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Vaccination practices in Germany are driven by scientific developments and a complex regulatory environment. Some important developments in 2019/20 are described here: Work-related vaccination recommendations for measles, rubella, and chickenpox have been streamlined and expanded. In addition, measles vaccination or documentation of immunity is now mandatory for employment at and attendance of many institutions, specifically including day care centers and schools. Owing to the shift of pneumococcal serotypes since the introduction of conjugate vaccines the US ACIP no longer recommends these for the routine administration to healthy persons of older age. Reduced series of 2 or even 1 dose of an HPV vaccine may be sufficient, however definitive RCT data are not yet available. After years of development and clinical studies the first vaccine against Ebolavirus disease has been licensed by EMA in November and by FDA in December 2019. More than 150 SARS-CoV-2 vaccine candidates are being developed with massive financial support, several phase 1/2 trials have started. A licensed vaccine may actually be available in 2021 and thus dramatically faster compared to any other modern vaccine development.MASERN-MUMPS-RöTELN- (MMR) UND VARIZELLEN-IMPFUNG (VZV): Das 2020-Update der beruflichen MMR-Impfempfehlungen gilt in betroffenen Einrichtungen für alle Beschäftigten und vereinfacht die Vorgaben: Für die meisten Erwachsenen ab Jahrgang 1971 sind 2 dokumentierte Gaben notwendig. Das Masernschutzgesetz beinhaltet eine Impflicht für verschiedene Einrichtungen und Schulen.Aufgrund der Veränderung der zirkulierenden Serotypen seit Anwendung der Konjugatimpfstoffe bei Kindern empfiehlt die amerikanische ACIP diese nicht mehr für die Routine-Erwachsenenimpfung.Beobachtungsstudien legen eine ausreichende Wirksamkeit von reduzierten Impfschemata mit 2 Dosen oder nur 1 Dosis nahe, Daten aus randomisierten Studien liegen aber noch nicht vor.Eine Abschwächung der Vakzineffektivität durch jährliche wiederholte saisonale Impfungen und auch im Verlauf einer Saison wird immer wieder festgestellt. Eine Veränderung der bestehenden Impfempfehlung ergibt sich daraus nicht.Nach jahrelanger Entwicklung und Testung erfolgte die Zulassung der ersten Impfstoffe durch die EMA im November 2019 und Juli 2020. SARS-CORONAVIRUS-2-IMPFUNG (SARS-COV-2): Aktuell werden mit massivem finanziellem Aufwand 150 Vakzinkandidaten entwickelt, erste Phase-I/II-Studien sind auch mit deutscher Beteiligung angelaufen. Damit könnte 2021 ein zugelassener Impfstoff zur Verfügung stehen.

Since the baseline study of the "German Health Interview and Examination Survey for Children and Adolescents (KiGGS)" in 2003-2006, vaccination conditions in Germany have changed and additional vaccinations have been included in the immunization schedule. The current KiGGS data can be used to assess the current vaccination status of 3‑ to 17-year-olds and trends in the 1985-2013 birth cohorts.Of the 15,023 total participants in KiGGS Wave 2, 3238 aged 3-17 years participated in the KiGGS Wave 2 examinations and submitted the complete vaccination certificate or were, according to their parents, unvaccinated. In this group, vaccination coverage was high for the majority of vaccinations for both girls and boys. Vaccination coverage has increased in children and adolescents in the last 10 years. This is especially true for vaccines for which there were strong deficiencies in the KiGGS baseline study, such as the hepatitis B and second measles vaccinations in all age groups, the booster dose against pertussis (11- to 17-year olds), as well as the booster dose against tetanus in the 7‑ to 10-year-olds.Sociodemographic factors are still determinants of vaccination status. Less than one child in two is vaccinated against hepatitis B (45.9%) when parents state fear of side effects or indicate vaccine skepticism as reasons against vaccinations. Despite significant increases, vaccination coverage at the end of the second year of life is still far below 95% for all vaccinations (measles: 1st dose: 88.6%; 2nd dose: 64.4%) even in the most recent birth cohorts.The results show where further efforts are needed to increase vaccination coverage by the remaining last percentage points, achieve the timely delivery of all vaccinations listed in the immunization schedule, as well as meet the defined elimination goals.Seit der Basiserhebung der „Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland (KiGGS)“ 2003–2006 haben sich die Rahmenbedingungen des Impfens in Deutschland verändert und es wurden zusätzliche Impfungen in den Impfkalender aufgenommen. Mit den jetzt vorliegenden KiGGS-Daten können der aktuelle Impfstatus der 3‑ bis 17-Jährigen und seine Veränderung über die Zeit in den Geburtsjahrgängen 1985–2013 beurteilt werden.Von insgesamt 15.023 Teilnehmenden in KiGGS Welle 2 hatten 3238 der 3‑ bis 17-Jährigen am Untersuchungsteil von KiGGS Welle 2 teilgenommen und den vollständigen Impfausweis vorgelegt oder waren laut Elternangabe ungeimpft. In dieser Gruppe zeigte sich für die meisten Impfungen eine gute Durchimpfung für Mädchen und Jungen. Im Vergleich zu Gleichaltrigen vor 10 Jahren sind die Impfquoten angestiegen. Das gilt insbesondere für Impfungen, für die in KiGGS-Basis noch starke Defizite bestanden, wie z. B. die Hepatitis-B- und 2. Masernimpfung in allen Altersgruppen, die Pertussisimpfung (11- bis 17-Jährige) sowie die Auffrischimpfung gegen Tetanus bei den 7‑ bis 10-Jährigen.Wie in KiGGS-Basis zeigen sich Unterschiede beim Impfstatus in Abhängigkeit von soziodemografischen Faktoren. Weniger als jedes zweite Kind ist gegen Hepatitis B geimpft (45,9 %), wenn Eltern Angst vor Nebenwirkungen oder eine impfskeptische Haltung als Gründe gegen Impfungen nennen. Trotz deutlicher Anstiege liegen auch bei den jüngsten Geburtskohorten die Impfquoten zum Ende des 2. Lebensjahres für alle Impfungen noch weit unter 95 % (1. Masern: 88,6 %; 2. Masern: 64,4 %).Die Ergebnisse zeigen, wo noch weitere Bemühungen notwendig sind, um die Impfquoten um die verbleibenden letzten Prozentpunkte zu steigern und die zeitgerechte Gabe aller im Impfkalender aufgeführten Impfungen sowie die gesetzten Eliminationsziele zu erreichen.

