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Vaccination means protecting a living being from a disease with a vaccine. The vaccine activates the immune system - especially against infections. To put it simply: When an active vaccination is used, the animal or human patient ingests the pathogen in a small dose in a killed or weakened form. This alarms the body's defenses and the antibodies ward off intruders that are harmless in small quantities. In the future, the body's own security system will now have its "enemy" in its sights and will close the gaps in the defense through which it could penetrate. The virus and bacterial protection program will receive an update.
Active and passive vaccinations
We differentiate between active and passive vaccinations. With active vaccination, the aim is to prepare the immune system to fight the pathogen so effectively in an emergency that the disease does not break out or only weakly. With passive vaccination, the patient receives additional antibodies artificially.
What do vaccines help against?
Vaccinations primarily help against infections with viruses and bacteria - from measles to smallpox to rabies and typhoid. Today there are also vaccines that address chronic infections that can indirectly trigger cancer.
How do you vaccinate?
The best known active vaccinations are by injection with a syringe, either into the skin, under the skin, or into a muscle. In the past, vaccines were also injected in the buttocks, but this procedure is outdated because the effectiveness is less than with injections in the upper arm. For passive vaccinations, however, an “injection in the butt” is sufficient.
When swallowing vaccinations, we take the vaccine by mouth, and there are few vaccinations with skin patches.
Danger recognized, danger averted?
We know the active vaccination as the "actual vaccination" - the vaccination against smallpox became famous. The immune system is practically trained here. Metaphorically speaking, the defense functions of our body develop the necessary know-how to fight an infectious disease by getting to know the pathogen in harmless amounts.
The patients are "infected" with live or dead vaccines. A life vaccine contains live pathogens in a weakened form, with dead vaccines the pathogens are killed.
If the pathogen is in the body, the white blood cells, our "health polity", recognize the proteins and sugar molecules of the intruder as foreign bodies.
The immune system now forms memory cells, lymphocytes, which render the pathogen harmless and, ideally, prevent later infection with it according to the motto "danger recognized, danger eliminated".
In the event of renewed infection, the memory cells recognize the pathogen, and now lymphocytes convert to plasma cells that give birth to antibodies and to T lymphocytes and NK cells as a defense of the cells.
A vaccine is not necessarily the entire pathogen. Dead vaccines, for example, sometimes only contain the toxin (poison) of a pathogen - this applies, among other things, to tetanus vaccination.
In contrast to other active vaccinations, such a dead vaccine does not prevent the pathogen from entering and multiplying. So the person affected is infected, but no disease breaks out because the toxins that trigger this disease are eliminated. The bomb detonator is removed.
Passive vaccination was born in 1890, against a common disease at that time, diphtheria. Emil von Behring isolated antibodies against the disease from the blood of horses. Antibodies derived from horses, including those from cattle and sheep, also helped against tetanus until 1965.
A passive vaccination is recommended if the affected person already came into contact with the pathogen without being actively vaccinated. The body no longer has time to "prepare its troops" and needs outside help.
The patient now receives a simultaneous vaccination, an immune serum. This contains antibodies against the intruder to a high degree.
In a narrow sense, it is not a vaccination because the body itself does not form any additional defenses.
Blood extracts from immunized animals and humans or human antibodies produced from cell cultures serve as passive vaccines. A passive vaccination in this sense is not a prevention, but an aid in an emergency.
It is particularly appropriate for events with a high risk of becoming infected, for unvaccinated people and for diseases for which vaccination is not the norm. For example, passive vaccination against tetanus as a simultaneous vaccination in the event of injury and insufficient vaccination protection or against rabies is classic.
Rigid seizures and hepatitis
You also usually get an immune serum if a wound is dirty and not vaccinated against tetanus, if you work in the hospital and blood from patients with hepatitis B might have got into your body.
Fast and short, slow and sustainable
In contrast to an active vaccination, an immune serum works quickly and quickly. Defense bodies with an active vaccination, on the other hand, need a longer period to form, but they also hold for this in the long term. The protection of an immune serum, however, expires after a few weeks. The body then faces a new infection from the same pathogen without protection.
This is because the immune serum is not cells that the body produces itself. If the pathogen strikes again, the cells have no memory of it, so the immune system is not activated.
