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The decrease in infectious diseases preventable by immunisation and the absence of complications caused by these diseases leads to an increased awareness of vaccine-associated adverse events. The analysis of a survey of the vaccine injury compensation data from the German Bundesländer shows the decrease in accepted and demanded compensation from 1991 to 1999. From 1976 to 1990 1139 of 4569 demands were accepted, whereas from 1991 to 1999, acceptance of only 389 of 2543 demands was reported. In all, 38% of the accepted compensations refer to the smallpox vaccine which is not longer recommended by the STIKO (Permanent Vaccination Commission in Germany) since immunisation against smallpox was stopped in the 1980s. Regional differences show that process elements of the German healthcare system as well as political and social reasons express most of the differences in rates and prevalence of vaccine associated adverse events. Epidemiological questions and questions of causality cannot be answered by the analysis of data collected in vaccine injury programs. Valid analysis needs a register of individual documented cases of vaccine adverse events. The surveillance of adverse events following immunisation will make progress by the analysis of data reported according to the Protection against Infection Act (IfSG) and by further surveillance systems that should be implemented in the near future. A centralised commission with expert opinion concerning causality could increase transparency and homogeneity within judgement and documentation of vaccine associated adverse events.