Another big group of patients are business travellers.
A well-paying job in Singapore these days involves a lot
of travelling in the region as companies expand overseas.
I encourage business travellers to get the influenza
vaccine annually. Sometimes the whole family shows up
for vaccination prior to a holiday at year end to a winter
destination. This is sadly because they previously had a
whole vacation ruined because they caught the flu bug.
Yet other travellers are encouraged to update their
Hepatitis A and typhoid vaccines. They are both
oralfecal in transmission. Hepatitis A can be quite
debilitating and the natural course may run for up to eight
weeks. Some patients may feel very fatigued for up to six
months thereafter. Typhoid fever can be persistent and
sometimes diagnosis is delayed; ultimately typhoid can
be life threatening.
The vaccines are tolerable and there is an oral and
injectable typhoid vaccine. Some of my patients get a
fever with the typhoid injectable vaccine but it is usually
resolved quickly with paracetamol. As for Hepatitis A, we
can also test if the patient is protected against the virus
with a simple blood test. About half of those aged 50 and
above have natural immunity.
Some of my travellers ask me about tetanus. Most of us
have been vaccinated against tetanus in childhood, hence
the protection is good enough for a decade till the age of
21 years old. We are actually not worried about stepping
on a rusty nail, but whether a wound is dirty. Animal bites
are probably the worst and if one fell into a filthy drain,
one should get a booster too. A good alternative to the
tetanus vaccine is the combined tetanus, diphtheria and
pertussis (whooping cough) Tdap vaccine. There is a
resurgence of pertussis which is responsible for 10 per
cent of emergency room patients presenting with cough.
As for animal bites, I caution travellers not to play
with cats, dogs or monkeys when abroad. Singapore is
rabiesfree but the surrounding countries are still endemic
for rabies. When bitten abroad, the rabies vaccines and
antibody shots should be administered immediately and
are both costly and involve multiple injections.
Sometimes, patients ask me about Japanese B
encephalitis. This is a disease with high fatality but you
need a mosquito to bite an infected pig and then transmit it
to man. Since we have phased out pig farms in Singapore,
it is very rare. We would recommend vaccination if one
is travelling to certain endemic countries, and staying for
more than a month in a rural setting.
In our local context, there is always the threat of dengue
despite our world class mosquito control programme. In
dengue infections, we are very concerned if there is a
huge viral load coupled with an overwhelming response
from the immune system of the patient. This often leads
to severe dengue or dengue shock.
The current thinking is that we should vaccinate
patients who had dengue previously. The data shows that
if we vaccinate dengue-naïve patients; the body becomes
primed for severe dengue illness when the infection does
occur.
In my older patients, I am often asked about
pneumonia vaccines and shingles vaccine. The
pneumonia vaccines are very useful. There are two
available: one covers 13 strains (conjugate PCV13) and
the other covers 23 strains (polysaccharide PPV23) of
GlobalHealthAndTravel.com
A 3d illustration of rabies
the bacteria that causes pneumonia. We recommend
that all above the age of 65 years be vaccinated with
both vaccines. We usually advise that the patient be
vaccinated with the conjugate vaccine first followed by
the other vaccine a year later. This is to avoid the two
vaccines affecting each other’s efficacy. Incidentally the
conjugate vaccine is given to children under our national
immunisation schedule.
Finally, we have shingles, which is a painful ordeal for
patients. Some patients have it on their face and suffer a
great deal. There is always the risk of post-shingles pain
(post-herpetic neuralgia) that can go on for years. The
pain has been known to drive patients to suicide. The
current single dose vaccine is available to those 50 years
and older. A newer two-dose shingles vaccine offers very
high efficacy but it is not available yet.
A final word about the naysayers of vaccines; this
is also known as vaccine hesitancy. There are many
complex reasons for vaccine hesitancy; and social media
and Dr Google have not been helpful. There are also the
controversies such as Hepatitis B vaccine and multiple
sclerosis in France in the 90s and the association of the
MMR (measles, mumps and rubella) vaccine and autism.
These have been found to be false but the damage has
been done.
There has been a drop in the coverage of the MMR
vaccine in the US and UK with a rise in measles cases
worldwide. There is an ongoing measles outbreak in the
US originating in the orthodox Jewish communities in
New York since October last year. The city has passed
a law that prohibits exemptions from vaccines on non-
medical grounds. This law will affect 26,000 school-going
children in New York.
Thankfully in Singapore, vaccine hesitancy has not
been a big issue as our population believes that vaccines
are safe, effective and necessary.
Protect yourself and
your family. Contact
us at 8181 8671 or
9237 2747.
Visit us at
Singapore Medical
Specialist Centre
290 Orchard Road,
Paragon Tower 2,
Lift Lobby C, #09 –
23 to 27, Singapore
238859
MAY 2020
51