Monatsschrift Kinderheilkunde

, Volume 161, Issue 12, pp 1154–1162 | Cite as

Rotaviruserkrankung und ihre Impfprävention in Deutschland

Leitthema
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Zusammenfassung

Bedeutung von Rotaviruserkrankung

Rotavirusinfektionen (RV-Infektionen) sind weltweit die führende Ursache für Gastroenteritiden im Säuglings- und Kleinkindesalter. Nach dem Infektionsschutzgesetz werden seit 2001 fallbasierte Daten zur Epidemiologie der RV-Gastroenteritiden (RVGE) in Deutschland erfasst. Die höchsten jährlichen Inzidenzen werden bei < 2-Jährigen (1.850/100.000) gemessen. In diesem Alter müssen Kinder, die an RV-Infektionen erkranken, häufig zur Flüssigkeitssubstitution stationär aufgenommen werden. Dies geht mit einer erheblichen medizinischen und ökonomischen Belastung des Gesundheitssystems einher.

Rotavirusimpfung

Seit 2006 sind in Deutschland 2 RV-Impfstoffe zugelassen, die ein gutes Sicherheits- und Wirksamkeitsprofil aufweisen. Mit dem Ziel, primär bei Kindern < 5 Jahren eine stationäre Behandlung aufgrund schwerer RVGE zu verhindern, empfahl die STIKO (Ständige Impfkommission am Robert Koch-Institut) 2013 die routinemäßige Rotavirusimpfung von Säuglingen im Alter < 6 Monaten. Zusätzlich wird erwartet, dass über Herdeneffekte auch nicht geimpfte Personengruppen von der Impfung profitieren können. Monitoringsysteme sind implementiert, um die Auswirkungen der RV-Impfung fortlaufend zu evaluieren.

Schlüsselwörter

Rotavirus Gastroenteritis Rotavirusimpfstoffe Impfempfehlung Epidemiologie 

Abkürzungsverzeichnis

DRG

„Diagnosis-related groups“

DTaP

Impfstoff gegen Diphtherie, Tetanus, Pertussis

EKG

Elektrokardiogramm

ELISA

„Enzyme linked immunosorbent assay“

EMA

„European Medicines Agency“

ESPGHAN

„European Society of Pediatric Gastroenterology, Hepatology and Nutrition“

FDA

„Food and Drug Administration“ (US-amerikanische Zulassungsbehörde)

Hep B

Impfstoff gegen Hepatitis B

Hib

Impfstoff gegen Haemophilus influenzae Typ B

IPV

Poliototimpfstoff

HUS

Hämolytisch-urämisches Syndrom

IfSG

Infektionsschutzgesetz

KG

Körpergewicht

KI

Konfidenzintervall

OR

„Odds ratio“

ORL

Orale Rehydratationslösung

PCR

Polymerasekettenreaktion

RCT

Randomisierte kontrollierte Studie

RKI

Robert Koch-Institut

RNA

Ribonukleinsäure

RV

Rotavirus

RVGE

RV-Gastroenteritis

STIKO

Ständige Impfkommission am RKI

VP

Virale Strukturproteine

WHO

Weltgesundheitsorganisation

Rotavirus infections and vaccination prevention in Germany

Abstract

Significance of rotavirus infections

Rotavirus (RV) infections are the leading cause of gastroenteritis (GE) in infants and young children worldwide. Since 2001 case-based data on the epidemiology of RVGE in Germany have been recorded according to the German Protection against Infection Act. The highest annual incidences are observed in children under 2 years of age (1,850/100,000). Children in this age group who suffer from RV often need to be hospitalized for fluid substitution. This causes a significant medical and economic burden on the healthcare system.

Rotavirus vaccination

In 2006 a total of 2 RV vaccines were licensed for use in Germany and have proven to have a good safety and efficacy profile. In 2013 the standing vaccination committee of the Robert Koch Institute (STIKO) recommended the routine RV immunization of infants aged < 6 months. The primary goal of this recommendation is to prevent severe RVGE requiring hospital treatment in children under 5 years of age. It is expected that non-vaccinated individuals may also benefit from vaccination by herd effects. Monitoring systems are implemented to continuously evaluate the impact of RV vaccinations.

