Virtus Medical Group
HEALTH ASSESSMENT

VACCINATION

Human Papillomavirus
Human papillomavirus (HPV) is a group of more than 100 types of viruses, around 40 of which can infect the genital areas of men and women mainly through sexual contact. It is an important cause of cervical cancer and is also associated with other types of genital cancer. Anyone who is sexually active is at risk of getting HPV.
You can lower your chances of getting HPV by receiving HPV vaccine which protects against infection by certain HPV types. The 2 high risk HPV types (HPV-16 and HPV-18) account for about 70% of cervical cancer and vaccines prevent infection by these 2 high-risk HPV types. Anyone above the age of 9 can receive the vaccine. The vaccine is most effective when completed before the commencement of sexual activity. The vaccine does not treat or cure HPV infection. Pregnant women should not receive the vaccine as there is limited data on the safety of the vaccine in pregnancy. The common side effects are mild, including soreness, redness or swelling around the injection site. The vaccine is given as a series of 2 to 3 injections over a 6-month period. HPV-vaccinated women should still undergo regular cervical cancer screening. They can develop cervical cancer caused by HPV types not included in the vaccine and the vaccine cannot clear the virus in those who are already infected. The cervical screening test effectively picks up the pre-cancerous cell changes which can be treated to prevent cervical cancer. Therefore, the HPV vaccine cannot replace cervical cancer screening.
* The above information on Human Papillomavirus (HPV) vaccine is provided by Centre for Health Protection (CHP) of the Department of Health on their website.
Diphtheria, Tetanus, acellular Pertussis & Inactivated Poliovirus (4-in-1)
Diphtheria is caused by bacteria. Affected persons may have fever, sore throat with patches of greyish membrane adhered to the throat and breathing difficulty. In serious cases, it can cause airway obstruction, heart failure, nerve damage or even death. The disease is spread by contact with patient or carrier. Less commonly, a person may get infected through contact with articles soiled with discharges from affected persons.
Tetanus is caused by bacteria, which gets into the body through a break in the skin and produce a toxin that attacks the nervous system. It can cause painful tightening of the body and locking of the jaws, so that the infected person cannot open his/her mouth or swallow. When tetanus affects muscles that help to breathe, the patient can die very quickly.
Pertussis, also known as “whooping cough”, is an acute respiratory illness caused by bacteria. The infected person may initially have non-specific symptoms like runny nose, sneezing, low grade fever and mild cough. The cough gradually becomes more severe and spells of violent coughing can interfere with eating, drinking and breathing. The symptoms can last for weeks. Complications include lung infection, seizures and brain damage. It is spread by direct contact with droplets from patients.
Poliomyelitis is caused by one of the 3 types of Poliovirus (1, 2 and 3). The virus enters the body through oral route and eventually invades the central nervous system. Symptoms include fever, severe muscle pain, stiffness in the neck and back, paralysis, or even breathing difficulty and death.
DTaP-IPV vaccine can effectively prevent the above 4 serious diseases. In Hong Kong, DTaP-IPV is included in the Hong Kong Childhood Immunisation Programme. In order to achieve good and lasting protection, a child should receive 3 doses of DTaP-IPV vaccine in the first year of life (at 2 months, 4 months and 6 months), and another booster dose at 18 months. Two other doses will be given to primary one students and primary six students*. DTaP-IPV can be given with other vaccines. Diphtheria, tetanus, acellular pertussis (reduced dose) & inactivated poliovirus vaccine is recommended for primary six students. Persons with serious allergic reaction to any of the vaccine components or following previous dose of DTaP-IPV vaccine, persons with encephalopathy or other neurological conditions within 7 days following previous dose of DTaP-IPV vaccine or a pertussis-containing vaccine, or persons with serious allergic reaction to certain antibiotics or preservatives should NOT receive DTaP-IPV vaccine. Minor side effects include local reactions (such as pain, redness or swelling). Moderate or severe systemic side effects occur less frequently which include temperature of 40.5°C (105°F) or higher, persistent crying lasting for 3 hours or longer, febrile seizures as well as hypotonic-hyporesponsive episodes. Parents can use anti-fever medication to relieve the symptoms. Infrequently, transient benign swelling of the entire upper arm or/and thigh after the 4th and 5th doses of DTaP vaccines has been reported. If the child develops breathing difficulty or coma (which are extremely rare) after vaccination, please bring him/her to the Accident & Emergency Department of hospitals immediately for management.
