Compulsory vaccination programs

The Measles Protection Act has been in force in Germany since 01.03.2020. This amended the Infection Protection Act (IfSG) so that certain groups of people can now receive the vaccinations recommended by the Standing Committee on Vaccination (STIKO). measles vaccinations recommended by the Standing Committee (STIKO).

In particular, all children from the age of one must provide proof of a measles vaccination when entering kindergarten, daycare facilities or school. Sufficient vaccination protection against measles exists for children from the age of one with at least one measles vaccination and for children from the age of two with two measles vaccinations.

People born after 1970 persons who live in certain community facilities or medical facilities must also have protection against measles. This applies, for example, to nursery school teachers, teachers, day care workers and medical staff. Asylum seekers and refugees must also be vaccinated 4 weeks after being admitted to shared accommodation.

Non-participation in compulsory vaccination programs and the consequences

Persons who do not have sufficient proof of having been vaccinated against measles may not be supervised, employed or work in the facilities concerned. However, this does not apply to persons who are subject to compulsory education.

Should the Paul Ehrlich Institute publishes a supply shortage of vaccines with a measles component on its website, exceptions can be made. exemptions from the statutory ban on admission and activities may be permitted by the supreme state health authorities or the body designated by them.

In the event of intentional or negligent non-compliance with the obligations fines of up to EUR 2,500 may be imposed by the authorities responsible under the Administrative Offenses Act. For example, a fine of up to EUR 2,500 can be imposed,

1. if the management of a facility, contrary to the statutory prohibitions

a) supervises or employs a person or

b) fails to inform the health authorities in the event of an obligation to notify, and

2. if persons do not provide proof within a reasonable period of time despite the obligation to provide proof and a request from the health authorities.

A repeated imposition of the fine is also possible if a final or legally binding decision exists or a new (cease and desist) decision is to be assumed.

When determining the amount of the fine, the competent authorities must always observe the principle of proportionality. principle of proportionality be observed.

In addition to or as an alternative to the fine, a penalty payment under administrative enforcement law may also be considered if the enforceable obligation to provide proof is not complied with.

Conditions for exemption from any mandatory vaccination programs

An exemption or possibility of exemption on religious grounds is not provided for by law . The legislator has deliberately provided an exemption only for persons who, due to a medical contraindication cannot be vaccinated. A medical contraindication may exist, for example, in the case of an allergy to components of the vaccine. A medical certificate confirming the medical contraindication must then be submitted to the facility.

Health check-up for children and adolescents

Children and adolescents are entitled to special health check-ups as a benefit of statutory health insurance. This is laid down in § 26 of the Fifth Book of the Social Security Code. There are currently 10 health check-ups for children (the so-called U-examinations U1 to U9) and one examination for adolescents (J1 examination) are available. The doctor examines the general state of health and whether there are any health risks or certain serious illnesses. Finally, it is determined whether the child is developing appropriately for its age. The program is tailored to the child's age group and includes, for example

• Early detection examinations for congenital metabolic diseases
• Early detection examinations for severe bilateral hearing disorders in newborns
• examinations of the hip joints
• A variety of examinations of individual organs
• Examinations of motor skills and social development

The costs for these early detection examinations are covered by statutory health insurance if they are carried out at the specified times. In general, the participation voluntary, but some federal states have made participation in these examinations compulsory.

Medical care and midwife assistance during pregnancy

Insured persons are entitled to medical care and midwife assistance during pregnancy, during and after delivery, including examinations to determine pregnancy and prenatal care; an entitlement to midwife assistance with regard to postnatal care exists up to twelve weeks after the birth; further services require a doctor's order. If the child cannot be cared for by the insured person after the birth, the insured child is entitled to the benefits of midwife assistance that relate to this child. Medical care also includes advising the pregnant woman on the importance of oral health for mother and child, including the connection between nutrition and the risk of illness, as well as assessing or determining the risk of transmission of caries. If necessary, the medical advice given to insured persons also includes information on regional support services for parents and child.

Since 2008, all women under the age of 25 have been offered a chlamydia test once a year and during pregnancy.

