Adult vaccination should no longer be considered a luxury for developed countries. Instead, we must view how lifelong immunisation can have an important public health role in reducing vaccine preventable diseases and their sequelae. In Singapore, we do not have an “official” adult immunisation schedule and many of the references and recommendations that I will discuss come from the United States where such recommendations have been in existence for many years. Travel vaccinations are being considered in a separate article in this series. The “routine” adult vaccinations are against: Influenza, pneumococcal infection, tetanus, diphtheria, pertussis, varicella zoster, human papilloma virus, measles, mumps, and rubella.

Anti-Bacterial Agents ; therapeutic use ; Drug Resistance, Microbial ; Humans ; Singapore

Anti-Bacterial Agents ; therapeutic use ; Drug Resistance, Microbial ; drug effects ; Education, Medical, Continuing ; standards ; Humans ; Practice Guidelines as Topic

In temperate countries, the seasonal influenza epidemics in the winter months have been predictable. While this “seasonal” pattern is less clear in tropical countries such as Singapore, the burden of influenza is no less than in temperate countries. In Singapore, a recent study has estimated that from 2010 to 2017, the influenza-associated hospitalisation for pneumonia and influenza was 50 per 100,000. Vaccination has been the most important public health prevention tool for influenza. The vaccine efficacy of the current influenza vaccines has been suboptimal, and efforts are underway to improve this to develop a universal influenza vaccine. The public health crisis brought upon by SARS CoV2 in 2020 has resulted in changes to the epidemiology of many respiratory infections, including influenza. While the reduction of seasonal influenza cases in the first three quarters of 2020 has been a welcome relief, it is critical to maintain vigilance as seasonal and pandemic influenza remains a global health threat.

It has been about 100 years since the Spanish influenza pandemic of 1918-19 that killed an estimated 50 million individuals globally. While we have made remarkable progress in reducing infection-related mortality, infections still account for 13 to 15 million deaths annually. This estimate is projected to remain unchanged until 2050. We have identified 4 megatrends in infectious diseases and these are "emerging and re-emerging infections", "antimicrobial resistance", "demographic changes" and "technological advances". Understanding these trends and challenges should lead to opportunites for the medical community to reshape the future. Further inroads will also require broad approaches involving surveillance, public health and translating scientific discoveries into disease control efforts.

INTRODUCTIONLiving donor liver transplantation (LDLT) has progressed dramatically in Asia due to the scarcity of cadaver donors and is increasingly performed in Singapore. The authors present their experience with adult LDLT.

MATERIALS AND METHODSAdult LDLTs performed at the Asian Centre for Liver Diseases and Transplantation, Singapore from 20 April 2002 until 20 March 2006 were reviewed. All patients received right lobe grafts and were managed by the same team throughout this period. Data were obtained by chart review. This study presents both recipient and donor outcomes in a single centre.

RESULTSA total of 65 patients underwent LDLT. Forty-three were genetically related while 22 were from emotionally-related donors. The majority were chronic liver failure while 14% were acute. The most common indication for LDLT was end-stage liver disease due to hepatitis B virus. A total of 22 patients with hepatoma were transplanted and overall 1-year disease specific survival was 94.4%. The mean model for end-stage liver disease (MELD) score was 17.4 +/- 9.4 (range, 6 to 40). Six patients had preoperative molecular adsorbent recycling system (MARS) dialysis with 83% transplant success rate. The mean follow-up was 479.2 days with a median of 356 days. One-year overall survival was 80.5%. There was 1 donor mortality and morbidity rate was 17%. Our series is in its early stage with good perioperative survival outcome with 1-month and 3-month actuarial survival rates of 95.4% and 87.3% respectively.

CONCLUSIONThe study demonstrates that LDLT can be done safely with good results for a variety of liver diseases. However, with dynamically evolving criteria and management strategies, further studies are needed to maximise treatment outcome.

Adult ; Female ; Hospitals, Special ; Humans ; Liver Transplantation ; mortality ; utilization ; Living Donors ; Male ; Medical Audit ; Middle Aged ; Outcome Assessment (Health Care) ; Perioperative Nursing ; Singapore ; epidemiology ; Survival Rate

Aged ; Aged, 80 and over ; Betacoronavirus ; genetics ; Coronavirus Infections ; epidemiology ; therapy ; DNA, Viral ; analysis ; Disease Management ; Female ; Humans ; Male ; Pandemics ; Pneumonia, Viral ; epidemiology ; therapy ; Singapore