The National Adult Immunization Schedule
As of 1st November 2020, all vaccines recommended in the National Adult Immunization Schedule (NAIS) will be partially-subsidized based on their Community Health Assistance Scheme (CHAS) card status, or other relevant cards such as Merdeka or Pioneer Generation (PG) for Singapore citizens and Permanent Residents (PR) at the polyclinics, as well as CHAS-approved GP private clinics. We are pleased to inform that Intemedical clinic is a part of this initiative as well, as we strive to serve everyone in the committee, regardless of their financial status. This new NAIS initiative will be able to offer subsidies for certain vaccines to eligible adults that will reduce the cost of the vaccine drastically for patients, making it much for affordable for patients with financial difficulties, as well as being able to have patients willingly come in for their vaccinations without feeling bogged down by finances.
How do vaccines work?
Vaccines are usually cultured from the actual live virus or bacteria itself, and most are then inactivated such that it is unable to cause disease. Each vaccine usually contains very small amounts of the inactivated virus/bacteria, and once injected, it tricks our immune system into thinking that the body is under attack by the virus/bacteria. When this happens, immune antibodies are formed, which is what protects us from future disease. It is important to note, however, that vaccines do not have a 100% preventive rate, as many other factors can come into play, such as a person’s immune system not reacting as robustly as expected to produce sufficient antibodies, which can happen when a person is vaccinated while fighting a cold and most of the battle gear are directed in the direction of the cold virus, as well as antibody levels waning over time. Hence, sometimes, multiple doses of a vaccine are recommended, or booster doses advised once every couple of years. Usually once a vaccine is given, even if it does not provide 100% protection to that person, it typically causes milder symptoms, and a faster recovery.
Recommended Adult Vaccines in Singapore
Influenza – Influenza virus, commonly known as the flu, can cause symptoms ranging from a mild respiratory tract infection, to a full blown pneumonia with respiratory failure. As such, it is recommended to get the influenza vaccine on an annual basis. In adults, the influenza vaccine is subsidized for persons aged 65 and above, due to the increased risk factors with age. Those aged 18 to 65 may also qualify under the NAIS if they suffer from specific medical conditions such as chronic heart disease, chronic lung disease, immunosuppression etc. Other healthy adults who choose, and would be recommended to go for the annual influenza vaccination would not be able to benefit from subsidies, nor use Medisave to make payment, but it is often a worthy exchange in terms of health and prevention of severe influenza. Influenza vaccinations should be administered once a year, unless specified otherwise by health authorities of a significant difference between the Northern and Southern Hemisphere strains of that year. It is important to keep in mind that the vaccine only protects against certain strains of the Influenza virus, so you may still fall sick from things like the common cold. If you are not sure if you belong into the high-risk groups which would be covered via NAIS, feel free too consult our doctors to seek advice and recommendations as to which vaccinations you should consider getting.
Pneumococcal Conjugate – The Pneumococcal Conjugate vaccine is used to protect persons from infection from Streptococcus pneumoniae, whose symptoms may range from a mild flu-like illness to respiratory distress and ultimately death. Even if a person had received a full 3-dose vaccination when they were a baby, the PCV13 is still recommended as a once-dose from the age of 65 years onwards. This helps to boost antibodies that would likely have waned over time, and helps target a population that is more susceptible to the disease and its complications.
Pneumococcal Polysaccharide – The Pneumococcal polysaccharide vaccine (PPSV23), similar to the Pneumococcal conjugate vaccine, covers against the pneumococcal bacteria as well, but the vaccine was manufactured using a different method, allowing it to cover strains that the PCV13 was unable to. It covers for 23 strains of the pneumococcus bacteria. Vaccination in adults is recommended in those above the age of 65 years, one year after the administration of the PCV13 vaccine. Those between the ages of 18 to 65 should be vaccinated if they suffer from specific medical conditions such as chronic heart disease, chronic lung disease, chronic metabolic disease, immunosuppression, and diabetes. In this age group, the PPSV23 vaccines should be administered every 5 years until the age of 65 is reached, following that just one dose is satisfactory. If you are not sure if you belong into the high-risk groups which would be covered via NAIS, feel free too consult our doctors to seek advice and recommendations as to which vaccinations you should consider getting.
