Adult Vaccination

Recommendation on additional dose of COVID-19 vaccine for medically vulnerable persons who are at higher risk of severe disease due to medical risk factors.

Background

The National Adult Immunisation Schedule (NAIS)¹ provides nationally recommended vaccinations that persons aged 18 years or older should adopt to protect themselves against vaccine-preventable diseases.

This Care Protocol also includes advice on COVID-19 vaccination for high-risk groups, for protection against severe disease.

Clinical Approach

Certain adults are at increased risk of complications or susceptible to vaccine preventable diseases if they have not previously received the vaccination and are in contact with individuals who have the infection. Vaccinations recommended under the NAIS aim to prevent such infections among susceptible individuals and reduce complications, morbidity, and mortality.²

The NAIS was developed based on international best practices and the recommendations of the Expert Committee on Immunisation (ECI). Considerations include:

Local disease burden;
Age, occupation, pre-existing medical conditions, vaccination history;
Vaccine safety, efficacy and cost effectiveness of the vaccines in preventing infections among susceptible individuals and reducing complications, morbidity and mortality.

The NAIS is summarised in Table 1 below.¹

Table 1: National Adult Immunisation Schedule

Vaccine	18-26 years	27-64 years	≥ 65 years
Influenza (INF)	1 dose annually or per season		1 dose annually or per season
Pneumococcal conjugate (PCV13)	1		dose
Pneumococcal polysaccharide (PPSV23)	1 or 2 doses (depending on indication)		1 dose
Tetanus, reduced diphtheria and acellular pertussis (Tdap)	1 dose during each pregnancy
Human papillomavirus (HPV2 or HPV4)	3 doses (Females)
Hepatitis B (HepB)	3 doses
Measles, mumps and rubella (MMR) (live)	2 doses
Varicella (VAR) (live)	2 doses

	Recommended for adults who meet age requirement
	Recommended for adults with specific medical condition or indication
	Recommended for adults who have not been previously vaccinated, or lack evidence of past infection or immunity

COVID-19 Vaccinations

The Expert Committee on Immunisation (ECI) had recommended that all persons aged 60 years and above, medically vulnerable persons and residents of aged care facilities should receive an additional dose of COVID-19 vaccine in 2024, around one year (and not earlier than five months) after last dose received. An additional dose of COVID-19 vaccine is encouraged for all other individuals aged 6 months and above, in particular, healthcare workers, as well as household members/caregivers of medically vulnerable individuals. Refer to MOH Circular No. 12/2024 for more details.

Other Vaccinations

For the use of other vaccinations (e.g. yellow fever for travel to endemic areas, meningococcal for Haj), please refer to the Package Insert (PI), available on the Register of Therapeutic Products (under E-services, Infosearch) on the Health Sciences Authority (HSA) website. The National Immunisation Registry (NIR) only accepts vaccination records for those under the NAIS.

Administering Vaccinations

Healthcare providers should ensure the following during the administration of any vaccine:

The vaccine is being given to the correct patient.
The vaccine is given at the appropriate time, i.e. appropriate age and interval.
The correct vaccine and diluent are given to the patient.
The appropriate dose has been measured.
The vaccine is being administered via the correct route and technique e.g. subcutaneously vs intramuscularly.
The vaccine is administered at the correct site e.g. deltoid vs anterolateral thigh.
The vaccination details should be documented in NIR and the clinic's Electronic Medical Records (EMR) accurately with the type of vaccine, diluent, dose, batch, expiry, date and time administered, route, and consent.

After the administration of vaccines, patients should be observed for any immediate post-vaccination adverse effects. Patients should also be advised to monitor for possible side effects of the vaccine once they have been discharged. Details on NAIS for the public are available at Stay One Step Ahead with Vaccinations.

Data Submission

The following data fields should be documented in GPs' case notes as part of good clinical practice for all patients enrolled to their practice.

Submission of data fields marked with asterisks* are required for the Healthier SG Annual Service Fee payments. These are also required for subsidy claims submitted under the Vaccination and Childhood Development Screening Subsidies (VCDSS).

Singapore Drug Dictionary (SDD) code*^,^
Date*
Due date of next dose
I acknowledge that I have reviewed the results and care delivery provided, that the vaccinations done are clinically indicated as per MOH's prevailing guidelines
Vaccination Exception Condition(s) (if applicable)*
COVID-19 Vaccination Dose Type*
COVID-19 Vaccination Condition(s)*
[COVID-19 Vaccination fields will be implemented in Healthier SG-compatible Clinic Management Systems in November 2024]

^Refers to claim code for MOH Healthcare Claims Portal (MHCP) submission.

All vaccination records for NAIS should be promptly notified (i.e. within 72 hours of vaccination) to the national systems i.e., NIR or National Electronic Health Records (NEHR).

Financing

Fully-Subsidised Vaccinations under Healthier SG

NAIS Vaccinations

For Singapore Citizens (SCs) enrolled in Healthier SG and are medically eligible for NAIS vaccinations, these vaccinations will be fully subsidised at their own enrolled provider. GPs are advised to check the enrollee’s eligibility for the vaccination subsidies using the subsidy eligibility tool for VCDSS in MOH Healthcare Claims Portal.

Healthier SG GPs therefore do not need to collect payments from Singapore Citizens enrolled to their clinics. Instead, Healthier SG GPs should claim for the full remuneration using the same process and to the same bank account as for payments made under the Vaccination and Child Development Screening Scheme (VCDSS).⁴

If the enrollee receives the NAIS vaccination at another provider that they are not enrolled to, prevailing subsidies and co-payment will apply.

COVID-19 Vaccinations

COVID-19 Vaccinations are fully-subsidised under the National Vaccination Programme for all Singaporean Citizens, Permanent Resident, Long-Term Pass Holders and certain Short-Term Pass holders.

Details on the GP Annual Service Fee can be found in the Healthier SG Enrolment Programme Agreement.

References