Vaccination practices in Germany are driven by scientific developments and a complex regulatory environment. Some important developments in 2018 are described here: Starting in 2018 only quadrivalent influenza vaccines will be used for the seasonal vaccination. Despite the availability of meningococcus ACWY and B vaccines and their use in other countries only the type C conjugate vaccine will be used for the routine vaccination of children. For the first time there is now an official recommendation to also vaccinate boys against HPV using either the bivalent or the nonavalent vaccine. After promising trial results a timely guideline for the use of the newly available adjuvanted subunit zoster vaccine is to be expected. Negative trial results mark a major setback for the development of a CMV vaccine. While only developed during the 2013 - 16 outbreak a highly effective Ebola vaccine is already being distributed to fight the current Congo outbreak.Ab der Saison 2018/19 werden ausschließlich quadrivalente Influenzaimpfstoffe zum Einsatz kommen.Auch nach Verfügbarkeit von jeweils 2 Präparaten für die MenACWY- und MenB-Impfung empfiehlt die Ständige Impfkommission (STIKO) diese nur bei spezifischen Immundefekten, für Kinder weiter nur die MenC-Impfung ab 12 Monaten. HPV: Die STIKO empfiehlt 2018/19 erstmals die HPV-Impfung auch für Jungen, jedoch weiter nicht für Erwachsene. Weiter keine Präferenz des nonavalenten Impfstoffs.Überzeugende Studiendaten für den seit Mai 2018 verfügbaren adjuvantierten Subunit-Zoster-Impfstoff lassen eine Stellungnahme der STIKO erwarten. CMV: Negative Studienergebnisse für die DNA-Vakzine ASP0113 bei Nieren- und Stammzelltransplantat-Empfängern bedeuten eine Verzögerung auf dem Weg zu einer CMV-Impfung.Der erst im Rahmen des Ausbruchs 2013 – 2016 entwickelte rVSV-ZEBOV-Impfstoff wird bereits im aktuellen Ausbruch im Kongo eingesetzt.

Since 2004 a single varicella vaccination for all infants aged 11-14 months has been recommended in Germany and since 2009 a second dose at the age of 15-23 months is recommended. Vaccination coverage after 24 months rose from 43% in 2006 to 87.5% in 2012. A mandatory notification system was introduced in the New Federal States (NFS) between 2002 and 2009 and nationwide in 2013. A national sentinel system has been in place since 2005.We analyzed both data sources to describe the varicella epidemiology related to vaccination coverage after initiation of routine childhood varicella vaccination and to evaluate both notification systems regarding informative value and data quality. We looked at trends, age distribution and incidences using Microsoft Excel and Stata12. Vaccination coverage data were available from health insurance claims data.By 2013 a decrease of cases/medical practice/month from 3.47 to 0.43 was observed. The incidence in the NFS declined from 32 to 12 out of 100,000. Sentinel and mandatory notification data showed the largest decrease among the 1-4 year-olds (-94 and -90% resp.). In 2014, varicella incidences increased in all age groups, but not the cases/medical-practice/month by age in the sentinel.Increasing vaccination coverage and decreasing varicella cases demonstrate the success of routine childhood varicella vaccination. Mandatory notification data allow incidence calculation; The sentinel system has been providing more detailed information about vaccination status, better data quality and continuous national data since 2005, irrespective of the Infectious disease protection act. Trends and age distribution can be continuously calculated, whereas the nationwide mandatory data collected in the short period since April 2013 can only be evaluated to a limited extent.

At a young age, health care is mainly provided by doctors in private practice. In this study, the health care of children and adolescents in Thuringia is analysed. Data base is the federal state module Thuringia (2010-2012, n = 4884; 0-17 years), which was conducted by the Robert Koch Institute as part of KiGGS wave 1 (2009-2012). The health care of children and adolescents is described based on 7 indicators: total medical visits, paediatrician visits, general practitioner visits, hospitalisation, health screening examinations and vaccination against human papillomavirus (HPV). Prevalence and mean values with 95 % confidence intervals were reported, and with logistic and linear regressions, the significance of the group differences was examined. Results show that 93.9 % of children and adolescents aged 0-17 years in Thuringia went in the last 12 months to doctors in private practice; the average number of doctor visits was 6.6 contacts. 75.1 % of 0‑ to 17-year-olds were treated by a paediatrician, and 29.9 % visited a general practitioner. In addition, 13.1 % of 0‑ to 17-year-olds in Thuringia have spent at least one night in hospital in the last 12 months; the average number of hospital nights was 7.2. With 90.5 %, the majority of the children aged 7-13 years completed the health screening program for children (U3-U9, without U7a). 67.5 % of the 14- to 17-year-old girls were vaccinated against HPV with at least one dose (lifetime prevalence), and 56.3 % have received a full vaccination with 3 doses. In addition, 62.0 % of 14- to 17-year-old girls went at least once to a gynaecologist. There are significant differences by gender, age, socio-economic status and place of residence (urban/rural). In summation, the results indicate a high utilisation rate by children and adolescents in Thuringia. Additionally, the findings point out prevention potentials such as the vaccination against HPV.

The medical treatment of migrants and refugees has recently become an important topic in the German healthcare system due to the large numbers of migrants. Healthcare for migrants includes treatment of acute illnesses and trauma on arrival, screening for chronic communicable and non-communicable diseases and in the long term, the integration into the local healthcare system. As health problems of migrants are diverse and dependent on the region of origin, guidelines should be readily available for all healthcare professionals involved in migrant healthcare. A literature search for comprehensive guidelines for screening and treatment of migrant's health problems detected 47 different guidelines including 2 comprehensive ones from the US Centers of Disease Control and Prevention and the Canadian Collaboration for Immigrant and Refugee Health. Comparative analysis of these guidelines could be a starting point for evidence-based European guidelines on migrant health.

