Meningokokken-Erkrankungen auf Reisen – Schutz durch tetravalente Konjugatimpfstoffe

In der Vergangenheit waren vorwiegend die Serogruppen A und C für Meningokokken-Epidemien verantwortlich. In den letzten Jahren hat die Serogruppe W-135 an Bedeutung gewonnen, etwa in Afrika und Saudi-Arabien. Auch die Serogruppen X und Y treten in den letzten Jahren in einigen Ländern vermehrt auf. Die Epidemiologie der Meningokokken ist sehr variabel und der relative Anteil der Serogruppen kann sich über die Zeit in verschiedenen Regionen wesentlich ändern. Reisende sollten deshalb einen möglichst breiten Impfschutz erhalten. Für Reisen in Gebiete des sogenannten Meningitisgürtels in Afrika und zur Pilgerzeit nach Saudi-Arabien sind tetravalente ACWY-Impfstoffe strengstens empfohlen oder sogar verpflichtend. Tetravalente Polysaccharidimpfstoffe sind nicht in Kindern unter 2 Jahren immunogen, sie rufen kein immunologisches Gedächtnis hervor und bei wiederholter Impfung ist mit einer verminderten Immunantwort zu rechnen („hyporesponsiveness“). Dagegen sind Polysaccharid-Konjugatimpfstoffe auch in Kindern unter 2 Jahren immunogen. Des Weiteren sind diese Impfstoffe boosterfähig und können die Trägerrate reduzieren, was zu einer Herdenimmunität beitragen kann. Die jetzigen Impfempfehlungen zielen darauf ab, Reisende in Länder des Meningitisgürtels, Pilger nach Saudi-Arabien, und Menschen mit erhöhtem Risiko bei einem Ausbruch zu schützen. In Kürze ist mit der Registrierung neuer tetravalenter Konjugatimpfstoffe zu rechnen.

Serogroups A and C have been responsible for epidemics of meningococcal disease in the past – mainly in Africa. In recent years, serogroup W-135 has emerged, e. g. in Saudi Arabia and Africa. Serogoups Y and X are emerging in some countries for a couple of years. There are significant variations in the incidence of meningococcal disease and the distribution of serogroups responsible for disease. The broadest coverage of serogroups for which vaccines are available should be offered to travellers. For regions such as the meningitis belt and Saudi Arabia during the Hajj and Umrah pilgrimages, broad meningococcal vaccination is either mandatory or strongly recommended. Tetravalent serogroup A, C, W-135, Y polysaccharide vaccines are limited by poor immunogenicity in young children, lack of inducing immunological memory, lack of inducing herd immunity and can induce hyporesponsiveness with repeated dosing. In contrast, novel polysaccharide conjugate vaccines can reduce nasopharyngeal carriage and are immunogenic over a broader range of age. Globally, current recommendations are to vaccinate all Hajj pilgrims and all travellers to areas with outbreaks or increased risk to acquire meningococcal disease and individuals with certain medical conditions. Novel conjugate vaccines will be licensed in the near future.

Key words

meningococcal disease - meningococcal serogroups - polysaccharide vaccine - polysaccharide conjugate vaccine

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