The Implementation and Impact of a Revised National Childhood Immunization Schedule in an Urban Asian Community
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Sites and Population
2.2. Vaccination Schedule
2.3. Data Extraction, Processing and Audit
2.4. Outcomes Definitions
2.5. Statistical Analysis
3. Results
4. Discussion
Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Gaudelus, J.; Denis, F.; Cohen, R.; Stahl, J.P.; Pujol, P.; Gauthier, E.; Martinot, A. Is the simplification of the immunization schedule applied? Review 2 years after its implementation. Arch. Pédiatrie 2016, 23, 1012–1017. [Google Scholar] [CrossRef] [PubMed]
- Ong, E.C. Vaccinating a Nation. BiblioAsia, 2021. Available online: https://biblioasia.nlb.gov.sg/vol-17/issue-2/jul-sep-2021/vaccinating-nation (accessed on 17 July 2022).
- Ministry of Health, Singapore. Childhood Immunisation. 2016. Available online: https://www.moh.gov.sg/docs/librariesprovider5/resources-statistics/reports/childhood-immunisation.pdf (accessed on 17 July 2022).
- Soh, A.; Sharma, A.; Muscatello, D.J. Impact of seasonal influenza on polyclinic attendances for upper respiratory tract infections in Singapore. West. Pac. Surveill. Response J. WPSAR 2020, 11, 27–36. [Google Scholar] [CrossRef] [PubMed]
- Chong, C.Y.; Yung, C.F.; Gan, C.; Thio, S.T.; Tan, N.W.H.; Tee, N.W.S.; Lin, C.; Lin, R.T.P.; Thoon, K.C. The burden and clinical manifestation of hospitalized influenza among different pediatric age-groups in the tropics. Influenza Other Respir. Viruses 2020, 14, 46–54. [Google Scholar] [CrossRef] [PubMed]
- Fatha, N.; Ang, L.W.; Goh, K.T. Changing seroprevalence of varicella zoster virus infection in a tropical city state, Singapore. Int. J. Infect. Dis. 2014, 22, 73–77. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Zucker, J.R.; Rosen, J.B.; Iwamoto, M.; Arciuolo, R.J.; Langdon-Embry, M.; Vora, N.M.; Rakeman, J.L.; Isaac, B.M.; Jean, A.; Asfaw, M.; et al. Consequences of Undervaccination-Measles Outbreak, New York City, 2018–2019. N. Engl. J. Med. 2020, 382, 1009–1017. [Google Scholar] [CrossRef] [PubMed]
- Ministry of Health, Medisave. 2022. Available online: https://www.moh.gov.sg/cost-financing/healthcare-schemes-subsidies/medisave (accessed on 17 July 2022).
- Ministry of Health, Singapore. Subsidised Vaccine List. 2021. Available online: https://www.moh.gov.sg/resources-statistics/subsidised-vaccine-list (accessed on 17 July 2022).
- Healthhub. National Childhood Immunisation Schedule, Singapore. Available online: https://www.healthhub.sg/live-healthy/1633/all-you-need-to-know-about-vaccinations (accessed on 17 July 2022).