The Cologne statement resulted from both regional and nationwide controversial discussions about meaning and purpose of an initial examination for infectious diseases of refugees with respect to limited time, personnel and financial resources. Refugees per se are no increased infection risk factors for the general population as well as aiders, when the aiders comply with general hygiene rules and are vaccinated according to the recommendations of the German Standing Committee on Vaccination (STIKO). This is supported by our own data. Based on individual medical history, refugees need medical care, which is offered purposeful, economic, humanitarian and ethical. In addition to medical confidentiality, the reporting obligation according § 34 Infection Protection Act (IPA) and the examination concerning infectious pulmonary tuberculosis according to § 36 (4) IPA must be considered.

In Germany, seasonal influenza vaccination has been recommended for pregnant women since 2010 and human papillomavirus (HPV) vaccination for girls since 2007. Gynecologists play an important role in the communication and vaccination of these two target groups. Moreover, seasonal influenza vaccination is also recommended for healthcare workers, as well as adults aged ≥ 60 years and individuals with underlying chronic diseases. The aim of this study was to gain first insights into the acceptance and implementation of the seasonal influenza und HPV vaccination recommendations in gynecological practices. In the context of the national influenza immunization campaign-which is jointly carried out by the Robert Koch Institute (RKI) and the Federal Centre for Health Education (BZgA)-a questionnaire was sent together with influenza information kits to 7477 gynecologists in September 2014. Data from 1469 (20 %) gynecologists were included in the analysis. 72 % of respondents reported that they themselves received a seasonal influenza shot each year. The majority of gynecologists recommended seasonal influenza vaccination for pregnant women (93 %) and HPV vaccination for girls (97 %). The most commonly stated reasons against influenza vaccination were safety concerns. Those against HPV vaccination were effectiveness concerns. Additionally, for both vaccinations the provision of vaccine-related information to the patient was considered too time consuming.The high acceptance of seasonal influenza and HPV vaccination among gynecologists is discordant with the available vaccination coverage figures in Germany. Gynecologists must be reminded of their important role in the prevention of vaccine-preventable diseases in adolescents and adult women. Immunization and communication skills should be considered more strongly as an integral part of medical education and further training for gynecologists.

Currently, the German Advisory Committee on Immunization Practices recommends the pneumococcal polysaccharide vaccine (PSV23) instead oft the pneumococcal conjugate vaccine (PCV13) for standard vaccination of adults 60 years. Whereas the efficacy of PSV23 against bacteraemia has been proven by numerous studies, there is increasing evidence that there is no efficacy against non-bacteraemic pneumococcal pneumonia. This is in contrast to PCV13, for which the CAPITA study has recently revealed an efficacy of 45% against non-bacteraemic pneumonia by the 13 vaccine types.In this position paper we argue that this decision is not justified by the available evidence for the following reasons: i) the main burden of pneumococcal diseases is non-bacteraemic pneumoniaii) the clinical evidence for the efficacy against pneumonia is of higher quality for PCV13 than for PSV23 iii) the duration of clinical efficacy PSV23 starts to decrease after 2 years, whereas this has not yet been observed for PCV13 in the CAPITA study for at least four years, and iv) herd protection effects observed after PCV7 infant vaccination program on invasive pneumococcal disease must not be extrapolated to PCV13 and non-invasive pneumococcal diseases.

The World Health Organisation initiated the Global Polio Eradication Initiative in the year 1988. With the large-scale application of routine and mass vaccinations in children under the age of 5 years, polio disease has become restricted to only 3 endemic countries (Afghanistan, Pakistan and Nigeria) by today. However, since the beginning of the 21st century, increasing numbers of secondary polio epidemics have been observed which were triggered through migration, political turmoil and weak health systems. In addition, there emerged serious technical (e. g., back-mutations of oral vaccine virus to wild virus) and socio-political (refusal of vaccinations in Muslim populations of Nigeria and Pakistan) problems with the vaccination in the remaining endemic countries. It thus appears questionable if the current eradiation initiative will reach its goal in the foreseeable future.

TBE is a public health problem well under control in Austria because of a mass vaccination programme. There have been 50-100 registered cases per year for many years, the vaccination rate of the population is currently 85 %. Special attention has to be given to the "older" generation 40 plus as this is the segment of the population where the majority of cases are observed annually. In comparison of the counties, Tyrol and Upper Austria finished first and second after a long time when Styria and Carynthia had observed most of the cases. For TBE applies the same as for Tetanus, namely the principle of disease control or disease elimination: The virus cannot be eliminated and vaccination provides individual protection. The both available TBE vaccines have proven to be very effective with an effectivity of 96-99 %, also when given irregular vaccinations the protection rate is still very high (90 %). More than 4000 prevented cases between 2000 and 2011 prove this impressively.

Pneumococci remain the most important cause for community-acquired pneumonia. The colonization of the nasopharynx is prerequisite for their transmission and the colonization of toddlers are an important reservoir also for infections in the elderly. Since pneumococcal conjugate vaccines reduce the colonization rate of children its widespread use has also resulted in a reduction of invasive pneumococcal disease in adults. Advanced age and comorbidity are the most important risk factors for pneumococcal pneumonia and the mortality in this risk group is still very high. The strongest risk factor for invasive pneumococcal infections, however, is HIV/AIDS and solid or hematologic malignancies. A more rapid identification could aid de-escalation of empiric antibiotic therapy. The pneumococcal urinary antigen test, however lacks sensitivity for this purpose. In contrast, the direct identification of pathogens from positive blood culture bottles by MALDI-TOF is a very encouraging development in diagnostic microbiology. In several cohort studies patients treated with a combination of a betalactam plus macrolide had a lower mortality than patients treated with betalactam monotherapy. If these observations reflect a truly beneficial effect of combination therapy or rather confounding of the studies remains unclear and evidence from interventional studies is needed.

