No evidence to support parents' concerns about vaccinating too much too soon

from: Dtsch Arztebl 2018; 115 (20-21): A-1007 / B-851 / C-850

Vaccinations are the most important pillar of health care for children worldwide. The number of recommended vaccinations has increased since the 1990s, also in Germany. Some parents fear that their children could be weakened by the many recommended vaccinations and that they have an increased risk of becoming infected with pathogens that have not been vaccinated. A large “nested” case control study in the USA has addressed this issue.

The cohort consisted of 495,193 children from 6 US health networks whose data was collected between 2003 and 2013. There were 47 061 infectious diseases caused by pathogens that were not vaccinated against (non-vaccine-targeted infections), of which 193 were found in children between 24 and 47 months. Those were the "cases". They were matched 1: 4 with non-cases (no non-vaccine-targeted infections) that were comparable in the other relevant parameters (n = 751). The mean age of the entire group (n = 944) was 32.5 months. The aim was to estimate the likelihood of non-vaccine-targeted infections in relation to the antigen doses administered.

During the first 24 months of life, the children in the case group had received an average of 240.6 antigen doses and in the control group 242.9 antigen doses. The difference was +2.3 antigen doses (control vs. cases; p = 0.55; not significant).

Conclusion: In children aged 24 and 47 months, the risk of infections caused by pathogens that are not part of vaccines does not increase as a result of increasing exposure to vaccine antigens. The vaccinations do not interfere with the immune system's ability to fight off pathogens effectively. "The concern that the many childhood vaccinations ultimately lead to a weakening of the immune system and thus more frequent infections is unfounded," commented Prof. Dr. med. Johannes Hübner, 1st chairman of the German Society for Pediatric Infectious Diseases, Department for Pediatric Infectious Diseases, Dr. von Hauner's Children's Hospital, Ludwig Maximilians University, Munich. “This is shown by this extensive and methodologically very good current study from the USA. The results can easily be transferred to the German situation; the vaccination plans are similar. The study confirms that vaccinations do not lead to more infections, as those who oppose vaccinations often claim. "

Dr. rer. nat. Nicola Siegmund-Schultze

Original work:

Glanz JM, Newcomer SR, Daley MF, et al .: Association between estimated cumulative vaccine antigen exposure through the first 23 months of life and non-vaccine-targeted infections from 24 through 47 months of age. JAMA 2018; 319: 906-13.

This flyer is intended to help you as a parent or as a teenager to better understand the necessity of the HPV vaccination. In the summer of 2018, the STIKO (Standing Vaccination Commission for Germany) expanded its vaccination recommendation for HPV vaccination and now recommends this vaccination not only (as before) for girls, but for all children and adolescents from 9-14 years of age.
Missing vaccinations should be made up for before the 18th birthday at the latest. According to the decision of the Federal Joint Committee (G-BA) and publication in the Federal Gazette, the costs for this vaccination are covered by all health insurances.

What does HPV mean?

»HPV stands for Human Papilloma Virus. HPV infections are among the most common sexually transmitted infections worldwide. A distinction is made between high-risk and low-risk types for HPV, whereby persistent infections with high-risk types can in rare cases lead to different types of cancer (cervical cancer, vaginal cancer, anal cancer, penile cancer, tongue / throat / throat cancer).

»There are currently 12 high-risk HPV types classified as carcinogenic, with type 16 playing a dominant role. The low-risk HPV types can trigger genital warts.

How many cases are there in Germany?

»In Germany, despite a long-standing early detection program, around 4,600 women develop cervical cancer every year and around 1,600 die from it every year.

»Approx. 1,750 men and women develop anal cancer every year, around 400 die from it.

»About 850 people of both sexes develop cancer of the oral cavity or throat caused by HPV every year, with a death rate of 50%.

»Around 750 men develop penile cancer each year, of which around 170 die

How does HPV develop into cancer?

“It is now scientifically proven that almost all cervical cancer cases are due to HPV. With the others mentioned
So far, science has assumed that at least half of all cancers are caused by HPV.