- Kalies, H.; Grote, V.; Verstraeten, T.; Hessel, L.; Schmitt, H.J.; von Kries, R. The Use of Combination Vaccines Has Improved Timeliness of Vaccination in Children. Pediatric Infect. Dis. J. 2006, 25, 507–512. [Google Scholar] [CrossRef] [PubMed]
- Davis, R.L.; Lieu, T.A.; Mell, L.K.; Capra, A.M.; Zavitkovsky, A.; Quesenberry, C.P., Jr.; Black, S.B.; Shinefield, H.R.; Thompson, R.S.; Rodewald, L.E. Impact of the Change in Polio Vaccination Schedule on Immunization Coverage Rates: A Study in Two Large Health Maintenance Organizations. Pediatrics 2001, 107, 671–676. [Google Scholar] [CrossRef] [PubMed]
- Bianco, A.; Mascaro, V.; Zucco, R.; Pavia, M. Parent Perspectives on Childhood Vaccination: How to Deal with Vaccine Hesitancy and Refusal? Vaccine 2019, 37, 984–990. [Google Scholar] [CrossRef] [PubMed]
- Alfonso, V.H.; Bratcher, A.; Ashbaugh, H.; Doshi, R.; Gadoth, A.; Hoff, N.; Mukadi, P.; Ghanem, A.; Cheng, A.; Gerber, S.; et al. Changes in Childhood Vaccination Coverage over Time in the Democratic Republic of the Congo. PLoS ONE 2019, 14, e0217426. [Google Scholar] [CrossRef] [PubMed]
- Ministry of Health, Singapore. Updates to NCIS. 2020. Available online: https://www.cfps.org.sg/assets/1-Circular-for-GPs/4-MOH-Cir-No-180-2020-13Jul20-Updates-to-NCIS-doctors-1.pdf (accessed on 17 July 2022).
- Forster, A.S.; Rockliffe, L.; Chorley, A.J.; Marlow, L.A.; Bedford, H.; Smith, S.G.; Waller, J. Ethnicity-specific factors influencing childhood immunisation decisions among Black and Asian Minority Ethnic groups in the UK: A systematic review of qualitative research. J. Epidemiol. Community Health 2017, 71, 544–549. [Google Scholar] [CrossRef] [PubMed]
- Anandappa, M.; Boakye, E.A.; Li, W.; Zeng, W.; Rebmann, T.; Chang, J.J. Racial disparities in vaccination for seasonal influenza in early childhood. Public Health 2018, 158, 1–8. [Google Scholar] [CrossRef]
- Department of Statistics, Singapore. 2020. Available online: https://www.singstat.gov.sg/-/media/files/publications/cop2020/sr1/findings.pdf (accessed on 17 July 2022).
- Zhong, Y.; Clapham, H.E.; Aishworiya, R.; Chua, Y.X.; Mathews, J.; Ong, M.; Wang, J.; Murugasu, B.; Chiang, W.C.; Lee, B.W.; et al. Childhood Vaccinations: Hidden Impact of COVID-19 on Children in Singapore. Vaccine 2021, 39, 780–785. [Google Scholar] [CrossRef] [PubMed]
- Parsons, S.; Maddock, J.; Di Gessa, G.; Green, M.J.; Thompson, E.J.; Stevenson, A.J.; Kwong, A.S.F.; McElroy, E.; Silverwood, R.J.; Katikireddi, S.V. Health Care Disruption Inequalities during COVID-19: Evidence from Eleven Longitudinal Studies. Eur. J. Public Health 2021, 31 (Suppl. 3), ckab164.118. [Google Scholar] [CrossRef]
- Ministry of Health, Singapore. Reminder to All Healthcare Institutions and Healthcare Workers on Safe Distancing Measures. 2020. Available online: https://www.ams.edu.sg/view-pdf.aspx?file=media%5C5506_fi_413.pdf&ofile=SAFE-DISTANCING-MEASURES-%26-DEFERMENT-OF-NONESSENTIAL-SERVICES_MOH-110-2020_1.pdf (accessed on 17 July 2022).
- Department of Statistics, Singapore. Birth and Fertility. Available online: https://www.singstat.gov.sg/find-data/search-by-theme/population/births-and-fertility/latest-data (accessed on 17 July 2022).
- Cadeddu, C.; Castagna, C.; Sapienza, M.; Lanza, T.E.; Messina, R.; Chiavarini, M.; Ricciardi, W.; de Waure, C. Understanding the determinants of vaccine hesitancy and vaccine confidence among adolescents: A systematic review. Hum. Vaccines Immunother. 2021, 17, 4470–4486. [Google Scholar] [CrossRef] [PubMed]
- Varela, F.H.; Pinto, L.A.; Scotta, M.C. Global Impact of Varicella Vaccination Programs. Hum. Vaccines Immunother. 2019, 15, 645–657. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ministry of Health, Singapore. Tighter Measures to Minimise Further Spread of COVID-19. 2020. Available online: https://www.moh.gov.sg/news-highlights/details/tighter-measures-to-minimise-further-spread-of-covid-19 (accessed on 17 July 2022).