In Germany, vaccination against HPV infection has been recommended for girls aged 12-17 years since 2007. The aim of this paper was to provide an overview of the current status and determinants of HPV vaccination uptake in Germany.Analyses included data from 14- to 17-year-old girls (n =1,337) of the German Health Interview and Examination Survey for Children and Adolescents - First Follow-up Survey (KiGGS Wave 1). Standardized telephone interviews included questions for girls on the number of HPV vaccine doses and visits to a gynecologist. Parents were asked about their socioeconomic status (SES) and the girls' participation in the J1 adolescent health check-up. Descriptive analyses of the HPV vaccination status with respect to social, demographic, and health-care utilization factors were performed. Factors associated with vaccination were identified and odds ratios (OR) were estimated by means of logistic regression analysis.The prevalence of vaccination with at least one HPV vaccine dose was 52.6% (95% confidence interval 48.5-56.6). Three-dose HPV vaccination coverage was 39.5% (35.3-43.9). Vaccine uptake increased with age, was higher in girls with middle and low SES compared with high SES, with residence in eastern Germany, in those who had already seen a gynecologist, and who participated in the J1. Multivariable logistic regression revealed a twofold increased chance of being vaccinated for girls with middle SES (OR 1.9) compared with high-SES girls and for those who had yet seen a gynecologist (OR 2.1).School-based vaccination programs and multi-tier vaccination campaigns have led to high vaccination rates in some European and non-European countries. In Germany, however, such high vaccination rates have not been achieved. To fully realize the potential of HPV vaccinations to reduce HPV-related cancer incidence at the population level, vaccination coverage in Germany must be increased. In absence of school-based vaccination programs, medical doctors should use each visit to check and complete the girl's vaccination status.

Pneumococci remain a major cause of bacterial pneumonia, sepsis and meningitis globally.The German National Reference Center for Streptococci at the Institute for Medical Microbiology of the University Hospital RWTH Aachen, Germany, has carried out surveillance studies on invasive pneumococcal disease (IPD) since 1992. This report is based on IPD-cases from adults and children, received between July 1992 and June 2013 and July 1997 and June 2013 respectively.From 1997-2006 the proportion of infections among children ≤ 23 months of age with serotypes included in the 7-valent vaccine was about 65%. Since the start of childhood vaccination in 2006 the percentage has continuously decreased, reaching5% in 2012 /2013. Also among adults, for whom conjugate vaccination was not indicated, this percentage decreased from 40-45% in 1992-2006 to about 8% in 2012 /2013. This phenomenon is denoted as herd protection. The resistance rate against Penicillin G remained under 4% among children and under 2.5% among adults over the whole study period. Since 2005 /2006 macrolide resistance levels have decreased to about 5% among children and 8% among adults.The continuous decrease of vaccine serotypes as well as the decreasing IPD incidence since the beginning of childhood vaccination document the success of pneumococcal conjugate vaccination.

In March 2013, the first cases of avian influenza virus infections in humans were reported by the authorities of the PR of China to the World Health Organization. This influenza A(H7N9) virus comprises genes of at least four different avian influenza viruses, some segments mimicking human-like influenza-signatures. Until 11 August, 2013 135 humans were infected, 44 (33%) died. The clinical course is characterized by fever, cough, gastrointestinal symptoms, lympho- and thrombopenia as well by the rapid onset of an acute respiratory distress syndrome in nearly 25% of the cases. Although human to human transmission may have occurred only in the context of three clusters, strict hygiene measures should be instituted and any suspect case should be reported to the local health authorities immediately. The detection of influenza A(H7N9) is based on real-time polymerase chain reaction (PCR). Antiviral treatment should be initiated as early as possible for suspect, probable or confirmed cases, even when 48 hours have passed after symptom onset. At present the future development of this epidemic cannot be predicted.

Vaccination against measles and rubella has been included in national immunization programs worldwide for several decades. In this article, we present the evidence related to the effectiveness of measles and rubella vaccination based on published systematic reviews, and we describe the epidemiological and health economic effects of vaccination at a population level. Several observational studies demonstrate the high effectiveness ( 90 %) of both measles and rubella vaccination. The global measles mortality reduction and the dramatic decrease in rubella and measles incidences after introduction of routine immunization contribute to the very high quality of evidence. The countries of the Americas have proved that it is feasible to eliminate measles and rubella by strengthening infant immunization through routine vaccination services and by conducting supplemental immunization activities in other childhood age groups so as to close immunity gaps. An economic evaluation of measles and rubella vaccination specifically for the healthcare system in Germany does not exist. However, we conducted a systematic review and identified 11 health-economic studies from other industrialized countries and one for a hypothetical industrialized country. Results indicate that vaccination against measles and rubella had either a cost-effective or even a cost-saving potential, which could be assumed with some limitations also for the German setting. In conclusion, there is compelling evidence that the available vaccines are very effective and that measles and rubella elimination is feasible if adequate vaccination strategies are implemented. In Germany, catch-up vaccination programs are urgently needed for children, adolescents, and young adults specifically in the western federal states.

Mumps is an acute viral infectious disease characterized by fever and swelling and tenderness of one or more salivary glands, usually the parotid gland. Since 1976, the German Standing Committee on Vaccination (STIKO) has recommended a mumps vaccination as part of the routine immunization schedule in former West Germany. In East Germany, the vaccination was only introduced in 1991 after reunification. In the preceding decades, no comprehensive surveillance system existed in Germany. However, for East Germany and the successional federal states of former East Germany, data on mumps incidence are available from different Eastern surveillance systems for the time period 1968-2012. According to these data, the incidence of mumps has dropped from 200 cases/100,000 annually in the pre-vaccine era to currently1/100,000. Recently, an age shift has been noted predominantly in the Western federal states. Based on data from school entry examinations and seroprevalence studies, the age shift is likely due to insufficient vaccination coverage and secondary vaccine failure ("waning immunity"). In view of the changes in mumps epidemiology and the increase of outbreaks among adolescents and young adults, the implementation of a nationwide mandatory notification was initiated and came into effect in March 2013. Mandatory notification enables the early detection of outbreaks and obtainment of comprehensive data for evaluation of the immunization program in place. Regarding the long-term prevention of mumps in Germany, it is hoped that--as part of the measles and rubella elimination effort--coverage rates for the second MMR dose among children will increase nationwide above 95% and existing vaccination gaps among adults will be closed.

