1. To facilitate the take up of important vaccinations amongst adults and help individuals make more informed decisions, the Ministry of Health (MOH) has established the National Adult Immunisation Schedule (NAIS) to provide guidance on vaccinations that persons aged 18 years and older should adopt to protect themselves against vaccine-preventable diseases.
2. From 1 November 2017, Medisave can be used to pay for recommended vaccinations for the specific target adult population groups under the NAIS.
3. Currently, the National Childhood Immunisation Programme (NCIP) aims to achieve herd immunity among children in the population and reduce the risk of disease outbreaks. With the NAIS, adults who have not been previously vaccinated or who are at risk will be able to make more informed choices on vaccination for personal protection. Together, the NAIS and NCIP provide comprehensive vaccination recommendations for Singaporeans and residents for all ages.
4. Senior Minister of State for Health Dr Lam Pin Min said, “Vaccination provides a person with protection against infectious diseases, and is one of the strategies to reduce the risk of disease outbreaks in the community. While the coverage for vaccinations under the National Childhood Immunisation Programme has been high for most of the vaccines, there is low awareness of the benefits of adult vaccination for personal protection and protection of at-risk family members. With the introduction of the National Adult Immunisation Schedule (NAIS), we hope to encourage Singaporeans to take up the recommendations made in the NAIS, to protect themselves and their loved ones against the relevant infectious diseases.”
Vaccines under NAIS
5. The NAIS will provide the public and healthcare professionals with information on the necessary vaccinations, targeted groups who should be vaccinated and frequency of vaccination. It was developed based on the recommendations of the national Expert Committee on Immunisation (ECI), and comprises seven types of vaccines that protect against 11 diseases, including:
(i) Influenza;
(ii) Pneumococcal (PCV13/PPSV23);
(iii) Human Papillomavirus (HPV2/HPV4);
(iv) Tetanus, Diphtheria and Pertussis (Tdap);
(v) Measles, Mumps and Rubella (MMR);
(vi) Hepatitis B; and
(vii) Varicella.
6. In deriving the recommendations, the ECI had examined the specific adult groups’ vulnerability to vaccine-preventable diseases. Considerations include age, occupation, pre-existing medical conditions, vaccination history, as well as efficacy and cost effectiveness of the vaccines. Individuals are advised to discuss their vaccination needs and suitability to receive the recommended adult vaccines with their doctor. Details of the NAIS are available in Annex A.
7. MOH regularly reviews its vaccination policies in consultation with the national Expert Committee on Immunisation (ECI), taking reference from latest international best practice.
Extension of Medisave
8. To enhance vaccination coverage and help Singaporeans pay for the recommended adult vaccines, Singaporeans will be able to use up to $400 of their Medisave per account, under the Medisave400 scheme, for all recommended vaccinations for the target adult population groups in the NAIS. This will take effect from 1 November 2017.
9. Singaporeans can use their Medisave for NAIS vaccinations at Medisave-accredited healthcare institutions, such as hospitals, polyclinics, and CHAS GP clinics. The list of recommended adult vaccinations and FAQ can also be found on https://www.moh.gov.sg/NAIS.
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ANNEX A
Summary of National Adult Immunisation Schedule (NAIS)
(For persons aged 18 years and older)
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Vaccine
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18-26 years
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27-64 years
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≥ 65 years
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Influenza*
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1 dose annually
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1 dose annually
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Pneumococcal* †
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1 or 2 doses§
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1 dose each§
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Human papillomavirus (HPV)†
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3 doses
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Tetanus, diphtheria and pertussis (Tdap)¶
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1 dose for each pregnancy
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Measles, mumps and rubella (MMR)† ¶
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2 doses
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Hepatitis B†
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3 doses
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Varicella
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2 doses
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Recommended for adults who have not been previously vaccinated or lack evidence of past infection/immunity
(Please consult your doctor for more details)
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Recommended for adults with specific medical conditions and indications
(Please consult your doctor for more details)
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* Also recommended for specific groups of children.
† Also included in the National Childhood Immunisation Schedule (NCIS).
§ Refer to next page for more details
¶ Protection against three diseases through one vaccination
National Adult Immunisation Schedule – recommended groups and vaccination schedule
(For persons aged 18 years and older)
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Vaccines
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Recommended Groups
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Schedule
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Influenza*
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• Persons aged 65 years or older;
• Persons aged 18 years and receiving long-term aspirin therapy;
• Persons who have chronic medical conditions such as diabetes mellitus, asthma, and heart disease;
• Persons who are immunocompromised;
• Persons receiving intermediate and long term care services;
• Women at all stages of pregnancy.
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1 dose annually
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Pneumococcal* † §
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• Persons aged 65 years or older
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1 dose each¶
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• Persons aged 18 years and older with chronic illnesses such as chronic lung, heart, kidney or liver diseases and diabetes mellitus;
• Persons who are immunocompromised or with other medical conditions.**
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1 or 2 doses††
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Human papillomavirus (HPV)† §§
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• Females aged 18 to 26 years
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3 doses (0, 1-2, 6 months)
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Tetanus, diphtheria and pertussis (Tdap)
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• Pregnant women (for each pregnancy)
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1 dose per pregnancy
(16-32 weeks)¶¶
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Measles, mumps and rubella (MMR)†
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• Adults without evidence of immunity and/or prior disease
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2 doses (0, 4 weeks)
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Hepatitis B†
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• Adults without evidence of immunity and/or prior disease
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3 doses (0, 1, 6 months)
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Varicella
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• Adults without evidence of immunity and/or prior disease
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2 doses (0, 4-8 weeks)
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Contraindications:
Persons who have had severe allergic reaction after a previous vaccination or allergies to specific vaccine components should not receive the vaccine, and those who are severely immunocompromised or are pregnant should not receive live vaccines such as MMR or varicella vaccines.
