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Sicherheit von Impfstoffen

Vaccine safety

  • Leitthema
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Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Schutzimpfungen sind eine der effektivsten Maßnahmen zur primären Prävention von Infektionskrankheiten. Fortschritte bei der Entwicklung, Herstellung und Kontrolle tragen zur zunehmenden Sicherheit und Verträglichkeit von Impfstoffen bei. Aber auch moderne Impfstoffe sind nicht vollständig frei von Nebenwirkungen. Solche Nebenwirkungen beziehungsweise Impfkomplikationen müssen kontinuierlich erkannt, verstanden, bewertet und, soweit möglich, verhütet beziehungsweise in ihrer Häufigkeit und Schwere reduziert werden. Mit diesen Aktivitäten beschäftigt sich die Pharmakovigilanz (Arzneimittelsicherheit) sowohl vor, während als auch nach der Zulassung der Arzneimittel, um deren fortwährende Sicherheit zu gewährleisten. Die klinische Prüfung von Impfstoffen ist eine Voraussetzung für ihre Zulassung. Trotz intensiver Forschung ist zum Zeitpunkt der Zulassung eines Impfstoffes die klinische Erfahrung jedoch begrenzt. Zumeist liegen Daten über wenige Tausend bis Zehntausend Impflinge vor. In der Regel können damit unerwünschte Ereignisse im Bereich von bis zu 1/1000, maximal von 1/10.000 bis 1/20.000 detektiert werden. Seltenere Nebenwirkungen und Langzeiteffekte werden daher zumeist erst nach der Zulassung erkannt. Ein passives Surveillance-System zum frühzeitigen Erkennen von Risikosignalen nach der Zulassung ist das sogenannte Spontanerfassungssystem. Hier werden spontane Verdachtsmeldungen an das Paul-Ehrlich-Institut gemeldet, dort registriert, bewertet und – falls erforderlich – Maßnahmen zur Risikoabwehr und Risikovorsorge eingeleitet. Aus dem Spontanerfassungssystem können jedoch keine Nebenwirkungshäufigkeiten sondern lediglich Signale ermittelt beziehungsweise detektiert werden. Auch ist es schwer, eine Kausalität zu belegen. Um Kausalität und Häufigkeiten von Impfkomplikationen zu ermitteln, sind andere Instrumente (zum Beispiel klinische Studien, epidemiologische Untersuchungen) erforderlich. Im vorliegenden Beitrag wird der wissenschaftliche Kenntnisstand zur Kausalität und Häufigkeit einzelner Nebenwirkungen und hypothetischer Risiken zusammengefasst.

Abstract

Vaccinations rank among the most effective preventive measures for protection against infectious diseases. Advances in development, production, and control of vaccines facilitate the increasing standards of vaccine safety and tolerance. Comprehensive pre-clinical and clinical tests as well as modern manufacturing and testing methods ensure that vaccines marketed nowadays are safe. As a rule, clinical trials performed before granting the marketing authorisation identify the most frequent adverse events and these results are used to evaluate the safety of the product. Such trials can identify relatively rare adverse events, which occur with a frequency of 1:1,000 to 1:10,000 of all vaccinated individuals. These adverse events will then be included in the summary of product characteristics (SPC) for the vaccine. Even after comprehensive clinical trials of vaccines, it is possible that very rare adverse events may be observed for the first time during general use of a vaccine. In recent years concern over real and alleged risks of vaccines relative to their benefit has grown in many countries including Germany. One reason for this is the fact that most infections that were previously feared have now faded from memory. This situation can be ascribed in part to the success of vaccination. In recent years an increased awareness of substantiated and assumed risks following immunization has been reported in Germany as well as many other countries. In part this may be due to the absence of infectious disease-related mortality and morbidity and to the fact that the severity of vaccine-preventable diseases is no longer observable. Consequently, rare and hypothetical adverse events attain undue public attention. As vaccination willingness diminishes, a resulting lower vaccination rate renders the population susceptible to the natural wild type infection with concomitant increases in mortality and morbidity of vaccine-preventable diseases. Thus, very rare or even unproven adverse events have attracted public attention. Declining vaccination rates resulting from these fears may result in a renewed increase of vaccine-preventable diseases. Adverse events following immunization (AEFI) need to be recognized and adequately assessed. This review presents the scientific knowledge concerning causality and frequency of several AEFI and hypothetical risks.

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Authors and Affiliations

  1. Bundesinstitut für Sera und Impfstoffe (PEI), Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51–59, 63225, Langen, Deutschland

    K. Weißer, I. Barth & B. Keller-Stanislawski

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  1. K. Weißer
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  2. I. Barth
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  3. B. Keller-Stanislawski
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Correspondence to K. Weißer.

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Weißer, K., Barth, I. & Keller-Stanislawski, B. Sicherheit von Impfstoffen. Bundesgesundheitsbl. 52, 1053–1064 (2009). https://doi.org/10.1007/s00103-009-0961-y

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