Impfen bei Immundefekten oder 
medikamentöser Immunsuppression

D. Boršo; M. Löbermann; C. Fritzsche; C. Hemmer; A. Führer; U. Zettl; E. C. Reisinger

doi:10.1055/s-0032-1327401

DMW - Deutsche Medizinische Wochenschrift, Inhaltsverzeichnis

Dtsch Med Wochenschr 2013; 138(04): 145-151
DOI: 10.1055/s-0032-1327401

Übersicht | Review article

Immunologie

Impfen bei Immundefekten oder medikamentöser Immunsuppression

Vaccinations in patients with immunodeficiency or immunosuppressive therapy

D. Boršo

¹Zentrum für Innere Medizin, Klinik und Poliklinik für Innere Medizin II, Abteilung für Tropenmedizin, Infektionskrankheiten und Sektion Nephrologie, Universitätsmedizin Rostock

,

M. Löbermann

¹Zentrum für Innere Medizin, Klinik und Poliklinik für Innere Medizin II, Abteilung für Tropenmedizin, Infektionskrankheiten und Sektion Nephrologie, Universitätsmedizin Rostock

,

C. Fritzsche

¹Zentrum für Innere Medizin, Klinik und Poliklinik für Innere Medizin II, Abteilung für Tropenmedizin, Infektionskrankheiten und Sektion Nephrologie, Universitätsmedizin Rostock

,

C. Hemmer

¹Zentrum für Innere Medizin, Klinik und Poliklinik für Innere Medizin II, Abteilung für Tropenmedizin, Infektionskrankheiten und Sektion Nephrologie, Universitätsmedizin Rostock

,

A. Führer

¹Zentrum für Innere Medizin, Klinik und Poliklinik für Innere Medizin II, Abteilung für Tropenmedizin, Infektionskrankheiten und Sektion Nephrologie, Universitätsmedizin Rostock

,

U. Zettl

²Klinik für Neurologie, Universitätsmedizin Rostock

,

E. C. Reisinger

¹Zentrum für Innere Medizin, Klinik und Poliklinik für Innere Medizin II, Abteilung für Tropenmedizin, Infektionskrankheiten und Sektion Nephrologie, Universitätsmedizin Rostock

› Institutsangaben

Abstract

Zusammenfassung

Aufgrund des erhöhten Infektionsrisikos bei immundefizienten und immunsupprimierten Patienten sollten Impfungen konsequent zur Vermeidung von Infektionskrankheiten eingesetzt werden. Je nach Ausprägung der Immundefizienz oder Immunsuppression ändern sich die Indikationen und Kontraindikationen zu Impfungen. Gemäß den aktuellen Empfehlungen der Ständigen Impfkommission am Robert-Koch-Institut (STIKO) besteht für diese Patienten keine Kontraindikation für Totimpfstoffe. Je nach Ausprägung der Immundefizienz kann die Impfantwort jedoch reduziert sein oder ganz ausbleiben, daher ist eine Kontrolle des Impftiters zu empfehlen. Lebendimpfungen galten bei immungeschwächten Patienten wegen lebensbedrohlicher Komplikationen lange als absolut kontraindiziert. Heute kann im Einzelfall eine Indikation für bestimmte Lebendimpfungen gestellt werden.

Abstract

Patients with immunodeficiency and patients under immunosuppressive therapy have an increased risk of infectious diseases. Vaccination strategies are needed to protect them from preventable diseases. The underlying disease and severity of the immune impairment may have influence on indications and contra-indications of vaccines. Inactivated vaccines can be administered safely according to the current recommendations of the Permanent Commission on Vaccinations of the Robert-Koch-Institut in Berlin, Germany (STIKO). Depending on the severity of the immune dysfunction, antibody response to vaccinations varies. Where possible, the antibody response following vaccinations should be tested. Previously, attenuated live vaccines were considered to be strictly contra-indicated in immunocompromised patients. Today, the administration of attenuated live vaccines is thought to be possible, depending on the degree and type of immunodeficiency or immunosuppression of the individual.

Schlüsselwörter

Impfen - Totimpfstoff - Lebendimpfstoff - Immundefekt - Immunsuppression - Sicherheit - Wirksamkeit

Keywords

Immunization - inactivated vaccine - attenuated live vaccine - immunodeficiency - immunosuppression - safety - efficacy

Volltext

Referenzen

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