Hepatitis A/B-Kombinationsimpfung: Evaluation eines Impfprogramms in Werkstätten für Menschen mit Behinderung

Zusammenfassung

Ziel der Studie:

Menschen mit geistiger und körperlicher Behinderung haben ein erhöhtes Infek­tionsrisiko für eine virale Hepatitis. Bisherige ­Studien zeigen widersprüchliche Daten zum Hepatitis-Impferfolg in dieser Personengruppe, die häufig unter besonderen Bedingungen lebt und arbeitet ­sowie gelegentlich Immundefekte aufweist.

Methodik:

Wir untersuchten die Antikörperantwort nach kombinierter Hepatitis A und B Impfung in den Werkstätten für behinderte Menschen der Stadt Essen (Deutschland) sowohl bei den dort beschäftigten Menschen mit Behinderung (n=949) als auch bei deren Betreuern (n=115).

Ergebnisse:

Schützende Antikörper gegen das Hepatitis A Virus fanden wir in 98,9% der Menschen mit Behinderung und bei allen Betreuern. Die HBV-Seroprotektionsrate der Behinderten lag bei 90,2% und war vergleichbar mit der Seroprotektionsrate der Betreuer (91,3%). Auffrischimpfungen wurden bei allen Impflingen mit anti-HBs Werten unter 100 IU/l angeboten (28% der Menschen mit Behinderung, 23,5% der Betreuer). Die Low-Responder in der Gruppe der Menschen mit Behinderung entwickelten im Anschluss an die Nachimpfung in etwa 50% der Fälle eine anti-HBs Konzentration von über 100 IU/l. Die Non-Resonder dagegen zeigten in etwa 30–40% eine Seroprotektion nach der jeweiligen Impfstoffgabe.

Schlussfolgerung:

Aufgrund der Ergebnisse unserer Studie würden wir die serologische Untersuchung des HBV-Impferfolgs etwa 4–8 Wochen nach der Impfung empfehlen. Zum einen werden so die Personen erkannt, die eine Booster-Impfung benötigen und zum anderen sollten die Non-Responder auf das Vorliegen einer aktiven Hepatitis B untersucht werden. Bei einem Fünftel der in dieser Studie eingeschlossenen Non-Responder wurde eine HBsAg-positive Hepatitis B gefunden.

Abstract

Aim of the Study:

People with mental and physical disabilities have a higher risk of infection with hepatitis viruses. Studies conducted so far show contradictory results on the success of vaccination in this population. These people live and work under special conditions and sometimes have immune defects.

Methods:

We investigated the antibody response after combined vaccination against hepatitis A and B in facilities for handicapped people in the city of Essen/Germany. Antibodies were determined in people with disabilities (n=949) and also in social workers taking care of handicapped people (n=115).

Results:

Protective antibodies against hepatitis A were detected in 98.9% in people with disabilities and social workers. The seroconversion rate against hepatitis B in handicapped people was 90.2% and was comparable to the seroconversion rate in social workers (91.3%). Re-vaccinations were offered to all people with anti-HBs titres below 100 IU/L (28% of handicapped and 23.5% of social workers). In the group of low responders in handicapped people about 50% developed anti-HBs concentration above 100 IU/L. Non-responders showed 30–40% seroconversion rate after re-vaccination.

Conclusion:

Based on this study we would recommend serological tests about 4–8 weeks after vaccination to confirm seroconversion. By this procedure people who need a booster vaccina­tion will be recognized and non-responders should be offered another HBV vaccination. In about 20% of the non-responders included in this study HBs antigen was detected.

Schlüsselwörter

Impfung - Hepatitis - HAV - HBV - Werkstatt für behinderte Menschen - Twinrix

Key words

vaccination - hepatitis - HAV - HBV - centers for handicapped people - twinrix

^* B. Wolters und T. Müller gemeinsame Erstautorenschaft.

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