Vaccination in Childhood: What the STIKO Recommends

The dangers that once emanated from diseases such as whooping cough, diphtheria or measles seem far away nowadays. Yet it wasn’t all that long ago that thousands of children and even adults died from them every year or suffered permanent damage after severe courses of the disease.

Hardly any fatalities thanks to consistent vaccination

Even today, these diseases still cause fatalities in Germany, although nowhere near as many as in the days of our grandparents. The reason for this positive development is primarily the consistent vaccination of children already in the first months of life. In many countries, childhood diseases such as measles or polio (infantile paralysis) are therefore almost eradicated today.

Vaccination recommendations by the STIKO

The Robert Koch Institute (RKI) is responsible for disease control and prevention in Germany. The Standing Commission on Vaccination (STIKO) is an institution within the RKI that is exclusively concerned with issuing the “General Vaccination Recommendations” as guidelines for physicians and health care facilities. An annual vaccination calendar lists updated vaccination recommendations for all age groups.

No comprehensive mandatory vaccination in Germany

Compulsory vaccination in Germany has so far existed only for measles. Otherwise, parents must make the decision for their children whether or not to vaccinate them. Even though you hardly hear about most diseases in Germany, vaccinations are explicitly recommended.

  • On the one hand, this protects the child against numerous diseases. This is especially significant when the child enters kindergarten and is exposed to risks of infection. Also, when traveling to countries where childhood diseases such as polio are still very common, vaccination provides protection.
  • On the other hand, the spread of these diseases is prevented if as many people as possible are vaccinated. Chronically ill people who may not be vaccinated due to a weak immune system are also protected in this way. One speaks then of herd immunity.

Even if babies get some protection through the mother’s milk (“nest protection”), breastfeeding can not replace vaccination. Because the protection provided by the mother’s antibodies lasts only a limited time and also does not protect against all diseases. Also, some diseases occur particularly often in infants and young children or are particularly dangerous for them. Therefore, it is strongly advised to conscientiously carry out the recommended vaccinations in childhood.

Vaccination side effects less than consequences of any of the diseases

Although vaccination is not without risk, the likelihood of it is disproportionate to the consequences that any of the respective diseases might bring. Supposed vaccine side effects such as redness of the skin, swelling, nausea, or fever may well occur in the first three days after vaccination. They are signs that the immune system is working and creating antibodies.

14 vaccinations recommended for children

Currently, 14 vaccinations are offered that are recommended in childhood and paid for by health insurance. Vaccinations are given as early as six weeks of age and must be boostered at specified intervals. Combination vaccines are usually used to reduce the number of injections needed, especially in children and babies.

1. tetanus (lockjaw).

This infectious disease affects the muscle-controlling nerve cells and is fatal if left untreated. The disease is triggered by a pathogen that occurs primarily in the soil and enters the body through wounds. The STIKO recommends starting vaccination in the second month of life. A booster is necessary at regular intervals even in adulthood.

2. diphtheria

Diphtheria is a highly contagious disease of the upper respiratory tract. Without treatment, it leads to death. Diphtheria is particularly common in countries of the former USSR. While children are quite well protected against the disease by vaccination, adults often do not have sufficient protection due to lack of booster vaccination. The STIKO recommends starting vaccination in the second month of life. A booster is also necessary at regular intervals during adulthood.

3. pertussis (whooping cough).

Pertussis is a highly contagious infectious disease that causes cramping coughs for several weeks.For babies, the disease can be life-threatening. Vaccination is also recommended by the STIKO from the second month of life. A booster is also necessary at regular intervals in adulthood.

4. haemophilus influenzae type b (Hib).

Since 1990, this vaccination has been recommended for all infants because the bacterium can cause meningitis and other inflammatory diseases, especially in children younger than 18 months. The STIKO recommends starting vaccination in the second month of life. After complete basic immunization, boosters are no longer necessary in adulthood.

5. poliomyelitis (polio).

The polio pathogen primarily affects the nerve cells in the spinal cord and is extremely contagious. Although the disease usually runs harmless and resembles a flu-like infection with diarrhea. However, paralysis of the limbs occurs in about one percent of patients. Damage to the respiratory muscles and brain can also result. The course of the disease is often more severe in adults than in infected children. The STIKO recommends starting vaccination in the second month of life. A booster is recommended for adolescents aged 9 to 17 years.

6. hepatitis B (jaundice).

