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The Ultimate Guide to Flu aka Influenza Vaccination in Singapore (2020)

in:General Healthpublished:27 Oct 2020, last updated:26 Nov 2020

Should I get vaccinated against the flu bug?

YES! Flu vaccination, also known as influenza vaccination is recommended yearly or every flu season. It is strongly recommended for vulnerable groups of our population under Singapore's Ministry of Health's ( MOH) National Adult Immunisation Schedule. This article will share with you why should we do the flu vaccination, the latest subsidy available for flu vaccination in Singapore and cost of influenza vaccination for different groups of Singaporeans!

What do you need to know about Influenza and the flu vaccine?

Influenza also known as the flu virus is spread by human to human via droplets when people with flu sneeze, cough or talk. These droplets can enter our respiratory tract and is highly contagious. It is also possible for a person to contract flu by touching surfaces or objects that are contaminated with the flu virus. 

There are 3 major types of influenza - Type A, B and C. Influenza Type A and B are usually responsible for epidemics while type C infections are usually mild. Type A viruses are further divided into subtypes based on their surface antigens named hemagglutinin ( H) and neuraminidase ( N). There are multiple H and N subtypes. 

The influenza virus constantly mutate and change, hence the flu vaccine injected in previous years are ineffective. Therefore there is a need to vaccinate against influenza regularly - yearly or every flu season.

The flu vaccine is only effective against the strains of the virus contained in the vaccine and only becomes effective after 2 weeks of being vaccinated as it takes time for the body to produce antibodies against the virus.


Are there different types of flu vaccines?

Yes, there are different brands of flu vaccines available and in fact the latest Northern Hemisphere 2020/2021 Flu Vaccination is now available! Here's a list of the different type of vaccines:

  • Vaxigrip Tetra
  • Influvac Tetra
  • Influvac
  • Fluarix Tetra

Northern vs Southern

Northern Hemisphere vaccines are produced usually in September/October of the year to prevent the flu from spreading during winter in the Northern Hemisphere.

In contrast, Southern Hemisphere vaccines are usually produced around  March, in preparation of winter in the Southern Hemisphere.


4 strains vs 3 strains

Influenza vaccine manufacturers will include the prevailing influenza virus strains in their latest flu vaccines. Quadrivalent influenza vaccine protects the patient against 4 influenza viruses while Trivalent influenza vaccine protects the patient against 3 influenza viruses.

Safety of vaccines

It is important to inform your doctor if you have previous drug allergy, egg allergy or previous allergic reaction to influenza vaccinations.


Influenza vaccination is generally safe for patients above 6 months of age. eg Fluarix Tetra. However some influenza vaccines are only approved for use for children above 3 years of age eg Influvac Tetra.


On 25th October 2020, Ministry of Health Singapore informed all healthcare institution to temporary cease the use of SKYcellflu Quadrivalent and Vaxigrip Tetra as a precautionary measure following reported deaths after influenza vaccination in South Korea. 

Latest Update: On 31st October 2020, Ministry of Health Singapore has allowed the resumption of Vaxigrip Tetra and Skycellflu Quadrivalent as they have been assessed to be safe.


What are the signs and symptoms of the flu virus?

Many commonly misunderstood other respiratory infections caused by other viruses as flu. It is important to differentiate a common cold from flu, which refers specifically to influenza. Cold usually develop slowly while flu tends to come on suddenly.  Flu (Influenza)  infection usually lead to higher fever, more fatigue and bodyaches than other respiratory viruses. Being infected with influenza can lead to hospitalization and is possibly life threatening.

  • Fever
  • Cough
  • Sorethroat
  • Runny nose
  • Headache
  • Bodyache
  • Fatigue
  • Breathlessness
  • Vomiting and Diarrhoea


How can I differentiate between Influenza vs COVID-19 Virus?

Based on symptoms, it is hard to differentiate. That is why Ministry of Health Singapore recommends COVID-19 Swab test to be performed on all patients above 13 years of age who first present to doctors with respiratory tract infection.


Hence, it is important to help reduce the background noise for doctors to diagnose and manage COVID-19 by taking the flu vaccination.


Unlike the high publicity of COVID-19 swabs, there are actually influenza swabs that can be performed on patient to confirm influenza infection too.


How contagious is flu virus as compared to COVID-19?

Reproductive number – refers to the number of secondary infections generated from one infected individual. The number is about 1.2 to 1.6 for Influenza  and higher for other viruses such as COVID-19 and MERS as shown in the charts below.

Source: Business Insider


How lethal is flu virus as compared to COVID-19?

Influenza mortality is 0.02% meaning for every 10,000 patients infected with influenza H1N1 virus, 2 will die as compared to 220 patients dying from COVID-19 for every 10,000 patients infected with COVID-19.

Fatality rate of major virus outbreaks worldwide in the last 50 years

Source: https://www.statista.com/statistics/1095129/worldwide-fatality-rate-of-major-virus-outbreaks-in-the-last-50-years/


Should I get vaccinated against influenza?

Apart from wearing your mask and washing your hands regularly, you can prevent contracting the influenza virus by getting your annual/ seasonal flu vaccination.

Even though influenza is less contagious and lethal than other viruses such as COVID-19, it is preventable and flu vaccines are readily available!

