Status: 11.06.2024 06:00 a.m.

Various waves of infection caused a stir in pediatric and gynecological practices this spring. For example, there is a STIKO vaccination recommendation for expectant parents against the whooping cough pathogen. But the vaccination rate is lacking – even in northern Germany.

by Korinna Hennig

The Figures from the Robert Koch Institute speak for themselves: 60 out of 100 pregnant women do not have sufficient vaccination protection against whooping cough (pertussis). The situation is even worse with influenza: only 17 percent of expectant mothers are vaccinated against the flu. The northern German states are doing somewhat better compared to the rest of Germany – but even here the vaccinated make up on average not much more than a fifth. “We have a lot of room for improvement because my colleagues are sometimes very hesitant,” says Cornelia Hösemann from the Professional Association of Gynaecologists (BVF).

The data is clear when it comes to the risk-benefit analysis: There is no increased risk for pregnant women with the recommended vaccinations. And the professional association offers annual training courses. But the gynecologist believes that many people overestimate the amount of advice required and are worried about making mistakes: “But not giving advice is actually the biggest mistake.”

Further information

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Disease defense in pregnant women shifts

Pregnant women are considered a risk group for several infectious diseases. This is because their immune response is different: “To put it simply, we have a shift away from the cellular immune response towards the so-called humoral immune response,” explains Janine Zöllkau, a specialist in Obstetrics at the University Hospital of Jena. This means that antibodies in the blood, which can decrease over time, now play a greater role. The immune memory in the cells, on the other hand, can do less during pregnancy.

And there are also very simple physical limitations, especially in the case of respiratory infections: “The growing uterus and the reduced space in the abdomen and then also in the chest mean, for example, that the pregnant woman can no longer ventilate certain parts of the lungs as well towards the end of her pregnancy,” says Zöllkau.

Influenza: Increased risk for mother and child

Pregnant women infected with influenza therefore have a 6.5-fold higher risk of having to go to hospital than other patients. They are three times more likely to develop pneumonia. This can also harm the unborn child. The STIKO therefore recommends that pregnant women get vaccinated against influenza at the latest. And Covid should also still be on your list, says Janine Zöllkau, who also researches infections during pregnancy.

Whooping cough, on the other hand, mainly affects newborns, because they often catch it from relatives. The problem is that immunity after a previous infection or vaccination decreases over the course of life, sometimes quite quickly. However, adults often become ill without the typical, extremely painful cough and unknowingly infect the child. And babies do not receive their first dose of whooping cough vaccine until they are two months old at the earliest.

Nest protection: surprisingly high antibody levels

The idea of ​​vaccinating pregnant women is therefore based on the so-called nest protection: “A fundamentally mega-cool principle of nature,” says specialist Zöllkau. “Immunologically, this is basically the great gift that the mother gives the child.”

Antibodies from the mother’s blood are passed on to the child via the placenta. And because they are actively bound and enriched, newborns can have an antibody level that is even higher than that of the mother. “It really is as if the placenta with its receptors were reaching out and actively taking the antibodies over to the child. This only works in one direction,” explains Zöllkau. This protects the children in the first weeks of their lives.

Breastfeeding, on the other hand, only indirectly contributes to nest protection – contrary to a widespread belief: the mammary gland can accumulate various classes of antibodies in the milk, says the specialist. But because the milk has to be swallowed and digested, these do not appear in the blood in relevant quantities. But they do appear on the mucous membranes: “Especially for respiratory infections, which have their entry mechanism via the nose, mouth and throat, it is of course great if breast milk moistens this area.”

Partners and grandparents can also help protect the child

But experts also advise other relatives to get vaccinated for the sake of the newborn. Gynaecologist Cornelia Hösemann therefore also focuses on partners and grandparents in her practice: “I always ask husbands when they come to pregnancy counseling whether they have their vaccination certificate with them.” Not all doctors realize that this is not a problem in terms of billing.

