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Vaccination - Vaccination against infectious diseases
contents
- Active and passive vaccinations
- What do vaccines help against??
- How is vaccinated?
- Danger detected, danger averted?
- Passive vaccination
- Tetanus and hepatitis
- Fast and short, slow and sustainable
- reason unknown
- Alternative explanations
- How effective are vaccinations?
- Vaccinations offer absolute protection?
- Repeat vaccinations
- What are the side effects?
- herd immunity
- smallpox
- poliomyelitis
- measles
- mumps
- Rabies - serum or death
- Who is at risk?
Active and passive vaccinations
We distinguish between active and passive vaccinations. In active vaccination, the goal is to prepare the immune system to fight the pathogen in an emergency so effectively that the disease does not break out or only weakened. In passive vaccination, the patient is artificially supplied with additional antibodies.
In vaccination, a distinction is made between active and passive immunization. (Image: Richard Villalon / fotolia.com) What do vaccines help against??
Vaccinations help against infections with viruses and bacteria - from measles to smallpox to rabies and typhoid fever. Today, there are also vaccines that target chronic infections that can indirectly trigger cancer.
How is vaccinated?
The best-known active vaccines are by injection with a syringe, either in the skin, under the skin or in a muscle. In the past, vaccines were also injected into the buttocks, but this procedure is outdated because its efficacy is lower than with injections in the upper arm. For passive vaccinations, however, a "syringe in the butt" is sufficient.
In the case of oral vaccines, we take the vaccine by mouth, and there are also few skin patches.
Danger detected, danger averted?
The active vaccine we know as the "actual vaccine" - became famous vaccination against smallpox. The immune system is trained here to some extent. Metaphorically speaking, our body's defense functions provide the necessary know-how to combat an infectious disease by getting to know the pathogen in a harmless amount.
The patients are "infected" with live or dead vaccines. A life vaccine contains living pathogens in attenuated form, in dead vaccines, the pathogens are killed.
If the pathogen is in the body, the white blood cells, our "health polyp", recognize the proteins and sugar molecules of the invader as foreign bodies.
The immune system now forms memory cells, lymphocytes, which render the pathogen harmless, and, ideally, according to the motto "danger recognized, danger spellbound" prevent a later infection with it.
In a re-infection, the memory cells recognize the pathogen, now lymphocytes convert to plasma cells that give birth to antibodies and to T-lymphocytes and NK cells as a defense of the cells.
It is not necessary for a vaccine to the entire pathogen. Dead vaccines, for example, sometimes contain only the toxin (poison) of a pathogen - this applies among other things to the tetanus vaccine.
Dead vaccines contain killed pathogens or in part only their toxin. (Image: REDPIXEL / fotolia.com) In contrast to other active vaccinations, such a dead vaccine does not prevent the penetration and multiplication of the pathogens. The person is infected, but it does not break any disease, because the toxins that trigger this disease are eliminated. The detonator of the bomb is removed.
Passive vaccination
Passive vaccination was born in 1890, against a widespread evil, diphtheria. Emil von Behring isolated antibodies against the disease from the blood of horses. Antibodies obtained from horses, as well as those of cattle and sheep, also helped against tetanus until 1965.
Passive vaccination is recommended if those affected have already come into contact with the virus without being actively vaccinated. The body now has no 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 the narrow sense, it is not a vaccine, because the body itself does not create additional defenses.
Passive vaccines are blood extracts from immunized animals and humans, or human antibodies produced from cell cultures. A passive vaccination in this sense is not a prevention, but an emergency aid.
It is particularly useful in high risk events of becoming infected, in unvaccinated individuals and in diseases for which vaccination is not the norm. For example, the passive vaccine against tetanus is a classic vaccine for simultaneous injury and insufficient vaccine protection or against rabies.
Tetanus and hepatitis
You will usually also get an immune serum if a wound is dirty and you have not been vaccinated against tetanus, if you work in the hospital and blood from patients with hepatitis B could have entered their body.
Fast and short, slow and sustainable
Unlike an active vaccine, an immune serum works fast and in a short time. In contrast, defensive bodies with an active vaccination need a longer period of time to form themselves, but they also do so in the long term. The protection of an immune serum, however, expires after a few weeks. The body is then defenseless against a new infection by the same pathogen.
An immune serum works fast, but only briefly protects against the pathogen. (Image: psdesign1 / fotolia.com) That's because the immune serum is not the body's own cells. Now when the pathogen strikes again, the cells have no memory of it, so the immune system is not activated.
