Zusammenfassung
Die Leitlinien vieler Länder empfehlen Pneumokokken-Schutzimpfungen für Patienten mit obstruktiven Lungenkrankheiten. Diese Arbeit gibt eine Übersicht zur Immunogenität und Sicherheit dieser Maßnahme. Es gibt keine Evidenz für eine nennenswerte Beeinträchtigung oder Gefährdung dieser Patienten durch eine Pneumokokken-Schutzimpfung. Wenige Arbeiten haben sich mit der Bedeutung der Pneumokokken-Schutzimpfung für die Vermeidung von Exazerbationen obstruktiver Lungenkrankheiten befasst. Vorhandene Studien haben diese Fragestellung meist nur als Nebenaspekt untersucht. Die Ergebnisse sind im Kindes- wie Erwachsenenalter imkohärent. Da jedoch die Konjugatvakzine Kinder unter 5 Jahren zusätzlich effektiv vor lebensbedrohlichen invasiven Infektionen schützt, und bei gesunden Erwachsenen bakteriämischen Pneumonien durch die Polysaccharidvakzine vorgebeugt wird, erscheint der Einsatz bei chronisch lungenkranken Patienten gerechtfertigt.
Summary
Many countries’ guidelines recommend pneumococcal vaccination for patients suffering from obstructive airway disease. This paper reviews the literature as to immunogenicity and safety of this immunization. There is no evidence for a negative effect of pneumococcal vaccination on these patients. Only a few data exist on the preventive impact of pneumococcal vaccination as to exacerbations of obstructive airway diseases. Existing studies mostly took up this question as a side aspect. The effect in children and adults appears limited. On the other hand, the pneumococcal conjugate vaccine prevents life-threatening invasive infections in children younger than 5 years, and pneumococcal polysaccharide vaccine protects healthy adults against bacteriaemic pneumonia. Thus, pneumococcal vaccination of patients suffering from obstructive airway disease is recommendable.
Literatur
-
1
Black S, Shinefield H, Fireman B. et al. Northern California Kaiser Permanente Vaccine Study Center Group .
Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children.
Pediatr Infect Dis J.
2000;
19
187-195
-
2
Black S, Shinefield H.
Safety and efficacy of the seven valent pneumococcal conjugate vaccine: evidence from Northern California.
Eur J Pediatr.
2002;
161
127-131
-
3
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 Inf Dis J.
2002;
21
810-815
-
4
Bogaert D, van der Valk P, Ramdin R. et al .
Host-pathogen interaction during pneumococcal infection in patients with chronic obstructive pulmonary disease.
Infect Immun.
2004;
72
818-823
-
5
Christensen B, Hedlund J, Lundberg P, Ortqvist A.
Additive preventive effect of influenza and pneumococcal vaccines in elderly persons.
Eur Respir J.
2004;
23
363-368
-
6
Dagan R, Givon-Lavi N, Zamir O, Fraser D.
Effect of a nonavalent conjugate vaccine on carriage of antibiotic-resistant Streptococcus pneumoniae in day-care centers.
Pediatric Infect Dis J.
2003;
22
532-540
-
7
Dagan R, Muallem M, Melamed R, Leroy O, Yagupsky P.
Reduction of pneumococcal nasopharyngeal carriage in early infancy after immunization with tetravalent pneumococcal vaccines conjugated to either tetanus toxoid or diphtheria toxoid.
Pediatr Infect Dis J.
1997;
16
1060-1064
-
8
Davies L, Hardcroft Mutton K, Earis J E, Kennedy N J.
Antimicrobial management of acute exacerbation of chronic airflow limitation.
QJM.
2001;
94
373-378
-
9
Davis L D, Fireman B, Shinefield H R.
Pneumococcal Conjugate Vaccine in Children.
NEJM.
