Zusammenfassung
Die überzeugenden Ergebnisse der allgemeinen Säuglingsimpfung mit konjugierten Pneumokokkenimpfstoffen vier Jahre nach Einführung in den USA machen eine Neubeurteilung der Empfehlung in Deutschland erforderlich. Die epidemiologische Situation in Deutschland und die bisherige Strategie werden beschrieben. Die Wirksamkeit der allgemeinen Pneumokokkenimpfung mit konjugierten Impfstoffen wird anhand der klinischen Studien und der Erfahrungen mit Bevölkerungsprogrammen dargestellt. Dabei zeigt sich eine rasche und nachhaltige Reduktion von Todes- und Krankheitsfällen durch Pneumokokkeninfektionen. Durch das Erzeugen einer Herdenimmunität stellt sich auch die Kosten-Nutzen-Relation insgesamt positiv dar. Die Auswertung der gesundheitsökonomischen Untersuchungen weist selbst aus der Krankenkassenperspektive die generelle Säuglingsimpfung als kostensparend aus. Sowohl die Effekte auf Mortalität und Morbidität als auch die Ökonomie lassen die Pneumokokkenimpfung als präventivmedizinische Maßnahme von vergleichbarem Nutzen mit den eingeführten Routineimpfungen einordnen. Die Übersicht über die Impfempfehlungen macht die Notwendigkeit einer Fortschreibung der deutschen Regelungen deutlich.
Abstract
Convincing results of conjugated pneumococcal vaccination since introduction as universal infant immunization in the United States makes it inevitable to reconsider current recommendation of its use in Germany. The epidemiological situation in Germany is described as well as the control strategy in place. Vaccine efficacy is demonstrated by outcome of clinical trials and results from population-based epidemiological surveillance data which demonstrate early and sustained reduction of mortality and morbidity due to pneumococcal infections. Health economic analyses reveal positive cost-effectiveness and cost-benefit relations due to the herd-immunity induced by universal immunization. Even from perspective of German health insurances a cost saving scenario can be expected. Impact on reduction of disease burden and attractive health economic effects make pneumococcal vaccination as preventive tool absolute comparable with well accepted routine childhood vaccinations. The review of existing recommendations and hurdles to implementation in the German system show potential for improvement.
Schlüsselwörter
Konjugierte Pneumokokkenimpfstoffe - Krankheitslast - Impfwirksamkeit - Gesundheitsökonomie - STIKO-Empfehlungen
Key words
Conjugated pneumococcal vaccine - disease burden - vaccine efficacy - health economy - STIKO-recommendations
Literatur
-
1
Ziebold C, v Kries R, Siedler A. et al .
Epidemiology of Pneumococcal disease in Children in Germany.
Acta Paediatr.
2000;
11
17-21
-
2
Adam D, Scholz H.
Bedeutung der Pneumokokkenimpfung bei Säuglingen und Kleinkindern.
Klin Pädiatr.
2001;
11
109-113
-
3
Hülße C, Littmann M, Fiedler K. et al .
Epidemiologische und serologische Untersuchungen von Pneumokokken-Infektionen im Hinblick auf die neuen STIKO-Empfehlungen.
Gesundheitswesen.
1999;
11
393-397
-
4 Reinert R R, Haupts S, van der Linden M. et al .Invasive pneumococcal disease in adults in North-Rhine westphalia,. Germany; J Clin Microbiol 2001 - 2003
-
5
Von Kries R, Siedler A, Schmitt H. et al .
Proportion of Invasive Pneumococcal Infections in German Children Preventable by Pneumococcal Conjugate Vaccines.
Clinical Infectious Disease.
2000;
11
-
6
Von Kries R, Hermann M, Al-Lahham A. et al .
Will the 7-valent pneumococcal vaccine have a similar impact on all invasive pneumococcal infections in children in Germany as in the Kaiser Permanente Trial?.
Eur J Paediatr.
2002;
11
140-143
-
7 Scholz H. Akute Otitis media - Krankheitsbild und Behandlung im Kindesalter. Stück B, von Voß H Pneumokokken-Erkrankungen bei Säuglingen und Kleinkindern Marburg; Kilian Verlag 2001: 15-22
-
8 Siedler A. Erkrankungen durch Pneumokokken. Stück B, von Voß H Pneumokokken-Erkrankungen bei Säuglingen und Kleinkindern Marburg; Kilian Verlag 2001: 44-53
-
9
Loddenkemper R.