Tetanus, reduced diphtheria & acellular pertussis – Pertussis, most commonly known as “whooping cough”, is caused by the bacteria Bordetella pertussis. It can cause symptoms similar to a common cold or flu, but eventually develops to worsening coughing fits with the characteristic “whoop” on breathing in before coughing. Tetanus infection is caused by the bacteria Clostridium tetani. It can result in severe symptoms such as “lockjaw”, with the patient being unable to open his/her mouth at all resulting in respiratory compromise, involuntary muscle spasms and contractions throughout the body, sometimes severe enough to cause fractures, as well as seizures. The bacteria is usually found in the environment, soil, and on rusty equipment, hence injuries breaching the skin layer are the typical methods of transmission and contracting of Tetanus. The Diphtheria vaccine protects against infection caused by Corynebacterium diphtheriae, which produces toxins resulting in a wide range of symptoms from mild respiratory symptoms such as a sore throat, to severe skin infections, heart failure, and even death. The Tetanus, reduced diphtheria & acellular pertussis (Tdap) vaccine is commonly administered in adults only during pregnancy, usually at 27 to 36 weeks of gestation. Regardless of interval between each pregnancy, the Tdap vaccine should be given during each pregnancy.
Human papillomavirus – The Human Papillomavirus (HPV) is a virus that is responsible for more than 97% of cervical cancer cases, in particular, strains 16 and 18. Other strains of HPV cause symptoms such as genital warts, and can be sexually-transmitted. There are a number of HPV vaccines out in the market presently – Cervarix, Gardasil-4, and Gardasil-9. Only Gardasil-4 is currently in the NAIS list, and is thus subsidized and Medisave claimable. The vaccine is recommended to be most efficient if administered within the ages of 9 and 26. The vaccine is given as a 3-dose regimen, at 0 months, 2 months, and then finally at 6 months from the 1st dose. Our clinic carries the Gardasil-4 vaccine as well. If Gardasil-4 is opted for, do note that as long as the 1st dose of the vaccine is administered before the patient’s 26th birthday, they will still be able to claim the entire 3 doses under Medisave, and also enjoy the subsidies under NAIS.
Hepatitis B – The Hepatitis B vaccine protects against the Hepatitis virus, a virus that affects the liver of the person who contracts it. The full 3 doses of the vaccine would have been given to a child during the first few months of their lives if they were born in Singapore. However, immunity often wanes with time, with reduced antibody levels found in the blood. It is recommended to first check antibody levels before deciding whether only one booster dose is required, if the antibody level is low but still >100, or if another full 3-dose regimen is required again if the antibody levels are extremely low or negligible. The doses are typically given at 0 months, 1-2 months later, and subsequently 6 months after the 1st dose.
Varicella – Varicella Zoster Virus (VZV) is responsible for causing chickenpox, especially in children. Although less uncommon, VZV infection can occur in adults as well, and when they do, complications tend to be more frequently seen, such as pneumonia. Although babies are routinely vaccinated now with MMRV (MMR + Varicella) as a child, this current batch of adults did not have the luxury of the VZV vaccine during their time. The VZV vaccine can be administered to anyone who does not have a previous history of VZV infection in the past, and consists of 2 doses, 4-8 weeks apart from one another. It is important to note that VZV vaccine protection is not 100%, and a vaccinated individual can still get VZV infection in the form of chickenpox, although usually of milder symptoms and a shorter course of illness.
Subsidized Prices for Vaccines under NAIS
As of 1st November 2020, MOH made major changes to the NAIS, which included providing significant subsidies on the prices of vaccines. The price varied depending on whether you are holding a CHAS card, and which CHAS card you have, PG card, or Merdeka card. Patients also has the option of using their Medisave500 to pay for the leftover amount, provided they still had sufficient funds in their Medisave accounts. Medisave500 allows use of up to $500 per year on vaccinations and outpatient treatment for chronic diseases. Those aged 60 and above can also use their FlexiMedisave of up to $200 a year for the vaccines. As per usual Medisave guidelines, patients are allowed to use their parents’, siblings’, and spouse’s Medisave500 to fund the vaccine, while FlexiMedisave allows only the patient’s spouse, if over 60 years of age, to utilize the funds as well.
Other Vaccines available in Singapore for adults but not in the NAIS
Hepatitis A – The Hepatitis A virus leads to infection and inflammation of the liver, which, in severe cases, can lead to acute liver failure. The virus can be passed from person to person through close contact, sexual contact, as well as contact with contaminated food and water, especially seafood/shellfish. This can be easily preventable with the Hepatitis A vaccine. This involves 2 doses of the vaccine, spaced 6 months apart. Any persons aged 18 and above should receive the full adult dose of the vaccine.
Hepatitis A & Hepatitis B combination – There is currently an available combination of Hepatitis A with Hepatitis B vaccine that allows for fewer vaccines to have be administered and minimize the discomfort from each injection. The 3-dose series at 0 months, 1 month, followed by 6 months after the 1st dose. The Twinrix full dose vaccine is applicable to persons aged 18 and above.