- Abebe, W.; Worku, A.; Moges, T.; Tekle, N.; Amogne, W.; Haile, T.; Mekonen, D.; Habtamu, A.; Deressa, W. Trends of Follow-up Clinic Visits and Admissions Three-Months before and during COVID-19 Pandemic at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: An Interrupted Time Series Analysis. BMC Health Serv. Res. 2021, 21, 731. [Google Scholar] [CrossRef] [PubMed]
- Ministry of Health, Singapore. Enhanced Subsidies for Nationally Recommended Vaccination and Childhood Developmental Screening. 2020. Available online: https://www.moh.gov.sg/news-highlights/details/enhanced-subsidies-for-nationally-recommended-vaccinations-and-childhood-developmental-screening (accessed on 17 July 2022).
- Health Promotion Board, Singapore. National Immunisation Registry. Available online: https://www.nir.hpb.gov.sg/ (accessed on 17 July 2022).
- Healthhub, Singapore. Children’s Health E-Services. 2020. Available online: https://www.healthhub.sg/programmes/125/children-health-ehb (accessed on 17 July 2022).
Old National Childhood Immunization Schedule | New National Childhood Immunization Schedule | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Month | HepB | 5-in-1 1 | PCV13 | MMR | Month | 6-in-1 2 | 5-in-1 1 | PCV13 | MMR | Varicella | Influenza |
1st | D1 | ||||||||||
2nd | D1 | ||||||||||
3rd | D1 | D1 | |||||||||
4th | D2 | 4th | D1 | D1 | |||||||
5th | D3 | D2 | |||||||||
6th | D2 | 6th | D2 | D2 | D1 | ||||||
12th | D1 | 12th | D1 | D1 |
NCIS | Total, n (%) | Old, n (%) | New, n (%) | p-Value |
---|---|---|---|---|
21,213 | 10,915 | 10,298 | ||
Age Group in Months | 0.338 | |||
1–5 | 6789 (32) | 3525 (32.3) | 3264 (31.7) | |
6–11 | 10,519 (49.6) | 5359 (49.1) | 5160 (50.1) | |
12–13 | 3905 (18.4) | 2031 (18.6) | 1874 (18.2) | |
Gender | 0.412 | |||
Female | 10,359 (48.8) | 5360 (49.1) | 4999 (48.5) | |
Male | 10,854 (51.2) | 5555 (50.9) | 5299 (51.5) | |
Race | <0.001 | |||
Chinese | 12,871 (60.7) | 6733 (61.7) | 6138 (59.6) | |
Malay | 5390 (25.4) | 2780 (25.5) | 2610 (25.3) | |
Indian | 1694 (8.0) | 808 (7.4) | 886 (8.6) | |
Others | 1258 (5.9) | 594 (5.4) | 664 (6.4) | |
6-Month Vaccination * | <0.001 | |||
Did not adhere to schedule | 4155 (28.8) | 2517 (34.1) | 1638 (23.3) | |
Adherence to schedule | 10,269 (71.2) | 4873 (65.9) | 5396 (76.7) | |
Less than 6 months | 6789 | 3525 | 3264 | |
12-Month Vaccination * | 0.179 | |||
Did not adhere to schedule | 1564 (40.1) | 834 (41.1) | 730 (39.0) | |
Adherence to schedule | 2341 (59.9) | 1197 (58.9) | 1144 (61.0) | |
Less than 12 months | 17308 | 8884 | 8424 |
Demographics of Children Who Fulfilled 12-Month Vaccination | Demographics of Children Who Did Not Fulfill 12-Month Vaccination Despite Eligibility (12 Months Old) | |||||||