European Lung White Book.
European Respiratory Society, European Lung Foundation.
2003;
-
10
Pedersen M K, Hoiby E A, Froholm L O. et al .
Systemic pneumococcal disease in Norway 1995 - 2001: capsular serotypes and antmicrobial resistance.
Epidemiolog Infect.
2003;
11
167-175
-
11 Australian Ministry of Health .Vaccine Preventable Diseases and Vaccination Covergage in Australia, 1999 - 2000. Pneumococcal disease May 2002: 47-52
-
12
Reinert R R, Simic S, Al-Lahham A. et al .
Antimicrobial Resistance of Streptococcus pneumoniae Recovered from Outpatients with Respiratory Tract Infections in Germany from 1998 - 1999: Results of a National Surveillance Study.
Journal of clinical Microbiology.
2000;
11
1187-1189
-
13
Reinert R R, Al-Lahham A, Siedler A. et al .
Nationwide Surveillance of Invasive Pneumococcal Disease (IPD) in the Pediatric Population of Germany, 1997 - 2002.
ESPED.
2004;
11
-
14
Kristinsson K G, Gunnarsdottir T H, Erlendsdottir H. et al .
High prevalence of oxacillin resistant and penicillin susceptible pneumococcal clones in day care centres in Iceland.
ISPPD.
2004;
11
-
15
Stephens D C, Zughaier S, Whitney C G. et al .
Rapid Decline of Macrolide Resistance in Streptococcus pneumoniae following Introduction of the pneumococcal Conjugate Vaccine: A Population-Based Asessement.
ISPPD.
2004;
11
-
16
Lebel M H, Kellner J D, Ford-Jones E L. et al .
A Pharmacoeconomic Evaluation of 7-Valent Pneumococcal Conjugate Vaccine in Canada.
Clinical Infectious Diseases.
2003;
11
259-268
-
17
Black S, Shinefield H, Fireman B. et al .
Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children.
Pediatr Infect Dis J.
2000;
11
187-195
-
18
Black S B, Shinefield H R, Ling S. et al .
Effectiveness of heptavalent pneumococcal conjugate vaccine in children younger than five years of age for prevention of pneumonia.
Pediatr Infect Dis J.
2002;
11
810-815
-
19
O’Brien K L, Moulton L H, Reid R. et al .
Efficacy and safety of seven-valent conjugate pneumococcal vaccine in American Indian children: group randomised trial.
Lancet.
2003;
11
355-361
-
20
Klugman K P, Madhi S A, Huebner R E. et al .
A Trial of a 9-Valent Pneumococcal Conjugate Vaccine in Children with and those without HIV Infection.
N Engl J Med.
2003;
11
1341-1348
-
21
Lucero M G, Dulalia V E, Parreno R N. et al .
Pneumococcal conjugate vaccines for preventing vaccine-type invasive pneumococcal disease and pneumonia with consolidation on x-ray in children under two years of age.
The Cochrane Library.
2005;
-
22
Black S, Shinefield H, Baxter R. et al .
Postlicensure Surveillance of Pneumococcal Invasive Disease after Use of Heptavalent Pneumococcal Conjugate Vaccine in Northern California Kaiser Permanente.
Pediatr Infec Dis.
2004;
11
485-489
-
23
Whitney C, Farley M M, Hadler J. et al .
Decline in Invasive Pneumococcal Disease after the Introduction of Protein-Polysaccaride Conjugate Vaccine.
N Engl J Med.
2003;
11
18
-
24
Flannery B, Schrag S, Bennettt N M. et al .
Impact of childhood Vaccination on Racial Disparities in Invasive Streptococcus pneumoniae Infections.
JAMA.
2004;
11
18
-
25
Davis M.
Race-Based Immunisation Recommendations and the Potential to Reduce Health Disarities.
JAMA.
