Die Perspektive der globalen Ausrottung der Poliomyelitis

Zusammenfassung

Der vor einigen Jahren in Deutschland und der Schweiz vollzogene Wechsel in der Schutzimpfung gegen Kinderlähmung von OPV (Orale Poliovakzine) zu IPV (Inaktivierte Poliovakzine) wurde begründet mit dem Wunsch, das minimale Risiko einer Impfpoliomyelitis für das geimpfte Kind völlig auszuschließen. Hier stellen wir die Frage, welche Folgen die Einführung eines reinen IPV-Schemas in mehreren Ländern für das Ziel der globalen Ausrottung der Poliomyelitis haben könnte. Veröffentlichte Arbeiten zeigen, dass nach dem Abschluss der weltweiten Impfkampagne, die in den Entwicklungsländern nur mit OPV geführt werden kann, von Impfviren abstammende Polioviren eine Zeit lang in der Umwelt überleben können. Nur mit IPV geimpfte Reisende würden diese Viren aufnehmen und in vielfacher Menge wieder ausscheiden. Deshalb plädieren wir für ein Impfschema, bei dem mindestens die letzte Dosis aus OPV besteht und mit dem ein guter Mukosaschutz erhalten wird.

Abstract

In recent years, Germany and Switzerland have changed national policies to recommend vaccination with IPV (inactivated polio vaccine) instead of OPV (oral polio vaccine) for protection against poliomyelitis. An all IPV-schedule in routine childhood polio vaccination eliminates the - albeit minimal - risk of OPV-associated paralytic poliomyelitis. However, the impact of such a vaccination scheme on the goal to eventually eradicate poliomyelitis on a global level remains debatable. Published studies indicate that vaccine-derived poliovirus may persist in the environment for prolonged periods of time even after completion of a global eradication programme that relies on the near-exclusive use of OPV in the developing countries. Travellers vaccinated with IPV only might become silently infected with vaccine-derived virus, shedding it in large quantities. We therefore plead for a vaccination schedule that includes at least one last dose of OPV to induce strong mucosal immunity.