»The infection with HPV usually takes place in the first years of sexual activity through direct contact with the skin and mucous membrane of the vagina, uterine neck, anal region or mouth. The infection occurs in around 80% of all men and women, regardless of their sexual orientation.

»In the vast majority of infections, this goes unnoticed and heals within 1 to 2 years without any consequences. During this time, the affected persons
at times contagious to their sexual partners.

“In a few cases, however, the infection does not heal and can lead to the respective types of cancer in a gradual process via various preliminary stages. The-
This process often takes many years and often goes unnoticed. With the existing gynecological cancer early detection program, some of these disease courses can be discovered and stopped, and often also cured. If the disease is detected at a late stage, the therapy is usually associated with risky surgical interventions.

And what is the HPV vaccination for?

»The HPV vaccination helps the vaccinated adolescents to achieve long-lasting immune protection against the HPV virus types on the skin and mucous membranes represented in the vaccines, so that after sexual contact with an HPV-infected partner they do not become infected with these HPVs Types and thus a significantly reduced risk of later cancer.

“It therefore makes sense and is most effective to vaccinate children against HPV, before starting sexual activity. The more young people are vaccinated, the less the HPV infection can spread later.

»The effectiveness of the HPV vaccination has been carefully examined both before the introduction of the vaccine (2007) and since then. Around 300 million vaccine doses have now been vaccinated worldwide. Due to the long period between an HPV infection and the development of an HPV-associated carcinoma, the number of prevented HPV-related cancer cases cannot yet be reliably measured. So far, however, all studies on the effectiveness of the vaccine against persistent HPV infections or against precancerous stages caused by HPV in cervical cancer show that the vaccines available are very effective.

Are there any side effects?

»The safety of HPV vaccines with regard to side effects, complications and vaccine damage has been checked worldwide since the introduction of this vaccination. The Vaccine Safety Commission of the World Health Organization (GACVS, Global Advisory Committee on Vaccine Safety) last approved the HPV vaccination in 2017 after more
than 270 million vaccinated doses worldwide. Like numerous national approval authorities, it comes to the conclusion that the HPV vaccines are very safe and classifies the possible side effects (pain, swelling, redness at the vaccination site, mild feeling of illness for 1-3 days) or complications (circulatory problems up to Fainting immediately after vaccination) as acceptable. These side effects are rare, last for a short time and heal completely. The risk of a life-threatening allergic reaction is no greater than with other vaccinations (approx. 1 case in 1.7 million vaccinations).

Who is not vaccinated?

»Vaccinations can be given for mild illnesses without a high fever. For more severe illnesses that require treatment, the best time to vaccinate should be with your
Pediatrician should be discussed.

»Children or adolescents who have already reacted to another vaccination with clearly allergic symptoms should only be vaccinated after consulting their pediatrician.

What vaccines are available?

»There are currently 2 vaccines: Cervarix® protects directly against HPV high-risk types 16 and 18 and indirectly against some rarer high-risk types, Cervarix® achieves protection against approx. 80% of HPV high-risk types. Gardasil9® protects directly against the HPV high-risk types 16, 18, 31, 33, 45, 51 and 58, thus against approx. 85% of the HPV high-risk types as well as the low-risk types 6 and 11.

Who should be vaccinated?

“So far only the girls have been vaccinated. Now the recommendation has also been extended to boys. All children should be vaccinated at the age of 9-14 years, twice with an interval of 6 months. The vaccination series can easily be started with the early detection examination U11 (with 9-10 years) or the youth health examination J1 (with 12-14 years) at your pediatrician. If vaccination is not started until the age of 15, a total of three vaccinations are required.

Who pays for the vaccination?

»Statutory and private health insurance reimburses the HPV vaccination up to the 18th birthday (after publication in the Federal Gazette).

