3 doses: the 1st will be at birth, the 2nd dose in the first month and the 3rd in the 6th month. Hepatitis B may not show signs until adulthood, such as liver cancer or chronic liver failure. It is crucial to follow your child’s immunisation schedule to ensure they receive all necessary doses on time.

Diphtheria/Pertussis/Tetanus (DPT) Vaccine

Your baby will be given three doses of the DPT vaccine from months 3-5. This 3-in-1 baby immunisation protects your child against Diphtheria, Whooping cough and Tetanus.

Diphtheria is a severe disease that can cause breathing problems, paralysis or heart failure.
Pertussis causes coughing spells, making eating, drinking, or breathing difficult.
Tetanus, also called lockjaw, is caused by bacteria commonly found in soil. When this germ gets into an open cut or wound, an unprotected person can get tetanus, creating severe muscle spasms that can be strong enough to snap the spine.

Poliomyelitis (Polio) Vaccine

Poliomyelitis is caused by the poliovirus and mainly affects young children. The virus lives in the throat and intestinal tract and is spread through contact with the stools of an infected person, usually through contaminated food and water.

When infected, children can become paralysed. While Singapore was declared polio-free in 2000, polio is still present in some countries, so the risk of getting this disease is still there, so it’s important to give it to your little one.

The first three doses are given when your baby is three months old, four months old and five months old. Boosters are given at 18 months, 6 and 11 years.

Measles, Mumps and Rubella Vaccine (MMR)

The MMR vaccine is given to your baby at 12 months old, with a booster at age 12. With this vaccination for newborns, they are also protected from German Measles, one of the more severe variants. Achieving high vaccination rates is crucial for herd immunity, which protects both individuals and the wider community by reducing the overall spread of infectious diseases and minimizing the risk of outbreaks.

Measles: A virus that leads to chest infections and severe ear infections. The results of such can lead to permanent loss of hearing, premature brain damage, and seizures.

Rubella: Has mild symptoms for adults but can cause serious effects such as miscarriage and congenital symptoms if it appears during the early stages of pregnancy. Children exposed to rubella in utero may also see congenital disabilities.

Mumps: Also caused by a virus that causes painful swelling of the salvatory glands and high fever. Children with mumps also experience compilations such as deafness, painful swelling of the testicles, meningitis, encephalitis and sometimes death.

Chicken Pox (Varicella Vaccination)

Varicella vaccination is an optional childhood vaccination that protects against chickenpox. Air droplets and direct contact with fluids from blisters spread it. Chickenpox is contagious 1 to 2 days before the rash appears and until they are totally dry at around 5 to 7 days.

Usually, it is a mild irritant wherein the blisters are extremely itchy. More serious cases lead to permanent skin damage (scarring, pneumonia, shingles, and encephalitis)

National Childhood Immunisation Schedule, Singapore (credit: HealthHub.sg)

Why are Immunisations important for your baby?

Immunisations protect your baby against vaccine-preventable diseases that can lead to serious complications or death by strengthening your baby’s immune system. Some immunisations require additional doses to be given later to maintain your child’s immunity to the disease (e.g. diphtheria and tetanus). These additional doses are called booster doses.

Immunisations are safe for most babies. However, live vaccines like MMR (measles, mumps and rubella) and oral polio must be avoided if your baby has a weak immune system due to illness or medical treatment. Please consult your doctor if you have concerns about your baby’s immunisations.

What are some side effects of vaccinations?

Vaccines are generally safe. They undergo years of testing for safety and effectiveness before they are approved and licensed.

The risk of serious complications from the vaccines is always much lower than the risk of complications if your child falls ill with one of the diseases. Also, allergy to vaccines is rare.

The vaccines against Diphtheria, Tetanus, Pertussis, Polio and Haemophilus influenzae type b (Hib) may cause redness and swelling at the injection site. This will resolve within a few days. Your child may have a fever on the day of the injection and the day after.

The MMR vaccine may cause a brief reaction from a few days to three weeks after vaccination. Your child may get a mild cough, runny nose, skin rash, fever or swollen salivary glands. The fever may occur from the 5th to the 10th day after the injection. Your child will not be contagious. Studies have shown no link between the MMR vaccine and autism.

The most common side effects of the Pneumococcal vaccine are redness and swelling at the injection site, fever and tiredness.

