Evaluation on the effectiveness of the national childhood immunisation programme in Singapore, 1982-2007

We undertook a study to evaluate the effectiveness of the National Childhood Immunisation Programme (NCIP) over the past 26 years by reviewing the epidemiological trends of the diseases protected, the immunisation coverage and the changing herd immunity of the population during the period of 1982 to 2007.

The epidemiological data of all cases of diphtheria, pertussis, poliomyelitis, measles, mumps, rubella and acute hepatitis B notified to the Communicable Diseases Division, Ministry of Health (MOH) from 1982 to 2007 were collated and analysed. Data on tuberculosis (TB) cases were obtained from the TB Control Unit, Tan Tock Seng Hospital. Cases of neonatal tetanus and congenital rubella syndrome (CRS) among infants born in Singapore were identified from the Central Claims Processing System. The number of therapeutic abortions performed for rubella infections was retrieved from the national abortion registry. Coverage of the childhood immunisation programme was based on the immunisation data maintained by the National Immunisation Registry, Health Promotion Board. To assess the herd immunity of the population against the various vaccine-preventable diseases protected, the findings of several serological surveys conducted from 1982 to 2005 were reviewed.

The incidence of vaccine-preventable diseases covered under the NCIP had declined over the last 26 years with diphtheria, neonatal tetanus, poliomyelitis and congenital rubella virtually eliminated. The last case of childhood TB meningitis and the last case of acute hepatitis B in children below 15 years were reported in 2002 and 1996, respectively.

The NCIP has been successfully implemented as evidenced by the disappearance of most childhood diseases, excellent immunisation coverage rate in infants, preschool and school children, and high level of herd immunity of the childhood population protected.