A classic immune serum derived from human or animal cells has a blatant disadvantage. Being foreign to the body, the body reacts in the same way as it does with foreign protein: it repels these invaders desired by the doctor and the patient.
Thus, the antibodies of the immune serum are excreted quickly. A foreign serum can also cause an allergic shock. This hurdle bypasses modern medicine with monoclonal antibodies that do not provoke this reaction.
reason unknown
In medicine, the question of causality arises again and again. Does a drug actually work or does it cure itself by accident just after taking the medicine? Our ancestors were largely dependent on speculation until modern times.
They certainly had empirical knowledge, gained from experiences that one generation of the next mediated and thus used plants whose healing effects evidence-based procedures and technical possibilities of modernity demonstrated.
So they also observed that who had once suffered certain diseases, this did not get back. Unfortunately, the explanations were wrong, because until the 18th century, nobody knew anything about bacteria and viruses that can be detected only under the microscope - the world's largest bacterium is as big as a dot at the end of a sentence.
Perhaps that's why the idea of treating like with like, coupled with the Christian world view, put God in the right place in the universe.
Some observations proved correct. So you should not eat the flesh of an animal that had killed a "great wolf", because otherwise you turn into such a "great wolf". It is the right recognition that you become infected with rabies when you come in contact with the saliva of a living being who has fallen ill with rabies.
However, real information about the effectiveness of medical treatments is only available in meta-studies that exclude subjective perceptions and individual experiences. For vaccinations, the total numbers of diseases are unique.
Alternative explanations
Alternative explanations do not dispel the decline in infections after the introduction of vaccination programs, and the number of infections in countries without nationwide vaccinations also proves successful.
Alternative explanations in historical comparison would be, for example: educating the population about possible sources of infection. Improvement of general hygiene. Healthy lifestyle. Vaccine-independent damming of the pathogen (for example, killing all stray dogs, wolves and foxes that could potentially transmit rabies), natural disappearance of the pathogens.
How effective are vaccinations?
A few examples before and after the introduction of vaccination programs in the United States: In 1922 there were 175,885 people infected with diphtheria, one more in 1998. In whooping cough the rate was 1937 at 147,271 and in 1998 at 6,279. In measles, 503,282 people died in 1962, 89 in 1998, in Mumps 1968 152,209 and in 1998 606.
Most impressive, however, is the eradication of smallpox. In 1904, the virus still attacked 48,164 people in America. In 1998, there was not a single case. Why: already in 1980, the WHO had declared the smallpox eradicated.
Even without these figures, the effects of vaccinations can be demonstrated: The laboratory clearly shows how many antibodies form against a pathogen after vaccination.
Randomized studies with animals or with and without a vaccine, divided into two groups, also provide information.
Vaccines are subject to strict controls. Before they are allowed to enter the market, they have to undergo a complex approval process, as do other medicines. (Image: Minerva Studio / fotolia.com) Vaccines are subject to a strict control procedure according to the standards of the European Medicines Agency. Before they enter the market, they go through a series of clinical trials. In Germany, the Paul-Ehrlich-Institut controls the approval.
Vaccinations offer absolute protection?
Vaccinations rarely provide complete protection against disease, because the struggle between the body's own defense and pathogens, in other words the evolutionary process, is far too dynamic.
Certain pathogens change very quickly or occur in various forms. Variants of them, so to speak, slip through the nets, and science is eagerly trying to upgrade the vaccines against these new "ways of fighting.".
In influenza, for example, whose pathogens repeatedly carry out an antigenic drift, usually only the worst effects can be prevented.
However, many old plagues, which are still rife in the Third World, have had very good vaccinations. Polio, measles and rubella are considered eradicated in the US today.
In tetanus, diphtheria, mumps and whooping cough, the number of US cases has "only" fallen 92% since the vaccination programs, but the mortality rate of those who died of it has dropped by more than 99%..
Repeat vaccinations
Most vaccinations must be repeated after the first immunization to maintain immunity. In this case, the vaccinated no longer needs the full dose of the vaccine when refreshing, since even a smaller amount causes the immune system to work effectively.
There is no rule of thumb; the frequency and timing of recurrences vary from disease to disease. A smallpox vaccine, for example, is likely to last a lifetime, measles, mumps and rubella vaccines usually last well over ten years, as does the hepatitis B vaccine.