Further information

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“Talking medicine” against vaccine skepticism

A study from Vienna on women’s willingness to be vaccinated and their perception of risk shows how important advice from doctors is. If pregnant women were given oral advice in addition to written information, almost twice as many decided to be vaccinated. Concerns about potential risks are particularly high when it comes to vaccinations during pregnancy. However, the Standing Committee on Vaccination only makes recommendations after a detailed risk-benefit analysis. But after a brief peak due to the pandemic, willingness to be vaccinated has stagnated or even fallen in many areas.

“Vaccination advice is a matter close to the hearts of many gynecologists,” says Janine Zöllkau. This is also a political question and could be due, among other things, to the fact that maternity care is a comprehensive and tightly timed affair. “What often limits us in our day-to-day practice is simply the time we can invest in our patients and in the consultation.” Integrating advice on several vaccinations, possibly even with a special risk constellation due to previous illnesses, is a challenge.

Will there soon be a recommendation for RSV vaccination?

Cornelia Hösemann, gynecologist and board member of the professional association of gynecologists, chairwoman of the Saxony regional association and member of the Saxon Vaccination Commission (SIKO) is in her practice. © picture alliance/dpa/dpa-Zentralbild | Jan Woitas
Gynaecologist Cornelia Hösemann says about vaccinations during pregnancy: “Not getting advice is actually the biggest mistake.”

This could soon become a little more complex. After being examined by the European Medicines Agency, a vaccine against RSV, a respiratory infection that is dangerous for newborns, has now been approved for pregnant women. The professional associations are already recommending the RSV vaccination, including the German Society for Perinatal Medicine, of which Janine Zöllkau is a member. And the Saxon Vaccination Commission (SIKO) has also already taken a position.

In her own practice, Cornelia Hösemann, herself a member of SIKO, already advises on the RSV vaccination and also administers it upon request. “I haven’t had a single pregnant woman who has refused the vaccination,” she says. However, as long as there is no recommendation from STIKO, the national committee, many health insurance companies will not cover the costs. Gynecologists can help to apply for reimbursement. Nevertheless, this detour makes vaccination more difficult.

Studies on the increased willingness to be vaccinated following the STIKO recommendation of a Covid vaccination for pregnant women show how much an official recommendation means and how much it can allay the concerns of expectant parents about potential vaccination risks.

Advice, not dogmatism

Cornelia Hösemann expects that the STIKO will soon also comment on RSV immunization. She advocates a pragmatic approach to vaccination advice: “Once you have integrated it into your practice, then in my opinion it’s almost a no-brainer.” This also includes the staff, who not only ask for the chip card and maternity record when greeting patients, but also for the vaccination record.

For Janine Zöllkau, one thing is particularly important: “We do not give dogmatic advice in the sense of ‘everyone has to get vaccinated’.” Pregnancy is also not the time to catch up on basic immunizations. “Our only concern is that everyone is so well informed that they can decide for themselves.”

Sources and background information

Further information

Epidemiological Bulletin of the Robert Koch Institute dated 9 August 2010. external

“The New England Journal of Medicine” – Risk of Fetal Death after Pandemic Influenza Virus Infection or Vaccination (Siri E. Håberg et al.) external

Wendelboe, A., Van Rie, A., Salmaso, S., Englund, J.: Duration of immunity against pertussis after natural infection or external vaccination

Schirwani N., Pateisky, P., Koren, T., Farr, A., Kiss, H., Bancher-Todesca, D.: Written and oral counseling increase willingness to receive SARS-CoV-2 vaccination in postpartum women: A qualitative prospective cohort study external

Bödeker, B., Betsch, C., Wichmann, O.: Skewed risk perceptions in pregnant women: the case of influenza vaccination extern

Association of Research-Based Pharmaceutical Companies: After the pandemic: How is vaccination behavior developing in Germany? [26. April 2023] external

Working Group for Infections and Infectious Immunology in Gynecology and Obstetrics of the German Society for Gynecology and Obstetrics (AGII): Benefit-risk assessment of RSV vaccination of pregnant women taking into account the data situation (as of 10/2023) external

Hagenbeck, C., Zöllkau, J., Helbig, M., Fehm, T., Schaal, N.: COVID-19 vaccination during pregnancy and breastfeeding: attitudes and utilization before and after official recommendations in Germany external

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NDR Info | Knowledge | 05.06.2024 | 08:56 a.m.