Additional information on the Internet:

www.impfen-info.de
www.kinderaerzteimnetz.de/impfen

Authors:

Dr. Martin Terhardt, pediatrician, member of STIKO, Berlin

Dr. Thomas Fischbach, pediatrician, president of the professional association of paediatricians, Cologne

Status: October 2018

This page is a copy of the “Vaccination protection for the whole family” page of the Federal Center for Health Education

This page is a copy of the page “Vaccinations - 20 Objections and Answers from the Robert Koch Institute and the Paul Ehrlich Institute

Preface

The number of vaccinations is increasing - but are we getting healthier as a result? The question has been discussed again and again, by no means only in recent years. When the smallpox vaccination for children was made compulsory by the Reich Vaccination Act of 1874, the debate turned over and critics founded magazines such as “Der Impfgegner” in order to make their arguments heard.

Even today, the discussion often revolves around vaccinations for children and the question of whether the injection syringe is doing them more harm than good. Are vaccinations dangerous? Or just superfluous? What role do profit interests in the pharmaceutical industry play?

One thing is clear: Vaccinations differ from other medical interventions. On the one hand, they aim not only at the benefit of the individual but also at the protection of the entire population. On the other hand, they are carried out on healthy people. It is justified to demand special care when vaccinating and to discuss controversial points critically - not least because vaccinations are one of the most common medical measures.

In 2005, around 44 million vaccine doses were sold in Germany. About half of this was accounted for by the annual flu vaccination, and another large proportion by vaccinations for children. In 2005, more than 90 percent of those starting school were vaccinated against diphtheria, tetanus, whooping cough, polio, the Haemophilus influenzae bacterium and at least once against measles. Around 85 percent had also received the hepatitis B vaccine recommended for infants since the mid-1990s.

In Germany, however, there is no compulsory vaccination, unlike in the former GDR, for example. Anyone can refuse a vaccination for themselves or their children without giving a reason. And those who see themselves as opponents or critics of vaccination do so from time to time. Your most frequent objections, 20 in number, are listed here. The answers should help to get an idea of ​​the benefits of vaccination.

1. The effectiveness of vaccinations has never been proven

The effectiveness of vaccinations has never been proven
Actually, there shouldn't be any commercially available vaccines - if this thesis were actually true. Because according to the current pharmaceutical law, a vaccine is only approved if it has been proven that it actually works. The manufacturer must provide evidence in experimental and clinical studies. The scientific evidence is checked at EU level under the direction of the European Medicines Agency EMEA, in this country responsibility lies with the Paul Ehrlich Institute as the Federal Office for Sera and Vaccines.
That's the legal side. The practical test is probably even more important. With many vaccines, for example, it is easy to understand that with the start of routine use, the relevant infectious disease was significantly reduced. A well-known example of this is the introduction of oral vaccination at the beginning of the sixties: while in the Federal Republic of Germany in 1961 almost 4,700 children were diagnosed with poliomyelitis, there were already fewer than 50 in 1965. After this success, there was no longer any accumulation of polio in Germany given (see also answer number 17).
The vaccination against the bacterium Haemophilus influenzae (type b), which can cause severe meningitis in infants and young children, was equally effective. In the former GDR, where the number of infections was recorded very precisely, around 100 to 120 such meningitis occurred in the years before reunification. When the Haemophilus vaccination was introduced in Germany in 1990, the annual number of cases in the new federal states quickly decimated to less than ten.

2. None of the alleged pathogenic pathogens has been seen, isolated and proven to exist so far

No vaccination without pathogens - that is a kind of basic law of microbiology. Vaccines are obtained on the basis of weakened and dead germs or their molecular components. Sometimes closely related strains are also used. In this way, the body's immune system can be prepared for the real illness. Without specific knowledge about the pathogen, however, no systematic vaccine development would have been possible.
Robert Koch created decisive methodological foundations for bacteriological research. These include the development of solid culture media for breeding bacteria and the introduction of microphotography, which contributed significantly to the spread of bacteriology in medical science. As a district physicist, he discovered anthrax spores, the dormant form of the pathogen, in 1876 and thus explained the chain of infection, which was not understood until then, and the bacterium's high resistance to environmental factors. Robert Koch was the first to prove the connection between a microorganism and the cause of an infectious disease.
Viruses, on the other hand, could not be visualized for a long time because they are too small for visualization in a light microscope. The physical limits of light microscopy were clearly shown here.
Due to the development of electron microscopy in the 20th century, which allows a much higher resolution than light microscopy, detailed images of numerous viruses are now available. In many cases, the genetic code of the germs is also known.
This knowledge is used, for example, for the genetic engineering of the hepatitis B vaccine in yeast cells. The vaccine only consists of a specific surface molecule of the hepatitis virus, the so-called HBs antigen. In contrast, the production of flu vaccines is still much more traditional: the flu viruses are propagated in chicken eggs, then killed and processed into highly purified vaccines.

