Important vaccinations in adulthood

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We have known for some years that cervical cancer is an infectious disease. There are very many different viruses from the group of human papilloma viruses, which are primarily transmitted sexually.

Who is at risk?

At the age of 20 to 30 years about 60% of the population might have had contact with those viruses.

The viruses can integrate themselves into the cells of the cervix. Therefore they get rid of their outer cover and integrate into the cells genotype – at first to reproduce and spread. Sometimes these are inactive for a while but cause cancerous growth later on. That happens especially with the viruses of the high-risk group.

Vaccination against the infection

There are currently three different preparations with which we can vaccinate against HP viruses. The vaccination causes the formation of antibodies against HPV in the vaccinated person, namely against the outer shell of the viruses. The antibodies are located in the

Three medications exist which we can inoculate. The vaccination causes the production of antibodies against HPV, actually against the outer cover of the virus. The antibody will be located in the mucous membrane of the cervix and will destroy the viruses before they can integrate into the cells.

However, they do not have an effect on those viruses that already are integrated into the cells. That means the vaccination is only a protection for those who are not infected yet.

Studies have shown a significant success of vaccinating young women of the age from 9 to 26 who were HPV negative and had not had sexual intercourse before. A relevant decrease of cell changes in the years following the inoculation was observed.

The examination in order to take precaution of cervical cancer will still be necessary. Experts believe that your protection will be at about 70% if you are immunized before you had the first contact with the viruses. If the vaccination took place after the first sexual events there would still be a protection probably more than 30%.

9-fold vaccine fights most of the known viruses

Unfortunately, the currently available vaccines do not cover all existing viruses. However, since April 1, 2016, there is a new 9-way vaccine that covers most of the known viruses.

Useful vaccination

The HPV vaccine has been on the market since 2006. It is recommended for girls and boys.

Vaccinations take place over the course of six months:

• Two vaccinations are needed for girls and boys aged 9-14, as the immune response is stronger at this age.
• From the age of 15, three vaccinations are given.
• Repeat vaccinations for unvaccinated girls and boys up to age 18 are still available and are also covered by insurance.

Other groups for HPV vaccination

There is increasing evidence that vaccination is protective after therapy for dysplasia. There is also discussion of vaccinating young women after the age of 26, as well as men, because HPV-associated cell changes, e.g., in the oral mucosa, can also be detected in them.

For these groups of people, however, there is currently no general coverage by health insurance companies. However, unvaccinated women between the ages of 18 and 26 should contact their health insurance provider, as individual cost coverage can be requested in this age group.

Side effects of HPV vaccination

There has been much discussion about the side effects of HPV vaccination. As with other vaccinations, there are side effects: Pain at the injection site, redness, fatigue, mild joint pain, and headache. Mild and more severe allergies with respiratory distress and even shock with kidney failure are also possible.

But vaccine reactions do not occur to a greater extent with HPV vaccination than with other vaccinations. An association between vaccination and individual unexplained deaths that occurred in close temporal relation after vaccination could not be proven.

Overall, vaccination is currently recommended by the STIKO (Standing Commission on Vaccination) and the Joint Federal Committee of physicians and health insurers for 9- to 18-year-old girls and boys. There may even be a benefit at any age, especially when entering into a new partnership – but studies are still lacking on this.

Vaccination does not replace cell smear

Although vaccination serves as a preventive measure, it cannot replace a cell smear test. Therefore, cancer screening with the well-known cell smears from the cervix, which have been performed for years, is still necessary for the early detection of cell changes.

In order to minimize the risk of severe cases of seasonal influenza The German Standing Committee on  Vaccination Recommendations (STIKO) recommends the vaccination for all pregnant women. We can avoid severe complications of influenza like pneumonia, miscarriage or premature birth for the mother, as well as we can protect the child in the first year after delivery because the maternal antibodies will be transmitted via the placenta.

