Prophylaxis through Vaccination
Principle of Vaccination
The idea is quite simple: The body is given the pathogenic substances in a harmless dose, which stimulates it to defend itself against these disease-causing agents. The body defends itself by producing its own defense substances, called antibodies. The defense cells have a "memory" (memory cells) and can immediately fight off the pathogenic invader upon re-exposure and prevent an infection.
For vaccines against diseases of the urinary tract, it is strictly speaking referred to as immune stimulation. These vaccines do not stimulate the body to produce antibodies but instead stimulate the innate immunity of the bladder. This can improve the defense mechanisms in the bladder beyond just antibodies.
Immunisation through vaccination is a ray of hope when bladder infections recur repeatedly. It is recommended in the medical S3 guidelines as a treatment attempt even before long-term antibiotic therapy.
All currently available preparations contain killed bacteria (either only E. coli or a mixture of bacterial strains), which are administered either by injection or orally. Depending on the preparation, immunisation has been shown to prevent recurring infections by up to 50%.
It is best to consult with a urologist for advice and support. Only after functional disorders of the bladder have been ruled out as causes and the germs that typically trigger your bladder infections have been identified through a urine culture, can vaccination be considered.
Uro-Vaxom®
Uro-Vaxom is an immunotherapeutic and is used to treat recurrent and chronic urinary tract infections (bladder infections, kidney pelvis infections, urethritis, asymptomatic bacteriuria). Uro-Vaxom activates various defense mechanisms in the body (cellular and humoral immunity), resulting in an enhanced immune response in the urinary tract. One capsule contains 6 mg of immune-active fractions from selected E. coli strains. This means that this oral vaccine is only suitable if the main cause of your urinary tract infection is E. coli bacteria.
Primary Immunisation: 1 capsule daily on an empty stomach (e.g. half an hour before breakfast) for 3 months, with some liquid.
Interval Boosting (Revaccination): At the beginning of the 7th, 8th, and 9th month after treatment starts, take 1 capsule daily for 10 days (and possibly repeat after 3-month intervals without therapy).
Treatment can already be started during acute therapy and should not be interrupted in case of breakthrough infections. Common side effects (1-10 out of 100) include headaches, nausea, diarrhea, and digestive disturbances.
Two meta-analyses (5 double-blind, placebo-controlled studies) on Uro-Vaxom® have confirmed its effectiveness in prevention, with recurrence rates decreasing by 22% to 65% (on average 39%).
In simple terms: Let’s assume you suffer from 6 urinary tract infections per year. After completing the immunisation (about 8 months and 10 days), you will ideally only have 2 bladder infections per year. In the worst-case scenario, you still have 4-5 infections per year.
The costs for Uro-Vaxom are covered by health insurance in Austria and Germany (subject to diagnosis and initiation of therapy by specialists in urology or gynecology).
StroVac®
StroVac is used for the prevention and treatment of recurring urinary tract infections of bacterial origin. Unlike Uro-Vaxom, it not only contains E. coli bacteria, but also 10^9 inactivated pathogens from the following 5 species: E. coli, Morganella morganii, Proteus mirabilis, Klebsiella pneumoniae, Enterococcus faecalis. StroVac is intramuscularly injected into the upper arm muscle. Avoiding the "vaccine arm": Reports online suggest that an injection into the buttocks causes fewer local reactions.
Primary Immunization: 3 injections of 0.5 ml vaccine suspension at intervals of 1 to 2 weeks.
Booster (Reinforcement): 1 injection of 0.5 ml vaccine suspension about 1 year after the primary immunization.
During pregnancy and breastfeeding, and for children aged 5 to 15 years, vaccination is not recommended. Children under 5 years old may not be vaccinated. Common side effects are local vaccination reactions at the injection site (redness, swelling, hardening, etc.) and general vaccination reactions in the form of flu-like symptoms.
The rate of urinary tract infections per year was reduced by 26% to 93% in several controlled studies.
In simple terms: The variability in proven efficacy is also high here. Suppose you suffer from 6 urinary tract infections per year. After completing the primary immunization (around 1 month), you will ideally only experience 1 bladder infection per year. If the vaccine is less effective, however, you may still experience 4-5 infections per year.