A classic immune serum, obtained from human or animal cells, has a blatant disadvantage. Since the substances are foreign to the body, the body reacts in the same way as it does with foreign protein: it repels these intruders that are desired by the doctor and the patient.
The antibodies of the immune serum are quickly excreted again. A foreign serum can also cause an allergic shock. Modern medicine overcomes this hurdle with monoclonal antibodies that do not provoke this reaction.
In medicine there is always the question of causality. Does a medication have a real effect or does it only heal accidentally immediately after taking the medicine. Our ancestors were largely dependent on speculation until modern times.
They certainly had empirical knowledge, gained from experiences that a generation of the next generation imparted and thus used plants, the healing effects of which are evidenced by evidence-based methods and modern technical possibilities.
They also observed that those who had suffered from certain diseases once did not get them again. Unfortunately, the explanations for this were wrong, because until the 18th century nobody knew anything about bacteria and viruses that can only be seen under the microscope - the world's largest bacterium is as big as a period at the end of a sentence.
This may be why the idea of treating like with like prevailed, combined with the Christian world view that God had put everything in the right place in the universe.
Some observations turned out to be correct. So you shouldn't eat the meat of an animal that had killed a "great wolf" because you would otherwise be transformed into such a "great wolf". It is the correct finding that you become infected with rabies when you come into contact with the saliva of a living being suffering from rabies.
Real information about the effectiveness of medical treatments can only be provided by meta studies that exclude subjective perceptions and individual experiences. In the case of vaccinations, the total number of diseases is clear.
Alternative explanations do not counter the decline in infections after the introduction of vaccination programs, and the number of infections in countries without nationwide vaccinations also testifies to the success.
Alternative explanations in a historical comparison would be, for example: educating the population about possible sources of infection. Improve general hygiene. Healthy lifestyle. Containing the pathogen independent of vaccinations (e.g. killing all street dogs, wolves and foxes that could potentially transmit rabies), natural disappearance of the pathogen.
How effective are vaccinations?
A few examples before and after the introduction of vaccination programs in the United States: in 1922, 175,885 people were infected with diphtheria, in 1998 another. For whooping cough, the rate was 147,271 in 1925 and 6,279 in 1998. Measles contracted 503,282 people in 1962, 89 in 1998, 152,209 in Mumps in 1968 and 606 in 1998.
The most impressive thing is the eradication of smallpox. In 1904 the virus affected 48,164 people in America. In 1998 there was not a single case. Why should it? The WHO had already declared smallpox eradicated in 1980.
The effects of vaccinations can also be demonstrated without these numbers: The laboratory clearly shows how many antibodies are formed against a pathogen after vaccination.
Randomized studies with animals or humans with and without vaccine, divided into two groups, also provide information.
Vaccines are subject to a rigorous control process based on the European Medicines Agency. Before going on the market, they go through a series of clinical trials. In Germany, the Paul Ehrlich Institute controls approval.
Do vaccinations offer absolute protection?
Vaccinations can rarely provide complete protection against an illness, because the struggle between the body's own defenses and pathogens, in other words the evolutionary process, is far too dynamic.
Certain pathogens change very quickly or occur in various forms. In a way, variants of them slip through the networks again and again, and science is eagerly trying to upgrade the vaccines against these new "ways of fighting".
In the case of influenza, for example, whose pathogens repeatedly carry out an antigen drift, only the worst effects can usually be prevented.
In many old plagues, which are still rampant in the Third World, vaccinations worked extremely well. Polio, measles and rubella are now considered extinct in the United States.
For tetanus, diphtheria, mumps and whooping cough, the number of illnesses in the USA has “only” decreased by 92% since the vaccination programs, but the death rate of the people who died as a result fell by more than 99%.
Most vaccinations must be repeated after the first immunization to maintain immunity. The vaccinated person no longer needs the full dose of the vaccine when refreshing, since even a small amount leads to the immune system working effectively.
There is no rule of thumb, the frequency and timing of repetitions vary from illness to illness. Smallpox vaccination, for example, is likely to last a lifetime, vaccination against measles, mumps, and rubella usually well over ten years, as well as vaccination against hepatitis B.
In some diseases, such as whooping cough, the antibodies produced will go down after four years and you should repeat the vaccination after ten years at the latest. This also applies to diphtheria and tetanus.
