Vaccinations can protect children, teenagers and adults against diseases by preparing their immune system to fight certain viruses and other pathogens (germs). If the body then comes into contact with the pathogen, it can react quicker and fight it more effectively.
Some vaccinations – such as those against measles, mumps and rubella (German measles) – generally provide protection for the rest of your life. Others, like the tetanus vaccination, have to be given again roughly every 10 years in order to keep up the protection. These are known as booster shots.
Potential serious consequences of vaccinations (e.g. polio) are rare or almost non-existent nowadays. Vaccinations are also an important way to prevent the spread of highly infectious diseases such as measles. They can only have this effect (known as herd immunity) if most of the population has been vaccinated. One of the aims is to protect people who are at particular risk, such as babies or chronically ill people who can't (yet) have the vaccination. In some cases vaccinations have completely – or almost completely – eradicated certain diseases, such as smallpox.
Vaccinations can have side effects. But they are usually only temporary reactions such as skin redness, swelling, muscle ache, headache, joint pain or fever. Although this can be unpleasant, they are usually totally normal reactions: They are a sign that the body's immune system has been activated so that it can provide the desired protection. In very rare cases, vaccinations can lead to serious side effects such as an allergic reaction. But vaccinations are only introduced if their benefits outweigh the potential harms of side effects.
This article describes the vaccinations that are currently recommended in Germany by the Standing Committee on Vaccination (STIKO) at the Robert Koch Institute (RKI), and also paid for by German statutory health insurers. You will find an overview of all vaccinations in the immunization schedule provided by the Robert Koch Institute.
A tetanus infection leads to severe, painful muscle spasms in one or more parts of the body. There is often cramping in the muscles of the face and jaw, so it’s no longer possible to open your mouth properly. The muscles in the back may become so stiff that your spine arches backwards. If the breathing muscles are affected, it could result in breathing difficulties or even suffocation.
Tetanus is caused by bacteria that live in soil. They can get into the body through small cuts, scrapes or puncture wounds (for instance, caused by a splinter). The symptoms usually start between three days and three weeks after becoming infected.
The tetanus vaccine is part of the 6-in-1 vaccine that babies are given in their first year of life. This combined vaccine protects them against 6 diseases: tetanus, diphtheria, whooping cough (pertussis), polio, hepatitis B and hemophilus influenzae type b (Hib). Four doses of the vaccine are given in total.
In Germany, the Standing Committee on Vaccination recommends the following schedule for the 6-in-1 vaccination:
- First dose at the age of 2 months
- Second dose at 3 months
- Third dose at 4 months
- Fourth (final) dose between 11 and 14 months
The first tetanus booster shot is given at the age of 5 or 6 years, and the second is given between the ages of 9 and 16 years. People are advised to have a booster shot every ten years after that.
Diphtheria leads to an inflammation of the upper airways (nose and throat). The throat may become so swollen that it’s hard to breathe and there’s a risk of suffocation. Other possible consequences of the infection are heart problems, paralysis and skin ulcers.
The first symptoms are a sore throat, fever and difficulty swallowing. This is followed by a cough, hoarse voice and swollen lymph nodes in the neck.
Diphtheria is caused by bacteria. It is usually spread through tiny drops of saliva (spit), for instance when you sneeze or kiss someone. The bacteria can also get into wounds through saliva. The symptoms usually first arise two to five days after being infected.
Diphtheria is also part of the 6-in-1 vaccination (for the vaccination schedule, look at the tetanus vaccine information above). The first booster shot is given at the age of 5 or 6 years, and the second one is given between the ages of 9 and 16 years. Adults are advised to have booster shots every ten years.
Whooping cough (pertussis)
The main symptom of whooping cough is severe bouts of coughing, mostly at night. The disease lasts several weeks or months and can be very distressing. In rare cases people may die of it. Flu-like symptoms develop at first. Possible complications include pneumonia (a lung infection) and a middle ear infection. The illness may result in permanent damage to the airways.
