Bacillus Calmette-Guérin (BCG) Vaccine
What is it ?
Newborns in hospitals are given BCG vaccination in Singapore routinely as it has been proven to be effective against the more serious forms of tuberculosis in babies ie TB meningitis (brain infection) and military Tuberculosis (a severe type of disseminated TB).  Tuberculosis is a disease that not only may cause lung damage but may spread to infect the brain, kidneys and spine. However if the child is less than 2.2 kg, the vaccination will be delayed as advised by the doctor. 

Dosage and administration: Given as a single injection at birth just under the skin 

Side Effects: At the time of vaccination, there is usually no reaction. A small red nodule(swelling) usually appears after 2 weeks to form a scar by 3 months. This is the one and only injection that leaves a scar on the child. 

Cost: Free at polyclinic

Hepatitis B vaccine
What is it?
Hepatitis B is a common disease in Singapore and South East Asia. Infant vaccination in Singapore since 1987 has brought the incidence down.  Hepatitis B virus may infect the liver to cause liver cirrhosis(hardening) and liver failure in the long term. Patients who are  hepatitis B carriers are at higher risk of liver cancer in adulthood. 

Dosage and administration for mothers who are Hepatitis B carriers: 3 doses of injection needed with first injection given as a single dose hepatitis vaccine at birth usually. Second dose preferably given as a single dose at 1 month old with the third dose given at 5-6 months old, either as a single dose or combined vaccine. In addition, the child is also given HBIg at birth. This is an antibody for Hepatitis. At about 9 months of age, a blood test may be performed to see the Hepatitis B status of the child and the response to the vaccination.

Age of Child (In Month)	At Birth	1	2	3	4	5	6
Hepatitis B
BCG
DTap/Hib/IPV (5-in-1)

Dosage and administration for mothers who are not Hepatitis B carriers: While first dose is usually given at birth as a single dose hepatitis B vaccine, subsequent doses maybe given as combination vaccines ie together with DTaP(see below) and haemophilus influenzae (as 6-in-1).

Age of Child (In Month)	At Birth	1	2	3	4	5	6
Hepatitis B
BCG
DTap/Hib/IPV/Hep B (6-in-1)

Age of Child (In Month)	At Birth	1	2	3	4	5	6
Hepatitis B
BCG
DTap/Hib/IPV (5-in-1)
DTap/Hib/IPV/Hep B (6-in-1)

Side Effects of Hepatitis B vaccine: very rare to have fever after hepatitis B vaccination.

Estimated Cost: $25-$35

Poliomyelitis vaccine 
What is it?
Poliomyelitis infection results in permanent paralysis leading to muscle atrophy (wastage) and deformity of the  limbs in the long term. 

Dosage and Administration: Injectable poliovirus vaccine is inactivated and now combined with DTaP and haemophilus influenza b vaccines to make up the 5-in-1 vaccine which allows 5 vaccines to be  given as a single injection. Hepatitis B vaccine may also be combined with the 5-in-1 vaccine to make the 6-in-1 vaccine, also given as a single injection.  

Side effect: oral polio is associated with vaccine-associated paralytic poliomyelitis(VAPP). Injectable poliovirus vaccine does not cause VAPP.

Diphtheria/ Pertussis/Tetanus (DTaP) vaccine
What is this combination of vaccines?
Diphtheria is a potentially fatal throat infection that may lead to obstruction of the airway. Another serious complication from diphtheria infection is myocarditis(inflammation of the heart muscles). 

Pertussis or better known as whooping cough (100 days of cough) locally, causes prolonged coughing.

The very young babies may unfortunately develop pneumonia (severe lung infection).   Other complications include convulsions (fits) and brain damage. In the long run, they may also have bronchiectasis. 

Tetanus may cause severe muscle spasms and rigidity of many parts of body. If  certain muscles are involved, then swallowing may even be seriously affected in the baby.  If breathing muscles are affected, then the child may experience breathing difficulty which is potentially fatal. 

Dosage and Administration: Given now popularly as 5-in-1 or 6-in-1 vaccination  at 3, 4, 5 months or 2, 4 or 6 months old respectively.  Both 5-in-1 and 6-in-1 vaccines will also consist of vaccines against poliomyelitis and haemophilus influenzae type b. 

