Nurse-led initiative for seniors and those at risk of the illnesses being piloted at 7 clinics
From 2023, Tan Tock Seng Hospital (TTSH) will progressively roll out a nurse-led initiative to get elderly patients and those at risk of developing influenza or pneumococcal infections to be vaccinated against the two diseases at the specialist outpatient clinic where they are seeking help.
The hospital is currently piloting it at seven clinics, and aims to offer this service at all of its 32 clinics in a few years’ time, said Ms Karen Gomathy Rajoo, TTSH’s deputy director of nursing for specialist outpatient clinics, at a media session on Thursday.
Outside this initiative, patients may get the flu or pneumococcal vaccines if their doctors recommend that they do so, and they have to make their way to another clinic to get the jabs.
Other hospitals may offer a service like TTSH’s in time to come. TTSH nurse clinician Ye Xiuhua said some staff of the upcoming Woodlands Health Campus who are currently stationed at TTSH are undergoing training.
In Singapore, the 2019 National Population Health Survey showed that one in five people aged 60 to 74 reported receiving the flu jab in the previous 12 months, and only one in 10 Singapore residents aged 65 to 74 had ever taken the pneumococcal vaccine.
The rates are low, Associate Professor Angela Chow, the head and senior consultant at TTSH’s Department of Preventive and Population Medicine, told the media. Many people do not bother about flu jabs, said Prof Chow. Some seniors, for example, think that influenza probably does not happen in Singapore.
“So, they take it only when they travel. They also think that they are not susceptible to it,” she added. Others mistake the common cold for influenza.
“It’s not really the common cold viruses that we are concerned about because all of us get the common cold... We might feel a bit unwell, a bit fatigued, but you will get over it,” said Dr Sapna P. Sadarangani, a consultant at the National Centre for Infectious Diseases.
But it is “well recognised” that influenza “can kill people... by causing pneumonia, triggering heart attacks, and even affect the brain and so on”.
And it is the very young, older adults with pre-existing conditions and those with weakened immune systems who are affected, she added. Dr Sapna said a recently published study in the npj Vaccines journal that she, Prof Chow and other experts worked on showed that adults aged 65 and above with metabolic comorbidities, such as diabetes and hypertension, have good immune response to the influenza vaccine if their conditions are well controlled.
Their antibody response to the vaccine was measured one month after vaccination. Furthermore, their level of antibodies against the most common circulating influenza sub-type goes up if they engage in physical activities.
“A lot of people were saying that they have diabetes, so they won’t respond to the vaccine, so why take it? But that’s not true,” said Dr Sapna, the principal investigator and first author of this study.
“If you’re active, if you treat your diabetes and so on... your immune system will respond to vaccines.” Dr Sapna said that only a subset of those who have the “flu” have influenza virus infection, as what many people perceive as flu may be an acute respiratory illness that is caused by other viruses.
Some people have complained about getting the flu after taking the flu vaccine, said Dr Sapna. “But it may be a cold virus,” she said. “The (flu jab) is not a live vaccine, so it cannot give you flu symptoms.
It protects against influenza infection, which has the potential to cause death, and ICU admissions, and not the normal cold,” she said. There is no vaccine for the common cold. Flu jabs are taken annually, while pneumococcal vaccines are taken once.
There are two types of pneumococcal vaccines. One dose of each type can provide those aged 65 and above with lifetime protection.
Dr Sapna and Prof Chow, the senior author of the study, said that the uptrend in flu cases here is expected to continue in the next few weeks, which makes it more important for the elderly and those at risk of severe infection to get the jab.