The effectiveness of childhood immunisation programme against poliomyelitis and diphtheria is shown in Figures 7.1 and 7.2. In 2016, no indigenous case of diphtheria, poliomyelitis and neonatal tetanus was reported.
With the implementation of the ‘catch-up’ measles vaccination programme using the MMR vaccine in 1997, and the introduction of the second dose of MMR vaccine to all primary six school children (11-12 years of age) in 1998 and subsequent changes in the immunisation schedule for the second dose (to primary one school children (6-7 years of age) in 2008 and 15-18 months of age in 2011), the incidence of measles decreased from 1,413 cases in 1997 to 136 in 2016 (Figure 7.3).
Rubella incidence decreased from 48 cases in 2013 to 12 cases in 2016. There were no reported cases of indigenous congenital rubella and no termination of pregnancy due to rubella infection was carried out in 2016 (Table 7.11).
The resurgence of mumps which began in 1998, continued until the year 2002. The resurgence was due to poor protection conferred by the Rubini strain of the MMR vaccine which was subsequently de-registered in 1999. The incidence of mumps remained largely unchanged in recent years; there were 478 cases in 2014, 473 cases in 2015 and 540 cases in 2016 (Table 7.12).
The incidence of acute hepatitis B for all age groups has declined from 243 cases in 1985 to 47 cases in 2016 (Figure 7.4). During the same period, the reported number of cases in children <15 years decreased from 10 to 0 (Table 7.12).
A national sero-prevalence survey was conducted in 2012 to determine the prevalence of antibody against vaccine preventable diseases and other diseases of public health importance in the adult Singapore resident population aged 18-79 years using residual sera from the National Health Survey 2010. The overall sero-prevalence was 85.0% for rubella in those aged 18 – 79 years. 11.1% of women 18 – 44 years of age remained susceptible to rubella infection.
About 43.9% of Singapore residents aged 18 – 79 years possessed immunity against hepatitis B virus (anti-HBs ≥10 mIU/mL). The overall prevalence of HBsAg in the population was 3.6%.
Figure 7.1
Incidence of reported poliomyelitis cases and immunisation coverage in Singapore, 1946-2016
Figure 7.1
Incidence of reported poliomyelitis cases and immunisation coverage in Singapore, 1946-‐2016
Figure 7.2
Incidence of reported diphtheria cases and immunisation coverage in Singapore, 1946-‐2016 Figure 7.2
Incidence of reported diphtheria cases and immunisation coverage in Singapore, 1946-2016
Figure 7.3
Impact of catch-up MMR vaccination programme and introduction of second dose of MMR vaccine on the incidence of reported measles cases in Singapore, 1997-2016
Figure 7.3
Impact of catch-‐up MMR vaccination programme and introduction of second dose of MMR vaccine on the incidence of reported measles cases in Singapore, 1997-‐2016
Figure 7.4
Incidence of reported acute hepatitis B cases and immunisation coverage in Singapore, 1985-‐2016
Figure 7.3
Impact of catch-‐up MMR vaccination programme and introduction of second dose of MMR vaccine on the incidence of reported measles cases in Singapore, 1997-‐2016
Figure 7.4
Incidence of reported acute hepatitis B cases and immunisation coverage in Singapore, 1985-‐2016 Figure 7.4
Incidence of reported acute hepatitis B cases and immunisation coverage in Singapore, 1985-2016
Table 7.11
No. of therapeutic abortions performed for rubella infection, 2007-2016 Year Total no. of abortions No. of therapeutic abortions performed
for rubella infections
No. (%)
2007 11,933 1 0.01
2008 12,222 0 0
2009 12,316 0 0
2010 12,082 0 0
2011 11,940 0 0
2012 10,624 1 0.01
2013 9,282 2 0.02
2014 8,515 0 0
2015 7,942 1 0
2016 7,217 0 0
Table 7.12 Reported cases of diphtheria, poliomyelitis, measles, acute hepatitis B, neonatal tetanus, pertussis, congenital rubella, and childhood tuberculous meningitis in Singapore, 1990-2016 YearDiphtheriaPoliomyelitisMeaslesMumps*Rubella*Acute hepatitis B†
Neonatal tetanus
‡Pertussis§Congenital rubella¶Childhood tuberculous meningitis# 199011(1)143--108‡‡40 19911(1)021663651305††10 1992106061,9813703014††40 1993006651,962423201††40 1994001591,636299212††20 199500185786326001††2*2* 19961(1)0308765487304(1)‡‡2*2* 1997001,413674360002††0*2* 1998001141,183179001**0*0 19990065††6,384(28)432001††2*1* 200000141††5,981**312**002(1)‡‡01* 20010061††1,399**242**001**2*0 20020057††1,090**152**00011 20030033††878**88**001‡‡00 20040096††1,003**141**001‡‡00 20050033††1,004**139**002††10 200601(1)§§28††844**90**003‡‡00 20070015††780**83**0038††00 20080018††801**180**0033††20 20090013††631**178**001300 20100049††452‡‡158‡‡008††2§§2 201100148††501‡‡110‡‡0029††20 20120038††521‡‡64‡‡0024††2§§0 20130046††495‡‡48‡‡0017††1§§0 201400148††478‡‡17‡‡0021††00 20150042††473‡‡15‡‡0057††00 201600126††540‡‡10‡‡0082††00 ( ) Imported cases. * Notifiable with effect from April 1990. †Indigenous cases below 15 years of age. ‡Source: Central Claims Processing System, Ministry of Health. §All pertussis cases reported prior to 1986 were based on clinically diagnosed cases seen at the Communicable Disease Centre. ¶Cases diagnosed in KK Women’s and Children’s Hospital, Singapore General Hospital and National University Hospital. #Below 10 years of age. **Based on clinically diagnosed cases. ††Based on laboratory confirmed cases. ‡‡Based on laboratory confirmed and clinically diagnosed cases. §§Foreigner who came for treatment.
