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Sinnvolle Impfprävention bei Kindern und Jugendlichen mit rheumatischen und muskuloskelettalen Erkrankungen

Immunization in children and adolescents with rheumatic and musculoskeletal diseases

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Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Kinder und Jugendliche mit entzündlich-rheumatischen Erkrankungen haben ein krankheits- und therapiebedingt erhöhtes Risiko für Infektionen. Dieses Risiko schließt impfpräventable Erkrankungen ein. Impfungen stellen somit eine wichtige infektionspräventive Maßnahme bei diesen Patienten dar. Etwa jedes dritte rheumakranke Kind ist heutzutage aber noch unzureichend geimpft, u. a. wegen bestehender Unsicherheiten bezüglich Wirksamkeit und Verträglichkeit von Impfungen bei diesen Patienten.

Ziel der Arbeit

Dieser Beitrag fasst die vorhandene Evidenz zu Wirksamkeit und Sicherheit von Impfungen bei rheumakranken Kindern und Jugendlichen zusammen und gibt basierend darauf Handlungsempfehlungen.

Ergebnis und Ausblick

In den bisher publizierten über 30 Impfstudien, die nahezu alle im Impfkalender enthaltenden Impfungen einschlossen, wurden knapp 2000 rheumakranke Kinder und Jugendliche untersucht. Das Impfansprechen war in der Regel ausreichend. Hinweise auf relevante Aktivierungen der Grunderkrankung fanden sich nicht. Empfehlungen für den klinischen Alltag können auch im Hinblick auf Daten jenseits der pädiatrischen Rheumatologie gegeben werden, eine abschließende Nutzen-Risiko-Bewertung ist jedoch nicht möglich.

Abstract

Background

Children and adolescents with inflammatory rheumatic diseases have a disease and treatment-related increased risk of infections. This risk includes vaccine-preventable diseases; therefore, vaccinations represent an important preventive measure against infection in these patients. However, approximately one in three patients with a juvenile rheumatic disease is nowadays still inadequately vaccinated, mostly due to uncertainty regarding the efficacy and safety of vaccination in these patients.

Objectives

This paper summarizes the available evidence regarding the efficacy and safety of vaccinations in children and adolescents with rheumatic diseases and gives recommendations for the clinical practice.

Results and perspectives

Almost 2000 children and adolescents with rheumatic diseases were examined in the more than 30 previously published vaccination studies, comprising nearly all standard vaccinations in the immunization schedule. The immunogenicity was usually sufficient and there was no evidence of a relevant aggravation of the underlying disease. Recommendations for the clinical practice are given also considering data beyond pediatric rheumatology; however, a final benefit-risk assessment is not yet possible.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. Die Autoren weisen auf die folgenden Beziehungen hin: K. Minden: Forschungsunterstützung Abbvie, Pfizer; Honorare Abbvie, Gentech/Chugai, Medac, Pharm-Allergan, Pfizer, Roche. F. Speth: keine. H.-I. Huppertz: Beratung und Vortragshonorare von Abbvie, Chugai, Novartis, Pfizer, Roche, Swedish Orphan. M. Borte: Forschungsunterstützung CSL Behring, Octapharma; Beratung und Vortragshonorare Abbvie, Baxter, Pfizer. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Universitätskinderklinik Charité, Campus Virchow, Otto-Heubner-Centrum, SPZ, Deutsches Rheuma-Forschungszentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    K. Minden

  2. Deutsches Zentrum für Kinder- und Jugendrheumatologie, Garmisch-Partenkirchen, Deutschland

    F. Speth

  3. Prof. Hess-Kinderklinik, Klinikum Bremen-Mitte, Bremen, Deutschland

    H.-I. Huppertz

  4. Klinik für Kinder- und Jugendmedizin, Klinikum St. Georg gGmbH, Leipzig, Deutschland

    M. Borte

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  1. K. Minden
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  4. M. Borte
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Correspondence to K. Minden.

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Minden, K., Speth, F., Huppertz, HI. et al. Sinnvolle Impfprävention bei Kindern und Jugendlichen mit rheumatischen und muskuloskelettalen Erkrankungen. Z. Rheumatol. 73, 878–889 (2014). https://doi.org/10.1007/s00393-014-1396-x

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  • DOI: https://doi.org/10.1007/s00393-014-1396-x

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