Archive for the ‘pneumococcal vaccine’ Tag

Prevenar schedule (from Wyeth)   1 comment

based on material from Wyeth
for Prevenar use in Singapore for routine childhood immunisation, see here
for Prevenar use in Singapore for catch-up immunisation in children, see here

Age at first dose & number of doses:

  1. 2 – 6 months: 3 + 1
    • can give as early as 6 weeks old
    • interval between first 3 doses: 4-8 weeks
    • booster: at least 2 months after 3rd dose (approx. 12-15 months old)
  2. 7 – 11 months: 2 + 1
    • primary doses at least 4 weeks apart
    • booster dose after 1 year old & at least 2 months after 2nd dose
  3. 12 – 23 months: 1 + 1
    • at least 2 months apart
  4. 24 months through 9 years: 1 dose only

 
Ref:

  1. Product information and promotional material from Wyeth, WP-PREV-07/05-2-SG
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Catch-up & unscheduled Pneumococcal Vaccination (Singapore) for Children & Adults, upd 2011   1 comment

Catch-up pneumococcal vaccination for children under 5:
PCV (13-valent pneumococcal conjugate vaccine eg. Prevenar ®)

MOH (Ministry of Health, Singapore) recommends catch-up immunisation for all previously unimmunised children under 5 years of age (updated Jan 2011).
(for recommended schedule from Wyeth, see here)

For previously unimmunised children:

  • <12 months old: 2 doses + 1 booster
    recommended interval between first & 2nd doses: 8 weeks (minimum 4 weeks)
    minimum interval between second dose & booster: 8 weeks

  • 12-23 months old: 1 dose + 1 booster (prev single dose only)
    minimum interval between doses: 8 weeks

  • 24-59 months old: single dose only
  • 24-59 months old with expected suboptimal response: 1 dose + 1 booster
    minimum interval between doses: 8 weeks
    eg. asplenia, splenic dysfunction, immunocompromised

 
Previous recommendation (Nov 2009) superseded.

  • <1 year old: as per primary series, 2 doses + 1 booster
    recommended interval between D1 and D2: 8 weeks (minimum 4 weeks)
    minimum interval between D2 and booster: 8 weeks

  • 1-5 years old: single dose of PCV
  • 1-5 years old with expected suboptimal response: 2 doses, interval 8 weeks between (eg. asplenia, splenic dysfunction, immunocompromised)

Pneumococcal vaccination for adults
PPSV23 (23-valent pneumococcal polysaccharide vaccine, eg. Pneumovax 23, Pneumo23):

Single dose only:

  • 2-5 years old in high-risk groups*: in addition to PCV
  • 2-64 years old in high-risk groups*
  • all elderly 65 years and older

one-time revaccination after 5 years:

  • persons aged 2-64 years with medical indications: chronic renal failure or nephrotic syndrome; functional or anatomic asplenia (eg. sickle cell disease or splenectomy); or immunocompromising conditions
  • elderly persons who previously received PPSV23 before the age of 65 are recommended for another dose if at least 5 years have passed since previous vaccination

Booster every 5 years:
not routine; recommended only for individuals with asplenia, splenic dysfunction and chronic renal disease

*High-risk groups:

  1. Chronic illnesses
    • chronic respiratory disease (incl. COPD, chronic bronchitis, emphysema, bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis, bronchopulmonary dysplasia; children with neuromuscular disease eg. cerebral palsy with risk of aspiration, or respiratory conditions caused by aspiration)
    • chronic heart disease (incl. ischaemic heart disease, congenital heart disease, hypertensive heart disease, chronic heart failure)
    • chronic renal disease (incl. nephrotic syndrome, chronic renal failure, renal transplant)
    • chronic liver disease and alcoholism (incl. biliary atresia, cirrhosis, chronic hepatitis)
    • diabetes mellitus
  2. Cochlear implants
  3. Cerebrospinal fluid leaks
  4. Anatomic or functional asplenia (incl. homozygous sickle cell disease, coeliac syndrome)
  5. Immunocompromised patients (incl. HIV infection, asplenia, splenic dysfunction, undergoing chemotherapy, likely to be on systemic steroid therapy more than a month at a dose equivalent to prednisolone at >=20mg/d (any age), or for children under 20kg at a dose of >=1mg/kg/day)

 
Ref:

  1. MOH Circular 42/2013: Pneumococcal and Seasonal Influenza Vaccinations (MH 34:03). Ministry of Health, Singapore. 6 September 2013.

