1. Decision-making process and impact of implementation of hexavalent vaccines in immunisation programmes:
the case of Germany
Wolfgang Jilg
Institute for Medical Microbiology and Hygiene
University of Regensburg, Germany

2. STIKO = Ständige Impfkommission
board of experts appointed by the German Ministry of Health
makes recommendations on vaccination for the German states
recommendations made by the STIKO generally accepted as guidelines
vaccinations recommended by STIKO are usually paid by the insurances

3. STIKO recommendations and hexa-valent vaccines
no specific recommendation for combined vaccines other than DT or Td
general recommendation, that combined vaccines should be used “.... whenever possible and applicable”

4. Combined vaccines for infants
available in Germany Me Mu Ru T D Pa
Hib HB
IPV

5. Recommendations of STIKO
for vaccination of infants and adolescents (STIKO 2001)
age
vaccines
2 months
DTPa
Hib
IPV HB
3 months
DTPa
(Hib)
(IPV)
(HB)
4 months
DTPa
Hib
IPV HB
11-14 months
DTPa
Hib
IPV HB
MMR
15-23 months
MMR
years
DT/Td
9-17 years
Td, Pa
IPV
3xHB*
MMR**
* when not vaccinated in infancy
** when not vaccinated so far or only once

6. How are hexavalent vaccines accepted in Germany?
no data available so far
personal impression: pentavalent vaccines plus additional hepatitis B vaccine still preferred, but use of hexavalent vaccine increases slowly

7. Reasons impeding the implementation of hexavalent vaccines
lack of additional reimbursement for the doctor when using combined vaccines
fear of exhaustion of the immune system (by parents/vaccinees and some doctors!)

8. What can we do to improve the use of hexavalent vaccines in Germany?
better the situation regarding reimbursement of doctors when using combined vaccines
inform doctors and parents about the advantages and the safety of combined, esp. hexavalent vaccines