The cost of StroVac (around 150 euros including the booster) is NOT covered by health insurance in Austria and Germany.
Uromune® - A Ray of Hope
This is a new preparation (also called MV140) for the treatment of recurrent urinary tract infections, produced by Inmunotek (Madrid, Spain) and marketed by Q-Pharma (Alicante, Spain). In Germany, Uromune® is currently being tested for vaccination. The 10^9 inactivated bacteria contained in it, which are administered via a pump spray sublingually, are designed to be even more targeted.
The preparation is available in 3 forms:
- Generic composition (Escherichia coli, Klebsiella pneumoniae, Proteus vulgaris, Enterococcus faecalis in equal parts)
- Specific composition (The percentage of bacteria can be individually adjusted)
- Autovaccine (made with the organisms from the patient's urine sample)
Early results are promising: 78% of the 77 women with recurrent bladder infections who were tested with Uromune® remained infection-free the following year.
Another study with 166 women also confirms its effectiveness. The recurrence rate was reduced by more than 50%.
In summary: Observational studies with over 1,000 participants show excellent clinical benefit. In a randomized, placebo-controlled Phase III study, the safety and clinical effectiveness in preventing rUTI (recurrent urinary tract infections) are still to be confirmed.
Autovaccine - The Individual Key
Autovaccines are so-called "autologous vaccines" (a personalised, patient-specific individual medicine) that have a positive impact on various defence cells.
Autovaccines (or autovaccines) have little in common with traditional vaccination, although the desired effect (fewer or ideally no urinary tract infections) aligns with other existing forms of bladder immune stimulation. Autovaccines are used after the symptoms have occurred, not preventively, as with conventional vaccination.
They are a kind of natural vaccination made from the body's own materials, such as inactivated E. coli bacteria from the intestine or urine, and are administered nasally (as a nasal spray) or by injection. The information contained in the autovaccines causes the body to produce protective defence cells and modulate the immune system.
AutoColiVaccines contain E. coli fragments from the patient's digestive tract. To produce the vaccine, E. coli are cultured from the patient's stool, inactivated, and then processed into the AutoColiVaccine.
If you're more of a visual learner, feel free to watch the video (see above). Dr. Thomas Ellwanger (MVZ Institute for Microecology) explains in detail how immune training with AutoColiVaccines works and what the practical process looks like. At the beginning of treatment, a stool sample is sent for the production of the AutoColiVaccine.
Why E. coli from the intestine? Studies have shown that E. coli species move back and forth between the urinary tract and the intestines. The pathogens not only colonise the urinary tract, but also retreat to the intestines, where they can then re-colonise the urinary tract.
It might sound quite adventurous at first, but a nasal spray for bladder infections has been found to help. The Working Group for Microbiological Therapy (AMT) conducted a practical survey on the effectiveness of AutoColiVaccine in the treatment of chronic recurrent urinary tract infections. The result: The therapy with AutoColiVaccines was able to break the long-standing cycle of recurrent urinary tract infections in 20 out of 21 treated patients. The number of urinary tract infections was reduced from an average of 3 to 0.1 per year.
But not only in studies and papers, also in Facebook groups and various reports online, there are many positive feedbacks about the treatment with autovaccines.
Conclusion: In the treatment of recurrent urinary tract infections, AutoColiVaccine is an interesting and above all very well tolerated alternative to already established therapeutic methods. In combination with probiotic therapy, the use of autovaccines in the treatment of recurrent urinary tract infections has proven to be very effective and well tolerated over decades.
My thought on this: Definitely worth a try! Autovaccines are also a possible treatment alternative for other complaints like allergies or chronic sinus infections.
The bad news: SymbioVaccin GmbH has ceased the production of autovaccines at the end of 2021. The BfArM (the regulatory authority for medicines) revoked the legal basis for the production and distribution of autovaccines in 2006 by classifying them as medicinal products. Efforts to reverse this classification over 15 years were unfortunately unsuccessful. However, other options are currently being explored, and there is hope that production will resume in 2023.