The resurgence of measles and other vaccine-preventable diseases all over the world has been alarming. In many parts of the world, parents are choosing not to vaccinate their children for religious or personal reasons. Anti-vaxxers are underestimating the dangers of not vaccinating their children, and wrongly believe that vaccines are unsafe.
In fact, vaccine hesitancy – the reluctance or refusal to vaccinate, despite the availability of vaccines – has been identified by the World Health Organization as one of the top ten global health threats of 2019.
Measles, for example, has seen a 30% increase in cases globally, and a resurgence in countries that were close to eliminating the disease. Approximately 110, 000 people died from measles in 2017 – mostly children under the age of 5 years, despite the availability of a safe and effective vaccine.
There has been a spate of measles outbreaks recently across the US, Australia, and closer to home, the Philippines. Vaccine hesitancy is said to be one of the main reasons behind this spike in cases.
In Singapore, immunisations for Diphtheria and Measles are COMPULSORY by Law. The first dose of MMR (Measles, Mumps and Rubella) vaccine is given at 12 months.The 2nd dose of MMR can be given between 15-18 months.
Dangers of not vaccinating our children
theAsianparent asked Dr Tan Zhen Han, Paediatrician, SBCC Baby & Child Clinic, for his expert opinion on the importance of vaccination, and on the precautions parents need to take, especially when travelling abroad. Here are his responses.
Why is vaccine misinformation so widespread?
Vaccine misinformation stems from the rampant spread of medical misinformation through the internet and social media. Some sources of vaccine misinformation include:
- People with medical credentials stoking unfounded fears. The most infamous example of this is the discredited former British doctor Andrew Wakefield, who co-authored a now notorious and debunked medical paper that claimed to have found a link between autism and the MMR vaccine
- People with financial or political agendas
- People who propagate their vaccine beliefs to others via social media
To combat the spread of vaccine misinformation, the American Medical Association recently called upon top technology companies like Amazon, Facebook, Google, Youtube to be responsible and ensure that end users have access to scientifically valid information on vaccinations.
How should we fact-check the information we are receiving?
Parents and caregivers should refer to authoritative websites such as the World Health Organization or the U.S. Centres for Disease Control and Prevention for verification. Alternatively, they can also supplement their understanding by referring to the Health Promotion Board’s website or checking with a healthcare provider.
The required list of vaccinations in Singapore and the rationale
The purpose of vaccination is to protect infants and children by providing immunity early in life before they are exposed to potentially life-threatening diseases.
Under the National Childhood Immunization Schedule in Singapore, the following vaccines are recommended:
Tuberculosis (TB) is an airborne disease that often affects the lungs but can also involve other organs like the brain, kidneys and bones, and is endemic in Singapore.
The BCG vaccine mainly protects young children against disseminated TB (a disease in multiple parts of the body) and TB meningitis (disease involving the brain lining).
Hepatitis B is a virus that can cause chronic swelling of the liver and possible lifelong complications.
Diptheria, pertussis & tetanus
Diphtheria is a serious bacterial infection that causes a thick covering in the back of the throat. It can lead to breathing difficulties, heart failure, paralysis, and even death.
Pertussis, also known as whooping cough, is a highly contagious disease known for uncontrollable, violent coughing spells. It can lead to breathing difficulties, pneumonia (lung infection) in babies, and even death.
Tetanus is a potentially deadly infection that causes painful muscle stiffness and lockjaw.
Poliomyelitis is a highly infectious disease caused by a virus that can invade the brain and spinal cord. Polio can cause lifelong paralysis and even death.
Haemophilus influenzae type b
Hib disease can range from mild ear infections to serious infection of the blood, pneumonia, hearing loss, and meningitis.
Pneumococcal disease is an infection caused by Streptococcus pneumoniae bacterium, and infection can cause pneumonia, middle ear infection, and meningitis.
Measles, mumps & rubella
The measles virus is highly contagious, and the infection can lead to complications of ear infection, pneumonia, brain damage, deafness, and death.
Mumps is usually a mild illness in most people, resulting in swelling of the salivary glands, but sometimes it can cause long term problems, such as deafness, meningitis, and swelling of the testicles or ovaries.
Rubella can cause arthritis (inflammation and stiffness of the joints), and in pregnant women, the infection may cause miscarriage or serious birth defects in the unborn baby.
Human papillomavirus (HPV) is the most common viral infection of the reproductive tract.
Some HPV infections can cause genital warts.
A small proportion of infections with certain types of HPV can persist and lead to the following cancers:
Other recommended vaccinations on top of the required vaccination list
On top of the above vaccinations, optional vaccinations include:
Rotavirus is a virus that is the leading cause of diarrhoea hospitalisations among children worldwide. It affects mostly babies and young children, and can cause severe diarrhoea and vomiting, which can lead to serious dehydration.
Chickenpox, also known as varicella, is a common and vaccine-preventable disease. It is usually mild but can potentially lead to serious complications, such as skin infection, brain damage and lung infection.
Those at risk for severe symptoms or complications include infants, pregnant women, and those who have a weakened immune system such as patients undergoing chemotherapy or long-term steroids. Pregnant women who contract chickenpox can spread the disease to their babies, causing stillbirths or birth defects.
Hepatitis A is a liver disease caused by the hepatitis A virus. The virus spreads when a person ingests contaminated food or water with the faeces of an infected person. The condition may cause acute liver failure, which can be fatal.
Influenza (also known as flu) is a highly contagious illness commonly caused by the influenza viruses A and B. It usually presents with high fever (can be up to 41oC), body aches, tiredness, headaches and cough. It can cause life-threatening complications such as lung infection, respiratory failure, and worsening of chronic medication conditions.
The Ministry of Health of Singapore recommends annual influenza vaccination for individuals at higher risk of complications, including children aged 6 months to 5 years of age, elderly, pregnant women, and the chronically ill. As flu viruses are constantly changing and the body’s immune response from vaccination also declines over time, getting vaccinated every year would provide the best protection.
Meningococcal disease is a rare but potentially life-threatening bacterial infection which causes the lining of the brain and spinal cord to be infected (meningitis), or blood poisoning (septicaemia).
If not treated promptly, the disease can lead to death within a few hours, and around 15% of those who survive are left with disabilities that include deafness, brain damage, and neurological problems.
Extra precautions we should take when travelling abroad
Vaccinations play an important role in protecting travellers from serious diseases. Depending on where you travel, you may come into contact with diseases that are uncommon in Singapore. In addition, some vaccines (e.g. yellow fever vaccine) may also be mandatory for travel to certain areas.
To prepare for an upcoming trip, you can visit the Centers for Disease Control and Prevention (CDC) travel website (https://wwwnc.cdc.gov/travel) to find out which vaccines are recommended before travel. It is also useful to read the current travel notices (https://wwwnc.cdc.gov/travel/notices) to get information about any new disease outbreaks in the country or area of travel.
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