A typhoid vaccine, for example, only works for two to three years.
You should ideally be vaccinated against flu every year if you are over 60, have contact with the sick or suffer from chronic illnesses yourself.
What are the side effects?
An active vaccination means above all to let a pathogen into the body. Many people are afraid of this, a fear that may even be evolutionary. The real side effects of current vaccinations have no real relation to this fear: Like any intervention in the body, vaccination is associated with risks. However, these are small and cannot be remotely compared to the outbreaks of disease.
Vaccine reactions are normal reactions of a healthy person. These may include: a slight feeling of being tired, swelling at the injection site, headache or muscle pain.
Such vaccination reactions are not complications, but a normal process: the pathogen is in the body and the organism forms antibodies. Swelling, slight pain and a feeling of weakness show that the immune system is working.
Vaccination complications also occur. Active vaccinations very rarely lead to an outbreak of the disease in a weak form. In measles, up to 5% of those vaccinated experience the “vaccination measles”, measles symptoms in a mild form: rash and fever.
In extremely rare cases, an allergic shock occurs when the body reacts to the vaccine. Such a shock can be life threatening, and doctors are required to have all the materials on site to handle the emergency. You must educate patients about this possible side effect.
Some vaccination critics ask that vaccinations be made dependent on an individual decision. While this is understandable, it contradicts the nature of a vaccination.
The more people in a society are vaccinated, the less rampant the pathogen is. This also promotes the protection of people without vaccination, such as infants.
So-called bar vaccinations, i.e. mass vaccinations of a population when a pathogen spreads, should build up this herd immunity in the short term.
Vaccination of the population is now considered the most effective measure to prevent infectious diseases.
Smallpox vaccination is one of the greatest successes in the history of medicine. Smallpox is caused by a virus that passes from person to person through droplets when coughing. The infection leads to high fever, chills, and blisters on the skin. Survivors are disfigured by the so-called smallpox scars, every third sick person died. Survivors went blind, lost hearing or were paralyzed.
WHO vaccination programs defeated the plague: In 1980, WHO declared the world free from smallpox after the last documented case occurred in Somalia in 1977. Today there is no more smallpox vaccination because the virus is no longer rampant.
This is also a viral infection caused by the poliovirus. In every tenth case, those affected become seriously ill: they suffer from headaches, a stiff neck, bowel problems and muscle pain. With every thousandth person affected, the virus attacks the spinal cord and brain, and the patients are paralyzed.
Vaccination against polio has been standard in the FRG since 1962. The number of new cases decreased by 99% within five years. Vaccination with a dead vaccine has been taking place since 1998.
In contrast to smallpox, polio has never disappeared worldwide. The virus still occurs in Nigeria and Pakistan, for example.
Meanwhile, the WHO has declared Europe, the West Pacific and America to be free of the poliovirus, as well as India recently - and the diseases have declined massively in Africa and Asia.
Regional outbreaks in Europe, especially among religious groups that refuse vaccinations, show that if there is no vaccination, the virus can spread again at any time.
The eradication of measles is a declared goal of the WHO. America, Australia and Scandinavia are now considered measles-free. In Germany, vaccination of primary school children is around 90%. Measles is no longer a childhood disease in Germany that everyone goes through, but occurs on average in little more than 100 cases per year. For example, children in Waldorf schools are affected, whose anthroposophical parents and teachers reject vaccinations.
Individual measles outbreaks nonetheless affect thousands of people in Germany: 780 fell ill in 2005 and 2242 in 2006. Vaccinations worldwide fell from around 500,000 in 1980 to 139,300 in 2010.
Like measles, mumps is a classic childhood disease, but both infections also affect adults. The cause is a virus that is transmitted by droplets. The salivary glands become inflamed, especially the parotid glands - those affected get the proverbial "thick cheek". However, every third infected person shows no symptoms at all.
Most of the time, mumps is harmless, but in adults there is an increased risk of contracting meningitis or testicular inflammation with the risk of congenital failure. In Germany, vaccination against mumps is carried out with a vaccine that also protects against measles and rubella.
Rabies - serum or death
The Lyssavirus causes an infection that almost always leads to death without vaccination. Humans are primarily infected by animal bites, mostly from canids such as dogs, jackals, wolves and foxes, but also from cats or bats, raccoons or skunks - even from squirrels.
