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Impfungen zur Pneumonieprophylaxe

Vaccinations for pneumonia prophylaxis

  • Leitthema
  • Published:
Der Pneumologe Aims and scope

Zusammenfassung

Hintergrund

Die ambulant erworbene Pneumonie (CAP) ist eine häufige Infektionskrankheit mit hoher Morbidität und Mortalität und entsprechender ökonomischer Bedeutung. Pneumokokken sind mit Abstand die am häufigsten nachgewiesenen Erreger der CAP. Influenza A wird als Virus häufig bei CAP sowie bei exazerbierter COPD und Bronchitis nachgewiesen.

Ziel der Arbeit

Ziel der Arbeit war es, zu untersuchen, wie sich eine Impfung gegen diese Keime auf die Hospitalisationsrate, den Nachweis der jeweiligen Infektionen und die Mortalität auswirkt.

Material und Methode

Es erfolgte eine Literaturdurchsicht bezüglich Pneumokokken- und Influenzaimpfungen. Auch die aktuellen Impfempfehlungen der ständigen Impfkommission (STIKO) wurden berücksichtigt.

Ergebnisse

Gegen Pneumokokken stehen zwei Impfstoffe zur Verfügung: Der nichtkonjugierte Impfstoff (PPV23) sowie die mit einer besseren Immunantwort einhergehenden konjugierten Impfstoffe (PCV7 und PCV13). Diese sind auch bei Kindern unter 2 Jahren wirksam. Seit Einführung dieser Impfstoffe bei Kindern ist es zu einem signifikanten Rückgang der Infektionen durch die im Impfstoff enthaltenden Serotypen sowie einem Rückgang der Makrolidresistenz gekommen, auch bei den nichtgeimpften Erwachsenen („Herdeneffekt“). PPV23 hat keine signifikanten Effekte bei der Prävention der CAP. Was PCV13 angeht, so werden die Ergebnisse der CAPITA-Studie erwartet, welche sich mit der Wirksamkeit von PCV13 bei Erwachsenen über 65 Jahren mit CAP beschäftigt. Gegen Influenza stehen gut verträgliche und gut wirksame konventionelle Impfstoffe mit und ohne Adjuvantien zur Verfügung. Hinzu kommen lebendattenuierte Impfstoffe. In vielen Studien wurde bei Erwachsenen sowie Kindern eine signifikante Reduktion der Hospitalisationsraten und der Influenzanachweise gesehen.

Schlussfolgerung

Gegen Pneumokokken und Influenza stehen wirksame und sichere Impfungen zur Verfügung. Leider ist die Impfrate gerade bei den Risikopatienten noch zu gering. Dies sollte in Zukunft verbessert werden.

Abstract

Background

Community-acquired pneumonia (CAP) is a common infectious disease with high morbidity and mortality and corresponding economic importance. Pneumococci are by far the most frequently detected pathogens in CAP. Influenza A virus is commonly detected in CAP and in exacerbations of chronic obstructive pulmonary disease (COPD) and bronchitis.

Objectives

Do vaccinations against these pathogens decrease infections, hospitalization and mortality rates?

Material and methods

We performed a literature search regarding pneumococcal and influenza vaccinations. The current vaccination recommendations of the Standing Committee on Vaccination of the Robert Koch Institute (STIKO) were taken into consideration.

Results

There are two pneumococcal vaccines: the non-conjugated polysaccharide vaccine (PPV23) and the conjugated vaccines (PCV7 and PCV13) which seem to be associated with a better immune response. These are also effective in children under 2 years old. Since the introduction of these vaccines in children there has been a significant decrease in infections caused by serotypes contained in the vaccine as well as a decline in macrolide resistance, even in non-vaccinated adults (herd effect). The results of the CAPITA study are currently expected, which assesses the effectiveness of PCV13 in adults over 65 years with CAP. Against influenza there are well-tolerated and highly effective conventional vaccines with and without adjuvants. In addition, live attenuated vaccines are available. In many studies, a significant reduction in influenza infections as well as hospitalization rates were observed in adults and children.

Conclusion

Pneumococcal and influenza vaccines are effective and safe. Unfortunately, the vaccination rate is still too low particularly in high-risk patients. This needs to be improved in the future.

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Literatur

  1. Ambrose CS, Wu X, Knuf M, Wutzler P (2012) The efficacy of intranasal live attenuated influenza vaccine in children 2 through 17 years of age: a meta-analysis of 8 randomized controlled studies. Vaccine 30(5):886–892

    Article  CAS  PubMed  Google Scholar 

  2. Ansaldi F, Canepa P, Ceravolo A et al (2012) Intanza® 15 mcg intradermal influenza vaccine elicits cross-reactive antibody responses against heterologous A(H3N2) influenza viruses. Vaccine 30(18):2908–2913

    Article  CAS  PubMed  Google Scholar 

  3. Baldo V, Baldovin T, Floreani A et al (2007) MF59-adjuvanted influenza vaccine confers superior immunogenicity in adult subjects (18–60 years of age) with chronic diseases who are at risk of post-influenza complications. Vaccine 25(20):3955–3961

    Article  CAS  PubMed  Google Scholar 

  4. Banzhoff A, Nacci P, Podda A (2003) A new MF-59 adjuvanted vaccine enhances the immune response in the elderly with chronic diseases: results from an immunogenicity meta-analysis. Gerontology 49(3):177–184