The measles virus circulates within Switzerland in an endemic way leading to sporadic outbreaks. The most recent outbreak occurred in 2011. It lasted 9 months and had 687 reported cases. This is in contrast to 2012 when there were 66 cases,corresponding to an incidence of 8 cases per million inhabitants. During 2008-2010, the average national vaccination coverage for one or two doses of measles vaccine amounted to 92 and 83 % for 2-year-olds, 95 and 85 % for 8-year-olds, and 95 and 85 % for 16-year-olds, respectively. To improve the national vaccination coverage, the Federal Council adopted the National Strategy for the Elimination of Measles 2011-2015 in 2011.The strategy was drawn up in a participative process led by the Federal Office for Public Health.The cantons as key partners were represented by the Conference of the Cantonal Directors for Public Health and the Association of Cantonal Health Officers. The strategy pursues the vision of eliminating measles in Switzerland in order to protect the population against measles and its complications, including all persons who may not be vaccinated for medical reasons. The strategy comprises six axes of intervention:(1)political engagement and support by all stakeholders, (2)a targeted ≥ 95 % two-dose vaccination coverage for all 2-year-olds, (3)easier access and incentives for the booster vaccination for everyone in the 2-year-old age group up to those born in 1964, (4)communication and promotion, (5)uniform national outbreak control, and (6)targeted surveillance.

Achievement of the goal to eliminate measles by 2015 set by the European region of the World Health Organization (WHO) necessitates an increase in the willingness of German nationals to get vaccinated. To identify influential factors on vaccination behavior as the basis for communication measures specific to target groups, the Federal Centre for Health Education (BZgA) has conducted two representative surveys on attitude, knowledge, and practice concerning vaccination among parents of children between 0 and 13 years as well as among adolescents and adults. The parents' survey (n = 3,002) revealed that more than one-third see measles as a harmless disease. The survey of adolescents and adults (n = 4,483, 16-85 years) also shows that about one-quarter of the interviewees between 16 and 44 years regarded vaccination against measles as not very important. Moreover, 81 % of adults born after 1970 without sufficient existing vaccine protection were not aware of the new measles vaccination recommendation for this age group. Personal consultation with the physician was regarded as the major source of vaccination information in both surveys. About half of all persons interviewed intended to obtain information about vaccinations on the Internet. The results of these studies were used for the development of a nationwide multilevel BZgA campaign on vaccination protection against measles, its goal being to support medical professionals with comprehensive information and to enable adolescents and young adults via different communication measures to make well-informed vaccination decisions.

In 2004, a general varicella immunization was introduced in Germany for infants from the age of 11 months, followed by the subsequent recommendation in 2009 of a second vaccine dose. The vaccination is carried out at the same time as the immunization against measles, mumps, and rubella (MMR). Results of the nationwide sentinel surveillance of varicella and herpes zoster implemented by the Varicella Working Group (Arbeitsgemeinschaft Varizellen, AGV) show that the defined goals for varicella immunization (reduction of varicella-related morbidity, complications and hospitalizations) have been reached within a few years owing to the advances in vaccine coverage. Although coverage rates for varicella have not yet reached the same levels as for MMR, varicella immunization seems to have benefited from the established MMR immunization schedule. Moreover, there is no evidence for an adverse effect on the use and acceptance of the MMR vaccine. Lessons learnt in measles epidemiology (such as trends in the incidence of the disease in adolescents and infants), as well as in the history of MMR recommendations, may be useful for the evaluation of future epidemiological changes with respect to varicella and herpes zoster. In view of a rapidly waning immunity against the varicella zoster virus after vaccination with one dose and the lifelong persistence of the virus, achieving a robust and sustainable immunity in the general population seems to be an ambitious goal. However, this accomplishment will be indispensable in preventing breakthrough infections and a shift of varicella to older ages and in avoiding an increase in herpes zoster incidence.

From September 1999 to March 2011, sentinel surveillance of measles was conducted by a self-selected sample of private physicians in Germany. From 2001, when mandatory surveillance for measles was established, two surveillance systems worked in parallel. The aim of this article is to summarize the strengths and limitations of sentinel versus mandatory surveillance. Active monthly reporting included case-based questionnaires on patients with (suspected) measles or zeroreporting. For confirmation of measles, the diagnostic patient specimens were sent to regional laboratories for serological tests or to the National Reference Laboratory (NRC). In the NRC in addition to serological tests measles-virus (MV) detection by PCR in urine, throat swabs, and oral fluid (since 2003) as well as MVgenotyping was offered. From January 2000 to December 2010, 934 out of 1,488 participating sentinel-practices did not see any measles case, while 554 reported 3,573 suspected cases. Measles was confirmed by laboratory testing in 801 cases, excluded in 473 cases, and the diagnosis remained uncertain in 215 cases. Of 3,100 analyzed cases, 2,712 (87 %) were unvaccinated, 217 (7 %) and 32 (1 %) were vaccinated with one or two doses, respectively, and for 139 (4 %) cases the vaccination status was unknown. The main reason for not being vaccinated against measles was refusal (n = 1,383). The confirmation rate was lower in the vaccinated than in the unvaccinated patients (19 % vs. 63 %). Since 2006, sentinel-cases have differed from notified cases by region and age. The proportion of sentinel cases from all NRC-investigated cases decreased from more than 50 % (2002) to less than 5 % (since 2007). Sentinel surveillance allowed for the detection of trends, delivered additional information for measles prevention, and played a major role in measles diagnostics. Since mandatory surveillance was established and sentinel surveillance no longer reflected the epidemiologic situation, the latter was abandoned in April 2011.