* The above information on Diphtheria, Tetanus, acellular Pertussis & Inactivated Poliovirus (DTaP-IPV/4-in-1) vaccine is provided by Centre for Health Protection (CHP) of the Department of Health on their website.
5-in-1 and 6-in-1
Both DTaP-IPV-Hib (5-in-1) and DTaP-HB-IPV-Hib (6-in-1) combination vaccines can effectively prevent diphtheria, tetanus, pertussis, polio and haemophilus influenzae type B infections. DTaP-HB-IPV-Hib (6-in-1) vaccine protects against one additional virus – Hepatitis B virus. By combining vaccines that are traditionally separate, DTaP-IPV-Hib (5-in-1) and DTaP-HB-IPV-Hib (6-in-1) combination vaccines can greatly reduce the number of vaccinations for children (from 13 to 7), thus reducing pain, discomfort and side effects, and parents' anxiety and inconvenience.
Haemophilus influenzae type B
Haemophilus influenzae type b (Hib) is a bacterium which can cause serious invasive disease especially in young children. Contrary to what the name Haemophilus influenzae suggests, the bacterium does not cause influenza or flu. Hib infection usually affects children aged below five years. The risk of infection among older children is relatively low. Invasive Hib infection commonly presents with symptoms of infection of membranes covering the brain (meningitis), often accompanied by bacteria entering the bloodstream. It may also affect other parts of the body, such as the lungs, upper part of the throat (epiglottis), joints and bones. The clinical features will depend on the parts of body being affected. When the membranes covering the brain are infected, there will be fever, headache and stiff neck, coupled with decreased appetite, nausea, vomiting, fear of bright light, confusion and sleepiness. When the upper part of the throat is infected, there will be fever, sore throat, drooling, pain on swallowing, refusal to swallow or difficulty in breathing. If a child has persistent fever, unusual changes in behaviour and deteriorating condition, or in cases of doubt, medical attention should be sought immediately. Hib infection can be spread by contact with nose or throat secretion of an infected person. The incubation period usually varies from 2 - 4 days, but can be longer.
Effective vaccine against Haemophilus influenzae type b is available. For personal protection, please seek advice from the family doctor. Both the 5-in1 vaccine and the 6-in-1 vaccine protect against Hib disease (Haemophilus influenzae type b). Alternatively, the vaccine can be injected separately.
* The above information on Haemophilus influenzae type B (Hib) vaccine is provided by Centre for Health Protection (CHP) of the Department of Health on their website.
Pneumococcal
Pneumococcal infection is caused by the bacteria Streptococcus pneumoniae (pneumococcus). Streptococcus pneumoniae causes a wide range of diseases, more common ones include middle ear infection (acute otitis media) and chest infection (pneumonia). It may also cause various forms of invasive pneumococcal diseases (IPD), such as infection of the brain membranes (meningitis) and blood stream (bacteraemia and sepsis). The infection can be serious or even life-threatening.
Pneumococci are commonly found in the nose and throat of healthy people, particularly in children. Occasionally, these bacteria will cause an infection. They mainly spread through droplets via coughing and sneezing, close contact with the patients or contact with materials soiled with the bacteria. Incubation period is about 1 - 3 days. High-risk groups include young children, elders and persons with history of IPD, weakened immunity (such as asplenic patients, cancer patients, HIV/ AIDS patients), chronic illnesses (such as diabetes mellitus) and cochlear (inner ear) implants.
There are several types of pneumococcal vaccines. They are safe and effective. Newborn should follow the schedule recommended in the "Hong Kong Childhood Immunisation Programme" for vaccination. Parents may consult family doctors or Maternal and Child Health Centres for details. Elders aged 65 years or above should also get pneumococcal vaccination. Persons in the high-risk groups should consult their family doctors on having the vaccination for personal protection.
