Why vaccinations are vital

The Straits Times (4 June 2015) - A 65-year-old housewife with hypertension and asthma came to Tan Tock Seng Hospital (TTSH) with fever and a headache, and was vomiting.

The doctor at the emergency department found her in a confused state with a stiff neck and heard from her family that this had occurred over one day.

Tests confirmed that she had meningitis due to streptococcus pneumoniae, a bacterial infection. She required a prolonged hospital stay and developed long-term neurological complications.


Yet, she should have received pneumococcal and influenza vaccinations because of her known heart and lung disease, as well as her age.

She and her family were aware of this but viewed vaccination as an additional expense and potentially harmful, and did not know how severe an infection could be.

Preventing infections by vaccination is critical and globally recommended in the elderly, defined as people aged 65 and older.

It is well known that one’s immune defence system declines with age, in particular the weakening of cells that play a crucial role in guarding the airway against infections, such as streptococcus pneumoniae and influenza.

Indeed, such is the poor response of the elderly to infections (compared with younger people) that pneumonia is cited as the second most common cause of death in Singapore. It also falls within the top five causes of death in the elderly in similarly developed nations.


Singaporeans are living longer, so it is essential for us to keep up with vaccinations against bacterial pneumonia and influenza.

People with an increased risk of complications benefit further from vaccination.

Chronic health problems, such as lung, heart and kidney diseases, diabetes mellitus, human immunodeficiency virus and cancer can weaken immune defences.

So can lifestyle factors, such as cigarette smoking and high alcohol intake.

These factors raise the risk of infection in already vulnerable older patients and, indeed, in people of any age.

Getting the pneumococcal vaccine can protect us from the most common bacterial cause of pneumonia in the community.

Many of us carry the bacterium streptococcus pneumoniae in our noses and can, therefore, spread this to each other via secretions from our noses and mouths, even without showing symptoms .

An infection can result in pus formation in major organs, usually in the chest (pneumonia), rarely in the covering of the brain (meningitis), and also in the blood.

By then, even patients who receive prompt diagnosis and treatment face antibiotic-resistant strains of the bacteria, which make treatment increasingly difficult.

Elderly people should get both the Prevnar 13 and Pneumovax 23 vaccines. The former is given first, followed by Pneumovax 23 vaccine a year later.

If one received the Pneumovax 23 vaccine first, then the Prevnar 13 immunisation should be given a year later or at least eight weeks later.

A second dose of Pneumovax 23 at the five-year mark may be given if the first dose was administered when the person was under 65.

Meanwhile, the influenza vaccine can protect us from the most common viral cause of pneumonia in the community.

People with influenza can have a spectrum of infections, ranging from the common cold, bronchitis, sinus infection, ear infection and the potentially fatal pneumonia.

The vaccine contains inactivated virus and is updated annually to incorporate circulating strains, which explains the yearly dosage schedule.


Overall, vaccine risk is minimal. However, there are instances when vaccination should not be given and medical advice should be sought, such as if you feel unwell on the day of vaccination or are having specific allergic reactions.

Elderly people should not receive Prevnar 13 if there has been a severe allergy to a previous dose, an early pneumococcal vaccine (PCV7) or any vaccine containing diphtheria toxoid.

On the other hand, Pneumovax 23 should not be given if there has been a severe allergy to a previous dose.

Influenza vaccine should not be given if there has been allergy to a past influenza vaccine, gelatin, or eggs; or if the person has a history of a neurological illness called the Guillain-Barre syndrome.

Adverse effects during vaccination are rare. Importantly, they are mild and temporary. Examples are pain, redness and swelling at the injection site, as well as headache, muscle ache and fever.


Improving the rate of vaccination is your responsibility.

Studies have shown that the elderly do not receive vaccinations because of a lack of awareness and misinformation.

At the heart of this, it is clear that if the elderly person has a stable, trusting relationship with a healthcare provider and an informed and supportive family, they are more likely to get their vaccinations.

In a recent local study of patients hospitalised with pneumonia, it was noted that three in every four hospitalisations could have been prevented if the patients had been vaccinated.

That is why local health institutions have started vaccination programmes in recent years.

TTSH was the first hospital in Asia to adopt a pre-discharge vaccination programme for all its patients in 2010, which has seen increased vaccination uptake rates.

Having observed the burden that vaccine-preventable infections can place on patients and their families, I hope that more people will keep themselves and their loved ones safe by getting the appropriate vaccinations.

This is especially so during the June school holidays when more families travel, as this puts the elderly at a higher risk of picking up an infection.

Dr Pathak Smriti is an associate consultant with the Travellers’ Health and Vaccination Clinic at Tan Tock Seng Hospital. 

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Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.