INVASIVE PNEUMOCOCCAL DISEASE IN CHILDREN

INVASIVE PNEUMOCOCCAL DISEASE IN CHILDREN: 17.

Dr Lam Pin Min asked the Minister for Health (a) if he will provide the incidences, mortality rates and morbidity rates of invasive pneumococcal disease in children over the past five years; and (b) what factors will bring about the introduction of pneumococcal vaccination in the National Childhood Immunisation Programme.

The Minister of State for Health (Mr Heng Chee How) (for the Minister for Health): Mr Speaker, Sir, as invasive pneumococcal disease (IPD) is not a notifiable disease, we do not have the information on its incidence rate in

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Singapore. But we do have the hospitalisation data, and that has been on a downward trend. Between 2004 and 2006, the hospitalisation rate for IPD has declined by almost a third. Last year, there were 55 cases of hospitalisation of children aged five years and below due to IPD.

IPD is not a major cause of morbidity in Singapore. As a comparison, there were some 20,000 cases of hospitalisation of children below the age of five each year.

In terms of mortality, there were three deaths from IPD in the past five years. That translates to a mortality rate of less than one per 100,000. Over the same period, there were about 700 deaths among children in this age-group.

Our IPD hospitalisation rate of 26 per 100,000 for children under five years of age recorded in 2006 is significantly lower than the US' rate of 97 per 100,000 which was recorded in 1998/1999, before the US included pneumococcal vaccination into its childhood immunisation programme. The US has since brought down its rate to 24 per 100,000 in 2003, which is comparable to our rate. So they are 24 per 100,000 and we are 26 per 100,000. The US experience shows that universal pneumococcal vaccination does not eradicate IPD.

Nonetheless, as the vaccine is safe and effective, vaccination is a viable option. However, for mass vaccination, its high cost is a major constraint. Currently, there is one manufacturer, and it costs up to $480 to vaccinate one child. Compare this to the existing childhood vaccination programme where the most expensive vaccination, ie, for diphtheria, tetanus and whooping cough, which are the major causes of childhood morbidity and mortality in the past, together cost $40 per child.

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So we will continue to monitor the cost-effectiveness and, if and when more competitively priced vaccines become available and significantly alter the cost-benefit ratio of pneumococcal vaccination, we will consider its inclusion in the childhood immunisation programme.

Dr Lam Pin Min: I would like to thank the MOS for the comprehensive answer. I think besides mortality, pneumococcal infection can also result in permanent morbidities, such as brain damage and permanent deafness. I was just wondering whether the cost of immunisation outweighs the cost to the society in cases where they develop brain damage and deafness in the long term.

Mr Heng Chee How: Mr Speaker, Sir, first of all, I would like to clarify that even though the vaccine is not included in the immunisation programme, it is available. So it is an option that parents who want to immunise their child can do so. But when you talk about mass immunisation, that is, without exception, every child that is born here, then we would have got to look at the cost-effectiveness of things and weigh it against how many people are likely to contract such a disease, and looking at the hospitalisation data to see whether or not that is the best course of trying to prevent some of the complications that Dr Lam mentioned. Certainly, in terms of the treatment of the cases that have surfaced, there would be every attention paid to it. We will continue to monitor the cost-effectiveness of it. We do not exclude this as a possibility but it is to look for a time where if the cost comes down to a level that can justify its inclusion, then we can consider it.