2004;
11
18
-
26 Whitney C. Effect of Pneumococcal Conjugate Vaccine on Invasive Disease in the U.S. Presentation at ISPPD-4 Helsinki,. 2004
-
27
Jenson H B, Baltimore R S.
Impact of pneumococcal and influenza vaccines on otitis media.
Current opinion in Pediatrics.
2004;
11
58-60
-
28
Escola J, Kilpi T, Palmu A. et al .
Efficacy of a pneumococcal Conjugate Vaccine against acute Otitis media.
New England Journal of Medicine.
2001;
11
6
-
29
Dagan R, Sikuler-Cohen M, Zamir O. et al .
Effect of a conjugate pneumococcal vaccine on the occurrence of respiratory infections and antibiotic use in day-care center attendees.
Pediatr Infect Dis J.
2001;
11
951-958
-
30
Firemann B, Black S, Shinefield H. et al .
Impact of the pneumococcal conjugate vaccine on otitis media.
Pediatr Infect Dis J.
2003;
11
10-16
-
31 Veenhoven R, Bogaert D, Uiterwaal C. et al .Effect of conjugate pneumococcal vaccine followed by polysaccharide pneumococcal vaccine on recurrent acute otitis media. A randomised study. Lancet 2003 11: 2189-2195
-
32
Straetemans M, Sanders E, Veenhoven R H. et al .
Pneumococcal vaccines for preventing otitis media.
Cochrane Library.
2005;
-
33
Schmitt H J, Faber J, Lorenz I. et al .
The safety, reactogenicity and immunogenicity of a 7-valent pneumococcal conjugate vaccine (7VPnC) concurrently administered with a combination DTaP-IPV-Hib vaccine.
Vaccine.
2003;
11
3653-3662
-
34 Olivier C, Liese J G, Stojanov S. et al .Immunogenicity and Reactogenicity of the 7-Valent Pneumococcal Conjugate vaccine (Prevenar®) Coadministered with a Pediatric hexavalent Combination Vaccine (Hexavac®). Booster Phase Results 2004. ESPED 2004 11
-
35
Schmitt H J, Petersen G, Corsaro B.
Immunogenicity and safety of a 7-valent Pneumococcal Conjugate Vaccine (/VPnC) Co-Administered with a DTPa-IPV-HBV/Hib Vaccine.
ESPED.
2004;
11
-
36
Adam D, Scholz H, Helmerking M.
Incidence of Acute Otitis media and Risk Factors in Children Younger than 2 years of age: Efficacy of a Pneumococcal Conjugate Vaccine (PCV).
ESPED.
2004;
11
-
37
Wise R P, Iskander J, Pratt R D. et al .
Postlicensure Safety Surveillance for 7-Valent Pneumococcal Conjugate Vaccine.
JAMA.
2004;
11
1702-1710
-
38
Von Kries R, Hermann M, Hachmeister A. et al .
Prediction of the potential benefit of different pneumococcal conjugate vaccines on invasive pneumococcal disease in German Children.
Paediatr Infect Dis J.
2002;
11
1017-1023
-
39
Ispahani P, Slack R CB, Donald F E. et al .
Twenty year surveillance of invasive pneumococcal disease in Nottingham: serogroups responsible and implications for immunisation.
Arch Dis Child.
2003;
11
757-762
-
40
Moore D, Bigham M, Patrick D.
Modelling the cost and effects of a universal infant immunization program using conjugated pneumococcal vaccine in British Columbia.
Canada Communicable Disease Report (CCDR).
2003;
11
-
41
Hausdorff W P.
Prospects for the use of new vaccines in developing countries- cost is not the only impediment.
Vaccine.
1996;
11
1179-1186
-
42 Robert Koch-Institut .Impfempfehlungen der Ständigen Impfkommission (STIKO). Epidemiologisches Bulletin 1998 11
-
43 Robert Koch-Institut .Empfehlungen der Ständigen Impfkommission (STIKO). Epidemiologisches Bulletin 2002 11
-
44 Robert Koch-Institut .Empfehlungen der Ständigen Impfkommission (STIKO). Epidemiologisches Bulletin 2004 11
-
45
Kalies K, Hermann M, Schmitt H J. et al .
Prävention invasiver Pneumokokken-Infektionen im Kindesalter.
Kinderärztliche Praxis.