3. Vaccinations do not protect in the long term and have to be repeated constantly

Whether a vaccination has to be repeated or not varies greatly from case to case. If, for example, a child receives two combination injections against measles, mumps and rubella during the so-called primary immunization, it can be assumed that the immune protection will actually last a lifetime.
The situation is different with tetanus, diphtheria, polio or whooping cough. For these diseases, you can rely on the vaccination for five to ten years - after which it should be repeated. A flu vaccination offers even shorter protection: because the flu pathogen changes extremely quickly, people at risk have to refresh their immune protection every year with a newly composed vaccine.
The fact that the effect of a vaccine is limited in time does not mean that it is useless. An annual flu vaccination can prevent life-threatening courses of illness in chronically ill or old people. Immunization against tetanus every ten years also appears to be a minor effort in view of the sometimes fatal infection.
But even those who have survived an infectious disease are not necessarily permanently immune. Tetanus, diphtheria or whooping cough can affect you several times in your life. There are even some known cases in which a person got measles twice.

4. You can get sick despite being vaccinated

It is correct: not a single vaccination protects 100 percent of those vaccinated, just as no drug works for all patients. However, vaccinations can significantly reduce the likelihood of illness.
Imagine the following scenario: a measles epidemic occurs in a primary school. Half of the children are vaccinated and half are not. From a purely statistical point of view, it would be expected that around 97 to 98 percent of students without immune protection would fall ill - but only two to three percent of those vaccinated.
With the flu vaccination, however, the effect is less good. Depending on age and state of health, it protects 50 to 90 percent of those vaccinated against flu, with the vaccination usually having the worst effect on the elderly.
Even if a necessary booster vaccination was not carried out in time or the immune protection has not yet fully developed, the effect of a vaccination often remains incomplete. The classic children's vaccinations must first be repeated several times according to a time-regulated scheme before one can count on a reliable and permanent protective effect.
In addition, there are vaccinations that only prevent particularly severe disease courses. This is the case with the so-called BCG vaccination against tuberculosis, which was carried out as standard in infants in this country until the end of the 1990s, but has since been abandoned as a standard vaccination due to the comparatively low probability of the disease. The vaccination did not protect the children from tuberculosis per se - but from their worst complications involving the whole body and brain.

5. Going through illness is important for the normal development of the child and provides better protection than vaccination

So far there are no scientific studies that would show that unvaccinated children develop mentally or physically better than vaccinated children. This would also not be plausible.
Vaccinations are directed against around a dozen particularly notorious and dangerous pathogens - the immune system has to deal with hundreds more every day. The vaccination itself is also a stimulus for the immune system and trains the immune system. Accordingly, it would be extremely surprising if vaccinated children generally had a weaker constitution or permanently had fewer immune systems. There is no evidence to support this thesis.
In addition, even if one might ascribe a positive value to some illness experiences, there is no question that infections can also set children back in their development and cause health complications and even death. This is exactly what can often be avoided with vaccinations.

6. We parents went through these infectious diseases and got through well

It is true that many infections heal without consequences. However, so-called teething troubles can also be very drastic in certain cases. Childhood disease does not mean that the disease is harmless, but that it tends to occur in childhood. The best example is measles: about 1 in 1,000 children who develop measles develop an inflammation of the brain, the so-called measles encephalitis. This often leads to permanent brain damage or is even fatal.
In about one in a million cases, such encephalitis also occurs after vaccination - this is a thousand times less common than with the disease. The febrile seizures, which are quite common in measles, can also be largely avoided with a vaccination syringe. While the cramps affect about one in 15 measles sufferers, only one in 100 vaccinated people suffers from it.
The same applies to childhood illnesses such as mumps or rubella. When mumps occurs in young men, it can cause testicular inflammation with fertility problems. Rubella, on the other hand, can cause serious malformations in the unborn child in pregnant women who are not immune to the disease. Both consequences of the disease can be prevented in practically all cases by vaccination.
Finally, there was also the fact that in the past there was no vaccination for many diseases, just as there used to be no seatbelt in the car, no motorcycle helmet or no protective bicycle helmet. Today all these protection options exist and they are gladly used.