Side Effects: May occasionally get a fever (usually <38 ^oC).  Swelling and redness at injection site is less common. 

Estimated Cost: $85-95 for 5-in-1, $95-105 for 6-in-1 

Measles, Mumps, Rubella (MMR) vaccine 
What is this combination of vaccines?
Children with measles infection present with high fever and rashes.  Measles can spread to other parts of the body resulting in complications such as pneumonia (lung infection), otitis media (ear infection) and encephalitis(brain infection) 

Rubella infection also causes fever and rashes in children. Pregnant women who contract rubella infection may give birth to babies with with multiple organ involvement resulting in hearing loss, mental retardation and congenital heart disease. 

Mumps is a viral disease that causes swelling of the salivary glands.  It may lead to complications such as meningoencephalomyelitis(brain infection) and orchitis(infection of the testis) in older boys.         

Dosage and Administration: Given between 12 to 15 months old with a booster at primary one or 6-7 years old.  

Side Effects: High grade fever may occur 5-10 days after vaccination.  Rashes and swelling of the lymphatic glands around the neck may occur.  MMR is NOT associated with autism. 

Estimated Cost: $25-35 at private clinics (available free at polyclinics)

Measles, Mumps, Rubella, Varicella (MMRV) vaccine – Priorix-Tetra ^New*
What is this combination of vaccines?
This new combination vaccine available from May 2009 in Singapore consists of Measles Mumps Rubella (MMR) vaccine and the varicella (chickenpox) vaccine.   

Dosage and Administration: First dose is given  at about 15 months old with a booster dose at an interval of at least 6 weeks  between the 2 doses. Priorix-tetra allows MMR and varicella vaccines to be administered simultaneously with less injections needed (See schedule below : Option 1 and 2).  If MMR and varicella vaccines were each given separately, there will be a total of four injections instead of two injections with Priorix-Tetra.

Age of Child	12 mths	15 mths	18 mths	4 to 6 yrs	7 yrs	No of Jabs
MMR						2
Varicella						2
Priorix Tetra Option 1						2
Priorix Tetra Option 2						2

Estimated Cost: About $120 - $140 per dose

PNEUMOCOCCAL VACCINATION
What is it ?
Pneumococcal disease is a group of illnesses caused by the bacterium Streptococcus pneumoniae, also known as pneumococcus. 

They include meningitis, bacteraemia (blood infection ), pneumonia (lung infection ), otitis media (ear infection) and sinusitis 

Pneumcoccal disease may  thus lead to brain damage, permanent hearing loss, paralysis or severe disability, mental retardation, speech delay and in the worst case scenario,  death. 

About 15 per 100 000 children less than 5 years old are infected with pneumococcal disease each year in Singapore. A total of 144 cases of invasive pneumococcal disease were notified from January to June 2009 

In serious cases, about 25% will suffer from complications and about 6% will die. 

The pneumococcus bug can be passed easily via respiratory droplets through sneezing, coughing or close contact. 

Currently, the available pneumococcal conjugate vaccine (PCV) is known as Prevenar. From 2010, a new pneumococcal vaccine known as Synflorix^NEW will be available. MOH's Expert Committee on Immunisation (ECI) has recommended that PCV be included into the National Childhood Immunisation Programme from 2009 (see article). The target population groups are infants and children aged 6 weeks to 5 years.

Dosage and Administration

Side effects: In clinical trials, the pneumococcal vaccine, prevenar , was found to be generally well tolerated. Most reactions to the vaccine, such as local irritations and fever, were mild, resolved spontaneously and were comparable to those commonly observed with other vaccines. 

Estimated Cost: 1 dose of prevenar costs $160-$180 (With effect from 1 Nov 2009, Medisave use will be allowed for pneumococcal vaccinations in children under 5 years of age. As per current practice, parents can also pay using Baby Bonus)

The information on this website is  strictly  meant to be used as an educational guide.  Parents are advised to consult their family doctor or paediatrician for  specific medical advice.