Overview of the development of the immune system and general questions about vaccination
When Louis Pasteur discovered microbes, i.e., bacteria, as the cause of epidemics in the nineteenth century, and Robert Koch later postulated that every infectious disease was caused by such a bacterium, an organ system responsible for defending against these germs was not yet known. However, Robert Koch had not only found that a germ is always necessary for an infectious disease (Koch’s first postulate), but had also observed that not everyone exposed to a particular germ falls ill, meaning a predisposition to illness must exist (so-called predisposition, Koch’s second postulate). Even when the first successful vaccination against smallpox was carried out in England (Edward Jenner, 1798, England), almost nothing was known about immunological processes. Due to the severe course of this widespread disease, smallpox vaccination soon became widespread, although no one knew exactly how its effect could be explained. Immunology is one of the youngest disciplines in medicine; even today, many mechanisms are still completely unclear. However, this does not prevent us from intervening in many ways in this complicated system of our body; vaccinations are just one example, immunomodulatory therapies, e.g., in the field of so-called “alternative medicine,” also fall into this category. The immune system is an organ system that, like a large network, permeates our entire body; it consists of lymph nodes, the spleen, liver, thymus, and other organs, as well as mobile cells that can migrate to any region of our body and perform very specific functions, the so-called white blood cells (lymphocytes, granulocytes, and monocytes). In addition, there are many proteins, some of which are only formed during infections. However, the immune system is not only responsible for defending against foreign organisms that penetrate our body, but also for defining our very individual cell properties, because every person has a uniquely designed body with cell properties that are unique to them (so-called HLA antigens). These individual cell properties, the best known of which are blood groups, are the main problem in human organ transplantation; these HLA antigens mark the donor organ as foreign, and it is rejected by the recipient organism. It is interesting that the human organism has the most individual HLA system, meaning humans have the immunologically most individual organism, while that of animals, although having different antigenic properties from species to species, differs only slightly from pig to pig, for example (1). “Immunis” means free, independent, and originally comes from political life in ancient Rome. Senators were immune, i.e., free from taxes to the state, independent in their decisions. Even today, we speak of the immunity of parliamentarians. However, freedom is something we must acquire in the course of our lives; freedom of thought and action is ultimately something that is seen in idealism as the epitome of humanity. So it is perhaps not surprising that the immune system is not fully developed from birth, but rather represents only a rudimentary organ system that must first “learn” its function. Just as human freedom in thought and action arises through experience, the immune system also develops through “experience”; every infection is such an experience that leads to the formation of antibodies, small protein crystals. These antibodies generally make it possible to recognize the germ causing the infection early on at the next opportunity and to prevent a second illness, generally for life. The illness itself, which follows such an infection, can perhaps be compared to the learning process that, more or less invasively, leads to knowledge. At birth, humans have a minimal immunological endowment; most antibodies are still antibodies that have passed from the mother via the umbilical cord (passive immunity). The HLA antigens are also rudimentary at birth; the fetus shortly before birth would be the ideal organ donor. (It is currently unclear whether HLA antigens are already fully formed at birth but only slightly activated, or whether they are actually fully formed only in the course of life (1)). At three months, the mother’s antibodies are “used up”; the infant now becomes susceptible to infection if it does not continuously receive antibodies through breast milk. The development of one’s own immune system begins through past infections. In the first years of life, 8-12 febrile infections are not uncommon and are not an expression of an immune defect, but rather the learning of immunity. In the first decade of life, children’s immune organs (tonsils, adenoids, thymus, and lymph nodes) are often very large, almost as an expression of the learning process. These organs could be compared to the sensory organs, which are also very active at this age. Later, these organs regress; the thymus disappears completely by adulthood. It is interesting that the appendix may also belong to these immune organs, which play an important role during this period. A known fact is that people who were often ill as young children or had frequent infections are often healthy in old age. Based on the antibodies detectable in the blood, it is sometimes possible to accurately deduce past infections (e.g., “rubella titer” during pregnancy). What is not so well known is the fact described above that HLA antigens, as an expression of our body’s individuality, also differentiate in the context of past infections (1). Very little is known about the exact mechanism of these changes. This change in HLA antigens is perhaps the organic expression of the frequently expressed opinion that diseases lead to “changes” in people. This is often expressed, especially in connection with the so-called “childhood diseases.” So far, we have considered the “learning” of immunity by the immune system and learning in the sense of knowledge and insight separately. However, there are a number of indications that upbringing, psychological situation, and the immune system are very closely linked and interact. Everyone knows the experience that in acute stress situations, e.g., exam preparations, an acute illness rarely occurs; this is referred to as “stress metabolism,” meaning a very complicated metabolic situation with hormonal shifts, etc. This stress metabolism also includes higher numbers of granulocytes, a special group of white blood cells that are responsible for non-specific infection defense. (A similar effect can be achieved in the short term by injecting cortisone). In allergy research, there are now a multitude of indications that upbringing and immunity are also related; for example, allergies are more common in so-called “well-educated” circles, and rather rarer in the so-called “Third World,” where education is often a luxury, etc. In these studies, it is difficult to see upbringing as the sole factor in the development of allergies (more on allergies below). Unfortunately, the relationship between upbringing and immunity has not yet been investigated. Two immunological terms still need to be examined more closely: the term “childhood disease” and allergy.