Whooping cough is caused by bacteria and is spread through tiny drops of saliva (spit). The symptoms start about one to three weeks after infection.
As part of the 6-in-1 vaccine, the whooping cough vaccine is given four times (for the vaccination schedule, look at the tetanus vaccine information above). The first booster shot is given at the age of 5 or 6 years, and the second one is given between the ages of 9 and 16 years. Adults are advised to have a booster shot every ten years.
Polio usually doesn't cause any symptoms. It sometimes leads to flu-like symptoms such as a fever, headache and sore throat. But in rare cases it can result in severe, permanent paralysis – particularly in the arms and legs.
Polio is caused by viruses. These viruses leave the body in the stool (poo) of infected people when they go to the toilet, and might then get on to their hands and spread to others in that way. But you can also catch it through contaminated drinking water. The first symptoms occur about 3 to 35 days after being infected. Most people around the world have now been vaccinated against polio. So it now only rarely occurs, in poorer countries.
The polio vaccine is given four times as part of the 6-in-1 vaccine (for the vaccination schedule, look at the tetanus vaccine information above). A booster shot is given once , between the age of 9 and 16 years.
In hepatitis B, the liver becomes inflamed. This can lead to a fever, headache, joint pain, nausea and vomiting. Some people’s skin turns a yellow color. Hepatitis B usually affects teenagers and adults. If the infection doesn’t clear up completely, it can lead to liver damage or sometimes even liver failure.
Hepatitis B viruses are spread through bodily fluids such as blood, saliva (spit), urine (pee) or sperm – for instance, during sex or when using contaminated syringes. The first symptoms arise about one to six months after infection.
As part of the 6-in-1 vaccine, the hepatitis B vaccine is given four times (for the vaccination schedule, look at the tetanus vaccine information above). No booster shot is needed.
Hib (hemophilus influenzae type b)
Hib is a severe infection of the upper airways (nose and throat) that mainly affects children under 6 years old. The possible complications include life-threatening infections such as meningitis (inflammation of the membranes covering the brain and spinal cord), pneumonia (lung infection) and epiglottitis (inflammation of the flap that covers the entrance to the windpipe). Hib can also lead to blood poisoning (sepsis).
Hib is caused by bacteria and spread through droplets of saliva (spit). The symptoms start about two to five days after infection.
The Hib vaccine is part of the 6-in-1 vaccine, which is given in four doses (for the vaccination schedule, look at the tetanus vaccine information above). No booster shot is needed.
Pneumococci can lead to inflammation of the lungs, middle ear or sinuses (hollow spaces near the nose), and sometimes the meninges too (the membranes around the brain and spinal cord).
Pneumococci are bacteria that are spread through droplets of saliva (spit).
In Germany, the Standing Committee on Vaccination recommends the following vaccination schedule:
- First dose at the age of 2 months
- Second dose at 4 months
- Third (final) dose between 11 and 14 months.
No booster shot is needed.
The pneumococcal vaccine is also recommended for everyone over 60 years of age who hasn't yet had the vaccine.
Rotaviruses cause belly ache, watery diarrhea and violent vomiting. Children who become infected lose a lot of fluid and sometimes have to be treated in a hospital as a result.
Rotaviruses infect the digestive tract, are found in the stool (poo) of infected people and can then be spread to others through hand-to-mouth contact. But they can also be spread through contaminated objects, food or drinking water. The symptoms start about one to three days after being infected.
This vaccine is given by mouth (an oral vaccine). The first dose is given around the age of six months. Depending on the vaccine used, one or two more doses are given at least four weeks apart after that.
Type C meningococcal disease
Meningococci can lead to meningitis or blood poisoning (sepsis). The infection mainly occurs in young children and teenagers.
Meningococci are bacteria that are spread through small droplets of saliva (spit) and fluids from the nose or throat. They can’t live for long outside of the body so they are only spread through close physical contact. It usually only takes a few days for the symptoms to start after infection.