* The above information on pneumococcal vaccine is provided by Centre for Health Protection (CHP) of the Department of Health on their website.
Rotavirus
Rotavirus, which has a characteristic wheel-like appearance under electron microscopy, is one of the most common causes of diarrhoea among children worldwide. The disease is more commonly seen in cooler months. The disease is characterised by fever, vomiting and watery diarrhoea for 3 – 7 days. Abdominal pain is also frequently reported. Rotavirus gastroenteritis is a self-limiting illness in healthy persons. However, it is occasionally associated with severe dehydration in young children. Immunity after infection is incomplete, but re-infections tend to be less severe than the original infection. The primary mode of transmission is predominantly faecal-oral. Transmission can also occur through ingestion of contaminated water or food, or contact with contaminated surface. Outbreaks can occur among children in day care settings. Incubation period is approximately 24 – 72 hours.
Oral Rotavirus vaccines for infants are effective in preventing rotavirus infection. Parents can approach their family doctors for further advice and information.
* The above information on Rotavirus vaccine is provided by Centre for Health Protection (CHP) of the Department of Health on their website.
Hepatitis A
Hepatitis A is a liver disease caused by the hepatitis A virus (HAV). Clinical features of hepatitis A are similar to those of other types of viral hepatitis. Typical signs and symptoms of hepatitis A include fever, malaise, loss of appetite, diarrhoea, nausea, abdominal discomfort, or jaundice (yellowing discolouration of the skin and sclera of the eyes, dark urine and pale stool). Not everyone who is infected will have all of the symptoms. Adults have signs and symptoms of illness more often than children, and the severity of disease increases in older age groups. Recovery from symptoms following infection may be slow and may take several weeks or months. Hepatitis A infection does not cause chronic liver disease and is rarely fatal, but it can cause debilitating symptoms and fulminant hepatitis (acute liver failure), which is associated with high mortality. HAV is transmitted primarily by the faecal-oral route, that is when an uninfected person contacts or ingests objects, food or water that has been contaminated with the faeces of an infected person. The virus can also be transmitted through close physical contact with an infectious person including sexual contact and not limited to anal-oral contact. Hepatitis A outbreaks among men who have sex with men (MSM) have been reported. Waterborne outbreaks, though infrequent, are usually associated with sewage-contaminated or inadequately treated water. The incubation period of hepatitis A is usually 14 – 28 days.
Hepatitis A vaccination is a safe and effective means to prevent the infection. Persons who are at increased risk for acquiring hepatitis A and persons with increased risk for severe adverse consequences should discuss with their doctors about hepatitis A vaccination for personal protection. Travellers to endemic areas of hepatitis A, persons with clotting factors disorders receiving plasma-derived replacement clotting factors, persons with chronic liver diseases and men who have sex with men (MSM) are recommended to have hepatitis A vaccination.
* The above information on Hepatitis A vaccine is provided by Centre for Health Protection (CHP) of the Department of Health on their website.
Hepatitis B
Hepatitis B is another type of viral hepatitis that leads to acute hepatitis. It can be followed by chronic liver damage, including cirrhosis and liver cancer. It has an incubation period of 6 weeks to 6 months. About 5-10% of infected adults and 70-90% of infected infants are unable to clear the virus, therefore becoming chronic hepatitis B and serving as a source of infection to others. HBV infection occurs throughout the world. It is estimated that more than 2 billion people have been infected worldwide, of which more than 350 million have chronic liver infection. Hepatitis B is endemic in Southeast Asia. In Hong Kong, the overall prevalence of chronic hepatitis B infection is moderate. The hepatitis B virus is found in the body fluids of an infected person, mainly in the form of blood, amniotic fluid, semen and vaginal secretions. Routes of transmission include perinatal transmission, blood contact and sexual contact.