This vaccination is also recommended for all people older than 60 years in general, for patients with chronic diseases in any age group and for persons who are in contact with public or could infect newborns in their family (father/grandparents).

The health insurance providers in most cases cover the costs for the vaccination.

Women, who plan to become pregnant, as well as everyone, who takes care of the child later on, should check whether they are immune against pertussis (whooping cough).

Pertussis can take an untypical course and be misinterpreted since the symptoms seem similar to bronchitis. The survival chances for an infected newborn are low. That is why I recommend the booster inoculation when you plan to become pregnant. A combination vaccine exists that includes tetanus and pertussis.

Since April 2020 we also give this vaccination to the pregnant woman to booster the production of antibodies in the mother to transmit them to the unborn baby, so that the baby has a better protection in the first months after the birth.

I recommend a booster inoculation every 10 years.

TETANUS

Tetanus is a dangerous disease. Through the penetration of bacteria into, for example, a wound, the muscles will be paralyzed until respiratory paralysis results in the patient’s death. The vaccination has no side effects; therefore it should definitely be carried out.

The vaccination should always be administrated after a severe injury, if the last booster inoculation is more than five years ago. If the last vaccination is more than 10 years ago it might be necessary to have an active and passive vaccination carried out.

DIPHTHERIA

Diphtheria is a severe bacterial disease, which became nearly unknown in Germany since everyone was vaccinated against it. Unfortunately, travelers or people from other countries such as migrants from less developed countries have brought the disease back into Germany. That’s why you definitely need to repeat the vaccination.

An infection with rubella in the first three months of pregnancy can cause severe harm to the unborn child. Possible consequences are deafness and blindness, as well as mental handicaps of the child or even a miscarriage. Rubella has not such an impact on children and adults; therefore, the vaccination should protect the pregnant woman.

If you wish to become pregnant, we will check whether you need a booster inoculation.

A possible place where the risk of the infection is fairly high is the kindergarden. That is true for all infectious diseases and just one of many places where the risk of infections is high. The occurrence of measles and mumps has increased in the last years. Every year one person dies of measles in Germany. Mumps can also be lethal and boys can become unfertile through the infection if it occurs after puberty. Both diseases can cause meningitis.

An important question when you plan to become pregnant is whether you have already had chickenpox.

For all those, who did not have the chickenpox and that is especially true for those, who plan to become pregnant, a vaccination was invented. If you get in contact with chickenpox while you are pregnant and are not immune, an immunoglobulin will be administrated in order to prevent a negative impact on the child.

An important question in counseling for those planning to have children or at the latest prenatal care is: “Have you had chickenpox?”

For all adults who have not had chickenpox as a child, there is a vaccination that should be given in time before pregnancy if you wish to have children. In the event of contact with chickenpox and lack of immune protection in a pregnancy, an immunoglobulin can be given to prevent harm to the child.

Everyone, who is more than 60 years old, should get a vaccination against pneumonia. The immune system gets weaker especially after severe illnesses and when the person is getting older.

Many statutory health insurance institutes do cover the costs of those vaccinations, though you should check it first. Usually you will get a bill that you can submit to your health insurance.

POLIO

Polio is also known as poliomyelitis. It is a vaccination that is needed in certain areas.

HEPATITIS A AND B

Hepatitis B is transmitted through sexual intercourse worldwide! Hepatitis A is widely spread in southern Europe and is transmitted through contact with fecal matter (stool). A good combination vaccine exists.

RABIES

One should think about an anti-rabies inoculation if a trekking holiday in endangered areas is planned.

FSME

That vaccine protects you against diseases that are spread by ticks. The risk is high in southern Germany, as well as other specific areas.

TYPHUS/ENTERIC FEVER

You should think of protecting yourself against those diseases if you plan to travel to Africa or tropical areas. Please note: For the enteric fever vaccination you have to visit a certified contact point, e. g. the Robert-Koch-Institut in Frankfurt am Main.

You can also find further information on the website www.fit-for-travel.de.