* Also recommended for specific groups of children, including those with medical conditions or immunocompromised or with other rare conditions.
† Also included in the National Childhood Immunisation Schedule (NCIS)
§ Pneumococcal vaccines in the NAIS include 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23).
¶ One dose each of PCV13 and PPSV23 is recommended for persons aged 65 years and above.
** Other medical conditions include: Persons with cochlear implants or cerebrospinal fluid leaks; persons with anatomic or functional asplenia (including conditions such as homozygous sickle cell disease and coeliac syndrome that may lead to splenic dysfunction).
†† The number of recommended doses and vaccine type depend on medical condition and age. Please consult your doctor for more details.
§§ Also recommended for females aged 9 to 17 years. Two types of HPV vaccines are in the NAIS – bivalent HPV vaccine (HPV2) and quadrivalent HPV (HPV4) vaccine.
¶¶ Tdap can also be considered for pregnant women after 32 weeks of gestation during each pregnancy. Please consult your doctor for more details.
FREQUENTLY ASKED QUESTIONS (FAQs)
1. Why is MOH introducing a national adult immunisation schedule?
The Ministry of Health (MOH) has established the National Adult Immunisation Schedule (NAIS) to provide guidance on vaccinations that persons aged 18 years and older should adopt to protect themselves against vaccine-preventable diseases.
Certain adult groups are more susceptible or at risk of acquiring vaccine preventable diseases if they have not previously received the vaccination and are in contact with individuals who have the disease. Vaccines recommended under the NAIS prevent the risk of disease infections among susceptible individuals and reduces complications, morbidity and mortality. Individuals should discuss their vaccination needs with their doctor to assess their suitability to receive the recommended adult vaccines.
2. What are the types of vaccines included in the National Adult Immunisation Schedule (NAIS)?
Seven types of vaccines that protect against 11 diseases are included in the National Adult Immunisation Schedule (NAIS). These vaccines are:
(i) Influenza;
(ii) Pneumococcal (PCV13/PPSV23);
(iii) Human papillomavirus (HPV2/HPV4);
(iv) Tetanus, diphtheria and pertussis (Tdap);
(v) Measles, mumps and rubella (MMR);
(vi) Hepatitis B; and
(vii) Varicella.
The vaccines are recommended for different target groups based on the individual’s and their family’s susceptibility to the diseases. Individuals should seek advice from their family doctor on the vaccines which are recommended for them.
3. Are there any mandatory vaccinations under the NAIS?
Vaccinations recommended under the NAIS are not mandatory. The recommended vaccines are meant for personal protection and the protection of at-risk family members. Individuals are advised to seek advice from their family doctor on the vaccines which are recommended for them.
4. How often should I be vaccinated? Some of the recommended vaccines under the NAIS are similar to that of the National Childhood Immunisation Schedule (NCIS). Is there a need for adults to go for these vaccines when they would have been vaccinated against it during their childhood?
Vaccines under the NAIS are recommended for adults to protect their health and well-being. Some vaccines such as MMR and hepatitis B are recommended for adults who have not been previously vaccinated during their childhood. Other vaccines are recommended for specific groups, such as pneumococcal vaccines for persons with pre-existing medical conditions; and the tetanus, diphtheria, and pertussis (Tdap) for pregnant women.
5. Where can Singaporeans go to get the vaccines recommended under the NAIS? How can I check if the recommended vaccine is available at the GP clinic/ polyclinic/ hospital?
The recommended vaccines are generally available at GP clinics and polyclinics. Individuals should discuss their vaccination needs and check with their doctor on the availability of the vaccine(s).
6. Who should not be vaccinated? Why/why not?
Vaccines are generally safe for use in the majority of the population. However, persons who have had severe allergic reaction after a previous vaccination or allergies to specific vaccine components should not receive the vaccine, and those who are severely immunocompromised or are pregnant should not receive live vaccines such as MMR or varicella vaccines. Individuals should consult their doctor who will advise if they are suitable to receive a specific vaccine.
7. Are we allowed to use Medisave for vaccinations under the NAIS? When will Medisave be implemented?
Medisave use will be allowed for recommended vaccinations for the relevant target population groups under the NAIS, at all public healthcare institutions, Medisave-accredited GPs, and private hospitals with effect from 1 November 2017. Singaporeans will be able to use up to $400 of their Medisave per account, under the Medisave400 scheme.
Patients should check with their healthcare provider before their vaccination if they wish to use Medisave.
8. How much do the various vaccines recommended under NAIS cost before subsidy? How much do they cost after Medisave deduction? Are the costs standardised across public healthcare institutions?
There may be some pricing differences between the various institutions, and as such patients are advised to approach their healthcare providers if they wish to enquire about their prices of the various vaccines under NAIS. The vaccines under NAIS are not subsidised. Nevertheless, Medisave use under the Medisave400 scheme is allowed for recommended vaccinations for the respective target population groups under the NAIS.
9. Will there be financial assistance for needy patients?
Patients who need the vaccines but are unable to pay for it can approach medical social workers at polyclinics and public healthcare institutions to explore financial assistance.