7. A baby also gets antibodies with breast milk, this natural protection is enough

In fact, the pregnant woman transfers antibodies to the unborn child via the bloodstream. With the breast milk, the infant then receives further antibodies. This so-called nest protection is a crucial support for the developing child's immune system, especially in the first months of life - but it is not comprehensive. Since these antibodies are broken down very quickly, the child lacks any protection as soon as the mother stops breastfeeding.
The mother can pass on antibodies against diseases that she has gone through or against which she has been vaccinated. With certain infections such as Whooping cough, however, the immune system does not produce any transmissible antibodies even in the event of illness - the baby is therefore in no way protected against these diseases. It is also known that nest protection is less developed, especially in premature babies, who therefore benefit from vaccinations.
In any case, nest protection and vaccination do not have to conflict with each other; in some cases they rather complement each other. Swedish paediatricians have found that breastfed children are less likely to develop severe meningitis caused by the bacterium Haemophilus influenzae type b (Hib) and that they also develop more antibodies against the germ after an Hib vaccination. However, meningitis can almost always be avoided only with a completed vaccination.

8. Women who have had an illness themselves give their newborn children more antibodies against infections than vaccinated mothers

This has been shown to be the case for measles, mumps and rubella. A vaccination against these diseases stimulates the mother's immune system less strongly than a wild virus infection, which is why there are fewer maternal antibodies in the infants. For this reason, pediatricians generally carry out the first vaccination against measles, mumps and rubella a little earlier than they did 20 years ago.
However, this relationship does not apply to some other infections. Since the maternal immune system does not produce any transmissible antibodies in the case of whooping cough infection, for example, the baby does not enjoy nest protection either. Rather, it is known that adults can become infected with whooping cough several times in their lives and the germs can then often pass unnoticed to their children. According to a 2007 US study, parents and close relatives are by far the most common source of infection when an infant develops whooping cough. The Standing Vaccination Commission at the Robert Koch Institute therefore recommends immunization of the contact persons before the child is born.
For other diseases such as Tetanus or diphtheria is a nest protection in newborns of vaccinated mothers, which is not detectable in newborns of mothers who have gone through an infection.

9. Too early vaccinations expose children to avoidable risks

Certain infections affect infants much more severely than older children - this is a major reason why babies are vaccinated against various diseases after they are two months old. Classic examples are infections with the Haemophilus influenzae bacterium and whooping cough. With whooping cough, complications such as pneumonia or respiratory arrest occur in around 25 percent of cases if the child is younger than six months. After that, the complication rate drops to around five percent. An infant therefore benefits particularly from a whooping cough vaccination.
Even the first dose of vaccine at two months old can reduce the likelihood that an infant will have to be hospitalized for whooping cough by around two thirds. The repetitive vaccination during the first year of life completes the whooping cough protection.
It has not been proven that infants generally tolerate vaccinations worse than older children. In extremely premature babies born before the 32nd week of pregnancy, heart and lung function should be monitored after certain vaccinations in order to quickly identify any vaccination complications. On the other hand, however, premature babies are also more susceptible to infections - the risk-benefit ratio is therefore also positive here for the vaccines.
However, by no means all vaccines are administered in infancy. Immunization against measles, mumps and rubella, as well as against particular pathogens causing meningitis - so-called meningococci - does not take place until around the age of one.