In some diseases, such as whooping cough, the antibodies that are produced go back four years, and you should repeat the vaccine after ten years at the latest. This also applies to diphtheria and tetanus.
So that the once built immune protection is not lost again, many vaccinations must be refreshed regularly. The timing and frequency of recurrence depend on the disease. (Image: Martin Lang / fotolia.com) For example, a typhoid vaccine only works for two to three years.
Ideally, you should have a vaccination against influenza every year if you are over 60, in contact with the sick, or if you have chronic illness yourself.
What are the side effects?
Above all, active vaccination means letting a pathogen enter the body. Many people are afraid of that, a fear that may even be evolutionary. The real side effects of common vaccines are related to this fear but in no real relationship: As any intervention in the body is also a vaccine associated with risks. But these are small and can not be compared in the least with the outbreak of illness.
Vaccination reactions are normal reactions of a healthy person. These may include: a slight sense of lethargy, 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, mild pain and a feeling of weakness show that the immune system is working.
Complications of vaccinations also occur. Thus, active vaccinations very rarely lead to an outbreak of the disease in a weak form. In the case of measles, up to 5% of those vaccinated experience the "vaccine", ie measles symptoms in a mild form: rash and fever.
In very rare cases, an allergic shock occurs when the body reacts to the vaccine. Such a shock can threaten life, and doctors are required to have all the material they need to handle the emergency. You need to educate patients about this potential side effect.
herd immunity
Some vaccine critics call for vaccinations to be made dependent on an individual decision. This is understandable, but contradicts the nature of a vaccination.
The more people in a society are vaccinated, the less the pathogen is rampant. This also promotes the protection of people without vaccination, such as infants.
So-called Riegel vaccinations, ie mass vaccinations of a population when a pathogen spreads, should build up herd immunity in the short term.
An inoculation of the population is considered today as the most effective measure to prevent infectious diseases.
smallpox
The smallpox vaccine 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 causes high fever, chills and blisters on the skin. Survivors are disfigured by the so-called pockmarks, every third person died. Survivors went blind, lost their hearing or became paralyzed.
The WHO vaccination programs defeated the plague: in 1980, WHO declared the world free of smallpox after the last proven case occurred in 1977 in Somalia. Today no more smallpox vaccination takes place because the virus is no longer rampant.
Since the beginning of the 1960s, children in this country are vaccinated as standard against polio. (Picture: Picture-Factory / fotolia.com) poliomyelitis
This is also a viral infection caused by the poliovirus. In every tenth case, sufferers suffer seriously: they suffer from headaches, a stiff neck, intestinal complaints and muscle aches. For every thousandth sufferer, the virus attacks the spinal cord and brain and paralyzes the patients.
The vaccination against polio has been standard in Germany since 1962. Within five years, the number of new cases decreased by 99%. Since 1998, vaccination with a dead vaccine.
In contrast to smallpox, polio has by no means disappeared worldwide. In Nigeria and Pakistan, for example, the virus is still occurring.
Meanwhile, WHO has since declared Europe, the Western Pacific and America free of poliovirus, and more recently India - and in Africa and Asia, the disease has been massively reduced.
Regional outbreaks in Europe, especially among religious communities that reject immunization, show that in the absence of vaccination, the virus can re-emerge at any time.
measles
The eradication of measles is a declared WHO goal. America, Australia and Scandinavia are now considered to be free of measles. In Germany, the vaccination of primary school pupils is about 90%. Measles are no longer a childhood disease in Germany that everyone goes through, but occur on average in little more than 100 cases per year. Affected are, for example, children in Waldorf schools whose anthroposophic parents and teachers reject vaccinations.
Nonetheless, individual measles outbreaks affect thousands of people in Germany: 780 fell ill in 2005, and 2242 in 2006. Worldwide illnesses fell from around 500,000 in 1980 to 139,300 in 2010.
mumps
Like measles, mumps is one of the classic childhood diseases, but both infections also affect adults. The cause is a virus that transmits through droplets. The salivary glands are inflamed, especially the parotid glands - those affected get a proverbial "big cheek". However, every third infected person shows no symptoms at all.
Mostly, mumps are harmless, but in adults there is an increased risk of contracting meningitis or scrotum with the risk of conception. In Germany, the vaccine against mumps is given with a vaccine that simultaneously protects against measles and rubella.