Hepatitis B viruses can cause fatal liver inflammation. The risk of contracting hepatitis B as an infant or child is relatively low because the viruses are transmitted through contact with body fluids. Nevertheless, the STIKO recommends vaccination from the second month of life, as the risk of infection increases with age. A later booster vaccination is not necessary after successful basic immunization.

7. pneumococcal

The bacteria can cause a variety of diseases. However, the main danger for infants, children and people with weakened immune systems is pneumonia. Middle ear or meningitis can also be the result of a pneumococcal infection. The STIKO therefore advises vaccination from the second month of life, which is repeated once more as standard vaccination in senior age. For premature infants, it is recommended that four vaccine doses instead of three be given during basic immunization.

8. rotavirus

Rotaviruses are very contagious and one of the most common causes of diarrhea and vomiting in children. Infants in particular are at risk of dehydration if they become ill, requiring hospital treatment. The first oral vaccination against rotavirus is therefore recommended by the STIKO at the age of six weeks.

9. meningococcal C

These bacteria can cause life-threatening meningitis (inflammation of the brain) or blood poisoning (sepsis), which particularly often affects children under five years of age and adolescents. The STIKO recommends a single vaccination after the first year of life.

10. measles

Measles is a very contagious, notifiable disease. Without vaccination or having experienced measles, people are almost one hundred percent likely to get sick if they come in contact with the virus. Measles can be accompanied by serious complications such as pneumonia or meningitis, and in rare cases can lead to death. The STIKO therefore recommends a vaccination against measles, which is administered from the first year of life (between the completed 11th and 14th month of life). A second vaccination is given in the second year of life. After these two vaccinations, there is lifelong vaccination protection. The Measles Protection Act has been in force in Germany since March 1, 2020. This includes a vaccination obligation for all children from the completed first year of life. Proof of vaccination must be provided before entering kindergarten or school. For children already attending school or kindergarten, proof of vaccination must be provided by July 31, 2021. This regulation also applies to medical personnel as well as teachers, educators and daycare providers.

11. mumps

Mumps is a contagious viral disease. Because the typical symptoms do not always occur, the disease is often not recognized. In almost ten percent of cases, mumps is accompanied by meningitis. Inflammation of the pancreas, the auditory nerve or the testicles and epididymis (especially in adolescents) can also be the result. The vaccination twice should be given, as well as the measles vaccination, from the first and in the second year of life.

12. rubella

Rubella is especially dangerous for pregnant women, because the unborn child can take serious damage.Nevertheless, vaccination is also recommended for boys, because the disease is very contagious only high vaccination rates can protect unborn children. As with measles and mumps, two vaccinations are recommended for rubella in the specified periods. Vaccination against measles, mumps, and rubella (MMR) is usually given with the combined MMR vaccine rather than individually.

13. chickenpox (varicella).

Chickenpox belongs to the viral diseases and is very contagious. The pathogen that causes chickenpox remains in the body after infection and can trigger shingles after many years. The STIKO recommends the two-stage standard vaccination, which should be given after the first year of life. It can also be given as a combination with the MMR vaccination.

14. human papillomavirus (HPV).

Some HP viruses can cause cervical cancer, as well as genital warts and some other forms of cancer (including in men). HPV is sexually transmitted. Pre-existing infections cannot be treated by the vaccination, so it is advisable to administer the vaccination before the first sexual contact. The STIKO recommends that girls and boys be vaccinated against HPV between the ages of nine and fourteen. Nevertheless, there is no complete protection against cervical cancer, as it can also have other causes.

Six-dose vaccination: 3+1 schedule or 2+1 schedule?

The so-called six-fold vaccination includes protection against tetanus, diphtheria, pertussis, Haemophilus influenzae type b, poliomyelitis and hepatitis B. This requires multiple vaccinations. Until the summer of 2020, the RKI recommended the so-called 3+1 schedule for infants, in which three vaccination dates in quick succession were followed by another at a greater interval. Thus, vaccinations were given at 2, 3, 4, and 11 months of age. The new, reduced 2+1 schedule provides fewer vaccinations for basic immunization while maintaining the same level of vaccine protection by eliminating vaccination at 3 months of age. This reduces the number of vaccination appointments required. However, this makes it all the more important to begin the appropriate vaccinations as early as 8 weeks of age and to strictly adhere to the recommended intervals between vaccinations. For premature infants born before 37 weeks of gestation, the 3+1 schedule continues to be recommended.