Tetanus – Tetanus infection is caused by the bacteria Clostridium tetani. It can result in severe symptoms such as “lockjaw”, with the patient being unable to open his/her mouth at all resulting in respiratory compromise, involuntary muscle spasms and contractions throughout the body, sometimes severe enough to cause fractures, as well as seizures. The bacteria is usually found in the environment, soil, and on rusty equipment, hence injuries breaching the skin layer are the typical methods of transmission and contracting of Tetanus. The Tetanus is usually given as a single dose, which has been found to be effective for approximately 5-10 years depending on the severity of the injury, before another booster shot is required for those for example working in certain industries putting them at higher risk of injuries. The vaccine can be found alone, or in combination with vaccines for Diphtheria and Pertussis (DTaP and Tdap).
Human papilloma virus – The Human Papillomavirus (HPV) is a virus that is responsible for more than 97% of cervical cancer cases, in particular, strains 16 and 18. Other strains of HPV cause symptoms such as genital warts, and can be sexually-transmitted. There are a number of HPV vaccines out in the market presently – Cervarix, Gardasil-4, and Gardasil-9. Only Cervarix is being used in school-based vaccination programmes. Gardasil-4 is claimable under NCIS and NAIS, while Gardasil-9, which protects against 9 strains of the HPV is not. The vaccine is recommended to be most efficient if administered within the ages of 9 and 26. The vaccine is given as a 3-dose regimen, at 0 months, 2 months, and then finally at 6 months from the 1st dose. Our clinic carries the Gardasil-4 and Gardasil-9 vaccines. If Gardasil-9 is chosen, please note the Medisave is unable to be used to claim for the Gardasil-9 vaccine.
Herpes Zoster – Herpes Zoster, commonly known as Shingles, is a virus that is a natural evolution from Varicella Zoster (VZV), which causes chickenpox. Anyone with a history of chickenpox will have risk of developing shingles later in life, usually aged 50 and above. Shingles causes a blister-like rash along a “zone” of the body, and is often accompanied by severe nerve-related pain as the virus specifically attacks the nerves. Even when the rash has subsided, it can still cause severe pain, known as post-herpetic neuralgia, resulting in functional impairment in some due to the chronic pain. Zostavax, one of the shingles vaccines available in Singapore, can help to prevent shingles, just with a single dose administered. It is available and evidenced only in persons aged 50 and above, due to the lack of studies on efficacy in the younger population due to a much reduced occurrence in that age group. Those in the age group of 50 to 59 years are counselled prior to receiving the vaccination as studies have shown efficacy of the vaccine lasts around 5 years, making protection during the most crucial years of 60 years and above to be much lower, possibly requiring a booster dose. Hence, Zostavax is usually recommended in those aged 60 and above.
Dengue – The Dengue fever epidemic has been something that authorities have been struggling to keep under control amidst the COVID-19 pandemic. However, less lime light is shone on Dengue despite the number of new cases being significantly more than the COVID-19 virus. Dengue fever does not spread from person by respiratory droplets or contact with someone who has been diagnosed by it, instead it is transmitted from a bite from the Aedes aegypti or Aedes albopictus. Common symptoms include a persistent fever past 3 days, muscle aches, bone pain and joint pain, headaches (especially behind the eyes), generalized non-itchy rash, easy bruising/bleeding, and abdominal symptoms. Dengvaxia is a vaccine for the Dengue virus, which was only rolled out a few years ago in 2015, and approved in use since 2016. Dengvaxia protects against the 4 serotypes of the Dengue virus, with focus of efficacy placed more on the first 2 serotypes' efficacy than the the other 2. The reason why the vaccine was created was because clinicians realized that patients with a prior history of Dengue infection, tend to suffer from more severe symptoms and complications on their 2nd infection. Eligibility criteria to qualify for Dengvaxia is strict though, which includes previous documented Dengue infection (or undergo a Dengue IgG antibody blood test to confirm previous infection), and the vaccine is only available to persons aged 12 through to 45 years. There is significant importance of a previous Dengue infection in order to administer the vaccine, as multiple studies all over the world have shown that patients without prior history who get vaccinated with Dengvaxia, tend to suffer from severe Dengue symptoms when they are bitten by an Aedes mosquito. The vaccine comprises of 3 doses, with each dose scheduled 6 months apart.