10. Due to the many vaccinations and multiple vaccines, the immune system of the small child is overloaded

It is true that children are now vaccinated against more diseases than in the past. The number of foreign molecules transferred in the process, the so-called antigens, has nevertheless decreased significantly. The old whooping cough vaccine alone contained around 3,000 such molecular foreign substances. In all current vaccinations taken together, however, there are only 150 antigens. The reason for this is that modern vaccines are highly purified and mostly only contain individual components of the pathogen. In fact, the child's immune system has to deal with a much larger amount of foreign molecules every day than is the case with vaccinations.
There is also no evidence that multiple vaccines would overload the immune system. It is known, however, that certain components of the combination vaccinations stimulate the immune system less than if they were given alone, which is why, for example, four instead of three injection syringes may be necessary. The bottom line, however, is that multiple vaccines can significantly reduce the number of syringes required.
Up to six vaccines - against tetanus, diphtheria, whooping cough, Haemophilus influenzae, polio and hepatitis B - can now be combined in a single vaccine. A frequent criticism of the six-fold vaccination is that hepatitis B is predominantly - if by no means exclusively - transmitted through sexual intercourse and the likelihood of illness in an infant is low. However, hepatitis B disease in infants is almost always very severe and becomes chronic in 90% of cases. In addition, pragmatic considerations also come into play when vaccinating infants with hepatitis. It is known that the vaccination rates for adolescents are low, but that a hepatitis B infection can lead to a serious illness and, if it is chronic, can even trigger liver cancer. This is why the Standing Vaccination Commission at the Robert Koch Institute and the World Health Organization (WHO) recommend immunization against hepatitis B in children. According to current knowledge, long-term, possibly even lifelong protection could be achieved for the majority of those vaccinated.

11. Vaccinations cause the diseases they are designed to protect against

Certain vaccines can actually cause disease-like symptoms - but full-blown disease practically never develops. The best known example are the "vaccine measles". Since the measles vaccine contains a weakened but still living measles virus, around five percent of those vaccinated develop a measles-like rash after about a week. However, middle ear infections or pneumonia, which may be associated with the actual infection, do not occur. The dreaded inflammation of the brain, measles encephalitis, is an absolute rarity after the vaccination: it affects about one in a million people who are vaccinated, whereas every thousandth child is affected with real measles.
In this country, cases in which polio occurred due to an oral vaccination have become historic. The live vaccine that helped reduce poliomyelitis on a large scale caused a few infections of its own every year. Since 1998, however, a polio vaccine has been administered by syringe in Germany that does not contain any live viruses and cannot cause the disease. Many vaccines consist of killed pathogens or, like the flu vaccines, from components of pathogens, only very few contain weakened, living pathogens.
Quite apart from these connections, vaccinations sometimes lead to fever, nausea or sleepiness as well as swelling and redness at the injection site. However, these are general, usually quickly subsiding reactions of the organism. They have nothing to do with the infectious disease that is being vaccinated against.

12. Vaccinations promote allergies

One thing is certain: these days there are more vaccinations - and more allergies. However, it has not been proven whether one is related to the other. Swedish doctors had shown a few years ago that children from anthroposophically oriented families are less prone to eczema. In fact, these children were not vaccinated as often. But they were also given antibiotics less often, had different diets, and their parents smoked less. In another study, American allergists found that parents who refuse vaccinations are less likely to see asthma or hay fever in their children. But even in this study it remained unclear whether there really was a causal connection.
Many other studies speak against such a connection. An analysis by Rotterdam doctors, for example, who evaluated all of the specialist articles published on the subject between 1966 and 2003, showed that the methodologically more reliable studies in particular did not reveal an increased risk of allergies.
An experience in this country also points in this direction: In the former GDR, where vaccination was mandatory and almost all children were vaccinated, there were hardly any allergies. They only increased in East Germany after reunification, while vaccination rates fell at the same time.