Since 1984, the World Health Organization (WHO) European Region has pursued the goal of eliminating measles. In 2005, it was decided to also stop the endemic transmission of rubellavirus, thereby eliminating congenital rubella syndrome. Both infections are to be eliminated by 2015. To document the progress and verify the elimination at country level, national verification committees should be established in WHO EU memberstates.In December 2012, the German Ministry of Health appointed the German National Verification Committee for Measles and Rubella Elimination. The commission meets at least twice a year to compile and analyze data on the epidemiology of measles and rubella in Germany and on the vaccination coverage/ immunity of the German population against these infections to assess progress in the elimination goals. Furthermore, the commission indicates whether the available data are sufficient or contain inconsistencies, evaluates the success of key strategies implemented, and advises on activities related to the verification of the elimination process in the country. A scientific report on the commission's findings is to be submitted annually to the WHO regional office.Germany is committed to the aim of eliminating measles and rubella. Thus, every possible effort should be made to reach this goal by the responsible players in the German immunization system. The commission - as an independent group of experts - will critically accompany and evaluate this process.

In the state of Hesse (Germany) all vaccinations were administered either by the public health-care (ÖGD) or private health-care facilities and were registered by week and age group. In the following article, the benefit of the vaccination campaign will be looked at in terms of preventable consultations due to acute respiratory tract infections (AK-ARI). AK-ARI were registered with the nation-wide sentinel of the AGI. Scenarios regarding timing and age-specific coverage are modelled. The achieved timing and age distribution was compared to assumed ideal distributions, e. g., having achieved the final coverage 2 weeks before epidemic start or having applied the used vaccine exclusively for the most affected age group 5-14 years. The timing and coverage actually achieved (7% overall) prevented an estimated 1.4% or, respectively, 1.1% of the total consultation excess. With the same amount of vaccine but ideally applied at least 2 weeks -before the begin of the epidemic and exclusively to the age group of the 5- to 14-year olds, an estimated 13.9% or, respectively, 18.2% of the total excess could have been prevented. The simulated scenarios give estimations as to what benefit potentially could have been achieved during the A(H1N1)pdm09 pandemic. Both the delayed successive access to vaccine and the not ideal age distribution reduced the benefit to about 30% of the optimum. These exemplary estimates underline the importance of timeliness and valid prioritising of vaccination campaigns, although footing on just one outcome. It appears beneficial to reduce uncertainties for a solid prioritisation by, e. g., timely extended surveillance. Short-term decisions and adoptions are likely for future campaigns, e. g., due to unexpected changes in the epidemic, demanding flexibility in the application management.

Ten years after seroepidemiological data were obtained in the German National Health Interview and Examination Survey 1998 (GNHIES98), German Health Interview and Examination Survey (DEGS1) data contribute to a population-based, representative surveillance of hepatitis A and B immunity and of the serological markers for hepatitis C in Germany. The prevalence of antibodies against the hepatitis A virus is 48.6 %. In comparison to the situation 10 years ago, seroprevalence is significantly higher among 18- to 39-year-old adults and is significantly lower in those aged 50-79 years. The association between age and seroprevalence has changed, indicating a decrease in naturally acquired hepatitis A immunity. Individual and population immunity has to be achieved through vaccination. Prevalence of hepatitis B antibodies indicates that 5.1 % of adults have been exposed to the virus, significantly fewer than 10 years ago (7.9 %). Prevalence of hepatitis B surface antibodies indicates that 22.9 % of adults have been vaccinated against hepatitis B. Vaccination coverage has increased in all age groups and is highest in the younger age groups. These positive trends can be attributed to the general recommendation since 1995 to vaccinate against hepatitis B. For hepatitis C, the prevalence of antibodies in the general population is 0.3 %. Germany thus remains a low-HCV-endemic country. An English full-text version of this article is available at SpringerLink as supplemental.

People with mental and physical disabilities have a higher risk of infection with hepatitis viruses. Studies conducted so far show contradictory results on the success of vaccination in this population. These people live and work under special conditions and sometimes have immune defects.We investigated the antibody response after combined vaccination against hepatitis A and B in facilities for handicapped people in the city of Essen/Germany. Antibodies were determined in people with disabilities (n=949) and also in social workers taking care of handicapped people (n=115).Protective antibodies against hepatitis A were detected in 98.9% in people with disabilities and social workers. The seroconversion rate against hepatitis B in handicapped people was 90.2% and was comparable to the seroconversion rate in social workers (91.3%). Re-vaccinations were offered to all people with anti-HBs titres below 100 IU/L (28% of handicapped and 23.5% of social workers). In the group of low responders in handicapped people about 50% developed anti-HBs concentration above 100 IU/L. Non-responders showed 30-40% seroconversion rate after re-vaccination.Based on this study we would recommend serological tests about 4-8 weeks after vaccination to confirm seroconversion. By this procedure people who need a booster vaccination will be recognized and non-responders should be offered another HBV vaccination. In about 20% of the non-responders included in this study HBs antigen was detected.

Every influenza season, vaccina­tion campaigns are launched with the aim to achieve higher vaccination rates. Despite diverse educational work, health behaviour regarding influenza vaccination falls short of expectations. The current study explores the relationship between vaccination behaviour and objective infection risk. The hypothesis is that vaccination is performed independently of the objective infection risk. Even with increasing infection risk, no increase of vaccination rate is expected.Questionnaires were filled in by passengers of public transportation services in a southern German city at 3 defined time points. Changes in vaccination behaviour were recorded in parallel with the objectively measurable risk of disease. The questions to determine vaccination behaviour and its causal impact factors are based on the Health Belief Model. The total sample consisted of 178 participants at each timepoint (n=534).Questionnaires were evaluated with regard to age and vaccination status. During the influenza season vaccinated and non-vaccinated participants show differences in risk perception. In vaccinated persons, the "perceived risk of disease" increases, while non-vaccinated participants develop a declining risk perception at the peak of influenza season.Vaccination is performed in all groups regardless of the objective risk. The decline in risk perception in non-vaccinated participants might be explained by a defensive mechanism of information processing. Consequently, a strategy of ­intensified education regarding the risk of disease seems not to be promising in future vaccination projects. Furthermore, it may be more effective to improve the status and importance of ­vaccination.