2004;
350
84-85
-
10 De Roux A, Schmidt N, Rose M, Zielen S, Pletz M, Lode H. Immunogenity of the 23-valent Pneumococcal Polysaccharide Vaccine in COPD Patients. 2004 akzeptiert für respiratory medicine
-
11 EMEA .Commission Decision amending the marketing authorization for the medicinal product for human use „Prevenar - Pneumococcal saccharide conjugated vaccine, adsorbed”,. EU/1/00/167/001 - 007, (EMEA/H/C/323/II/18) Var 18 type II 2004
-
12
Evans H E, Mandel I, Glass L.
Serum enzyme inhibitors, immunoglobulins, and upper respiratory tract bacteria in asthma.
Am Rev Respir Dis.
1973;
108
672-675
-
13
Fine M J, Smith M A, Carson C A. et al .
Efficacy of pneumococcal vaccination in adults.
Arch Intern Med.
1994;
154
2666-2677
-
14
Fletcher T J, Tunnicliffe W S, Hammond K, Roberts K, Ayres J G.
Simultaneous immunisation with influenza vaccine and pneumococcal polysaccharide vaccine in patients with chronic respiratory disease.
BMJ.
1997;
314
1663-1666
-
15
Gratten M, Morey F, Dixon J. et al .
An outbreak of serotype 1 Streptococcus pneumoniae infection in central Australia.
Med J Aust.
1993;
158
340-342
-
16
Haby M M, Peat J K, Marks G B, Woolcock A J, Leeder S R.
Asthma in preschool children: prevalence and risk factors.
Thorax.
2001;
56
589-595
-
17
Hausdorff W P, Bryant J, Kloek C, Paradiso P R, Siber G R.
The contribution of specific pneumococcal serogroups to different disease manifestations: implications for conjugate vaccine formulation and use.
Clin Infect Dis.
2000;
30
100-140
-
18
Hess T.
Pneumococcal vaccination: yes or no?.
Schweiz Med Wochenschr.
1998;
128
1096-1103
-
19
ISAAC .
The international study of asthma and allergies in childhood Steering Committee. Worldwide variation in prevalence of asthma, allergic rhinoconjunctivitis, and atopic eczema.
Lancet.
1998;
351
1225-1232
-
20
Klugman K P, Madhi S A, Huebner R E, Kohberger R, Mbelle N, Pierce N.
A trial of a 9-valent pneumococcal conjugate vaccine in children with and those without HIV infection.
NEJM.
2003;
349
1341-1348
-
21
Lahhod N, Emerson S S, Kumar P, Sorensen R U.
Antibiotic levels and response to pneumococcal vaccine in steroid-dependent asthma.
Ann Allergy.
1993;
70
289-294
-
22
Lee H J, Kang J H, Henrichsen J. et al .
Immunogenicity and safety of a 23-valent pneumococcal polysaccharide vaccine in healthy children and children at increased risk of pneumococcal infection.
Vaccine.
1995;
13
1533-1538
-
23
Lehmann D, Marshall T F, Riley I D, Alpers M P.
Effect of pneumococcal vaccine on morbidity from acute lower respiratory tract infections in Papua New Guinean children.
Ann Trop Paediatr.
1991;
11
247-257
-
24
Madhi S A, Klugman K P.
A role for Streptococcus pneumoniae in virus-associated pneumonia.
Nature Medicine.
2004;
10
811-813
-
25
Marfan A A, Sporrer J, Moore P S, Siefkin A D.
Risk factors for adverse outcomes in persons with pneumococcal pneumonia.
Chest.
1995;
107
457-462
-
26
Mbelle N, Huebner R E, Wasas A D, Kimura A, Chang I, Klugman K P.
Immunogenicity and impact on nasopharyngeal carriage of a nonavalent pneumococcal conjugate vaccine.
J Infect Dis.
1999;
180
1171-1176
-
27
Melegaro A, Edmunds J.
The 23-valent pneumococcal polysaccharide vaccine: Part I. Efficacy of PPV in the elderly: A comparison of meta-analyses.
Europ J Epidemiol.
2004;
19
353-363
-
28
Moore R A, Wiffen P J, Lipsky B A.
Are the pneumococcal polysaccharide vaccines effective? Meta analysis of the prospective trials.
