Which vaccinations are recommended in Germany?

Because of vaccinations, some serious diseases like polio are rare or nearly non-existent nowadays. Certain diseases, such as smallpox, have been completely eradicated. 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. This protects people who are at particular risk, such as babies or chronically ill people who can't (yet) have the vaccination.

Vaccinations can have side effects. But they are usually only temporary reactions to the vaccination, 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.

The following vaccinations 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.

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). Three 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 4 months
• Third (final) dose at 11 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 causes inflammation of the upper airways (nose and throat). The throat may become so swollen that it becomes 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 first symptoms occur about 2 to 5 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.

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. It is spread through tiny drops of saliva (spit), for instance when you sneeze or kiss someone. The first symptoms occur about 1 to 3 weeks after infection.

As part of the 6-in-1 vaccine, the whooping cough vaccine is given three 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.

A single booster shot is recommended for adults. The vaccination is also recommended for pregnant women.

People who have close contact with newborn babies and staff at institutions of public health and shared accommodation are advised to get the vaccination every 10 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 are vaccinated against polio, and the disease now only occurs in isolated incidents in poorer countries.

The polio vaccine is given three 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 occur about 1 to 6 months after being infected.

As part of the 6-in-1 vaccine, the hepatitis B vaccine is given three times (for the vaccination schedule, look at the tetanus vaccine information above). No booster shot is needed.

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. It is spread through tiny drops of saliva, for instance when you speak, cough or sneeze. The first symptoms occur about 2 to 5 days after being infected.

The Hib vaccine is part of the 6-in-1 vaccine, which is given in three doses (for the vaccination schedule, look at the tetanus vaccine information above). No booster shot is needed.

Pneumococci are bacteria that can be spread through tiny drops of saliva, for instance when you speak, cough or sneeze.

The bacteria 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).

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.

The pneumococcal vaccine is also recommended for everyone over 60 years of age.

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 first symptoms occur about 1 to 3 days after being infected.

This vaccine is given by mouth (an oral vaccine). The first dose is given at the age of about 6 weeks. Depending on the vaccine used, one or two more doses are given at least four weeks apart after that.

Meningococci are bacteria that can lead to meningitis ( inflammation of the membranes covering the brain and spinal cord) or septicemia (blood poisoning). It is most common in young children and teenagers.

Meningococci are spread through tiny drops of saliva, for instance when you speak, cough or sneeze. The bacteria can’t live for long outside of the body so they are only spread through close physical contact. The first symptoms usually start a few days after infection.

The vaccine is given once at the age of 12 months. 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, first on the face and then spreading to 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 very rare cases, a severe form of encephalitis with nervous system disease known as subacute sclerosing panencephalitis (SSPE) develops years after having the measles. This is always fatal.

Measles viruses are spread through small drops of saliva and fluids from the nose or throat that may be released when we speak, cough or sneeze. 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 it is given together with the mumps, rubella and chickenpox vaccines instead (MMRV vaccine). The first dose is given to children at the age of 11 months, and the second dose is given at 15 months. For children going to a daycare center, the first dose can also be given at the age of 9 months. There is no need for a booster vaccination.

The German Standing Committee on Vaccination also recommends that adults born after 1970 have the measles vaccination if they

• are not vaccinated,
• do not know whether they were vaccinated, or
• only were given one dose when they were a child.

In Germany, all children aged 1 and over who go to a daycare center, school or other community facility have to prove that they have been vaccinated against measles or are immune to it. This requirement also applies to people who were born after 1970, and

• work in community or medical facilities, or
• live in shared accommodations, such as those provided for refugees.

Proof can be provided in the form of vaccination records, the child's health record booklet (“U-Heft” in Germany) or a medical certificate. Immunity can be proven through a blood test to look for antibodies.

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 viruses, and usually spread through tiny drops of saliva, for instance when you speak, cough or sneeze. The first symptoms occur about 2 to 3 weeks after infection.

In Germany, no single vaccine is available just for mumps. Instead, the mumps vaccine is given together with those against measles 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). Sometimes it is given together with the measles, rubella and chickenpox vaccines (MMRV vaccine). Two doses of the vaccine are given in total (see measles information for the vaccination schedule). There is no need for a booster vaccination.

