[14 years of HPV vaccination: what has been achieved?] / 14 Jahre HPV-Impfung: was haben wir erreicht?

Professor Harald zur Hausen, "father of human papillomavirus (HPV) vaccination" turned 85 years old this year. To mark the occasion, a retrospective look at the introduction of HPV vaccination 14 years ago is presented, highlighting the resistance that accompanied the early years of this beneficial vaccination. Even from an early stage vaccination for girls was included in the standard vaccination program of the Standing Commission on Vaccination (STIKO) in 2007 but it was not until 11 years later that it was recommended for boys as well. At around 50%, vaccination rates in both groups in Germany remain too low compared with other countries with school vaccination programs. Yet there are no longer any scientific doubts about HPV vaccination, which has been shown to be safe and effective in studies worldwide. Not only the reduction of precancerous lesions but also of cervical cancers could be shown in real-life studies in addition to the strong reduction of cases of condylomata acuminata in the vaccinated individuals, which is why the World Health Organization (WHO) has declared the elimination of cervical cancer by building population immunity as a vaccination goal. To this end, further efforts should be made to increase vaccination rates in Germany, which was also included in a corresponding appeal at the Conference of Health Ministers in June 2021.

Vaccination in Pregnancy.

BACKGROUND: Vaccination during pregnancy can protect both the expecting mother and the unborn and newborn child from infectious diseases. METHODS: This review is based on publications retrieved by a selective literature search on the immunological particularities of infectious diseases affecting pregnant women, unborn children, and neonates, with particular attention to the guidelines of the German Standing Committee on Vaccinations (Ständige Impfkommission, STIKO) and the pertinent guidelines. RESULTS: Vaccination during pregnancy protects the expecting mother from a severe course of a number of different infectious diseases. Vaccination with inactivated vaccines against influenza, tetanus, and pertussis is effective, safe, and well tolerated. Women who are pregnant or of child-bearing age should be immunized against tetanus according to the STIKO recommendations. All pregnant women from the second trimester onward should receive an inactivated quadrivalent influenza vaccine. The immunity acquired after vaccination with an acellular pertussis vaccine is present only for a limited time. In a cohort study involving 72,781 pregnant women, pertussis vaccination during pregnancy was found to yield 91% protection against pertussis for their subsequently born children in the first three months of life. Further types of vaccine can also be given during pregnancy if indicated. Additional reasonable measures to protect the health of mother and child include the vaccination of other persons in close contact as well as the closure of relevant vaccination gaps among young adults, particularly women of child-bearing age. Treating physicians play a crucial role in encouraging vaccine acceptance by their patients. CONCLUSION: Maternal immunization is a safe and effective strategy for giving neo - nates passive immune protection against life-threatening infections by the vertical transmission of maternal antibodies until they are able to build up their own adaptive immunity.

Influenza and pertussis vaccination during pregnancy - attitudes, practices and barriers in gynaecological practices in Germany.

BACKGROUND: In Germany, antenatal influenza vaccination is recommended since 2010, but uptake remains low. Several countries recently introduced antenatal pertussis vaccination, which is currently under consideration in Germany. We conducted a survey among gynaecologists on attitudes, practices and barriers regarding influenza and pertussis vaccination during pregnancy. METHODS: Gynaecologists were invited to complete a pre-tested, 24-item questionnaire published in the German Professional Association of Gynaecologists' journal in September 2017 within 2 months. Associations between variables were examined using Chi-Squared, Fischer's Exact or t-tests. Variables associated with gynaecologists' self-reported implementation of vaccination in pregnant women were identified using univariate and multivariate logistic regression analyses. RESULTS: Of 867 participants (response 11%), 91.4 and 59.4% reported currently vaccinating pregnant women against influenza and pertussis, respectively. Gynaecologists who reported obtaining annual influenza vaccination and actively informing their patients about these vaccinations were significantly more likely to vaccinate pregnant women against influenza (96.5% vs. 65.7 and 95.1% vs. 62.2%) and pertussis (63.1% vs. 44.3 and 82.4% vs. 12.9%). Performing influenza vaccination was least likely among gynaecologists who perceived logistical difficulties as a vaccination barrier (35.9%), while pertussis vaccination was least likely if the lacking official recommendation (32.0%), logistical difficulties (27.1%), safety concerns (17.5%) and limited vaccine effectiveness (11.1%) were perceived as barriers. Of participants not yet vaccinating pregnant women against pertussis, 86.5% reported they would follow an official recommendation. Including vaccination recommendations in the maternity record (95.2%) and informing the public (88.7%) and health care professionals (86.6%) were considered the most suitable measures to achieve high pertussis vaccination coverage. CONCLUSIONS: The large proportion reporting performance of influenza vaccination during pregnancy and high acceptance of a potential recommendation for pertussis vaccination reflected positive attitudes towards vaccination among participants. However, factors associated with failure to vaccinate may be more prevalent among non-participants. Results suggest that gynaecologists' confidence in vaccination is crucial for implementing vaccination in pregnancy. Thus, doubts on vaccine effectiveness and safety should be allayed among gynaecologists and pregnant women via various communication channels, and solutions for logistical barriers sought. Including antenatal vaccination recommendations in the maternity record would serve as an important reminder for both groups.