Zusammenfassung
Frühgeborene sind wegen ihres oft deutlich verminderten „Nestschutzes“ (intrauterin übertragene IgG-Antikörper) sowie möglicher Begleiterkrankungen einem erhöhten Risiko ausgesetzt, an einer komplikationsreich verlaufenden impfpräventablen Infektionskrankheit zu erkranken. Daher ist ein frühzeitiger Impfschutz erforderlich, wobei sich die Frage nach dem optimalen Zeitpunkt sowie der Sicherheit und der Wirksamkeit von Impfstoffen in dieser besonderen Population stellt. Die meisten Expertengremien, auch die ständige Impfkommission am Robert Koch-Institut (STIKO), empfehlen einen Impfbeginn im chronologischen, nicht korrigierten Alter von 8 Wochen. Dem Bestreben, Frühgeborenen durch die Impfung eine wirksame und rechtzeitige Prophylaxe zu ermöglichen, steht in der Realität eine häufige Verzögerung des Impfbeginnes gegenüber. In vielen Studien konnte gezeigt werden, dass Frühgeborene in der Regel in der Lage sind, eine adäquate Immunität nach Impfung aufzubauen. Dies kann jedoch in Abhängigkeit vom Gestationsalter und chronischen Begleiterkrankungen deutlich variieren. Bezüglich der Sicherheit von Impfungen sollte dem möglichen Auftreten von Apnoen und Bradykardien sehr kleiner Frühgeborener besondere Aufmerksamkeit zukommen, hier wird v. a. im Rahmen der ersten Impfung ein Monitoring empfohlen.
Abstract
Due to the reduced transfer of maternal IgG antibodies and possible comorbidities, preterm infants are at increased risk of contracting an infectious disease with a complicated course which could potentially be prevented by vaccination. Therefore, early vaccination is necessary, although the question of optimal timing, safety and effectiveness of vaccinations in this particular population remain open. Most advisory boards, such as the permanent vaccination commission at the Robert-Koch Institute (STIKO) recommend starting vaccinations in the chronological, non-corrected age of 8 weeks. The important objective to provide preterm infants with effective early prophylaxis by means of vaccination is often contracted by a delay in the start of vaccination. According to the literature, pre-term infants are usually able to build adequate immunity following vaccination; however, this can vary depending on gestational age and chronic comorbidities. With regard to vaccine safety, careful attention should be paid to the possible onset of apnoea and bradycardia in very small pre-term infants. Those high risk infants usually necessitate monitoring, in particular following the first vaccination.
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Interessenkonflikt
Der korrespondierende Autor weist auf folgende Beziehungen hin: Durchführung von klinischen Impfstoffstudien und epidemiologischen Studien mit finanzieller Unterstützung von Impfstoffherstellern (GSK, Wyeth, Novartis, Sanofi-Pasteur-MSD). Vortragstätigkeit und Teilnahme am Advisory Board (Fa. GSK, Fa. Wyeth, Fa. Sanofi-Pasteur-MSD, Fa. Novartis).
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Liese, J., Knuf, M. Impfungen von Frühgeborenen. Monatsschr Kinderheilkd 157, 758–766 (2009). https://doi.org/10.1007/s00112-009-1978-x
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DOI: https://doi.org/10.1007/s00112-009-1978-x