The vaccine is given once in the second year of life. This provides permanent protection.
At first, measles causes flu-like symptoms such as a fever, headache and joint pain. After a few days a rash appears on the face and then spreads across the rest of the body. The possible complications include middle ear infections and pneumonia (a lung infection).
About 1 out of 1,000 people who have measles develop encephalitis – a potentially life-threatening inflammation of the brain that can lead to long-term problems. In rarer cases, a severe form of encephalitis known as subacute sclerosing panencephalitis (SSPE) develops years after having the measles. This is always fatal.
Measles viruses are spread through small droplets of saliva (spit) and fluids from the nose or throat. The symptoms start about two weeks after infection.
The measles vaccine is given together with those against mumps and rubella in a combined vaccine known as the MMR vaccine. Sometimes these three vaccines are given together with the chickenpox vaccine instead (the MMRV vaccine). The first dose is given at the age of 11 months, and the second dose is given at 15 months.
Since the beginning of March 2020, people in Germany are sometimes obliged to prove that they have immunity to (protection against) measles. Before being allowed to go to a daycare center, school or other community facility, all children aged 1 and over have to prove that they have been vaccinated against measles or are immune to it. Immunity can be proven through a blood test to look for antibodies. This obligation also applies to people who work at these facilities and were born after 1970. Proof can be provided in the form of vaccination records, the child's health record booklet (“U-Heft” in Germany) or a medical certificate.
The measles vaccination is also recommended for everyone who was born after 1970, hasn’t had the measles vaccine, doesn’t know whether they have had it, or only received one dose of the vaccine in childhood.
At first, mumps causes flu-like symptoms such as a fever, cough or headache. In many cases, salivary glands (saliva-producing glands) known as parotid glands also become inflamed on one or both sides of the face. This leads to the typical painful swelling of the cheeks. The possible complications include meningitis (inflammation of the membranes covering the brain and spinal cord) and – in rarer cases – inflammation of the pancreas or hearing nerves. In older boys, mumps often causes an inflammation in the testicles.
Mumps is caused by a virus and is usually spread through small droplets of saliva (spit). The symptoms start about two to three weeks after being infected.
The mumps vaccine is given together with those against the measles and rubella in a combined 3-in-1 vaccine known as the MMR vaccine. Depending on whether and which vaccines were previously given, it is also available in a 4-in-1 vaccine that includes the chickenpox vaccine too (the MMRV vaccine). Two doses of the mumps vaccine are given in total (see measles information).
Rubella (German measles)
Rubella (German measles) usually goes unnoticed or only causes mild cold-like symptoms, sometimes together with swollen lymph nodes, a fever and conjunctivitis (pink eye). That might be followed by a pink or red spotty skin rash that doesn’t itch.
The infection can be particularly dangerous in pregnant women because they might pass the virus on to their unborn child. Especially in the first four months of pregnancy, it can seriously harm the child – in most cases causing damage to their eyes, heart or inner ear. It can also lead to a miscarriage or premature birth.
Rubella viruses are spread through small droplets of saliva (spit). The symptoms start about two to three weeks after infection.
The rubella vaccine is given as part of the 3 in 1 MMR vaccine, together with the measles and mumps vaccines – sometimes together with the chickenpox vaccine too. Two doses of this combined vaccine are given in total (see measles information).
The vaccine is also recommended for women of childbearing age who haven’t yet had the rubella vaccine, or don't know if they have.
The first signs of chickenpox are a fever and exhaustion. An itchy skin rash develops next – usually on the face and torso at first, and later spreading to the scalp, arms and legs. The rash starts as small red spots and bumps, which then turn into fluid-filled blisters. Chickenpox usually doesn't lead to any complications. In rare cases only, it may cause pneumonia, meningitis or encephalitis. But it may eventually result in shingles later on in life. In very rare cases, the mother passes chickenpox on to her unborn child. But if she gets chickenpox just before or after the birth, there is a higher risk that she will pass it on and the child might become seriously ill.