A rubella infection doesn't usually have any noticeable symptoms. At most it might cause mild cold-like symptoms. Sometimes it may also result in swollen lymph nodes, fever or conjunctivitis. That might be followed by a pink or red spotty 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 is spread through tiny drops of saliva, for instance when you speak, cough or sneeze. The first symptoms occur about 2 to 3 weeks after infection.

In Germany, no single vaccine is available just for rubella. Instead, the rubella vaccine is given together with those against measles and mumps in a combined vaccine known as the MMR vaccine. Sometimes it is given together with the measles, mumps and chickenpox vaccines (MMRV vaccine). Two doses of the rubella vaccine are given in total (see measles information for the vaccination schedule). There is no need to prepare for a booster vaccination.

The vaccine is also recommended for women of childbearing age who haven’t yet had the rubella vaccine, or aren’t sure if they have.

The first signs of chickenpox are a fever and exhaustion. An itchy rash develops next – usually on the face and torso at first, and later spreading to the rest of the body. 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 is mostly spread through tiny drops of saliva, for instance when you speak, cough or sneeze. 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 at 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 at least four weeks apart. There is no need to prepare for a booster vaccination.

RSV is a virus that causes infections of the airways. Sometimes the infection is quite mild, like the common cold. But especially in infants and young children, it can also result in serious inflammation of the lower airways. This makes children feel short of breath and weak, and they drink much less than usual. It may also result in pneumonia. Serious RSV infections need to be treated in the hospital.

The infection is typically mild in adults, but older people or people who already have certain illnesses are at greater risk of developing pneumonia.

RSV infections are most common from October to March. The viruses are usually spread by droplets caused when you cough, sneeze or speak.

Doctors recommend giving all newborns and infants the antibody nirsevimab. It is injected into the thigh. These antibodies reduce the risk of a serious airway infection. This is a form of "passive immunization." That means that unlike a traditional vaccination, the body does not have to produce the antibodies itself.

The timing of the RSV passive immunization depends on when the baby was born: Infants who were born between April and November are given the immunization between September and November. Infants born between October and March are immunized within the first three days of birth.

The German Standing Committee on Vaccination recommends the RSV vaccination for

• everyone over the age of 75,
• people between the ages of 60 and 74 years who have serious diseases affecting their airways, cardiovascular (heart and blood vessels) system, kidneys, or nervous system, or who have severe diabetes, cancer or a weakened immune system.
• people over the age of 60 years who live in a nursing home.

The vaccination is given in autumn by injection. You can get the RSV vaccination and the flu vaccination at the same appointment.

The flu leads to a quite sudden fever, headache, and joint pain. Additional symptoms include a cough feeling 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 fluids from the nose or throat. The first symptoms occur about 1 to 2 days after infection.

The flu vaccine is recommended for people aged 60 and over. It is also recommended for people who are at greater risk of complications of the flu – for instance, because they already have other health problems such as asthma, heart disease or diabetes. Or because they have a weakened immune system.

The German Standing Committee on Vaccination also recommends the vaccination for

• people whose jobs involve a lot of contact with others,
• pregnant women, and
• people working in the medical field.

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.

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 are spread during sex and grow in the skin and mucous membranes near the genitals. 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. The German Standing Committee on Vaccination recommends getting any missed vaccines by their 18th birthday at the latest.

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 rheumatoid arthritis, 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 coronavirus SARS-CoV-2 has spread around the world since early 2020. This is the virus that causes COVID-19. Many people develop flu-like symptoms after they are infected, with some becoming very ill. Severe COVID-19 can cause pneumonia and spread to other organs. In the worst case, several organs fail and the infection becomes fatal. The risk of a severe course of illness increases with age and if you already have certain medical conditions, including diabetes, heart and circulation (cardiovascular) disease or a weakened immune system.

SARS-CoV-2 is spread mostly by droplets and aerosols, which can occur when you breathe, speak, sing, cough or sneeze. It usually only takes three to seven days for the symptoms to start after infection.

The COVID-19 vaccine is currently recommended for anyone over the age of 18 years. Various vaccines have been approved for use. In Germany, the Standing Committee on Vaccination provides information about which vaccine is suitable for whom, and when it is advisable to get a booster shot and who needs one.

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 doctors offer an individual consultation on travel vaccinations.

Not every health insurer covers all travel vaccinations. So it’s a good idea to contact your insurer before you travel to find out whether they will cover the costs of vaccination, or whether you have to pay for it yourself. If you are traveling for work, your employer might cover the vaccination costs.