For the first time in history, the conditions to influence the course of an influenza pandemic through vaccination were set during the influenza A H1N1 pandemic in 2009. The specific requirements for pandemic vaccines are to be highly immunogenic in immunologically naive individuals and to be producible quickly in large quantities. In contrast, seasonal influenza vaccines induce a booster response and a broadening of preexisting immunity. In this article the concepts of seasonal and pandemic influenza vaccines and data on their immunogenicity and clinical efficacy are reviewed and discussed. In the upcoming years, seasonal influenza vaccination will continue to be based on inactivated split-virion and subunit vaccines or the live attenuated cold-adapted vaccine. The pandemic vaccines used in 2009 proved to be more immunogenic than expected from prepandemic vaccine trials, while the adverse events observed with AS03-adjuvanted vaccines call their future use into question. However, neither seasonal nor pandemic influenza vaccines can be regarded to be an ideal solution, because they have to be frequently adapted to new virus strains and they lack effectiveness in particular risk groups. They can be regarded as interim approaches to highly immunogenic vaccines that hopefully become available in the future. The underlying principles of future vaccines are also presented in this article.

Each year, more than 55,000 people die from rabies. Rabies virus (RABV) is transmitted via bites from infected animals. Dogs represent the most important source of infections worldwide. In Germany, the last case of terrestrial rabies was reported in 2006. Therefore, the country has been considered rabies-free since September 2008 (as defined by World Organization of Animal Health, OIE). Bat rabies, however, is still endemic and mostly occurs in northern Germany. It is caused by the European Bat Lyssa Virus (EBLV), which is closely related to RABV. Cases of rabies in humans are almost 100 % lethal, therefore, the correct choice of prophylactic measures is essential. Pre-exposition vaccination is recommended for individuals at risk of contact to Rabies Virus. If used together with post-exposure measures, it confers high-grade protection against disease manifestation. Even non-vaccinated individuals exposed to Rabies Virus can be protected from overt disease in almost all cases with timely and accurate application of post-exposure vaccination. The mode and intensity of exposure determine the choice of regimen (wound treatment, active and passive vaccination).

The influenza virus isolation in embryonated chicken eggs was possible early in 1930er years and allowed the influenza vaccine production. Most influenza vaccines were derived from this, but actually new virus cell culture methods are established. For better tolerability, influenza vaccines include only antigen proportions (split- and subunit vaccines) but with the disadvantage of minor vaccine efficacy. This was compared with the addition of adjuvants. Aluminium salts are used for many decades and still in use to enhance the effect of vaccines. New formulations are MF59, AS03, AS04 or toll- like receptor-agonists. Also virosomal formulations and "ISCOMs"(Immune Stimulating Complexes) are newly designed and compromises enhanced immune reactions. Actually a broad range of various influenza vaccines exist and are available for a very different group of patients (which depends on physical conditions, age, immune status or allergies).

BACKGROUND AND OBJEKTIVES: In 1988 the German Vaccination Board (STIKO) at the Robert-Koch-Institute (RKI) in Berlin, recommended that German health care workers should be vaccinated annually against influenza. Despite this, vaccination rates have remained low (20 %). Between January and March 2009 a study was performed at the University Clinical Centre in Essen to determine reasons for low influenza vaccination rates and to assess improvement strategies.All employees and staff members of the University Hospital (n = 5349) were asked to fill in a questionnaire anonymously. The completed questionnaires were digitalized and the results analysed electronically.1 670 of the 5 349 (31 %) questionnaires were found to be satisfactory for evaluation. The vaccination rate among this cohort was 29 %. Vaccination rates varied widely between different departments (4 - 71 %). The most common reason for not undergoing vaccination was "forgotten" (32 %). The second most common reason was the fear of side effects (30 %). Only 32 % of the employees stated that the quality of the information about influenza vaccination provided by their employer was "good" or "very good".The vaccination rate of 29 % among this group of health care workers was higher than the average (20 %) in German hospitals and highest among medical doctors. Strikingly enough employees of theoretic departments were vaccinated to a higher percentage than those providing nursing care and thus had more frequent contact to patients. A number of comparatively basic and inexpensive measures would be enough to increase vaccination rates significantly.

Since 2001, the German states and federal institutions have been engaged in systematic pandemic preparedness planning. Preparedness was largely in an advanced stage and most probably contributed to successful control of the influenza H1N1 (2009) pandemic in Germany. Adaptation and improvement are needed most in the fields of vaccine logistics and communication. In the future, the national plan as well as the WHO pandemic plan should distinguish more clearly between pandemic warning phases for preparation of structures, on the one hand, and epidemiologic situations for activation of measures, on the other hand. The proper balance between a uniform national approach and the local adaptation of measures within Germany remains another challenge. Although the course of the influenza pandemic (H1N1) 2009 was moderate, pandemic preparedness planning remains of utmost importance and must be adapted rigorously and early according to the recent experience.

Despite decades of effort to encourage healthcare workers (HCWs) to be immunized against influenza, vaccination levels remain insufficient in Germany, with only one in five HCWs receiving the annual influenza vaccination. To prevent nosocomial influenza outbreaks and to ensure the protection of patients and HCWs, new approaches to increase vaccination rates are needed. The experience in the USA has shown that declination forms have increased vaccination coverage. One possible approach for Germany would be a combination of declination forms with the exclusive use of vaccinated staff in defined areas. This approach would respect a HCWs decision to refuse medical treatment, while at the same time protecting vulnerable patients. In addition, the influenza vaccination rates of HCWs should be collected in order to evaluate the implementation of vaccination policies. Similar to the setting of desired vaccination coverage for the chronically ill, a clearly defined vaccination goal should be established for HCWs.