Meningococcal polysaccharide – This vaccine protects against the Neisseria meningitidis bacteria that can most commonly lead to brain infection/inflammation (meningitis). In Singapore, it is not widely used due to herd immunity, causing cases locally to be so low that there is no need for prevention. The Meningococcal vaccine is often given to travellers for their Hajj and Umrah trips. Only one dose is required. The brand that we carry in the clinic is Menactra, and protects against Meningococcus ACYW135. Menactra should be used in caution in adults aged 55 and above due to the lack of scientific studies on possible complications as well as efficacy, above 55 years old. Nimenrix vaccine is used for young travellers above the age of 2 years old, and can be pre-ordered into our clinic if required. Travellers who have certain medical conditions that may caused them to be immunocompromised, may require 2 doses of the vaccine instead of 1, in order to generate sufficient antibodies for protection.
Typhoid - Typhoid fever is caused by a bacteria called Salmonella typhi. Salmonella may be something most people are aware of and have heard of in the past. It causes high fever and severe gastrointestinal symptoms such as severe abdominal pain, fever, excessive vomiting and severe diarrhoea. For most patients who ends fatally-affected, it tends to be a result of severe dehydration. If left untreated, the symptoms may persist for as long as weeks and months. Studies have shown that up to 30% of those afflicted with the Typhoid fever end up dying from it. The bacteria is most commonly found in soil, unsanitary places, sometimes roadside food stalls, and becomes a problem only when after coming into contact with it, the person ingests it, sometimes subconsciously and unknowingly. The typhoid vaccine is hence recommended to persons aged 2 years and older, with time of vaccination recommended 2 weeks before possible exposure, and repeat vaccinations once every 2 years for persons who remain at risk such as residing in an affected area for a prolonged. The bacteria is currently commonly found in many regions in the world, the most common being East and Southeast Asia, Africa, the Caribbean, and Central and South America. Travellers to these areas or persons living in these areas are recommended to get the vaccine.
Japanese Encephalitis - Japanese Encephalitis (JE) is a relatively uncommon infection seen in Singapore in general compared to many other diseases. It is spread via the bites of mosquitoes (Culex tritaeniorhynchus), and is most commonly found in Asia, especially in rural and periurban settings. Not all travellers become symptomatic when bitten by a mosquito carrying the JE virus. Those who do though suffer from symptoms such as fever, headache, vomiting, confusion, difficulty moving, and serious complications such as brain swelling and coma. The expected mortality rate for those who get the infected is expected to be as high as 30% of those affected. Unfortunately, there has not yet been a cure found for infection of the JE virus. Current circulating viruses now in these endemic countries have been found to be resistant and ineffective to previous possible cures found. The JE vaccine is recommended in travellers to areas where JE is endemic, particularly if they are travelling to rural and suburban places, and also planning a long stay of a month of move in these areas. It is administered as 2-dose regimen, given 1 month apart, with the last dose recommended to be given at least 1 week before travel. The current vaccine is licensed and tested to be given to persons aged at least 2 months old. The dose of the vaccine for children aged 2 months to 3 years of age, is half of what is provided in the vaccine itself.
The following table summarizes a list of prices of vaccines in our clinic (subject to changes) that are included in the NAIS, but non-subsidized and applicable to those who are not eligible for the subsidy. as well as prices of vaccines not included within the NAIS:
Please note that patients seen in the clinic who only require a vaccination without needing a consult of other symptoms they may have which may/may not result in prescription of medications, or ordering of investigative tests, will have their consultation fee WAIVED completely in goodwill. Hence, they would only be required to pay for the cost of the vaccine when checking out of the clinic.
If you are not a local, and are an expatriate for example, you may notice that our country’s vaccine guidelines may differ from your country in terms of types of vaccines, timing of vaccines given, or number of doses recommended. Rest assured that at Intemedical, we allow for flexibility, and would gladly follow your country’s guidelines if it is more familiar and convenient with you, or you can also switch over to our local guidelines if it is comfortable for you to.
If you would like to make an appointment with Intemedical for vaccination, kindly go through our appointment portal, call us at 6243 3036, or WhatsApp us at 8879 9404 with the patient’s name, date of birth, age at point of intended vaccination, and vaccination required. It is preferred that patient calls prior to coming down so that we are able to check and provide you with the current stock level of the non-reserved vaccines, and to be able to inform you if we are out of stock, and able to advise that you make a pre-order for that vaccine so that we can replenish the stock and reserve one vaccine for you. This especially applies to the vaccines that are not administered very frequently in our clinic.
How to make an appointment with Intemedical?
Appointment Portal: Kovan Clinic / Potong Pasir Clinic
(click and book with instant confirmation!)
WhatsApp: 8879 9404
(available during clinic opening hours, 8am to 12am)
Mobile: 8879 9404
Landline: +65 3165 9251
(please be aware that the phone might be engaged due to high call volume)
Credit: MOH, CDC, FDA, HealthHub