Der Internist

, Volume 52, Issue 3, pp 265–276 | Cite as

Impfungen gegen Pneumokokken und Influenza

Wie groß ist die Evidenz?
Schwerpunkt

Zusammenfassung

Durch Pneumokokken verursachte Infektionen und die Influenza können bei Kindern und älteren Personen sowie bei chronisch Kranken und Immunosupprimierten zu schweren, komplizierten Verläufen führen. Bei der alternden Bevölkerung in westlichen Ländern sind sie wichtige Ursachen für erhöhte Morbidität und Letalität. Weltweit unterstreicht die Antibiotikaresistenzentwicklung die Notwendigkeit der effektiven Impfung. Der 23-valente Polysaccharidimpfstoff gegen Pneumokokken wird kontrovers diskutiert. Neue Metaanalysen zeigten keine/wenig Wirksamkeit der Impfung in Bezug auf invasive Pneumokokkenerkrankungen oder Gesamtletalität. Jedoch dokumentierte eine neue Studie bei Pflegeheimbewohnern eine signifikante Reduktion von Pneumonie und Tod durch Pneumokokkenerkrankungen nach Impfungen. Der 7-valente Konjugatimpfstoff ist bei Kindern und bei Immunosupprimierten deutlich immunogener und effizienter und ist im schweizerischen Impfplan für Kinder integriert. In Deutschland wurde er bereits durch den 13-valenten Konjugatimpfstoff ersetzt. Influenzaimpfungen sind gut immunogen. Dies wird durch Adjuvanzien bei einer älteren Bevölkerung erhöht. Aufgrund der pandemischen Influenza H1N1 2009 wurden die Impfempfehlungen und die Zusammensetzung der Impfstoffe durch die WHO für den Herbst/Winter 2010/2011 entsprechend angepasst. Die Influenzaimpfung bietet zwar keinen guten Schutz gegen die Ansteckung, jedoch einen guten Schutz gegen Komplikationen der Influenza.

Schlüsselwörter

Pneumokokken Influenza Polysaccharidimpfung Konjugatimpfung H1N1 

Vaccination against pneumococci and influenza

How good is the evidence?

Abstract

Diseases caused by pneumococci and influenza viruses can lead to severe complications in children, in older, chronically ill and immunosuppressed patients. In an aging population in western countries they present an important cause of morbidity and mortality. Additionally, antibiotic resistance may complicate a therapy. Consequently, the need of an effective vaccine is obvious. The 23-valent polysaccharide pneumococcal vaccine has been discussed critically. New meta-analyses do not show an efficacy in preventing invasive pneumococcal disease or death of all cause. However, a very recent study has shown a significant reduction of pneumonias and death due to pneumococcal disease in nursing-home residents. The 7-valent conjugated vaccine is more immunogenic and efficient in children and first studies demonstrate its efficacy in immunosuppressed persons. In Switzerland this latter vaccine is used in children, in Germany the 7-valent vaccine has been replaced by the 13-valent conjugated vaccine since December 2009. Influenza-vaccines are effective, while vaccines with an adjuvance seem more immunogenic, in particular in older persons. The 2010/2011 influenza vaccine has been adapted and includes the pandemic influenza H1N1 2009 strain. The influenza vaccine often does not provide protection against infection, however, it does provide good efficacy against severe complications related to influenza.

Keywords

Pneumococci Influenza Polysaccharide vaccine Conjugate vaccine H1N1 

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  1. 1.Klinik für Infektiologie & SpitalhygieneUniversitätsspital BaselBaselSchweiz

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