Flu vaccination is recommended for all above the age of 6 months of age, especially those in the high risk group ( To be discussed in the next paragraph)

However there are some  groups of patients who should NOT be getting the flu shot. These are children younger than 6 months of age and people who developed severe and life-threatening allergies to flu vaccines or any ingredients in the vaccine which might include gelatin, antibiotics etc). Therefore Kindly inform your doctor about your food and drug allergies before commencing your vaccination.


Who should be vaccinated against the flu virus?

According to Singapore Ministry of Health  National Immunisation Schedule, the following groups of patients are recommended  to undergo flu vaccination yearly or every season.

  • All children between 6 months of age to 59 months of age ( less than 5 years old)
  • All adults above 65 years old.
  • All pregnant ladies in any trimester.
  • Patients between 5 to 64 years old with long term medical conditions such as Asthma, Chronic Obstructive Pulmonary Disease, Diabetes Mellitus, Chronic Kidney Disease , Chronic neurological conditions - Dementia, Epilepsy, Parkinson's Disease, Stroke


Why is influenza vaccination extremely important during the COVID-19 Pandemic?

Symptoms of influenza and COVID-19 are similar and not easy to differentiate. Hence it is important to reduce the influenza viruses circulating in the community, facilitating diagnosis and management of COVID-19. It also helps to reduce the strain on our healthcare facilities as fewer patients will need to be hospitalized due to influenza infection. 


How much is the cost of flu vaccination?

Cost vary according to manufacturers, type of flu vaccines ( trivalent vs quadrivalent) and individual clinic pricing. 

A typical flu vaccination in Singapore costs around S$35 to S$50. before GST. 

However good news for Singaporean Citizens. From 1st November 2020, the Singapore Government is subsiding flu vaccinations for only Singaporean Citizens in the high risk groups mentioned above. ( Under Who should be vaccinated against the flu virus)


How much subsidy is available for flu vaccination?

Here are some of the updated subsidies available at the point of writing .

Maximum out of pocket at the clinic for flu vaccine if you belong to the above high risk group of patients (Under Who should be vaccinated against the flu virus):

  • Singaporean Child (6 months to  <5 years old):  $0
  • Pioneer Generation: $9
  • Merdeka Generation/ CHAS Blue/ CHAS Orange card holders: $18
  • CHAS Green/ Non- CHAS Singaporeans: $35



You may wish to the full list of vaccinations recommended under the National Childhood Immunisation Schedule and National Adult Immunisation Schedule.  Kindly note that maximum out of pocket amount varies according to type of vaccination and types of cardholders ( PG/ Merdeka/ CHAS).


Where to go for your flu vaccination?

Flu vaccinations are widely available across Singapore at CHAS GP clinics. The latest 2020/2021 Northern Hemisphere Quadrivalent Flu vaccines are available at My Family Clinic (Angsana Breeze @ Yishun)*. We are a CHAS- accredited GP clinic and government subsidies are available at our clinic.

Click here to find other clinics close to you that provides subsidy for your flu vaccination too.

If your clinic offers flu vaccination, kindly email us at [email protected] to have your clinic included in our list


*Author Dr Tan Yan Yuan is a resident doctor at My Family Clinic( Angsana Breeze @ Yishun) located at 507 Yishun Ave 4 #01-05.





Author's Profile
FAMILY MEDICINE
Biography

Dr Tan Yan Yuan is a Family Physician and Designated Workplace Doctor accredited by Ministry of Health Singapore. He graduated with a Bachelor of Medicine and Bachelor of Surgery from the National University of Singapore (NUS). After graduation, he acquired a broad-based training in Primary Care, Emergency Medicine, Dermatology, Oncology, Occupational Health as well as Aesthetics. He has worked in leading tertiary medical institutions such as Singapore General Hospital, National Cancer Centre Singapore and National Skin Centre as well as leading private aesthetics clinics such as Novu Aesthetics and ClearSK Aesthetics. 

Dr Tan continued his academic pursuit after graduation and obtained his Graduate Diploma in Family Medicine from NUS. He subsequently graduated with a Distinction in Graduate Diploma in Practical Dermatology from Cardiff University, United Kingdom and obtained his Graduate Diploma in Occupational Medicine from NUS. He has a keen eye for aesthetics and is a member of the American Academy of Aesthetic Medicine. 

Dr Tan has a deep desire to leverage on technological advancement to optimise patient care, transcending conventional boundaries in the healthcare landscape. He is a strong advocate of delivering excellent quality, outstanding service and bringing convenience to patients. 

Dr Tan is currently practising Family Medicine at My Family Clinic ( Angsana Breeze @ Yishun) at Blk 507 Yishun Ave 4 #01-05 and Aesthetics at Scinn Medical Centre @ Somerset triple 1 #04-12/13. He is glad to be able to help address questions that patients have online and is happy to meet them in clinic to render medical assistance necessary. 

References
  1. https://www.cdc.gov/flu/season/faq-flu-season-2020-2021.htm
  2. https://www.healthhub.sg/a-z/diseases-and-conditions/103/topics_influenza
  3. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-similarities-and-differences-covid-19-and-influenza
  4. https://www.businessinsider.com/coronavirus-contagious-r-naught-average-patient-spread-2020-3
  5. https://www.statista.com/statistics/1095129/worldwide-fatality-rate-of-major-virus-outbreaks-in-the-last-50-years/
  6. https://www.medicinenet.com/flu_vaccination/article.htm
  7. https://www.moh.gov.sg/resources-statistics/nationally-recommended-vaccines

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