Schlüsselwörter

Ausrottung - Impfstoff - Poliomyelitis - Polioviren - Sabin

Key words

Eradication - vaccine - poliomyelitis - polio viruses - Sabin

Literatur

• 1 Hull H F, Aylward R B. Invited commentary: the scientific basis for stopping polio immunization.  Amer. J. Epidem. 1999;  150 1022-102
• 2 Centers for Disease Control . Poliomyelitis prevention in the United States: introduction of a sequential vaccination schedule of inactivated poliovirus vaccine followed by oral poliovirus vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP).  MMWR. 1997;  46 RR-3
• 3 Centers for Disease Control . Recommendations of the Advisory Committee on Immunization Practices: revised recommendations for routine poliomyelitis vaccination.  MMWR. 1999;  48 590
• 4 Ständige Impfkommission (STIKO) . Zum Schutz vor der Kinderlähmung wird jetzt inaktivierter Poliomyelitis-Impfstoff empfohlen. Robert Koch-Institut.  Epidemiologisches Bulletin. 1988;  4 21
• 5 Schweizerische Kommission für Impffragen . Neue Empfehlung zur Poliomyelitis-Impfung.  Bundesamt für Gesundheit Bulletin. 1999;  43 809-811
• 6 Jilg W. Poliomyelitis-Impfung. Die Änderung der Impfstrategie in der Diskussion.  Immunologie & Impfen. 1998;  1 2-8
• 7 Nathanson N, Martin J. The epidemiology of Poliomyelitis: enigmas surrounding its appearance, epidemicity and disappearance.  Amer J Epid. 1979;  110 672-692
• 8 Sabin A B. Paralytic consequences of Poliomyelitis infection in different parts of the world and in different population groups.  Amer J Publ Health. 1951;  41 1215-1230
• 9 Sabin A B. Poliomyelitis. Office of the Surgeon General, Dept. of the Army Preventive Medicine during World War II Washington; 1960 5: 367-400
• 10 Paul J R. Epidemiology of Poliomyelitis. WHO Geneva; WHO Monograph 26 1955: 9-30
• 11 Paul J R. Poliomyelitis attack rates in American troops.  Amer J Hygiene. 1949;  49 57-62
• 12 Sabin A B. The epidemiology of Poliomyelitis. Problems at home and among the Armed Forces abroad.  J Amer Med Ass. 1947;  143 749-756
• 13 Sabin A B. Paralytic Poliomyelitis: Old dogmas and new perspectives.  Rev Infect Dis. 1981;  3 543-564
• 14 Ku F C, Chang P J, Cheng Y L. et al . A large-scale trial with live poliovirus vaccine (Sabin’s strain) prepared in China.  Chin Med J. 1963;  82 131-173
• 15 Knolle H. Zur historisch-geographischen Epidemiologie der Poliomyelitis.  Gesnerus - Swiss J Hist Med Sci. 1994;  51 216-231
• 16 Ogra P L. Comparative evaluation of immunization with live attenuated and inactivated poliovirus vaccines.  Ann NY Acad Sci. 1995;  754 97-107
• 17 Ghendon Y, Robertson S E. Interrupting the transmission of wild polioviruses with vaccines: immunological considerations.  Bull WHO. 1994;  72 973-983
• 18 Fine P EM, Carneiro A M. Transmissibility and persistence of oral polio vaccine viruses: implications for the Global Poliomyelitis Eradication Initiative.  Amer J Epidemiol. 1999;  150 1001-1021
• 19 Zhaori G, Sun M, Ogra P L. Characteristics of the immune response to poliovirus virino polypeptides after immunization with live or inactivated polio vaccines.  J Infect Dis. 1988;  158 160-165
• 20 Onorato I M, Modlin J F, McBean A M. et al . Mucosal immunity induced by enhance-potency inactivated and oral polio vaccines.  J Infect Dis. 1991;  163 1-6
• 21 Herremans T MPT, Reimerink J HJ, Buisman A M. et al . Induction of mucosal immunity by inactivated poliovirus vaccine is dependent on previous mucosal contact with live virus.  J Immunol. 1999;  162 5011-5018
• 22 John T J. Anomalous observations on IPV and OPV vaccination. Brown F Progress in Polio Eradication: Vaccines Strategies for the End Game Dev Biol 2001 105: 197-208
• 23 Racaniello V R, Ren R. Poliovirus biology and pathogenesis.  Curr Topics Microbiol Immunol. 1996;  206 305-325
• 24 Prevots D R, Ciofi degli Atti M L, Sallabanda A. et al . Outbreak of paralytic poliomyelitis in Albania, 1996: high attack rate among adults and apparent interruption of transmission following nationwide mass Vaccination.  Clin Infect Diss. 1998;  26 419-425
• 25 Anonymous (various local organizations as well as WHO Regional Reference Laboratory and CDC) . Circulation of a type 2 vaccine-derived poliovirus - Egypt, 1982-1993.  Morb Mort Weekly Rep. 2001;  50 41-42, 51
• 26 Anonymous (various local organizations as well as PAHO and CDC) . Outbreak of Poliomyelitis - Dominican Republic and Haiti, 2000-2001.  Morb Mort Weekly Rep. 2000;  49 1094-1103 and 2001; 50:147-148, and 2001; 50: 855-856
• 27 Anonymous (various local organizations as well as WHO Regional Reference Laboratory and CDC) . Acute flaccid paralysis associated with circulating vaccine-derived poliovirus - Philippines, 2001.  Morb Mort Weekly Rep. 2001;  50 874-875
• 28 Cherkasova E A, Korotkova E A, Yakovenko M L. et al . Long-term circulation of vaccine-derived poliovirus that causes paralytic disease.  J Virol. 2002;  76 6791-6799
• 29 Hovi T, Huovilainen A, Kuronen T. et al . Outbreak of paralytic Poliomyelitis in Finland: widespread circulation of antigenically altered poliovirus type 3 in a vaccinated population.  The Lancet. 1986;  1 1427-1432
• 30 Zhaori G, Sun M, Faden H S. et al . Nasopharyngeal secretory antibody response to poliovirus type 3 virion proteins exihibit different specificities after immunization with live or inactivated poliovirus vaccines.  J Infect Dis. 1989;  159 1018-1024
• 31 Oostvogel P M, van Wijngaarden J K, van der Avoort H GAM. et al . Poliomyelitis outbreak in an unvaccinated community in the Netherlands, 1992-93.  The Lancet. 1994;  344 665-670
• 32 Herremans M MPT, van Loon A M, Reimerink J HJ. et al . Poliovirus-specific immunoglobulin A in persons vaccinated with inactivated poliovirus vaccine in The Netherlands.  Clin Diag Lab Immunol. 1997;  4 499-503
• 33 Herremans T, Kimman T G, van Conyn-Spaendonck M AE. et al . Immunoglobulin A as a serological marker for the (silent) circulation of poliovirus in an inactivated poliovirus-vaccinated population.  Clin Infect Dis. 2002;  34 1067-1075
• 34 Bellmunt A, May G, Zell R. et al . Evolution of poliovirus type 1 during 5.5 years of prolonged enteral replication in a immunodeficient patient.  Virol. 1999;  265 178-184
• 35 Kew O M, Sutter R W, Nottay B K. et al . Prolonged replication of a type 1 Vaccine-derived poliovirus in an immunodeficient patient.  J Clin Microbiol. 1998;  36 2893-1899
• 36 Martin J, Dunn G, Hull R. et al . Evolution of the Sabin strain of type 3 poliovirus in an immunodeficient patient during the entire 637-day period of virus excretion.  J Virol. 2000;  74 3001-3010
• 37 Arya S C. Letter to the editor, RE: Transmissibility and persistence of oral polio vaccine viruses: implications for the Global Poliomyelitis Eradication Initiative.  Amer J Epidemiol. 2000;  152 595
• 38 Burgener M. Development of molecular virus surveillance systems and monitoring of virus prevalence in the environment. Inauguraldissertation der philosophisch-naturwissenschaftlichen Fakultät der Universität Bern Bern,; 2001
• 39 Yoshida H, Horie H, Matsuura K. et al . Characterisation of vaccine-derived polioviruses isolated from sewage and river water in Japan.  Lancet. 2000;  356 1461-1463
• 40 Knolle H. Übertragung der Poliomyelitis durch Trinkwasser und das Problem der Ausrottung.  Gesundh-Wes. 1995;  57 351-354
• 41 Eggers H J. Kommentar zur Arbeit „Übertragung der Poliomyelitis durch Trinkwasser und das Problem der Ausrottung”.  Gesundh-Wes. 1995;  57 349-350