Vaccination in childhood: What the STIKO recommends

Vaccination in childhood: What the STIKO recommends

The dangers that diseases like whooping cough, diphtheria or measles once posed seem far away today. It is not that long ago that thousands of children and adults died from it every year or suffered permanent damage after a severe course of the disease. 

Hardly any fatalities thanks to consistent vaccination

Even today, these diseases still claim fatalities in Germany, albeit not as many as in the days of our grandparents. The main reason for this positive development is the consistent vaccination of children in the first months of life.

In many countries, childhood diseases such as measles or polio (child paralysis) have now almost been eradicated.


Vaccination recommendations by STIKO

The Robert Koch Institute (RKI) is responsible for disease control and prevention in Germany. The Standing Vaccination Commission (STIKO) is an institution that belongs to the RKI that is exclusively concerned with issuing the “General Vaccination Recommendations” as guidelines for doctors and health facilities.

An annual vaccination calendar lists updated vaccination recommendations for all age groups

No comprehensive compulsory vaccination in Germany

Up to now, there is only compulsory vaccination in Germany for measles. Otherwise, parents have to decide whether their children should be vaccinated. Even if you hardly hear anything about most diseases in Germany, vaccinations are expressly recommended.

  • On the one hand, the child is protected against numerous diseases. This is particularly important when the child comes to kindergarten and is exposed to the risk of infection. Vaccination also offers protection when travelling to countries where childhood diseases such as polio are still prevalent. 
  • On the other hand, the spread of these diseases is prevented if as many people as possible are vaccinated. Chronically ill people who cannot be vaccinated due to a weak immune system are also protected in this way. This is called herd immunity.

Even though babies receive a certain amount of protection (“nest protection”) from their mother’s milk, breastfeeding cannot replace vaccination. Because the protection provided by the mother’s antibodies only lasts for a limited time and does not protect against all diseases. Some diseases also occur particularly often in infants and small children or are particularly dangerous for them. It is, therefore, urgently advised that the recommended childhood vaccinations be carried out conscientiously.


Vaccine side effects less than consequences of one of the diseases

Although vaccination is not entirely without risk, the likelihood of this is disproportionate to the consequences that one of the respective diseases could potentially bring.

Alleged vaccination side effects such as reddening of the skin, swelling,  nausea  or  fever  can certainly occur in the first three days after vaccination. They are signs that the  immune system  is working and producing antibodies.

14 vaccinations recommended for children

There are currently 14 vaccinations available that are recommended for children and  paid for by health insurance  . The vaccinations are administered from the sixth week of life and must be refreshed at set intervals. Combination vaccines are usually used to reduce the number of injections required, especially in children and babies.

  1. Tetanus (Wundstarrkrampf)

The infectious disease affects the nerve cells that control muscles and is fatal if left untreated. The disease is caused by a pathogen that is found primarily in the soil and enters the body through wounds.

The STIKO recommends starting the vaccination in the second month of life. A booster shot is also necessary at regular intervals 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 fairly well protected against the disease through vaccinations, adults often do not have adequate protection due to a lack of booster vaccinations.

The STIKO recommends starting the vaccination in the second month of life. A booster shot is also necessary at regular intervals in adulthood.

3. Whooping cough (pertussis)

Whooping cough is a highly contagious infectious disease that causes spasmodic coughing fits that last for several weeks. The disease can be life-threatening for babies.

The STIKO also recommends vaccination from the second month of life. A booster shot is also necessary at regular intervals in adulthood.

4. Haemophilus influenzae Typ b (Hib)

Since 1990, this vaccination has been recommended for all young children because the bacteria can cause meningitis and other inflammatory diseases , especially in children under 18 months of age .

The STIKO recommends starting vaccination in the second month of life. After complete basic immunization, no further booster shots are necessary in adulthood.


5. Poliomyelitis (polio)

The polio virus primarily attacks the nerve cells in the spinal cord and is extremely contagious.

Although the disease is usually harmless and resembles a flu infection with  diarrhea , about one percent of patients experience paralysis of the limbs. Damage to the respiratory muscles and the brain can also result. The course of the disease is often more severe in adults than in sick children.

The STIKO recommends starting the 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 bodily fluids.

Nevertheless, STIKO recommends vaccination from the second month of life, as the risk of infection increases with age. A subsequent booster vaccination is not necessary after successful basic immunization.

7. Pneumococci

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 inflammation or meningitis can also be the result of a  pneumococcal infection  .

The STIKO therefore recommends vaccination from the second month of life, which is then repeated as a standard vaccination in old age. For premature babies, it is recommended that four doses of vaccine be administered as the primary immunization instead of three.


8. Rotaviren

Rotaviruses  are highly contagious and one of the most common causes of diarrhea and vomiting in children. If they become infected, infants in particular are at risk of dehydration, which requires hospital treatment.

The STIKO therefore recommends the first oral vaccination against rotaviruses at the age of six weeks.

9. Meningococcal C

Diese Bakterien können eine lebensgefährliche Hirnhautentzündung (Meningitis) oder Blutvergiftung (Sepsis) hervorrufen, von der vor allem Kinder unter fünf Jahren und Jugendliche besonders oft betroffen sind.

Die STIKO empfiehlt die einmalige Impfung nach dem ersten Lebensjahr.

10. Masern

Measles is a highly contagious, notifiable disease. Without vaccination or a history of measles, people who come into contact with the virus have an almost 100 percent chance of becoming ill. Measles can lead to serious complications such as pneumonia or meningitis and, in rare cases, can be fatal.

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 protection.

The Measles Protection Act has been in force in Germany since March 1, 2020. This includes compulsory vaccination for all children from the age of one. Appropriate proof of vaccination must be provided before entering kindergarten or school. For children who already attend 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 childminders.


11. Mumps

Mumps  is a contagious viral disease. Since 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 young people) can also be the result.

Like the measles vaccination, the two-dose vaccination should be given from the first and second year of life.

12. rubella

Rubella  is particularly dangerous for pregnant women, as the unborn child can suffer serious damage. However, vaccination is also recommended for boys, as the disease is very contagious and only high vaccination rates can protect unborn children.

As with measles and mumps, two vaccinations are recommended for rubella within the specified periods.

13. Chickenpox (varicella)

Chickenpox  is a viral disease and is very contagious. The chickenpox pathogen remains in the body after infection and can  cause 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 in combination with the MMR vaccination.


14. Human Papillomavirus (HPV)

Some HPV viruses can  cause cervical cancer  ,  genital warts  and some other forms of cancer (also in men).  HPV  is sexually transmitted. Existing infections cannot be treated with the vaccine, so it is advisable to administer the vaccine before the first sexual encounter.

The STIKO recommends that girls and boys between nine and fourteen be vaccinated against HPV. However, there is no complete protection against cervical cancer, as it can also have other causes.

Sextuple vaccination: 3+1 scheme or 2+1 scheme?

The so-called six-in-one vaccination includes protection against tetanus, diphtheria, pertussis, Haemophilus influenzae type b, poliomyelitis and hepatitis B. This requires several vaccinations. Until the summer of 2020, the RKI recommended the so-called 3+1 scheme for infants, with three vaccination appointments quickly followed by another at a greater interval. The vaccinations thus took place at 2, 3, 4 and 11 months.

The new, reduced 2+1 scheme provides fewer vaccinations for basic immunizations with the same protection by eliminating vaccinations at three months. This reduces the number of vaccination appointments required. However, it is all the more important to start with the appropriate vaccinations at the age of 8 weeks and to adhere to the recommended vaccination intervals strictly.

The 3+1 scheme is still recommended for premature babies born before the 37th week of pregnancy.




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