Childhood Diseases
Childhood diseases are illnesses that are obviously very contagious and widespread, which is why in an unvaccinated population, infection in childhood, mostly in preschool age, was the norm. Mostly, these are not “trivial” infections, but sometimes quite severe illnesses with high fever. This means they are diseases with very intense immune responses, metaphorically speaking, with difficult-to-learn tasks. All these childhood diseases lead to lifelong immunity. Nevertheless, it must not be overlooked that the “task” of these childhood diseases, albeit very rarely, is too difficult for some children and can lead to permanent damage. It is interesting that childhood diseases tend to cause complications at an older age (for example, the occurrence of bronchiolitis (severe lung reaction sometimes requiring ventilation) in measles is not described in preschool children, but is relatively common in adults with measles. Encephalitis (brain inflammation) as a complication of measles is also significantly more common the older the child is (5 and 6)). Vaccination most likely does not lead to lifelong immunity in any case, meaning vaccination probably does not lead to the same learning effect, which depends not only on recognizing the antigenic properties of the germ but also on the disease itself. Vaccinated people will probably need booster vaccinations repeatedly throughout their lives. Childhood diseases do not have to be fatefully severe, even if in most cases there is no conventional medical treatment. In homeopathy and anthroposophic medicine, there are indeed therapeutic approaches, but unfortunately, there are no classical studies on this yet.
Allergies and Autoimmune Diseases
Allergies and Autoimmune Diseases have massively increased in recent decades without a conclusive explanation. (Autoimmune diseases are conditions in which the body’s own tissue is recognized as foreign and destroyed. Rheumatism, ulcerative colitis, Crohn’s disease, etc., belong to this category). What allergies, which include neurodermatitis and asthma, and autoimmune diseases have in common is a misguided immune system. For whatever reason, substances that we normally tolerate are suddenly fought with inflammatory reactions by our body. Immunity, as an expression of freedom, thus becomes a sometimes extreme lack of freedom. It is reasonable to assume a false learning process here. And indeed, recent evidence strongly suggests that something similar is occurring (1); to the extent that acute infectious diseases in childhood decrease, allergies and autoimmune diseases increase. Environmental pollution, which was long blamed, apparently plays no role; for example, there were fewer allergies and autoimmune diseases in the former GDR than in the former FRG. However, children in daycare centers who were frequently ill early on have a lower risk of allergies. Recent studies now show a relationship between the development of asthma and ulcerative colitis and vaccinations (2, 3, and 4). Meanwhile, knowledge in immunology has advanced so much that an immunological explanation for these phenomena is also possible; defense cells that normally specialize in fighting germs during an infectious disease could be converted into allergy cells by vaccines (so-called T1-T2 shift (1, 7, 60)). This makes it clear: for learning immune competence, not only the recognition of the germ is necessary, but also the still partially unknown immune processes during the illness! Because, even if allergy cells are formed, antibodies are still produced by vaccination. If the increase in allergies and autoimmune diseases were indeed partly caused by our vaccination approach, a somewhat more cautious approach to the vaccination question would be necessary. In conclusion, let’s revisit the idea that a potential learning task for the immune system might be too difficult. Most children go through measles without significant complications; only a very small proportion are apparently unable to do so (as mentioned, this also depends on age). Haemophilus influenza usually only causes otitis media. However, 1 in 1000 children suffers from very dangerous meningitis. There are indications that these children suffer from an immunodeficiency (so-called complement deficiency), an immunodeficiency that cannot yet be predicted. It is interesting, but also confusing, that for the most malignant course of this meningitis, which usually ends fatally (Waterhouse-Friedrichsen syndrome), an excessive immune reaction is responsible (8). This means that initially there is a weakness, followed by a fatal overreaction! (The above also applies to two other infections, meningococcal and pneumococcal disease). Ultimately, in this case, at least the germ seems to be only a trigger, not the cause of the disease process; immunological phenomena become the central problem. In education, we try to avoid both over- and under-challenging. No one would think of trying to teach a baby to write. Even in pedagogy, it is difficult to find out which child might be overwhelmed by the task and consequently exhibit behavioral problems. In the immune system, this is much more difficult. Just as there can be no universally valid educational recommendation, advice for interventions in the immune system, such as vaccinations, can only ever be given on an individual basis. This brochure is intended to prepare for such a discussion, not replace it.
Specific questions regarding personal vaccination decisions:
Can I reliably adhere to certain hygiene rules? A child with an unexplained rash and no fever must not leave the house or be around other people until rubella is definitively ruled out, as a pregnant woman could become infected and her unborn child could suffer severe damage. Can my trusted doctor support my decision and help me if the child falls ill? Perhaps the question is sometimes not whether or not I want a certain vaccination, but rather when is the right time for it? When is the child at risk from which disease? For example, in certain cases, it might be appropriate to wait to see if my child contracts the disease in preschool age; if not, and the disease becomes more complicated with increasing age, vaccination would then also be possible (e.g., chickenpox). In other cases, only the infant is acutely at risk, meaning that early vaccination might be the better approach (e.g., whooping cough and Hib). Another reason for a vaccination decision can be of a broader societal nature: through consistent vaccination, polio was eradicated in Europe; now, the declared goal of the EU is the eradication of measles in Europe, meaning that if one agrees with this goal, one must opt for vaccination. A decision against vaccination can be changed at any time; a decision for vaccination cannot, and should bind every responsible person to remember regular booster vaccinations. Author: Bernhard Ulrich, Pediatrician and Adolescent Medicine Specialist, Anesthesiologist and Intensive Care Physician.