Rabies - serum or death
The Lyssavirus causes an infection that almost always leads to death without vaccination. People are infected mainly by animal bites, mostly by canines such as dogs, jackals, wolves and foxes, but also by cats or bats, raccoons or skunks - even squirrels.
Therefore, a bite is highly likely to infect because saliva containing the rabies virus enters the wound. The problem is not the bite, but the body fluid of the infected animal (or humans).
Rabies viruses are mainly transmitted to humans through animal bites (especially dogs, cats, foxes, bats). (Image: mydegage / fotolia.com) Also saliva of a rabies patient who gets on a skin wound, can trigger the epidemic. It is quite enough if they touch the carcass of a rabies-killed animal or the foam on the mouth of a sick person, even have a wound on their skin and transmit the virus through their own fingers.
Most people in industrialized countries do not regularly vaccinate themselves against this disease. For one, vaccination is sometimes associated with significant side effects, and it takes three injections every few weeks. On the other hand, rabies in Central Europe barely occurs. Dogs are regularly vaccinated against rabies, and in foxes, it comes de facto no longer in Germany thanks to baits.
Nevertheless, there are occasional isolated cases of rabies infections, for example, through bats or on long-distance trips to countries that are still plagued by the disease, such as India or Tanzania.
So if you caress a conspicuously friendly jackal on your Kenya trip, or if you cuddle with a confused street dog in Anatolia, you should go to the doctor as soon as possible, if only the possibility exists that he came into contact with the saliva or blood of the animal.
Fortunately, the duration from the contact with the pathogen to the onset of the disease in rabies is long - from several weeks to years. So, if you passively vaccinate in the first week after you're in contact with a potentially infected animal, your chance of not getting the disease is nearly one hundred percent. If you do not, and rabies erupts, your chances of surviving are close to zero percent.
Today, 55,000 people die of 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 and raccoons in the US. One in three sufferers contract the epidemic in India.
99% of transmissions worldwide are made by dogs. In the vaccinated US, however, the (very few) infections occur almost exclusively on wild animals such as bats - as well as in Australia.
It is estimated that more than 300,000 deaths are prevented each year by the injection of immune serums worldwide. Across Europe there have been officially only a few hundred rabies cases since 1977.
The outbreak of the disease can not be treated.
The virus inflames the brain and often the spinal cord. The pain shows up first on the bitten part of the body. The skin loses its sensitivity, followed by paralysis, anxiety, psychosis, hallucinations and delirium as a result of the destroyed nervous system.
The paralysis of the rear cranial nerves paralyzes the throat, the affected people can no longer swallow and speak. If you see water, it causes the spasm in the throat and larynx. They can no longer swallow the saliva, which leads to the typical spit in front of the mouth.
Without being able to drink and swallow, the virus is not diluted and works so effectively.
The sufferers are extremely sensitive to environmental stimuli such as light and noise and react to what our ancestors called "madness": they roar, beat, scream and bite. If they bite other people, they spread the virus further.
The destruction of brain and nerves leads to coma and death.
Who is at risk?
You should definitely take prophylactic vaccines against rabies when traveling to high-risk countries, ie generally to Africa, India, Central Asia or Arabia. If you become infected, you rarely expect to get a safe passive vaccine on the spot.
They are less likely to end up in typical rabies countries such as Bangladesh, Sri Lanka or Kenya if they take a package holiday and stay in screened hotels.
Stray dogs in holiday countries such as Thailand can transmit the dangerous rabies virus. (Image: Isabel B. Meyer / fotolia.com) You are most at risk when you are backpacking through the countryside, sleeping in the open air and getting in close contact with stray dogs.
The risk of becoming infected with rabies is ignored by many Germans. Vaccination continues for weeks, and some states that ravage the Lyssa are among the favorite destinations for last-minute tourists - such as Thailand.
Vaccinations are expensive, and some tourists think that nothing happens to me in the two-week holiday anyway, and if so, I get treated at home. However, rabies can be exactly the weeks between the infection with the virus and the onset of the disease - and then their journey does not end at the doctor, but in the cemetery.
Not only vaccinate yourself, but especially your children. Any cute kitten, any needy dog, who caresses her sweetheart on the beach in Pattaya, could infect her with the virus.
Employees of zoological gardens, foresters, hunters, veterinarians and dog trainers are rabies vaccines.
If the risk persists, you should repeat the vaccine every 2-5 years, or have your antibodies tested once a year. When fully immunized, cell memory lasts for more than ten years. (Dr. Utz Anhalt)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)