13. The side effects and risks of vaccinations are incalculable

The assumptions are numerous: In the past few years there has been a lot of argument about whether autism, diabetes or even multiple sclerosis could be triggered by vaccinations. However, there is still no evidence of this, but there are numerous studies that speak against it. For example, at the end of the 1990s a group of British scientists hypothesized that the measles, mumps and rubella vaccination could lead to damage in the intestine and thus to the penetration of neurotoxic substances into the organism. This hampers mental development and promotes autism. In the meantime, however, several studies have invalidated the thesis - ten of the original 13 authors officially withdrew their interpretation.
However, it is undisputed that vaccines have side effects. In 2005 a total of around 44 million vaccine doses were sold in Germany, around half of which was for the annual flu vaccination. In the same period, doctors and pharmaceutical manufacturers reported almost 1,400 suspected vaccination complications - this corresponds to a rate of around three suspected cases per 100,000 doses sold. As a detailed analysis of all suspected complications by the Paul Ehrlich Institute showed, there was no evidence of a possible causal relationship with the vaccination in almost a third of the reported cases. In addition, a large part of the health disorders reported - for example high fever - were of a temporary nature. A permanent health impairment, which might have been caused by the vaccination, was reported in only five vaccinated persons. In the case of an adult who died after the vaccination, a causal link with the vaccination could not be ruled out.
Indeed, this is a major difficulty in risk assessment: Vaccinations are so common that many health disorders can happen quite randomly after immunization. A real connection does not have to exist. A few years ago, for example, the assumption was discussed that cot death could be promoted by vaccinations, since in a number of cases children died shortly after immunization. Studies now point in the other direction. In an extensive analysis of a good 300 child deaths recently, doctors from the University of Magdeburg found that the babies who had died had been vaccinated less often and later than usual.

14. Vaccines contain dangerous chemicals that are knowingly used to poison children

Some vaccines contain formaldehyde, aluminum, phenol or mercury - but in extremely low concentrations (below the toxicological limit values). The substances are used, for example, to kill vaccine viruses (formaldehyde), to strengthen the immune response (aluminum hydroxide) or to make the vaccine durable (phenol).
A few years ago, two American doctors suggested that the increase in autism cases registered in the USA was related to the mercury-containing preservative thiomersal in some vaccines. The World Health Organization WHO, the US “Institute of Medicine” and the European Medicines Agency EMEA have come to the conclusion independently of one another that the available studies speak against such a connection.
Nonetheless, the pharmaceutical manufacturers have reacted to the heated debate: Mercury-free vaccines are now available for all generally recommended vaccinations.

15. The production of vaccines can lead to contamination that is responsible for diseases such as BSE and AIDS

It is true that, for example, when cultivating some vaccine viruses, the serum of calves is necessary as a nutrient medium for the corresponding cell cultures. However, only certified products from BSE-free countries such as New Zealand may be used.
The controls for certain protein components, so-called human albumin, from the plasma of blood donors are similarly strict. In some cases, these proteins serve to stabilize live vaccines and make them more durable. Plasma products are systematically tested for the pathogens so that there is no transmission of HIV or hepatitis viruses. In the further course of production, there are processes that kill any undetected viruses.

16. There are doctors who advise against vaccinating

Few doctors are completely against vaccination. However, there are indeed some who take a critical stance towards individual vaccinations - which does not necessarily mean that there are good scientific reasons for this. Personal experiences, religious or philosophical convictions also play an important role.
However, an alternative medicine orientation does not have to contradict the idea of ​​vaccination protection. A few years ago, Freiburg researchers found in a survey of more than 200 homeopathically oriented doctors that they administer the "classic" vaccinations against tetanus, diphtheria and polio almost as often as their purely conventional medicine colleagues. However, the homeopaths were more cautious about other immunizations.
The German Central Association of Homeopathic Doctors (DZVhÄ) emphasized in a statement from 2002 that a discussion about the benefits and disadvantages of vaccinations is perfectly legitimate and the decision for or against it must be made individually. At the same time, however, the DZVhÄ reaffirmed the importance of the Standing Vaccination Commission at the Robert Koch Institute. Their recommendations are "carefully considered and take into account the current state of knowledge with the aim of fundamentally preventing the occurrence of many infectious diseases."