Hepatitis B Vaccination is the most effective prevention method. The complete course of vaccination takes a total of three injections. The second injection is given 1 month after the first, and the third injection 5 months after the second. About 90 to 95% of people will gain life-long immunity to hepatitis B after a full course of vaccination. Preferably have blood tests before vaccinated. Only people who have never been exposed to hepatitis B should have vaccination. Hepatitis B Vaccination is recommended for newborn, household and sexual contacts of chronic hepatitis B, intravenous drug users, people who receive blood or blood products on a regular basis, people on dialysis and health care workers who might be in contact with blood or other body fluids.

* The above information on Hepatitis B vaccine is provided by Centre for Health Protection (CHP) of the Department of Health on their website.
Measles, Mumps and Rubella
Measles is caused by the Measles virus and spreads through the air by droplet or direct contact with nasal or throat secretions of infected persons, and less commonly, by articles soiled with nose and throat secretions. Affected persons will present initially with tiredness, fever, cough, red eyes and white spots inside the mouth. This is followed by a red blotchy skin rash 3-7 days later. The rash usually spreads from the face down to the rest of the body. In severe cases, middle ear, lungs and brain can get involved and lead to serious consequences or even death.
Mumps is caused by the Mumps virus which affects the salivary glands and sometimes the nerve tissue. It is spread by droplet and direct contact with the saliva of an infected person. The disease is characterized by painful swelling of the salivary glands, usually at the cheek(s), and fever. Sometimes, there may be complications like deafness, or infection of the brain. Adolescents might develop infection of the testicles or ovaries, which can affect fertility.
Rubella, also known as “German Measles”, is caused by Rubella virus. It can be transmitted by contact with secretions from nose and pharynx of infected persons through droplet spread or direct contact with patients. Symptoms are usually mild. Children usually present with fever, headache, diffuse rash and enlargement of lymph nodes behind the ears or in the neck. Sometimes there may be no symptom at all. Complications include arthritis, thrombocytopenia and encephalitis. Rubella infection produces anomalies in the developing fetus. Congenital rubella syndrome (CRS) is likely to occur in infants born to women who got infected during the first 3 months of pregnancy. CRS is characterized by deafness, blindness, heart malformations and mental retardation.
MMR vaccine can effectively prevent the above 3 infectious diseases. In Hong Kong, MMR vaccine is included in the Hong Kong Childhood Immunisation Programme. Women of childbearing age who are not previously immunised should receive MMR before pregnancy, to protect the health of her fetus. Children should receive two doses of MMR.
Persons with serious allergic reaction to a previous dose of MMR vaccine, with known history of severe allergy to gelatin or certain antibiotics, with cancer, on long term corticosteroids, with immunodeficiency, in pregnancy, received immunoglobulin or other blood products (e.g. blood transfusion) within the past 11 months or received other live vaccines in the past four weeks should NOT/ should wait to receive MMR. Women should avoid pregnancy for three months after vaccination
Some children may develop fever 5-12 days after vaccination, but the fever will usually subside within 2-5 days. Parents can use anti-fever medication to relieve the symptoms. A small number of children may also develop a rash 1-2 weeks after vaccination, but it will usually disappear within 1-2 days. A minority of children may develop transient swelling of salivary glands behind the cheeks, swelling of lymph glands (in the head or neck) or infection of the testicles. There is a 1 in 3 million chance of developing encephalitis or meningitis after receiving MMR vaccine, but this does not usually have long lasting ill effects on the child after recovery.
* The above information on Measles, Mumps and Rubella (MMR) vaccine is provided by Centre for Health Protection (CHP) of the Department of Health on their website.
Varicella
Varicella (also known as chickenpox) is a viral illness caused by the varicella-zoster virus. It is highly contagious and is spread by airborne transmission of droplets from the respiratory tract or from the vesicle fluid of the skin lesions of chickenpox or herpes zoster infection. Affected persons present with fever and itchy rash. The rash usually develops over 5 days with formation of vesicles and appears first on the scalp and face, moves to the trunk and then to the limbs. The rash occurs mainly over the trunk. The vesicles are itchy, and then dry up and form a scab in around 3 days. Affected persons usually recover in 2 to 4 weeks. Varicella is usually a mild disease of childhood. It is more severe in adults and in individuals of any age with impaired immunity. The disease may be complicated by skin infection, aseptic meningitis, encephalitis and pneumonia. Infection in early pregnancy may be associated with congenital malformation of the fetus.