Keywords

Rotavirus Gastroenteritis Rotavirus vaccines Vaccination recommendation Epidemiology 

Literatur

  1. 1.
    Adlhoch C, Hoehne M, Littmann M et al (2012) Rotavirus vaccine effectiveness and case-control study on risk factors for breakthrough-infections in Germany. Pediatr Infect Dis J 32(2):e82–89CrossRefGoogle Scholar
  2. 2.
    Anderson EJ, Rupp A, Shulman ST et al (2011) Impact of rotavirus vaccination on hospital-acquired rotavirus gastroenteritis in children. Pediatrics 127:264–270CrossRefGoogle Scholar
  3. 3.
    Ansari SA, Sattar SA, Springthorpe VS et al (1988) Rotavirus survival on human hands and transfer of infectious virus to animate and nonporous inanimate surfaces. J Clin Microbiol 26:1513–1518PubMedPubMedCentralGoogle Scholar
  4. 4.
    Block SL, Vesikari T, Goveia MG et al (2007) Efficacy, immunogenicity, and safety of a pentavalent human-bovine (WC3) reassortant rotavirus vaccine at the end of shelf life. Pediatrics 119:11–18PubMedCrossRefGoogle Scholar
  5. 5.
    Buttery JP, Lambert SB, Grimwood K et al (2011) Reduction in rotavirus-associated acute gastroenteritis following introduction of rotavirus vaccine into Australias National Childhood vaccine schedule. Pediatr Infect Dis J 30:S25–S29PubMedCrossRefGoogle Scholar
  6. 6.
    Clark HF, Lawley D, Mallette LA et al (2009) Decline in cases of rotavirus gastroenteritis presenting to The Children′s Hospital of Philadelphia after introduction of a pentavalent rotavirus vaccine. Clin Vaccine Immunol 16:382–386PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Cortese MM, Parashar UD, Centers for Disease Control and Prevention (CDC) (2009) Prevention of rotavirus gastroenteritis among infants and children: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 58:1–25PubMedGoogle Scholar
  8. 8.
    Desai R, Cortese MM, Meltzer MI et al (2013) Potential intussusception risk versus benefits of rotavirus vaccination in the United States. Pediatr Infect Dis J 32:1–7PubMedCrossRefGoogle Scholar
  9. 9.
    Desselberger U, Huppertz HI (2011) Immune responses to rotavirus infection and vaccination and associated correlates of protection. J Infect Dis 203:188–195PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Estes MK, Cohen J (1989) Rotavirus gene structure and function. Microbiol Rev 53:410–449PubMedPubMedCentralGoogle Scholar
  11. 11.
    European Medicines Agency (20 October 2011 – last update) Rotarix. EMA, London. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Scientific_Discussion/human/000639/WC500054589.pdf. Zugegriffen: 30.03.2012Google Scholar
  12. 12.
    European Medicines Agency (23 March 2012 – last update) RotaTeq. EMA, London. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Scientific_Discussion/human/000669/WC500054183. Zugegriffen: 30.03.2012Google Scholar
  13. 13.
    Flewett TH (1983) Rotavirus in the home and hospital nursery. Br Med J (Clin Res Ed) 287:568–569CrossRefGoogle Scholar
  14. 14.
    Guarino A, Albano F, Ashkenazi S et al (2008) European Society for Paediatric Gastroenterology, Hepatology, and Nutrition/European Society for Paediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: executive summary. J Pediatr Gastroenterol Nutr 46:619–621PubMedGoogle Scholar
  15. 15.
    Hanquet G, Ducoffre G, Vergison A et al (2011) Impact of rotavirus vaccination on laboratory confirmed cases in Belgium. Vaccine 29:4698–4703PubMedCrossRefGoogle Scholar
  16. 16.
    Hauer AC (2013) Akute Gastroentritis. In: Rodeck B, Zimmer P (Hrsg) Pädiatrische Gastroenterologie, Hepatologie und Ernährung. Springer, Berlin Heidelberg New York, S 292–294Google Scholar
  17. 17.
    Kawamura N, Tokoeda Y, Oshima M et al (2011) Efficacy, safety and immunogenicity of RIX4414 in Japanese infants during the first two years of life. Vaccine 29:6335–6341PubMedCrossRefGoogle Scholar
  18. 18.
