Zusammenfassung
Publizierte Daten zeigen, dass mit dem aus 4 Komponenten bestehenden Impfstoff 4CMenB und dem aus 2 Komponenten bestehenden Impfstoff MenB-fHbp zwei effiziente Impfstoffe zur Prophylaxe invasiver MenB-Erkrankungen zur Verfügung stehen. Es ist von einer möglichen Protektion vor invasiver Infektion für etwa 80 % der Fälle in Deutschland auszugehen.
Die Kommission hält folgendes Vorgehen für sinnvoll:
Kindern ab dem Alter von 2 Monaten mit bekanntem erhöhten Risiko für eine invasive Meningokokkeninfektion ist analog der Empfehlung der Ständigen Impfkommission (STIKO) die Impfung gegen die Serogruppen A, C, W und Y und die Impfung mit Bexsero® (4CMenB) zu empfehlen. Jugendliche ab dem vollendeten 10. Lebensjahr mit erhöhtem Risiko für eine invasive MenB-Infektion können mit Bexsero® (4CMenB) oder Trumenba® (MenB-fHbp) immunisiert werden.
Solange keine MenB-Standardimpfempfehlung durch die STIKO vorliegt, kann das strategische Ziel einer Senkung der Krankheitslast in der Allgemeinbevölkerung nicht erreicht werden. Bis dahin sollte unter Berücksichtigung der Zielsetzung eines individuellen Impfschutzes gegen MenB-Erkrankungen die Impfung frühestmöglich, also bereits ab einem Alter von 2 Monaten, durchgeführt werden. Gleichzeitig sollte allen älteren Säuglingen, Kindern und Jugendlichen im Sinne einer Nachholimpfung der MenB-Impfschutz individuell angeboten werden. Zum raschen Erreichen eines Impfschutzes kann die Immunisierung in Abhängigkeit vom Lebensalter zeitgleich mit oder getrennt von anderen Impfungen erfolgen. Um das bei der gleichzeitigen Impfung gegen MenB und anderen Routineimpfungen im Alter von 2 und 4 Monaten beschriebene erhöhte Risiko für das Auftreten von Fieber innerhalb von 48 h zu reduzieren, kann Paracetamol verabreicht werden.
Abstract
Published data show that the 4‑component vaccine 4CMenB and the 2‑component vaccine MenB-fHbp are effective vaccines for prophylaxis against invasive meningococcal B (MenB) disease. The rate of protection against invasive Men B infection in Germany can be expected to be in the range of 80%. The Committee for Infectious Diseases and Vaccinations of the German Academy for Pediatrics and Adolescent Health proposes the following approach for use of this vaccine: for children 2 months of age or older with a known increased risk for invasive meningococcal infections, immunization against MenB should be recommended using the 4CMenB vaccine. For adolescents of 10 years or above administration of either the 4CMenB or MenB-fHbp should be recommended in addition to immunization against serogroups A, C, W and Y as per the Standing Committee on Vaccination of the Robert Koch Institute (STIKO) recommendation. As long as there is no STIKO recommendation for general Men B standard vaccination, the strategic aim of reducing the burden of disease in the population cannot be achieved. In the meantime, individual protection against MenB disease should be achieved by aiming to administer the first dose of the vaccine as early as possible at the age of 2 months. Concurrently, MenB vaccination should be offered individually to all infants, children and adolescents as a catch-up vaccination. Depending on the age of the recipient, the MenB vaccine can be co-administered or given separately from other vaccinations. When administering the MenB vaccine jointly with other routine vaccinations at 2 and 4 months of age, the risk of fever within 48 h following the vaccination can be minimized by co-administering paracetamol.
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Mitglieder der Kommission für Infektionskrankheiten und Impffragen der DAKJ
Dr. med. Ulrich von Both (München); Prof. Dr. med. U. Heininger (Basel, Kommissionssprecher); Dr. med. A. Iseke (Münster); Prof. Dr. med. M. Knuf (Wiesbaden); Prof. Dr. med. G. Ch. Korenke (Oldenburg); Prof. Dr. med. A. Müller (Bonn, federführend); Dr. med. S. Peter (Berlin); Prof. Dr. med. H.-I. Huppertz (Berlin)
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Huppertz, HI., Kommission für Infektionskrankheiten und Impffragen der Deutschen Akademie für Kinder- und Jugendmedizin. Impfprophylaxe invasiver Erkrankungen mit Meningokokken der Serogruppe B. Monatsschr Kinderheilkd 167, 711–720 (2019). https://doi.org/10.1007/s00112-019-0698-0
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DOI: https://doi.org/10.1007/s00112-019-0698-0