Varicella vaccine can effectively prevent chickenpox infection. In Hong Kong, Varicella vaccine is included in the Hong Kong Childhood Immunisation Programme. Children should receive two doses of Varicella vaccine. The first dose is given at one year of age. The second dose is given when the children reach primary one. Persons with serious allergic reaction to a previous dose of Varicella vaccine, persons with known history of severe allergy to gelatin or certain antibiotics, cancer patient, persons on long term corticosteroids, persons with immunodeficiency, persons with moderate or severe acute illness, persons who have received immunoglobulin or other blood products (e.g. blood transfusion) within the past 11 months, persons who have received other live vaccines in the past four weeks, persons with untreated active tuberculosis, persons with family history of congenital or hereditary immunodeficiency or persons in pregnancy (women in reproductive age should avoid pregnancy for three months after vaccination) should not/should wait to receive the vaccine. In general, monovalent varicella vaccine is safe and well tolerated. Its adverse reactions include local reactions, such as pain, redness and rash at the injection site. These are usually mild and self-limited. Systemic symptoms such as fever and generalised skin rash occur less frequently. Latent infections leading to herpes zoster have been reported but the majority of cases have been mild and have not been associated with complications. Children should avoid taking salicylates (e.g. aspirin) within 6 weeks after receiving varicella vaccine. Rarely, the varicella virus in the vaccine may transmit from vaccine recipients who develop a varicella-like rash to susceptible high-risk individuals (e.g. immunocompromised, pregnant women without immunity to chickenpox, newborn infants of mothers without immunity to chickenpox, all newborn infants born at less than 28 weeks gestation). However, it is not a contraindication for a child to receive varicella vaccine just because there is high risk individual in the same household. A pregnant mother or other household pregnant member is also not a contraindication for immunisation of a child in the household. No precautions are needed following immunisation of a child who does not develop a rash. However, if the child develops a rash post-vaccination, high risk individuals should avoid close contact with the child until the rash has resolved.

* The above information on Varicella vaccine is provided by Centre for Health Protection (CHP) of the Department of Health on their website.
Measles, Mumps, Rubella, and Varicella
MMRV vaccine can effectively prevent Measles, Mumps, Rubella, and Varicella (also known as chicken pox). By combining vaccines that are traditionally separate (MMR and Varicella vaccine), MMRV vaccine (compared to MMR and Varicella vaccine) has enhanced immune response and can greatly reduce the number of vaccinations for children.
Meningococcal
Meningococcal infection is caused by the bacteria Neisseria meningitidis. The clinical picture may be variable. It may result in severe illness when the bacteria invade the bloodstream (meningococcaemia) or the membranes that envelop the brain and spinal cord (meningococcal meningitis). Meningococcaemia is characterised by sudden onset of fever, intense headache, purpura, shock and even death in severe cases. Meningococcal meningitis is characterised by high fever, severe headache, stiff neck followed by drowsiness, vomiting, fear of bright light, or rash; it can cause brain damage or even death. The brain damage may lead to intellectual impairment, mental retardation, hearing loss and electrolyte imbalance. For invasive meningococcal infection, it can be complicated by inflammation of joints, inflammation of heart muscle, inflammation of the posterior chamber of the eye or chest infection. The disease is mainly transmitted by droplets via sneezing or coughing or by direct contact through respiratory secretions from infected persons. Incubation period varies from 2 – 10 days, commonly 3 – 4 days. The risk of infection is higher among close contacts of patients with meningococcal infections. Close contacts include (1) family members, (2) day care centre contacts, (3) persons directly exposed to the patient's oral secretions, and (4) those who frequently sleep or eat in the same dwellings as the patient. Certain patients with defective immune systems are also at higher risk. Other risk factors include antecedent viral infection, overcrowding, chronic illness, and active and passive smoking. In general, the risk of acquiring meningococcal infection while travelling is low. However, in sub-Saharan Africa extending from Senegal to Ethiopia, particularly during the dry season (December to June), disease occurrence is higher, and there is additional risk for long-term travellers living in close contact with the indigenous population.