17. Most of the diseases that are vaccinated against no longer occur in Germany

Some infections such as polio or diphtheria have become a rarity in this country. However, this is already the result of vaccination programs. Falling vaccination rates would in principle also harbor the risk of new epidemics.
This is shown, for example, by outbreaks of poliomyelitis in 1978 and 1992 in Dutch communities where vaccinations were rejected due to religious reservations. In the first epidemic 110 people fell ill with polio, in the second 71 people. Far more dramatic were the waves of diphtheria in Russia and the other successor states of the USSR, where more than 150,000 people fell ill and more than 6,000 died as a result of falling vaccination rates in the 1990s. In the course of such epidemics, infections can also be brought into Germany through international travel. Polio still occurs, for example, in India and Egypt, where many holidaymakers also go.
But measles epidemics also occur again and again in Germany, most recently in North Rhine-Westphalia, where around 1,700 children fell ill in 2006. Overall, the measles rate in Germany is still high compared to other European countries. In addition, there are other germs such as the hepatitis B virus or certain pathogens of severe systemic inflammation in childhood - so-called pneumococci - which are practically constantly circulating in the population. When young children develop pneumococcal inflammation, they often need hospital treatment. Meanwhile, an extensive US study has shown that routine pneumococcal vaccination, which has also been recommended for infants in Germany for several years, can almost halve the number of hospital admissions.
A completely different type of vaccination has been on the program since the beginning of 2007: immunization against certain types of so-called human papillomaviruses in girls between the ages of 12 and 17. The viruses, which are often transmitted during sexual intercourse, can cause cervical cancer later in life. The new vaccine could prevent the majority of cases.

18. Vaccinations are superfluous as the diseases can be treated with antibiotics, for example

Today's treatment options are undoubtedly better than they used to be - but by no means random. Medicines are rarely used for viral infections, and antibiotics are not effective against viruses. And some bacterial diseases are also extremely difficult to treat. Among other things, tetanus infections, meningitis and whooping cough can be fatal even under modern treatment conditions.
In fact, vaccination and therapy are not opposing options, but part of the same chain of protection. Sometimes the vaccination does not prevent the infection, but it does prevent the most severe courses.

19. The decline in diseases is a result of improved hygiene and nutrition and has nothing to do with vaccinations

There is no question that prosperity and hygiene make a significant contribution to the prevention of infectious diseases. For example, the supply of clean drinking water and the establishment of good hand hygiene are essential for the prevention of hepatitis A, typhoid or cholera. However, there is no general connection between hygienic conditions and infectious diseases. For example, some pathogens such as measles, hepatitis B and polioviruses are only housed in the human organism and passed on from person to person, for example through sexual contact or coughing.
It is true that measles, for example, is often particularly severe in malnourished children. The actual likelihood of infection is directly related to how many children are vaccinated against measles. If the vaccination rate is around 95 percent, measles can be completely eradicated.
As a result of consistent vaccination programs, the entire South American subcontinent is practically measles-free. In sub-Saharan Africa, India and Southeast Asia, on the other hand, measles is still a common cause of death. In 1999, well over 800,000 children there died of measles. Large-scale vaccination campaigns that vaccinated over 360 million children in Africa and Asia have reduced the number of deaths to around 350,000 in 2005. In the long term, the World Health Organization is striving to eliminate measles worldwide.
Further efforts are also necessary in this country. It is true that vaccination rates have risen in recent years. But according to school entry examinations from 2005, over 90 percent of children received the first and around 75 percent also received the second measles vaccination. At least 95 percent are required for both vaccinations.

20. The pharmaceutical industry only wants to do business with vaccinations

Companies in other branches of industry also earn money with their products, that is the goal of all companies. However, lifelong medication for the chronically ill should be more profitable than vaccines, which are typically administered only a few times. The sales of the pharmaceutical industry are also often offset by considerable savings. In the old federal states, for example, at the time of oral vaccination, 90 marks were saved in therapy and rehabilitation costs for every mark that went into the vaccination. Today's vaccination against whooping cough reduces direct treatment costs by more than 200 million euros per year. For the now generally recommended vaccination against hepatitis B, it was calculated that, after initial additional costs for the health insurance companies, the burden on the health system would be relieved in the long term.

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