BMC Family Practice.
2000;
1
1471-2296
-
29
Obaro S, Adegbola R A, Banya W A, Greenwood B M.
Carriage of pneumococci after pneumococcal vaccination.
Lancet.
1996;
348
271-272
-
30
Obaro S, Adegbola R.
The pneumococcus: carriage, disease and conjugate vaccines.
J Med Microbiol.
2002;
51
98-104
-
31
O’Brien K L, Swift A J, Winkelstein J A. et al. Pneumococcal Conjugate Vaccine Study Group .
Safety and immunogenicity of heptavalent pneumococcal vaccine conjugated to CRM(197) among infants with sickle cell disease.
Pediatrics.
2000;
106
965-972
-
32
Pelton S I, Klein J O.
The future of pneumococcal conjugate vaccines for prevention of pneumococcal diseases in infants and children.
Pediatrics.
2002;
110
805-814
-
33
Reinert R R, Kaufhold A, Schlaeger J J, Meschery V, Lütticken R.
Serotype distribution and antibiotic susceptibility of Streptococcus pneumoniae isolates causing systemic infections among children in Germany, 1992 to 1996.
Pediatr Infect Dis J.
1997;
16
244-245
-
34
Riley I D, Lehmann D, Alpers M P, Marshall T F, Gratten H, Smith D.
Pneumococcal vaccine prevents death from acute lower-respiratory-tract infections in Papua New Guinean children.
Lancet.
1986;
2
877-881
-
35
Rose M, Hey C, Kujumdshiev S, Gall V, Schubert R, Zielen S.
Immunogenicity of pneumococcal vaccination of patients with cochlear implants.
J Infect Dis.
2004;
190
551-557
-
36
Rose M, Hey C, Kujumdshiew S, Gall V, Zielen S.
Gefahr der bakteriellen Meningitis.
Dtsch Ärztebl.
2004;
101
1072-1074
-
37
Schuller N.
Prophylaxis of otitis media in asthmatic children.
Pediatr Infect Dis.
1983;
2
280-283
-
38
STIKO .
Aktuelle Impfempfehlungen: Pneumokokken.
Epidemiol Bull.
2004;
-
39
Vernacchio L, Neufeld E, MacDonald K.
Combined schedule of 7-valent pneumococcal conjugate vaccine followed by 23-valent pneumococcal vaccine in children and young aduls with sickle cell disease.
J Pediatr.
1998;
133
275-278
-
40
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.
Pediatr Infect Dis J.
2002;
21
1017-1023
-
41
Whitney C G, Klugman K P.
Vaccines as tools against resistance: the example of pneumococcal conjugate vaccine.
Semin Pediatr Infect Dis.
2004;
15
86-93
-
42
WHO .
Pneumococcal vaccines.
Weekly Epidemiology Records.
1999;
74
177-183
-
43
Worth H, Buhl R, Cegla U. et al .
Guidelines for the diagnosis and treatment of chronic obstructive bronchitis and pulmonary emphysema issued by Deutsche Atemwegsliga and Deutsche Gesellschaft für Pneumologie.
Pneumologie.
2002;
56
704-738
-
44
Zielen S, Buhring I, Strnad N, Reichenbach J, Hofmann D.
Immunogenicity and tolerance of a 7-valent pneumococcal conjugate vaccine in nonresponders to the 23-valent pneumococcal vaccine.
Infect Immun.
2000;
68
1435-1440
-
45
Fiore A E, Levine O S, Elliott J A, Facklam R R, Butler J C.
Effectiveness of Pneumococcal Polysaccharide Vaccine for Preschool-Age Children with Chronic Disease.
Energy Infect Dis.
1999;
5(6)
828-831
Dr. med. Markus Rose
Zentrum der Kinderheilkunde und Jugendmedizin, Pneumologie und Allergologie, J. W. Goethe Universität
Theodor-Stern-Kai 7
60590 Frankfurt am Main
Phone: 069/63015754
Email: Markus.Rose@kgu.de