Meningococcal vaccines have been registered in Hong Kong. To minimise the risk of meningococcal infection, vaccination may be considered for those staying in the sub-Saharan Africa during the dry season. Travellers visiting Saudi Arabia during the Hajj annual pilgrimage should bring along certificate of vaccination with the quadrivalent (serogroups A, C, Y & W135) vaccine against meningococcal infection issued not more than 3 years and not less than 10 days before arrival in Saudi Arabia.
* The above information on Meningococcal vaccine is provided by Centre for Health Protection (CHP) of the Department of Health on their website.
Zoster
Anyone who has had chicken pox is at risk for developing shingles. It is estimated that 1 million or more cases occur each year in the United States. Shingles can occur in people of all ages and the risk increases as people get older. The causes of shingles aren't completely known, but it is thought that a combination of factors can trigger shingles, including aging and problems with the immune system. When shingles develop, a rash or blisters appear on the skin, generally on one side of the body. This is a sign that the virus, that has been dormant in the nerve cells, has reactivated and travelled from the nerves and followed a path out to the skin. Because the nerves along the path become inflamed, shingles can also be painful. Pain that lasts for months after the rash has healed is called post herpetic neuralgia or PHN. For some people, this pain can be severe and chronic.
Zoster vaccine helps to reduce the risk of getting herpes zoster (shingles) in individuals 50 years of age and older. As with all medications, adverse reactions, including serious reactions, can occur. The most frequent adverse reactions reported were headache and injection-site reactions. Zoster vaccine should not be given to individuals who have a weakened immune system caused by treatments such as radiation, chemotherapy or other medications that affect the immune system, or due to conditions such as HIV, leukaemia, lymphoma or other cancers of the lymphatic system, blood, or bone marrow. People who are allergic to any component of the vaccine, women who are or may be pregnant and children should not receive Zoster vaccine. People who are in close contact with pregnant women who have not had chickenpox should talk to their healthcare provider to decide if using Zoster vaccine is right for them.
* The above information on Zoster vaccine is provided by U.S. Food and Drug Administration (FDA) of U.S. Department of Health and Human Services on their website.
Seasonal Influenza
Seasonal influenza is an acute illness of the respiratory tract caused by influenza viruses. It is usually more common in periods from January to March and from July to August in Hong Kong. Three types of seasonal influenza viruses are recognised to cause human infection, namely A, B and C. For healthy individuals, seasonal influenza is usually self-limiting with recovery in 2 – 7 days. Symptoms may include fever, cough, sore throat, runny nose, muscle pain, fatigue and headache; some may also have vomiting and diarrhoea. Cough is often severe and prolonged but fever and other symptoms generally resolve in 5 – 7 days. However, influenza can be a serious illness to the weak and frail or elderly people, and may be complicated by bronchitis, chest infection or even death. Influenza viruses mainly spread through droplets when infected people cough, sneeze or talk. The infection may also spread by direct contact with the secretions of infected persons. Incubation period is usually around 1 – 4 days. Infected persons may pass the viruses to other people 1 day before and up to 5 – 7 days after they develop symptoms. The period may be even longer in young children or severely immunocompromised persons.
Seasonal influenza vaccination is safe and effective in preventing seasonal influenza and its complications. Influenza can cause serious illnesses in high-risk individuals and even healthy persons. Given that seasonal influenza vaccines are safe and effective, all persons aged 6 months or above except those with known contraindications are recommended to receive influenza vaccine for personal protection. Usually, it is suggested that vaccination should be received in autumn every year. About 2 weeks after vaccination, the body will develop a sufficient level of antibodies to protect against influenza virus infection.
* The above information on seasonal influenza vaccine is provided by Centre for Health Protection (CHP) of the Department of Health on their website.