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Effektivität, Populationseffekte und Gesundheitsökonomie der Impfungen gegen Masern und Röteln

Effectiveness, population-level effects, and heath economics of measles and rubella vaccination

  • Leitthema
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Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Seit mehreren Jahrzehnten gehört die Impfung gegen Masern und Röteln zum Standard der meisten nationalen Impfprogramme. Im vorliegenden Übersichtsbeitrag sollen die Evidenz für die Effektivität der beiden Impfungen auf Basis veröffentlichter systematischer Reviews dargestellt sowie die epidemiologischen und gesundheitsökonomischen Gesamteffekte der Impfung auf Bevölkerungsebene beschrieben werden. Zahlreiche epidemiologische Beobachtungsstudien belegen die gute Effektivität (> 90 %) beider Impfungen. Die Reduktion der weltweiten Maserntodesfälle sowie die dramatische Reduktion der Masern- und Rötelnkrankheitsinzidenz nach Einführung der Impfungen tragen zu einer sehr hohen Qualität der Evidenz bei. Die Länder des amerikanischen Kontinents konnten beweisen, dass durch sehr hohe Impfquoten in einem Routineimpfprogramm mit 2 Masern/Röteln-Impfdosen und mit zusätzlichen Impfaktivitäten zur Schließung von Immunitätslücken in höheren Altersgruppen eine Eliminierung beider Erkrankungen möglich ist. Eine gesundheitsökonomische Evaluation der Masern- bzw. Rötelnimpfung speziell für Deutschland gibt es nicht. Im Rahmen eines eigenen systematischen Reviews wurden jedoch 11 gesundheitsökonomische Studien aus anderen Industrieländern und eine für ein hypothetisches Industrieland identifiziert. In allen wurden sowohl der Masern- als auch der Rötelnimpfung stets ein kosteneffektives und teils sogar ein kostensparendes Potenzial zugerechnet, sodass dieses mit Einschränkungen auch für Deutschland anzunehmen ist. Zusammenfassend besteht ausreichend Evidenz für die hohe Effektivität der beiden Impfungen, mit denen die Masern- und Rötelneliminierung machbar ist, sofern eine adäquate Impfstrategie umgesetzt wird. In Deutschland sind dazu breit angelegte und koordinierte Maßnahmen zu Nachholimpfungen unter Kindern, Jugendlichen und jungen Erwachsenen speziell in den westlichen Bundesländern dringend notwendig.

Abstract

Vaccination against measles and rubella has been included in national immunization programs worldwide for several decades. In this article, we present the evidence related to the effectiveness of measles and rubella vaccination based on published systematic reviews, and we describe the epidemiological and health economic effects of vaccination at a population level. Several observational studies demonstrate the high effectiveness (> 90 %) of both measles and rubella vaccination. The global measles mortality reduction and the dramatic decrease in rubella and measles incidences after introduction of routine immunization contribute to the very high quality of evidence. The countries of the Americas have proved that it is feasible to eliminate measles and rubella by strengthening infant immunization through routine vaccination services and by conducting supplemental immunization activities in other childhood age groups so as to close immunity gaps. An economic evaluation of measles and rubella vaccination specifically for the healthcare system in Germany does not exist. However, we conducted a systematic review and identified 11 health-economic studies from other industrialized countries and one for a hypothetical industrialized country. Results indicate that vaccination against measles and rubella had either a cost-effective or even a cost-saving potential, which could be assumed with some limitations also for the German setting. In conclusion, there is compelling evidence that the available vaccines are very effective and that measles and rubella elimination is feasible if adequate vaccination strategies are implemented. In Germany, catch-up vaccination programs are urgently needed for children, adolescents, and young adults specifically in the western federal states.

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Interessenkonflikt

O. Wichmann und B. Ultsch geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Fachgebiet Impfprävention, Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland

    O. Wichmann & B. Ultsch

  2. Charité Universitätsmedizin Berlin, Berlin, Deutschland

    B. Ultsch

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Correspondence to O. Wichmann.

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Wichmann, O., Ultsch, B. Effektivität, Populationseffekte und Gesundheitsökonomie der Impfungen gegen Masern und Röteln. Bundesgesundheitsbl. 56, 1260–1269 (2013). https://doi.org/10.1007/s00103-013-1801-7

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