2001;
11
90-98
-
46 BEH .Avis du Conseil superieur d’hygiene publique de France. Republique Francaise, Calendrier vaccinal 2004 2004 11: 121-125
-
47
Reinert R R.
Pneumococcal conjugate vaccines - a European perspective.
IJMM.
2004;
11
277-294
-
48 Public Health Division Ontario .Immunization: Three new vaccines added to routine childhood schedule. www.health.gov.on.ca 2. July 2004
-
49 MMWR .Recommended Childhood and Adolescent Immunization Schedule. United States; July - December 2004 11
-
50
Goldblatt D, Ashton L, Southern J. et al .
Immunogenicity and boosting following a reduced number of doses of a Pneumococcal Conjugate Vaccine in infants and toddlers.
ISPPD 4.
2004;
-
51 MMWR .Updated Recommendations for Use of Pneumococcal Conjugate vaccine: Reinstaement of the third dose. 9. July 2004 11
-
52 EMEA .Public Statement - Prevenar - Resumptiuon of supplies. EMEA/21709/04 23. August 2004
-
53
LieuTA, Ray G T, Black S B. et al .
Projekted Cost effectiveness of Pneumococcal Conjugate Vaccination of Healthy Infants and Joung Children.
JAMA.
2000;
11
-
54
Ray G T, Butler J C, Black S. et al .
Observed costs and health care use of children in a randomised conrtolled trial of pneumococcal conjugate vaccine.
Pediatr Infect Dis J.
2002;
11
361-365
-
55
Thomas R G, Butler J C, Black S B. et al .
Observed costs and health care use of children in a randomized controlled trial of pneumococcal conjugate vaccine.
Pediatr Infect Dis J.
2002;
11
361-365
-
56
De Wals P, Petit G, Erickson L J. et al .
Benefits and costs of immunisation of children with pneumococcal conjugate vaccine in Canada.
Vaccine.
2003;
11
3757-3764
-
57
Butler J RG, McIntyre P, MacIntyre C R. et al .
The cost-effectiveness of pneumococcal conjugate vaccination in Australia.
Vaccine.
2004;
11
1138-1149
-
58
McIntosh E D, Conway P, Willingham J. et al .
The cost-burden of paediatric pneumococcal disease in the UK and the potential cost-effectiveness of prevention using 7-valent pneumococcal conjugate vaccine.
Vaccine.
2003;
11
2564-2572
-
59
Melegaro A, Edmunds W J.
Cost-effectiveness analysis of pneumococcal conjugate vaccination in England and Wales.
Vaccine.
2004;
11
4203-4214
-
60
Ruedin H J, Ess S, Zimmermann H P.
Invasive meningococcal and pneumococcal disease in Switzerland: cost-utility analysis of different vaccine strategies.
Vaccine.
2003;
11
4145-4152
-
61
Ess S M, Schaad U B, Gervaix A. et al .
Cost-effectiveness of a pneumococcal conjugate immunisation program for infants in Switzerland.
Vaccine.
2003;
11
3273-3281
-
62
Claes C, Schulenburg J M.
Kosteneffektivität der Pneumokokken-Impfung von Säuglingen und Kleinkindern mit der Konjugat-Vakzine PnC-7 in Deutschland.
Pharmacoeconomics.
2003;
11
587-600
-
63
Claes C, Reinert R R, Schulenburg J M.
Incorporating of herd immunity into pharmacoeconomic evaluation of pneumococcal conjugate vaccine PNC-7.
Value in Health.
2005;
11
298
-
64 Claes C, Reinert R R, von der Schulenburg J M. Kosten-Wirksamkeit des Konjugatimpfstoffes PnC7 bei Pneumokokken-Infektionen in Deutschland. Diskussionspapier Nr. 25 der Forschungsstelle für Gesundheitsökonomie und Gesundheitssystemforschung (in Zusammenarbeit mit der MHH). Hannover; Universität Hannover Februar 2005
-
65 Statistisches Bundesamt .Bericht Krankheitskosten 2002. Juli 2004
Dr. med. Johannes F. Hallauer
Bredenbekstraße 29
22397 Hamburg
Email: johannes.hallauer@gmx.de
