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Vaccination in Austria 1961-2001
E. G. Huber, Salzburg, Austria

In Austria after the Second World War we understood by the word "vaccination" only the smallpox vaccination. Only that was taught at the university. Besides that vaccination one also vaccinated against tuberculosis, diphtheria, tetanus, pertussis and - when strictly indicated - against rabies. There were no studies, no field trials and no quality control at all. The Austrian pertussis vaccine however was comparatively well tolerated because it has been cultured on a solid agar. In 1959 the desired vaccination against poliomyelitis was introduced (IPV), it was followed by the oral vaccine (OPV) in 1961. This vaccination was given until 2000 in two limited vaccination periods a year. Paid by the ministry it was free for children and very well accepted in the whole country. 
In 1965 I began a field trial about measles vaccination together with Dr. Lotte Rannon at the Paediatric Clinic of the University of Vienna. Since we did not know which vaccine would be more effective we used killed and live vaccines in different schedules. From 1970 on, only the live vaccine has been used except in combination vaccines. From 1970 to 1974 this vaccination was introduced in one country after the other. So the measles vaccination was given all over Austria but it took another couple of years until the vaccination rate was sufficient. In 1971 I started a field trial in Salzburg concerning the praepuberal Rubella vaccination of girls. 1972 this vaccination was given in the country of Salzburg, 1973 in Vienna and in 1974 all over Austria. In 1972 the next field trial was launched; the vaccination against mumps (parotitis). In 1974 the combination vaccine M-M made it possible to give this vaccination together with the measles vaccine.
Another field trial was made together with Ch. Kunz in 1976: we used the new subunit vaccine against influenza with children. It is only now that it has got the real importance because we know now that it is often necessary to vaccinate children.
When the WHO demanded the eradication of rubella we changed our schedule and vaccinated every child in its second year of life. The smallpox vaccination was compulsory until 1977 then voluntary and it was completely stopped in 1980. 
All newborns were vaccinated against tuberculosis (BCG) until 1989 and from 1989 to 2000 only when there was a special indication. In 2000 the BCG-vaccination was stopped completely.
Until 1991 almost every child was vaccinated against DPT in its first year of life. When my multicentric field trial about haemophilus vaccination was finished we swifted to the fourfoldvaccine DPTHib. This was the first conjugated antibacterial vaccine. Nowadays we have got a second one: the conjugated pneumococcal vaccine. During the 80'ies we began to vaccinate people with high risk against hepatitis B (HB). Doing this we could reduce the frequency but did not have a real success. This is only possible by the general vaccination. In 1992 I asked the ministry on behalf of the committee on vaccination to change step by step from OPV to IPV. It was not until 1999 that we could vaccinate the babies with an inactivated polio-vaccine in the form of a fivefold vaccine. In 2000 we added the HB-vaccine. However we had to give two injections in order to get a vaccination without mercury (Tetravac = D-T-aP-IPV and Procomvax = Hib + HB). Nowadays we use a sixfold vaccine (Hexavac) against D-T-aP-IPV-Hib-HB, of course without thiomersal, paid by the ministry and the general insurance. As every child is vaccinated a second time before its thirteenth year of life we have now the possibility to eliminate HB. In 1973 Ch. Kunz developed a vaccine against the tick-born-encephalitis (TBE, in German FSME) which was licensed in 1976. In this field the results were the same like with hepatitis B: the vaccination of high risk people brought a slight, the general vaccination brought a full success. So we have vaccinated practically everybody in Austria for 10 years - voluntarily and supported by the general insurance and we could decrease the annual frequency from more than 700 to 41 in 1999. 
Already in 1974 it was necessary to show in which order a child has to be vaccinated. Therefore I published the first Austrian vaccination schedule under my own name and improved it every two years. In 1984 the first official Austrian vaccination schedule appeared. Now the vaccination committee of the "Oberster Sanitätsrat" publishes the last recommendations every year.