In order to establish a joint pandemic strategy, the German states ("Länder") together with the German federal government ("Bund") agreed on joint preparations for pandemic scenarios. This included the description of procedures, such as infection control measures, stockpiling of antiviral drugs, and contracts with vaccine manufacturers to ensure supply of vaccines in the event of a pandemic. The situation during the influenza H1N1 pandemic differed from that planned so that many short-term adjustments were required. It highlighted the need to make pandemic planning more flexible. In spite of several obstacles which had to be overcome during the situation, the states managed to achieve a relatively coordinated procedure and provided the availability of vaccines. In the course of the pandemic, gaps and shortcoming in existing surveillance systems were identified, which should lead to further improvements. A key point for future pandemic events is successful communication between all interested parties, especially with the medical profession, to increase the acceptance of public policies.

In most cities and districts, the influenza pandemic of 2009 could be handled without any restrictions in providing medical care or any disturbance in public life. Despite its relatively mild course, the local public health services reached their limits of capacity. Based on nationwide regulations, the local management determines the success of the measures. Evaluating the experience on the community level offers the chance of facing future pandemics more efficiently. Press conferences, press releases, and the internet are the most reliable tools to inform the public even in terms of personnel expenses. Telephone conferences and internet platforms help to reduce time-consuming meetings. An electronic database and logbook provide up-to-date information for all parties involved and allow quick, rational, coordinated, and transparent decision-making. Local evaluation of registration data, reports on cases of illness, and the availability of hospital beds on a daily basis allow intervention at an early stage to cope with the pandemic efficiently and helps save resources. Recruitment of external personnel, e.g., for the call center and the vaccination campaign, relieves the public health employees in charge with respect to their main tasks of directing and management functions.

The KV-Sentinel, established in 2004, is a joint project of the Robert Koch Institute and the 17 associations of statutory health insurance physicians (ASHIPs) in Germany. The ASHIPs provide anonymous physicians billing data to the Robert Koch Institute. The aim of this article is to describe methodological approaches for processing these routine data to determine vaccination coverage and incidence of vaccine preventable diseases. Furthermore, we discuss limitations in interpreting these data.The ASHIPs perform a data query of all vaccinations and of ICD-10 codes for pertussis, measles, mumps, varicella and herpes zoster and send anonymous data to the Robert Koch Institute. We perform routine tests to ensure data quality. Study population is the statutory health insured population (85.5% of the German population). Vaccination coverage is determined by the number of vaccinated persons and the number of statutory health insured persons. Incidence is calculated by the number of diseased persons per 100 000 statutory health insured persons.All 17 ASHIPs participate in the project. In total, 95 905 605 data records for vaccinations and 4 570 919 data records for pertussis, measles, mumps, varicella and herpes zoster were provided from 2004 to 2007. After performing routine tests with regard to structure and content of data, more than 99% of the data records can be analysed. In 2007, the majority of given vaccinations were monovalent vaccinations against influenza (39%) and tick-borne encephalitis (17%). In 2006 and 2007, 1 893 790 data records for diagnoses were provided. Of these, 75% were acute diagnoses and of these 70% were confirmed diagnoses. Most often, ICD-10 codes for herpes zoster (57%) and varicella (35%) were reported.Nationwide vaccination coverage of statutory health insured persons by age group can be determined by using billing data. It is possible to validate billing data of vaccinations with available data from other studies. Interpretation of billing data of acute vaccine preventable diseases remains challenging because it is difficult to assess potential under- or overestimation without the possibility of external validation. Therefore, further research is needed.

Vaccination against infection with human influenza virus is considered to be one of the most effective preventive measures available, especially when complications such as hospitalisation or death and indirect costs from off-work are considered. General practice is the preferable place for annual influenza vaccination because here the elderly and those endangered from bad health conditions are cared for frequently and regularly. The aim of this study was to find out the frequencies of influenza vaccination by Lower Saxonian contract physicians during three time periods with special respect to patients of older age or at risk. Data from two sources of health-care service have been analysed, namely from the contract physicians' union of Lower Saxony with all physicians vaccinating against influenza in the winter seasons of 1995/1996, 2002/2003, and 2005/2006, and from direct access to the electronic practice record system of 79 general practices via the BDT software data interface. Contract physicians, of whom more than 90 % are general practitioners, from Lower Saxony, vaccinate patients of the statutory health insurance against influenza in markedly increasing numbers, since 1995/1996 and 2002/2003 up to 2005/2006. Those over sixty years old or at high risk from bad health conditions are vaccinated up to seven-fold more frequently, compared to other patients. Influenza vaccination coverage rates (VCRs) are significantly higher in small and in medium-sized practices, compared to those with many patients. Nevertheless, influenza VCRs in Lower Saxony are not yet as high as would be necessary or desirable when compared internationally. Secondary analysis of aggregated health service data revealed inconsistencies in the primary material on cross-checking and validating, probably being caused during the external process of data aggregation and anonymisation. Also major systematic obstacles were found in the subsequent process of analysis. Nevertheless, fundamental results have been produced and are valid for all statutory health insured Lower Saxonians. Data from direct access to electronic practice records allowed for a deeper and multi-faceted insight into 101 928 patients of the same population, limited by the possibility of selection bias ('convenience sample'). Secondary analysis of health service data from different sources and their cross-check comparison is possible and successful. It is important to inform and involve the holder of the primary data extensively, following the guide lines of "good practice secondary data analysis".

In Austria activities against smallpox started with variolation, the artificial infection with the smallpox virus, which bore the risk of contracting the disease. In 1800, Lower Austria was the first country in continental Europe to implement Edward Jenner's invention of vaccination with cowpox for mass vaccination. In the beginning vaccination was practised by inoculation from one human being to another. In this paper development of smallpox vaccination from the beginning to it's cessation in 1981 is described.

This year in May, the World Health Assembly will celebrate the thirtieth anniversary of world wide Smallpox eradication. For this reason we report on this program's vertices.