Table 7.12 Reported cases of diphtheria, poliomyelitis, measles, acute hepatitis B, neonatal tetanus, pertussis, congenital rubella, and childhood tuberculous meningitis in Singapore, 1990-2016 YearDiphtheriaPoliomyelitisMeaslesMumps*Rubella*Acute hepatitis B†
Neonatal tetanus
‡Pertussis§Congenital rubella¶Childhood tuberculous meningitis# 199011(1)143--108‡‡40 19911(1)021663651305††10 1992106061,9813703014††40 1993006651,962423201††40 1994001591,636299212††20 199500185786326001††2*2* 19961(1)0308765487304(1)‡‡2*2* 1997001,413674360002††0*2* 1998001141,183179001**0*0 19990065††6,384(28)432001††2*1* 200000141††5,981**312**002(1)‡‡01* 20010061††1,399**242**001**2*0 20020057††1,090**152**00011 20030033††878**88**001‡‡00 20040096††1,003**141**001‡‡00 20050033††1,004**139**002††10 200601(1)§§28††844**90**003‡‡00 20070015††780**83**0038††00 20080018††801**180**0033††20 20090013††631**178**001300 20100049††452‡‡158‡‡008††2§§2 201100148††501‡‡110‡‡0029††20 20120038††521‡‡64‡‡0024††2§§0 20130046††495‡‡48‡‡0017††1§§0 201400148††478‡‡17‡‡0021††00 20150042††473‡‡15‡‡0057††00 201600126††540‡‡10‡‡0082††00 ( ) Imported cases. * Notifiable with effect from April 1990. †Indigenous cases below 15 years of age. ‡Source: Central Claims Processing System, Ministry of Health. §All pertussis cases reported prior to 1986 were based on clinically diagnosed cases seen at the Communicable Disease Centre. ¶Cases diagnosed in KK Women’s and Children’s Hospital, Singapore General Hospital and National University Hospital. #Below 10 years of age. **Based on clinically diagnosed cases. ††Based on laboratory confirmed cases. ‡‡Based on laboratory confirmed and clinically diagnosed cases. §§Foreigner who came for treatment. Contributed by
Tiong Wei Wei, Yuske Kita PUBLIC EDUCATION
HPB educates parents on the importance of childhood immunisations through educational materials such as “Childhood Immunisations: Give your child the best protection” and “Protect your child against Measles, Mumps and Rubella with the MMR vaccination”. These are distributed in the polyclinics and other healthcare institutions. Under the Healthier Child, Brighter Future initiative, the “Healthy start for your baby” guide also contains a chapter on childhood immunisations.
This educates parents the importance of immunisation and to immunise their children according to the recommended National Childhood Immunisation Schedule. The guide is distributed to mothers who have delivered and before they are discharged from the maternity hospitals.
ACKNOWLEDGEMENT
We would like to thank all medical practitioners, laboratory personnel, nurses, public health professionals, as well as partners from public and private healthcare institutions and other government agencies, who have, in one way or another, contributed to the data and information reported in this publication. We acknowledge their valuable contributions towards our national efforts in communicable diseases surveillance, prevention and control, and look forward to their continued support and cooperation in our work.
We also gratefully acknowledge the contributions of many colleagues in the following: National Public Health Laboratory (Chapters 2, 4 and 5), National Environment Agency (Chapter 3), National Public Health Unit (Chapters 5 and 6), Department of STI Control (Chapter 5), National University Hospital (Chapter 5), Singapore General Hospital (Chapter 5), Tan Tock Seng Hospital (Chapter 5), National Skin Centre (Chapter 6), STEP Registry, TB Control Unit (Chapter 6), National Immunisation Registry (Chapter 7) and School Health Services, Health Promotion Board (Chapter 7). Without their diligent assistance, this publication would not have been possible.