BCG vaccination may cause a small boil to develop 2-3 weeks later at the injection site. It will resolve in 6-8 weeks. If the boil bursts, you may cover it with a piece of gauze.

Doctor makes a vaccination on a calm baby

Why is it so critical to keep up to date with immunisations?

Parents want to do everything possible to ensure their children are healthy and protected from preventable diseases. Vaccination is the best way to do that. Vaccination protects children from serious illness and complications of vaccine-preventable diseases, including amputation of an arm or leg, paralysis of limbs, hearing loss, convulsions, brain damage, and death.

Vaccine-Preventable Diseases

Outbreaks of preventable diseases occur when many parents decide not to vaccinate their children. If children aren’t vaccinated, they can spread disease to other children too young to be vaccinated or to people with weakened immune systems, such as transplant recipients and people with cancer. This could result in long-term complications and even death for these vulnerable people.

Vaccinationations To Get Before Travelling

Two vaccines that are normally recommended for those going to travel around Southeast Asian countries are hepatitis A and typhoid vaccines. Hepatitis A is an infectious disease of the liver caused by the hepatitis A virus. It is usually spread by eating contaminated food or drinking water.

It is important to note that overseas born children may require different immunisation schedules based on their country of birth. Customized vaccination options should be considered to accommodate these variations, and additional vaccinations may be necessary depending on the child’s overseas background.

The typhoid vaccine is a vaccine to protect against Salmonella typhi. Salmonella can lead to a high fever, diarrhoea, and vomiting. Salmonella is spread by eating or drinking food or water contaminated with the faeces of an infected person.

Rabies vaccination is also recommended for international travellers who are likely to come in contact with animals in parts of the world where rabies is common. Three doses of pre-exposure rabies vaccines are recommended. Make sure to start the first dose of the Rabies vaccine one month prior to travel to ensure that you have completed the three doses prior to your travel.

Another vaccination to be considered when travelling in Asia is Japanese encephalitis (JE). JE is a disease transmitted through mosquitoes that may cause swelling around the brain. You are at higher risk if you travel to rural areas (especially near rice paddies), will be outside frequently, or travel for a long time.

Common Misconceptions About Childhood Vaccinations

The biggest misconception about vaccination is that vaccines cause autism. The widespread fear that vaccines increase the risk of autism originated with a 1997 study published by Andrew Wakefield, a British surgeon. The article was published in The Lancet, a prestigious medical journal, suggesting that the measles, mumps, rubella (MMR) vaccine increased autism in British children.

Another important aspect to consider is the prevention of rotavirus infection. The rotavirus vaccine is an optional yet highly recommended vaccination that helps prevent severe diarrhoea and vomiting caused by the rotavirus. Without a specific medication for treating rotavirus infection, management typically involves rehydration to prevent dehydration.

The paper has been completely discredited due to serious procedural errors, undisclosed financial conflicts of interest, and ethical violations. Andrew Wakefield lost his medical license, and the paper was retracted from The Lancet.

Risks of NOT Immunising Your Children

The fact is, vaccines save lives and protect against the spread of disease. If you decide not to immunise, you’re putting your child at risk of catching a dangerous or deadly disease and putting others who come into contact with your child at risk. Getting vaccinated is much better than getting the disease.

Influenza vaccination is an important optional childhood vaccination that protects children from severe illnesses such as flu and pneumonia.

What are the penalties for not complying with the mandatory vaccination list in Singapore?

Standard Penalties

First offence: Fine up to $500
Second or subsequent offence: Fine up to $1,000

Additional Enforcement

Health Promotion Board sends reminders to parents if there is no record of vaccination
MOH attempts to educate and persuade parents before considering prosecution
The Director may issue a written notice requiring the child to be vaccinated within a specified timeframe

Severe Penalties

Maximum fine of up to $10,000
Imprisonment for up to 6 months
Or both fine and imprisonment

School Enrollment

Proof of vaccination against diphtheria and measles is required for school enrollment in Singapore. Without proper vaccination documentation, children may be denied admission to educational institutions.

Vaccination Subsidy Information

Singaporean children are eligible for full subsidies for NCIS-recommended vaccinations at:

CHAS GP clinics
Polyclinics3

These recommended vaccinations, while not legally required, are considered standard of care for protecting against vaccine-preventable diseases that could pose significant healthcare burden to Singapore

References:

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