Chickenpox viruses are mainly spread through small droplets of saliva (spit). The fluid that comes out of chickenpox blisters is contagious too. The symptoms usually start about two weeks after being infected.
The chickenpox vaccine is recommended for children from the age of 11 months, as well as for women who would like to have children – if they haven't yet been vaccinated against chickenpox and also haven't had the disease yet. It is also recommended for people who have severe eczema and haven't yet had chickenpox. The chickenpox vaccination consists of two injections given about four to six weeks apart.
The flu leads to a quite sudden fever, headache, cough and joint pain, and makes you feel very unwell. Rare complications include pneumonia (a lung infection), a middle ear infection or an inflammation of the heart muscle. This kind of “secondary infection” mainly happens in people who have a weakened immune system or a chronic disease.
Flu viruses are spread through small droplets of saliva (spit) and through secretions (fluids) from the nose or throat. The symptoms start about one to two days after infection.
The flu vaccine is recommended for people who are at greater risk of complications – for instance, because they already have other health problems such as asthma, heart disease or diabetes. Or because they have a weakened immune system. It is also recommended for over 60-year-olds, pregnant women and people who work in health care.
Flu viruses are constantly changing, so the vaccine doesn't provide permanent protection. As a result, if you want to have enough protection during the flu season you have to have a new vaccination every year. The flu vaccine is offered every year from the autumn onwards. It is only injected once. Children and teenagers can have the vaccine in the form of a nasal spray instead.
HPV (human papillomavirus)
Certain human papillomaviruses (HPV) increase the risk of developing cervical cancer, anal cancer or penile cancer (on the penis). Other types of HPV can cause genital warts.
The viruses infect the skin and mucous membranes in the genital area and are spread through sexual contact. Intimate skin-to-skin contact in that area is enough to pass the infection on. If the infection leads to cancer, it takes years or even decades until it develops.
The HPV vaccine is recommended for girls and boys between the ages of 9 and 14 years. It normally consists of two doses, given at least five months apart. In order to provide protection before their first sexual contact, it is recommended that these young people have the vaccine sooner rather than later. If they don't have the vaccine within the recommended age range, they should make sure that they have it by their 18th birthday at the latest.
Shingles (Herpes zoster)
Shingles can develop as a late complication of chickenpox. Both of these illnesses are caused by varicella-zoster viruses. These viruses stay dormant (inactive) in the body after a chickenpox infection. But they can become active again many years later and cause shingles (Herpes zoster). Shingles leads to a rash with blisters that usually forms a band across the skin on one side of the body and is often very painful.
In about 10 to 20 out of 100 people who have shingles, the pain lasts weeks, months or even years. This long-term pain is known as post-herpetic neuralgia. The main symptom is pain in the nerves (neuralgia). The skin is often overly sensitive and itchy as well.
The shingles vaccination is recommended for all people aged 60 and over, and for people aged 50 and over who already have certain other health problems. These include diabetes, chronic inflammatory bowel disease or a weakened immune system.
The vaccine consists of two doses that are given two to six months apart.
The vaccines that are recommended where you live will protect you from diseases that typically occur in your country. But if you travel overseas, they won’t cover other diseases that are found there. You can find out which vaccines are recommended for travel to other countries on the website of the Centers for Disease Control and Prevention. Many family doctor's practices offer personal consultations about travel-related health issues.
In Germany, the vaccinations that are paid for by statutory health insurance vary from insurer to insurer. So it’s a good idea to contact your insurer before having a travel vaccination to find out whether they will cover the costs or whether you have to pay for it yourself. If you are traveling for work, your employer might cover the vaccination costs.
Bundeszentrale für gesundheitliche Aufklärung (BZgA). Impfen-info.de.
Robert Koch-Institut (RKI). Impfungen A-Z.
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