Zusammenfassung
Infektionen mit Hepatitisviren können einerseits zu einer akuten Hepatitis mit Leberversagen führen, andererseits können sich chronische Verlaufsformen zu Leberzirrhose und hepatozellulärem Karzinom entwickeln. Daher ist die Prävention der Virushepatitis und ihrer Folgen von großer Bedeutung. Die Impfung gegen Hepatitis A ist nahezu immer erfolgreich und führt sehr rasch zu einer Seroprotektion. Der Impfschutz besteht mindestens 20 Jahre und eine Booster-Impfung ist generell nicht erforderlich. Seit Einführung der Impfung hat es einen deutlichen Rückgang an HAV-Neuinfektionen gegeben. Ebenso gibt es eine sichere und sehr effektive Impfung gegen Hepatitis B. Bei immunsupprimierten und Dialysepatienten ist die Seroprotektionsrate geringer und besondere Impfmaßnahmen sind erforderlich. Neue Impfungen mit besseren Adjuvanzien werden momentan in Studien geprüft. Für die Prävention der Hepatitis C ist noch keine Impfung in Sicht. Vorsichtsmaßnahmen und die frühe antivirale Behandlung der akuten Hepatitis C stehen im Vordergrund der Präventionsmaßnahmen. Die Hepatitis Delta ist durch effektive Prävention der Hepatitis B zu verhindern. Für die Hepatitis E wurden Impfstoffe in Phase-III-Studien getestet. Die Entwicklung einer Impfung bekommt eine neue Tragweite, da zunehmend Fälle von chronischer Hepatitis bei immunsupprimierten Patienten berichtet werden.
Abstract
Infection with hepatitis viruses can lead to acute hepatitis with the risk of developing liver failure. Chronic viral hepatitis may evolve into liver cirrhosis and hepatocellular carcinoma. Thus, prevention of viral hepatitis and its sequels is essential. Vaccination against hepatitis A is successful in almost all individuals. Protective antibodies maintain for at least 20 years. Booster vaccinations are not necessary. Since the introduction of hepatitis A vaccines, the incidence of new HAV-infections has declined significantly. Hepatitis B vaccines are safe and highly effective. Special populations such as dialysis patients or immunocompromised patients require special vaccine schedules. New vaccines with improved adjuvants are currently being tested in clinical trials. So far there is no hepatitis C vaccine on the horizon. Prophylaxis of HCV-infections relies primarily on hygiene measures. Early therapy of acute hepatitis C can prevent chronic hepatitis C. HDV-infection can only be established if HBsAg is present. Thus, prevention of hepatitis B or elimination of HBsAg means prevention of hepatitis delta. Hepatitis E vaccines have been evaluated in phase III studies. The development of HEV vaccines becomes more relevant since chronic HEV infections have been reported in immunosuppressed individuals.
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Interessenkonflikt
Der korrespondierende Autor weist auf folgende Beziehungen hin:
Beratertätigkeit für GSK (nicht für Vakzine).
Beratertätigkeit Roche, MSD (Medikamente zur Behandlung der Virushepatititis).
Vortragstätigkeit Roche, MSD, BMS, Gilead, Novartis (Medikamente zur Behandlung der Virushepatititis).
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Cornberg, M., Manns, M. Prävention der Virushepatitis A bis E. Internist 52, 250–264 (2011). https://doi.org/10.1007/s00108-010-2678-2
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DOI: https://doi.org/10.1007/s00108-010-2678-2