    Koch J, Wiese-Posselt M (2011) Epidemiology of rotavirus infections in children less than 5 years of age: Germany, 2001–2008. Pediatr Infect Dis J 30:112–117PubMedCrossRefGoogle Scholar
  19. 19.
    Koch J, Wiese-Posselt M, Remschmidt C et al (2013) Background paper to the recommendation for routine rotavirus vaccination of infants in Germany. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 56:957–984PubMedCrossRefGoogle Scholar
  20. 20.
    Krause G, Altmann D, Faensen D et al (2007) SurvNet electronic surveillance system for infectious disease outbreaks, Germany. Emerg Infect Dis 13:1548–1555PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Matthijnssens J, Ciarlet M, McDonald SM et al (2011) Uniformity of rotavirus strain nomenclature proposed by the Rotavirus Classification Working Group (RCWG). Arch Virol 156:1397–1413PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Matthijnssens J, Heylen E, Zeller M et al (2010) Phylodynamic analyses of rotavirus genotypes G9 and G12 underscore their potential for swift global spread. Mol Biol Evol 27:2431–2436PubMedCrossRefGoogle Scholar
  23. 23.
    Oberle D, Weisser K, Keller-Stanislawski B (2010) Aktuelle Erkenntnisse zum Risiko für Invagination und Kawasaki-Syndrom nach Rotavirusimpfung. Arzneimittel im Blick. Bull Arzneimittelsicherheit 4:8–13Google Scholar
  24. 24.
    Parashar UD, Gibson CJ, Bresse JS, Glass RI (2006) Rotavirus and severe childhood diarrhea. Emerg Infect Dis 12:304–306PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Patel MM, Haber P, Baggs J et al (2009) Intussusception and rotavirus vaccination: a review of the available evidence. Expert Rev Vaccines 8:1555–1564PubMedCrossRefGoogle Scholar
  26. 26.
    Paulke-Korinek M, Rendi-Wagner P, Kundi M et al (2010) Universal mass vaccination against rotavirus gastroenteritis: impact on hospitalization rates in Austrian children. Pediatr Infect Dis J 29:319–323PubMedGoogle Scholar
  27. 27.
    Phua KB, Lim FS, Lau YL et al (2009) Safety and efficacy of human rotavirus vaccine during the first 2 years of life in Asian infants: randomised, double-blind, controlled study. Vaccine 27:5936–5941PubMedCrossRefGoogle Scholar
  28. 28.
    Piescik-Lech M, Shamir R, Guarino A, Szajewska H (2013) Review article: the management of acute gastroenteritis in children. Aliment Pharmacol Ther 37:289–303PubMedCrossRefGoogle Scholar
  29. 29.
    Poggensee G, Benzler J, Eckmanns T et al (2006) On the 2007 edition of case definitions for the surveillance of notifiable infectious diseases in Germany. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 49:1189–1194PubMedCrossRefGoogle Scholar
  30. 30.
    Robert Koch-Institut (RKI) (2011) Allgemeine Aspekte meldepflichtiger Krankheiten. In: RKI (Hrsg) Infektionsepidemiologisches Jahrbuch für 2010. RKI, Berlin, S 35–36Google Scholar
  31. 31.
    Ruiz-Palacios GM, Perez-Schael I, Velazquez FR et al (2006) Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis. N Engl J Med 354:11–22PubMedCrossRefGoogle Scholar
  32. 32.
    Vesikari T, Karvonen A, Prymula R et al (2007) Efficacy of human rotavirus vaccine against rotavirus gastroenteritis during the first 2 years of life in European infants: randomised, double-blind controlled study. Lancet 370:1757–1763PubMedCrossRefGoogle Scholar
  33. 33.
    Vesikari T, Matson DO, Dennehy P et al (2006) Safety and efficacy of a pentavalent human-bovine (WC3) reassortant rotavirus vaccine. N Engl J Med 354:23–33PubMedCrossRefGoogle Scholar
  34. 34.
    WHO (2009) Meeting of the Strategic Advisory Group of Experts on immunization, October 2009 – conclusions and recommendations. Wkly Epidemiol Rec 84:517–532Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Abteilung für Infektionsepidemiologie, Fachgebiet 33 ImpfpräventionRobert Koch-InstitutBerlinDeutschland
  2. 2.Zentrum für Kinder- und JugendmedizinChristliches Kinderhospital OsnabrückOsnabrückDeutschland

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