---|---|---|---|---|---|---|---|---|
Total, n (%) | Old, n (%) | New, n (%) | p-Value | Total, n (%) | Old, n (%) | New, n (%) | p-Value | |
n | 2341 | 1197 (51.1) | 1144 (48.9) | 1564 | 834 (53.3) | 730 (46.7) | ||
Gender | 0.511 | 0.735 | ||||||
Female | 1197 (51.1) | 620 (51.8) | 577 (50.4) | 762 (48.7) | 403 (48.3) | 359 (49.2) | ||
Male | 1144 (48.9) | 577 (48.2) | 567 (49.6) | 802 (51.3) | 431 (51.7) | 371 (50.8) | ||
Race | 0.145 | 0.003 | ||||||
Chinese | 1554 (66.4) | 806 (67.3) | 748 (65.4) | 883 (56.5) | 450 (54.0) | 433 (59.3) | ||
Malay | 562 (24.0) | 281 (23.5) | 281 (24.6) | 166 (10.6) | 247 (29.6) | 161 (22.1) | ||
Indian | 140 (6.0) | 76 (6.3) | 64 (5.6) | 408 (26.1) | 89 (10.7) | 77 (10.5) | ||
Others | 85 (3.6) | 34 (2.8) | 51 (4.5) | 107 (6.8) | 48 (5.8) | 59 (8.1) | ||
Cost to healthcare system mean (SD) | 811.55 (34.20) | 837.81 (25.23) | 784.06 (15.78) | <0.001 | 495.35 (225.18) | 478.54 (242.78) | 514.56 (201.33) | <0.001 |
Cost to parents mean (SD) | 400.19 (29.4) | 0 | 174.50 (143.7) | 0 |
Cost of Vaccination at Private Clinics/Clinic Groups | PCV13 | MMR | 5-in-1 | 6-in-1 | Hepatitis B | Varicella | Influenza |
---|---|---|---|---|---|---|---|
Clinic A | SGD 200.05 | SGD 37.45 | SGD 107 | SGD 128.40 | SGD 55.64 | SGD 89.88 | SGD 48.15 |
Clinic B * | SGD 125–164 | SGD 38 | SGD 91 | SGD 110–113 | SGD 28–65 | SGD 75–90 | SGD 70 |
Clinic C | SGD 125 | - | - | - | SGD 75 | SGD 90 | - |
GP Group Practice D | SGD 150 | - | - | - | - | - | SGD 42.80 |
GP Group Practice E | SGD 166 | - | SGD 86 | SGD 133 | - | - | SGD 80.25 |
Mean | SGD 157.20 | SGD 37.73 | SGD 94.67 | SGD 124.30 | SGD 59.05 | SGD 87.46 | SGD 60.30 |
Cost | Old National Childhood Immunization Schedule | New National Childhood Immunization Schedule | |||||
To healthcare system, mean (SD) | 501.31 (257.34) | 486.22 (236.52) | |||||
To parents, mean (SD) | 194.64 (149.12) | 0 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Tan, N.C.; Tan, Q.; Aau, W.K.; Ng, C.W.M. The Implementation and Impact of a Revised National Childhood Immunization Schedule in an Urban Asian Community. Vaccines 2022, 10, 1148. https://doi.org/10.3390/vaccines10071148
Tan NC, Tan Q, Aau WK, Ng CWM. The Implementation and Impact of a Revised National Childhood Immunization Schedule in an Urban Asian Community. Vaccines. 2022; 10(7):1148. https://doi.org/10.3390/vaccines10071148
Chicago/Turabian StyleTan, Ngiap Chuan, Qifan Tan, Wai Keong Aau, and Chung Wai Mark Ng. 2022. "The Implementation and Impact of a Revised National Childhood Immunization Schedule in an Urban Asian Community" Vaccines 10, no. 7: 1148. https://doi.org/10.3390/vaccines10071148