Health check-up for adults

Women and men between the ages of 18 and 34 are entitled to a medical check-up once a year and every three years from the age of 35 as a statutory health insurance benefit. This is laid down in Section 25 (2) of the Fifth Book of the German Social Code. The health check-up serves to identify health risks and for the early detection of frequently occurring diseases, in particular cardiovascular diseases, kidney diseases and diabetes mellitus.

The examination includes

• Medical history, in particular to determine the risk profile (for example smoking, obesity, familial [cancer] risks), review of vaccination status
• Physical examination, including measurement of blood pressure
• Laboratory tests of urine, blood sugar and cholesterol levels (for 18- to 34-year-olds only if corresponding risk factors are present).
• Advice on the results of the examination and - if medically indicated - a prevention recommendation (e.g. courses on exercise, nutrition, stress management or substance abuse).

People aged 35 and over also have the opportunity to be tested once for the viral diseases hepatitis B and hepatitis C as part of the check-up.

As part of the check-up, men aged 65 and over are also entitled to a one-off ultrasound screening for the early detection of abdominal aortic aneurysms (abnormal bulging of the abdominal aorta in the abdominal cavity).

Early detection of cancer

Women and men are entitled to examinations for the early detection of cancer as a benefit of statutory health insurance. This is laid down in Section 25 (2) of the Fifth Book of the German Social Code. The following cancer screening examinations are currently available:

• Breast cancer for women: annual palpation examination from the age of 30 and biennial mammography screening from the age of 50 to 69
• Cervical cancer for women: annual cytological smear test from 20 to 34 years of age, triennial cytological smear test in combination with a test for human papillomavirus from 35 years of age
• Prostate cancer for men: annual palpation examination from the age of 45
• Colon cancer for men and women: from the age of 50, regular immunological stool blood test or from the age of 50 or 55, screening colonoscopy twice every 10 years
• Skin cancer for women and men: biennial examination of the skin surface with the naked eye from the age of 35

The mammography screening for the early detection of breast cancer and the early detection of cervical cancer in women as well as the early detection of bowel cancer in women and men are offered as so-called organized screening programs based on European guidelines. Since 2009, all women between the ages of 50 and 69 throughout Germany have been invited in writing to undergo mammography screening every two years and informed about the program.

Since July 2019, the statutory health insurance funds have been sending invitations and information on colorectal cancer screening to their eligible policyholders aged 50 and over every 5 years.

Since January 2020, the statutory health insurance funds have been sending invitations and information on cervical cancer screening to eligible women aged 20 and over every 5 years.

Dental examination

• Infants are entitled to 3 dental check-ups from the age of 6 to 33 months (§ 26 Fifth Book of the German Social Code - SGB V). The examinations include an inspection of the oral cavity, information for caregivers on the development of oral diseases, nutritional and oral hygiene advice for caregivers as well as recommendations on fluoridation and the selection of suitable fluoridation products. Children are also entitled to the application of fluoride varnish twice per calendar half-year to harden tooth enamel.
• Children from the age of 34 months to the age of the age of 6 years are entitled to 3 early dental check-ups (§ 26 SGB V). The examinations include an inspection of the oral cavity, an assessment of the caries risk, nutritional and oral hygiene advice for parents and guardians, the recommendation of suitable fluoridation agents for enamel hardening and, if necessary, the dispensing or prescription of fluoride tablets. For children with a high caries risk, the application of fluoride varnish twice per calendar half-year is also indicated to prevent caries.
• Children and adolescents from the age of 6 to the age of 17 are entitled to six-monthly individual prophylaxis (§ 22 SGB V). This includes, for example, oral health education with instructions on oral hygiene measures and fluoridation of the teeth to harden the enamel. Content and scope of the prophylaxis services are determined by the dentist according to the individual circumstances of each case.
• Children who have not yet reached the age of 12 are cared for as part of group prophylaxis in kindergartens and schools. In schools and institutions for the disabled, where the risk of caries among pupils is disproportionately high, the measures can be carried out up to the age of 16 (§ 21 SGB V).
• All insured persons, regardless of their age, are entitled to a thorough dental examination every six months to detect dental, oral and maxillofacial diseases as well as a dental scaling once a year.

• Paul Ehrlich Institute