  2. MOH Circular 103/2009: Pneumococcal Vaccination (MH 34:55/2). Ministry of Health, Singapore. 13 Oct 2009.

Posted November 11, 2009 by absinthemisia in vaccination

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What are the routine childhood vaccines in Singapore?   2 comments

from: the National Childhood Immunisation Programme, NCIP updated Nov 2009
**revised: 11 Nov 2011, effective 1 Dec 2011
***updated: 23 May 2013, effective 1 Jun 2013

Age BCG HepB DTaP Polio Hib 5in1 6in1 Mod PCV MMR
birth 1 BCG BCG BCG
birth D1 HepB HepB HepB
1 month D2 HepB HepB
2 month 6in1
3 month D1 D1-IPV*** D1*** 5in1 5in1 D1
4 month D2 D2-IPV*** D2 5in1 6in1 5in1
5 month (D3) D3 D3-IPV*** 5in1 6in1 D2
6 month D3 D3 HepB 6in1
12 month b1 D1**
15-18 month D2**
18 month b1 b1-IPV*** b1 5in1 5in1 5in1
6-7year (Pr1) b2*** * * * D2
10-11year (Pr5) b2** b3 b2-OPV*** * * *

 
Legend:

    D = dose number (primary schedule)
    b = booster
    BCG = Bacille Calmette Guérin (tuberculosis vaccine)
    DTaP = diphtheria, tetanus, acellular pertussis
    Polio = polio vaccine (oral Sabin OPV or injectable Salk IPV)
    Hib = Haemophilus influenza B (NCIS from 1 Jun 2013)
    PCV = pneumococcal conjugate vaccine

  • BCG 1 dose is always given at birth regardless of regime

  • measles, diphtheria vaccinations are mandated by law (Infectious Disease Act, IDA). BCG, Hep B, DTaP, Polio, MMR, PCV, Hib should be routinely offered as standard of care in Singapore unless contraindicated. HPV is recommended for females 9-26y/o.

  • ***from 1 Jun 2013, all vaccines in the NCIS can be paid for using Medisave.
  • in addition, the following vaccines are fully subsidised for children who are Singapore citizens, at all polyclinics: BCG, DTP, polio, MMR
  • **b2 of DTaP previously required Td-containing vaccine (reduced diphtheria component); as of 1 Dec 2011 a combined TdaP vaccine is recommended

  • TDaP comes combined with IPV as Infanrix-IPV; OPV carries a minute risk of vaccine-associated paralytic poliomyelitis (VAPP).

  • ***from 1 June 2013, the OPV-based polio vaccination schedule has been updated to a 5-dose regime: IPV for D1-D3 + b1; OPV for b2 at 10-11y/o.

  • IPV is contraindicated in allergy to streptomycin, polymyxin B, neomycin

  • Hib:*** children who previously received DTaP & OPV but have not completed primary and/or booster doses should complete their vaccination series up to first booster dose at 18m with DTp, IPV and Hib combination vaccines. Catch-up doses for Hib are not required for those who did not receive earlier doses.

  • 5in1: DTaP comes combined with IPV and Hib as Infanrix-IPV+Hib (5-in-1 vaccine); this regime utilises 5-in-1 and Hep B vaccine only.

  • 6in1: DTaP comes combined with IPV, Hib and Hep B vaccine as Infanrix hexa (6-in-1 vaccine); this regime utilises 6-in-1 and Hep B vaccine only, and boasts a total of only 4 injections in place of the conventional 6 injections in the first 6 months of life.

  • Mod(modified): a regime started with Hep B vaccine and 5-in-1 may be completed with 6-in-1 which replaces the final dose of both; this reduces the total jab count by 1 (to a total of 5).

  • *: the recommended schedules for 5-in-1 and 6-in-1 finish at 6 months with a booster dose at 18 months; after that the schedules follow the usual vaccination programme. Boostrix-IPV may be used for the DTaP-IPV booster at 11 years.

  • minimum interval between 1st & 2nd doses of Hep B-containing vaccine is 4 weeks; between 1st & 3rd doses is 16 weeks

  • children born to Hep B positive mothers should receive monovalent Hep B vaccine for D1 and D2; 6-in-1 vaccine can be used for D3.
  • PCV: PCV7 (Prevenar®) has been superceded by PCV13. PCV7 covers serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F. In addition, PCV13 covers 1, 3, 5, 6A, 7F and 19A. Serotype 19A is believed to be an emerging serotype responsible for serious invasive pneumococcal disease.

 

Ref:

  1. MOH Circular No.15/2013: Changes To The National Childhood Immunisation Schedule (MH 34:09/1 V16). MInistry of Health, Singapore. 23 May 2013.
  2. MOH Circular 27/2011: Changes in National Childhood Immunisation Schedule (MH 34:09/1). Ministry of Health, Singapore. 11 Nov 2011.
  3. MOH Circular 103/2009: Pneumococcal Vaccination (MH 34:55/2). Ministry of Health, Singapore. 13 Oct 2009.
  4. Polyclinic (NHG) Child Health Services website: http://www.nhgp.com.sg/Our_Services/General_Medical_Services/Child_Health_Services/