Medicine and Society: Not exactly world champion

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Medicine and Society: Not exactly world champion
Medicine and Society: Not exactly world champion

Not exactly world champion

We have caught up in recent years - but in a European comparison we are still anything but in the top group. Doctors believe that Germany's willingness to be vaccinated urgently needs to be increased. We should start with grain protection. Holiday trips to exotic regions require good preparation. Above all, it should be discussed with the doctor which vaccinations are necessary to return home he althy. But what is perceived as "exotic" depends on the point of view. The Pan-American He alth Organization (PAHO) recently issued a travel warning for Germany: the football fans who had traveled in large numbers to attend the World Cup were asked to clarify before they left whether they had been vaccinated against measles. The American continent has been considered measles-free for over ten years, a state from which Germany - especially because of the measles epidemic in North Rhine-Westphalia - still seems a long way off.


In 1998, as part of the WHO campaign "21 Goals for the 21st Century", Germany and other European countries committed to eliminating measles by 2007. However, according to the WHO, at least 95 percent of the population must be vaccinated to eradicate an infectious disease. In the case of measles, if you ask the parents of two-year-old children, only about 70 percent are fully vaccinated - that is, have received the required two doses of vaccine at this point. In addition, there are strong regional differences in the willingness to be vaccinated, which means that there are locally highly susceptible groups of people who can spread the measles.

In North Rhine-Westphalia, according to figures from the Robert Koch Institute, by 21. As of June 2006, 1,433 measles cases have already been reported this year. Other states are now also affected. The "Paediatricians on the Net" are currently reporting on 45 children in Schleswig-Holstein, some of whom have been infected with the same type of virus that is circulating in North Rhine-Westphalia. Overall, the number of cases is probably much higher, since experience has shown that not all cases of measles are reported. Are the Germans tired of vaccinations? Are they increasingly refusing vaccinations – or what are the reasons why a disease breaks out for which there has been effective preventive protection for many years?

Creeping Fatigue

"There are extremely few people in Germany who completely reject vaccinations. Estimates assume that this is around three percent of the population," says Sabine Reiter, who works in the infectious disease epidemiology group at the Robert Koch Institute in Berlin. In the case of measles in particular, against which vaccination is given in combination with mumps and rubella ("MMR vaccination"), a mixture of skepticism and ignorance about the benefits of timely vaccination seems to be the reason for the low rate. "In the first year of life, parents are very concerned and often take their children to the doctor," explains Heinz-Josef Schmitt, a pediatrician at the University Hospital in Mainz and chairman of the Standing Vaccination Committee (STIKO). The "collaboration" between parents and doctor is very close at this point, which explains why it is possible to reach between 50 and 90 percent of the children with the first MMR dose.

On the other hand, far fewer children receive the necessary second vaccination, which the STIKO recommends should be given no earlier than four weeks after the first "prick". "The organizational processes here are simply not ideal," says Sabine Reiter."We don't have an automatic reminder system that alerts people when something's missing for full immune protection." Not only for children, but also for adults, the following often applies: the vaccination appointments are simply forgotten. "In the case of measles, there is also a stubborn misconception that a previous infection would strengthen the child's immune system," says Reiter.

The organizational processes are simply not optimal here

(Sabine Reiter) But measles is a serious disease, with complications occurring in 10 to 20 percent of cases in western industrialized countries. These are either middle ear infections or pneumonia. And in every 1000th to 2000th the brain becomes inflamed in the course of the infection, which can cause serious damage or even be fatal. In the current measles outbreak, 207 mostly school-age children have had to be hospitalized so far, three of them for encephalitis

vaccination program? None

How can the measles vaccination rate be increased in the future and such an outbreak prevented? "In Germany there are only vaccination recommendations. We don't have a vaccination program like many other countries in the world," says Heinz-Josef Schmitt. Such a vaccination program would include formulating clear goals - what do I want to achieve with the vaccinations - there is a plan and, above all, a strategy for implementation and that success checks are carried out to monitor them. However, there is currently no continuous and timely recording of vaccination coverage among children in Germany. Vaccination rates are determined at the school entry examination, so in the case of measles four to five years after the recommended vaccination date.

As early as 1999, the RKI drafted a concept for eradicating measles in Germany with the "Measles, Mumps, Rubella Intervention Program". A 10-point plan to increase vaccination coverage was also presented. "But politics has left the matter alone so far," says Heinz-Josef Schmitt. Helen Kalies from the Institute for Social Pediatrics and Adolescent Medicine at the Ludwig-Maximilians-University in Munich points to an important German complication: "Since vaccination programs are unfortunately the responsibility of the federal states, a national project is very difficult."

Politicians have left the matter alone

(Heinz-Josef Schmitt) Helen Kalies is currently evaluating a parent survey that is intended to help explain which families do not accept vaccinations well and why they do so. "For programs to be effective, you have to know who is at risk," explains Helen Kalies. A team led by Helen Bedford of the Institute of Child He alth in London is a step further. The group recently published the results of a study involving nearly 20.000 children born in the UK between autumn 2000 and early 2002. The vaccination status in the first year of life and the factors associated with incomplete or no vaccinations should be recorded.

3, 3 percent of children were incompletely vaccinated. The British researchers identified growing up in large families, with single parents or teenage parents and in socially disadvantaged urban districts as risk factors for this condition. Only 1.1 percent of the babies were not vaccinated. Strikingly often these were the children of older mothers with a high level of education or those from Caribbean immigrant families. Exact knowledge of the groups of people affected now enables a specific approach to increase the willingness to be vaccinated.

Measles protection lags behind

If you leave out the MMR vaccination, there have also been successful vaccinations for children in Germany in the past. More than 90 percent of children are vaccinated against diphtheria, tetanus and whooping cough, and vaccination rates against polio, Haemophilus influenzae and hepatitis B have also improved. One explanation for this positive development could be the introduction of combination vaccines. A vaccine that targets six different pathogens has been approved on the German market since 2000. "The combination vaccines, which are viewed with suspicion by many vaccine skeptics, have been instrumental in improving timely immunizations, likely preventing some unnecessary childhood illnesses," says Kalies. One or two visits to the doctor are better coordinated in everyday family stress and between feverish colds and the first teeth than several appointments in a row.

Combination vaccines are likely to prevent some unnecessary diseases in children

(Helen Kalies) If you want to make sure that you don't miss your children's vaccination appointments, you can register on the website of the German paediatricians. Based on the dates of birth, you are automatically informed about upcoming vaccination dates and check-ups. Especially with the second measles vaccination, an active reminder seems to be a sensible approach to increase the low vaccination rate. Doctors and scientists would like to see a more consistent approach overall. The 109th German Doctors' Day in May of this year even called on politicians to make measles vaccination compulsory in Germany. According to the physicians, admission to kindergartens or crèches should only be possible if the children are fully vaccinated in accordance with the current STIKO recommendation.

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