Monday, December 2, 2013

Vaccination in Children - The Optional Vaccines

As soon as our children are born into this world, they receive what may seem like an endless number of vaccinations. There are those which are part of the National Immunization Schedule, which all children should receive. Then there are the optional vaccinations, which are also important. We discuss these vaccines in this article.
Optional Vaccinations may include:
  1. Hepatitis A Vaccine
  2. Hib (Haemophilus Influenza Type B) Vaccine
  3. Chicken Pox Vaccine
  4. Influenza Vaccine
  5. H1N1 Vaccine
  6. Rotavirus Vaccine
  7. Pneumococcal Vaccine
  8. Human Papillomavirus Vaccine
Hepatitis A Vaccine
The Hepatitis A virus (HAV) causes acute hepatitis (inflammation of the liver). Symptoms of acute hepatitis include fever, jaundice, nausea, abdominal cramps and occasionally death. The virus is spread via the oro-faecal route ie. via eating of food contaminated with the HAV. This is the virus that can be caught by eating improperly cooked contaminated cockles (commonly confused with the Hepatitis B virus which is transmitted from contaminated blood and intercourse).
Dose:
2 doses given 6 months apart
Common Side Effects:
Mild fever, headaches and swelling over injection site.
Hib (Haemophilus Influenzae Type B) Vaccine
H. Influenzae type B is a bacteria which is responsible for millions of deaths worldwide through meningitis and pneumonia. It affects mainly children under the age of five, with those between four and eighteen months particularly vulnerable. It leaves up to 35% of survivors with permanent disabilities such as mental retardation or deafness.
Dose:
3 Primary doses at ages 3, 4 and 5 months, followed by 1 Booster dose at 18 months. It usually given as one of the components of the 4-in-1, 5-in-1 and 6-in-1 vaccination.
Common Side Effects:
Redness and swelling over the site of injection.
Varicella (Chicken Pox) Vaccine
Chickenpox is caused by the varicella virus. Symptoms include fever and blisters all over the body. The blisters dry up subsequently and become very itchy. It is a typically benign and self-limiting disease which is highly contagious. Complications (secondary bacterial infections, encephalitis and pneumonia) occur more commonly in adults, newborns and in immuno-compromised individuals.
Dose:
Previously, only 1 Primary shot was given at about 12 months of age. However, as of 2007, the CDC has issued a new recommendation that a Booster dose be given at about 4 - 6 years old. This is to reduce the 30% breakthrough infection rate with a single dose (although breakthrough infections tend to be mild). Hence, all require 2 doses regardless of age. Note that the MMRV (ie. MMR Vaccine combined with the Varicella Vaccine) is now available for use.
Common Side Effects:
Mild pain and swelling over injection site.
Influenza Vaccine
Influenza is a viral infection caused by the Influenza virus. Symptoms include a fever, body aches, headache, dry cough, sore throat and slight runny nose. Symptoms are generally self-limiting, and most patients recover on their own. However, in high risk groups (eg. young children, pregnant women, the elderly, and those with chronic medical problems), influenza can lead to a higher rate of complications. These complications include ear infections, sinus infections, bronchitis, pneumonia and even death.
Dose:
The vaccine is indicated for children above 6 months of age. In children under 9 years old who have never had the influenza vaccine before, they will need 2 doses at least 1 month apart. Subsequently, they will only need yearly vaccinations. In children above 9 years and in adults, only yearly vaccinations are required.
Common Side Effects:
Mild flu-like symptoms
H1N1 Vaccine
The Influenza A (H1N1-2009) virus is a strain of influenza virus that spreads from human to human, which raised concerns in 2009 about a possible worldwide pandemic. Symptoms are similar to that of seasonal influenza, with severe illness and death reported in a small number.
Dose:
2 doses at least 4 weeks apart are required in children under 10 years of age.
Common Side Effects:
Mild fever and flu-like symptoms.
Pneumococcal Conjugate Vaccine
Pneumococcal disease is a group of illnesses caused by the bacterium Streptococcus pneumoniae, also known as pneumococcus. Pneumococcal infections can result in: pneumonia, meningitis, otitis media, sinusitis and bacteraemia. In Singapore, 18 per 100,000 children less than 5 years old are infected with pneumococcal disease each year. In serious cases, 1 in 4 suffer complications (brain damage, permanent hearing loss, paralysis, mental retardation) and 1 in 16 die.
Dose:
Indicated in infants and children from 6 weeks through 9 years of age. Between 1 to 4 doses required, depending on the age of the child when the 1st dose is given.
Common Side Effects:
Fever, irritability, decreased appetite, occasional vomiting and diarrhoea.
Rotavirus Vaccine
Rotavirus is a virus that infects the gastrointestinal tract causing gastroenteritis. Nearly every child worldwide will have at least one rotavirus infection before their 5th birthday. 1 in 3 hospitalizations due to diarrhoea in Singapore are caused by rotavirus. Infections are most frequent and severe in infants between 3 - 24 months old.
Dose:
2 oral doses (Dose 1 at 6 weeks and Dose 2 at 24 weeks).
Common Side Effects:
Slight irritability, loss of appetite.
Human Papillomavirus (HPV) Vaccine
The Human Papillomavirus (HPV) is one of the most common sexually transmitted infection, and certain species of HPV have an association with the development of cervical cancer, genital warts and some less common cancers. The HPV vaccine works by preventing the most common types of HPV that cause cervical cancer. 2 HPV vaccines are currently available: Gardasil and Cervirix.
It is important to remember that even after vaccination, one would still have to go for regular PAP smears.
Dose:
It is indicated for girls between the ages of 9 and 26 years. However, there are studies which suggest that they are effective in preventing cervical cancer for women up to 45 years of age. 3 injections are required over a 6 month period.
Common Side Effects:
Mild soreness over injection site. Mild to moderate fever.

Dr Ang C.D. is has been in medical practice for over 12 years. He graduated with an M.B.B.S. degree from the National University of Singapore in 1997 and subsequently completed his post-graduate diploma in Family Medicine. He has had training in Emergency Medicine, Internal Medicine, Geriatric Medicine, Orthopaedic Surgery, Obstetrics & Gynaecology, Neurosurgery, General Surgery, Colorectal Surgery and Urology. Dr Ang currently practices in a family clinic in Singapore, seeing a good mix of paediatric, adult and geriatric patients. With the goal of providing the public and family physicians with a resource for specialist care, Dr Ang has founded SingaporeDoc.com, a Web Directory of Specialists in Private Practice in Singapore.
Vaccination in Children - The Optional Vaccines
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