A bite is highly likely to infect because saliva containing the rabies virus gets into the wound. The problem is not the bite, but the body fluid of the infected animal (or human).
The disease can also trigger the saliva of a rabies patient that gets on a skin wound. It is enough if you touch the carcass of an animal that has died from rabies or the foam on the mouth of a sick person, have a wound on your skin yourself and transmit the virus through your own fingers.
Most people in the industrialized countries do not regularly vaccinate against this disease. On the one hand, vaccination is sometimes associated with not inconsiderable side effects, and three injections are required every few weeks. On the other hand, rabies hardly ever occurs in Central Europe. Dogs are vaccinated against rabies on a regular basis, and foxes no longer have them in Germany thanks to vaccinated baits.
Nevertheless, there are always isolated cases of rabies infections, for example through bat bites or on long-distance trips to countries that are still affected by the plague, such as India or Tanzania.
So if you pet a conspicuously trusting jackal on your Kenya trip, or if you cuddled with a confused street dog in Anatolia, you should go to the doctor as soon as possible, if there is even the possibility that he came into contact with the saliva or blood of the animal.
Fortunately, the time from contact with the pathogen to the onset of the disease in rabies is long - from several weeks to years. So if you passively vaccinate yourself in the first week after contact with a potentially infected animal, your chance of not getting the disease is close to a hundred percent. If you don't, and rabies breaks out, your chance of survival is close to zero percent.
Today, 55,000 people die of the Lyssa every year, more than half of them in Africa, the rest almost all in Asia. In South America, the blood-drinking vampire bat transmits the virus, in the United States, among other things, raccoons. One in three sufferers contract the plague in India.
99% of transmissions worldwide are through dogs. In the vaccinated United States, however, the (very few) infections occur almost exclusively via wild animals such as bats - as does Australia.
Presumably more than 300,000 deaths are prevented annually by the injection of immune sera worldwide. Officially, there have only been a few hundred rabies cases across Europe since 1977.
The outbreak cannot be treated.
The virus ignites the brain and often the spinal cord. The pain first shows on the bitten part of the body. The skin loses its sensitivity there, followed by paralysis, anxiety, psychosis, hallucinations and delirium as a result of the destroyed nervous system.
The paralysis of the posterior cranial nerves paralyzes the throat, the affected person can no longer swallow and speak. If you see water, it causes cramps in the throat and larynx. You can no longer swallow the saliva, which leads to the typical drooling in front of the mouth.
Without being able to drink and swallow, the virus is not diluted and therefore works particularly effectively.
The sufferers are extremely sensitive to environmental stimuli such as light and noise and react to it with what our ancestors called "madness": they roar, strike, scream and bite. If they bite other people, they spread the virus.
The destruction of the brain and nerves leads to coma and death.
Who is at risk
You should be vaccinated against rabies as a prophylactic measure if you travel to high-risk countries, i.e. generally to Africa, India, Central Asia or Arabia. If you become infected, you can rarely expect to get a safe passive vaccination on site.
They are less at risk in typical rabies countries like Bangladesh, Sri Lanka or Kenya if they go on a package tour and stay in shielded hotels.
You are most at risk if you backpack with your backpack through the country, sleep in the open air and thus come into close contact with street dogs. A rabies vaccination goes without saying for employees of zoological gardens, foresters, hunters, veterinarians and dog trainers.
If the risk persists, you should repeat the vaccination every 2-5 years or have your antibodies tested once a year. If they are completely immunized, the cell memory lasts for more than ten years. (Dr. Utz Anhalt)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dr. phil. Utz Anhalt, Barbara Schindewolf-Lensch
- Federal Center for Health Education (BZgA): Vaccination recommendations (available on August 16, 2019), impfen-info.de
- Robert Koch Institute (RKI): Vaccination (access: August 16, 2019), rki.de
- World Health Organization (WHO): Vaccine Safety Net (accessed: 16.08.2019), who.int
- Federal Ministry of Health: Vaccinations (accessed: 16.08.2019), bundesgesundheitsministerium.de
- Professional Association of Pediatricians e. V .: Vaccination: Current vaccination recommendations (available on August 16, 2019), kinderaerzte-im-netz.de