    Article  CAS  PubMed  Google Scholar 

  5. Black CL, Yue X, Ball SW et al (2014) Influenza vaccination coverage among health care personnel – United States. MMWR Morb Mortal Wkly Rep 63(37):805–811

    PubMed  Google Scholar 

  6. Bonten M, Bolkenbaas M, Huijts S et al (2014) Community acquired pneumonia immunization trial in adults (CAPiTA). Abstract no. 0541. Pneumonia 3:95. https://pneumonia.org.au/public/journals/22/PublicFolder/ABSTRACT BOOKMASTERforwebupdated20-3-14.pdf

  7. Centers for Disease Control and Prevention. 2010. Active Bacterial Core Surveillance Report, Emerging Infections Program Network, Streptococcus pneumoniae, 2009

  8. Centers for Disease Control and Prevention (2009) Epidemiology and prevention of vaccine preventable diseases. The Pink Book, 11. Aufl.

  9. Damme P van, Arnou R, Kafeja F et al (2010) Evaluation of non-inferiority of intradermal versus adjuvanted seasonal influenza vaccine using two serological techniques: a randomised comparative study. BMC Infect Dis 10:134

    Article  PubMed Central  PubMed  Google Scholar 

  10. Epidemiologisches Bulletin: Mitteilung der Ständigen Impfkommission am Robert Koch-Institut (RKI) Empfehlungen der Ständigen Impfkommission (STIKO) am Robert Koch-Institut/Stand: August 2014/Nr. 34

  11. European Medicines Agency recommends restricting use of Pandemrix. Http://www.ema.europa.eu/docs/en_GB/document_library/Press_release/2011/07/WC500109182.pdf. Zugegriffen: 20. Okt. 2014

  12. Han F, Lin L, Warby SC et al (2011) Narcolepsy onset is seasonal and increased following the 2009 H1N1 pandemic in china. Ann Neurol 70(3):410–417

    Article  PubMed  Google Scholar 

  13. Hoek AJ van, Andrews N, Waight PA et al (2012) The effect of underlying clinical conditions on the risk of developing invasive pneumococcal disease in England. J Infect 65(1):17–24

    Article  PubMed  Google Scholar 

  14. Hoft DF, Babusis E, Worku S et al (2011) Live and inactivated influenza vaccines induce similar humoral responses, but only live vaccines induce diverse T-cell responses in young children. J Infect Dis 204(6):845–853

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6332a3.htm#Groups_Recommended_Vaccination_Timing_Vaccination. Zugegriffen: 10. Okt. 2014

  16. http://www.kbv.de/media/sp/2014_09_01_Praxisinformation_Impfung__Influenza_2014.pdf. Zugegriffen 20. Okt. 2014

  17. Huss A, Scott P, Stuck AE et al (2009) Efficacy of pneumococcal vaccination in adults: a meta-analysis. CMAJ 180(1):48–58

    Article  PubMed Central  PubMed  Google Scholar 

  18. Imöhl M, Reinert RR, Mutscher C, Linden M van der (2010) Macrolide susceptibility and serotype specific macrolide resistance of invasive isolates of Streptococcus pneumoniae in Germany from 1992 to 2008. BMC Microbiol 10:299

    Article  PubMed Central  PubMed  Google Scholar 

  19. Jefferson T, Rivetti A, Harnden A et al (2008) Vaccines for preventing influenza in healthy children. Cochrane Database Syst Rev 2:CD004879

    PubMed  Google Scholar 

  20. Kyaw MH, Clarke S, Edwards GF et al (2000) Serotypes/groups distribution and antimicrobial resistance of invasive pneumococcal isolates: implications for vaccine strategies. Epidemiol Infect 125(3):561–572

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  21. Michiels B, Govaerts F, Remmen R et al (2011) A systematic review of the evidence on the effectiveness and risks of inactivated influenza vaccines in different target groups. Vaccine 29(49):9159–9170

    Article  PubMed  Google Scholar 

  22. Miller E, Andrews NJ, Waight PA et al (2011) Herd immunity and serotype replacement 4 years after seven-valent pneumococcal conjugate vaccination in England and Wales. Lancet Infect Dis 11(10):760–768

    Article  CAS  PubMed  Google Scholar 

  23. Moberley SA, Holden J, Tatham DP, Andrews RM (2008) Vaccines for preventing pneumococcal infection in adults. Cochrane Database Syst Rev CD000422

  24. Paradiso PR (2011) Advances in pneumococcal disease prevention: 13-valent pneumococcal conjugate vaccine for infants and children. Clin Infect Dis 52(10):1241–1247

    Article  PubMed  Google Scholar 

  25. Pilishvili T, Lexau C, Farley MM et al (2010) Sustained reductions in invasive pneumococcal disease in the era of conjugate vaccine. J Infect Dis 201(1):32–41

    Article  PubMed  Google Scholar 

  26. Poole P, Chacko E, Wood-Baker R, Cates C (2006) Influenza vaccine for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 1:CD002733

    PubMed  Google Scholar 

  27. Poolman J, Borrow R (2011) Hyporesponsiveness and its clinical implications after vaccination with polysaccharide or glycoconjugate vaccines. Expert Rev Vaccines 10(3):307–322

    Article  CAS  PubMed  Google Scholar 

  28. Pletz MW, Zanger P, Jilg W, Kern WV (2011) Impfungen. Dtsch Med Wochenschr 136:2011–2015

    Article  CAS  PubMed  Google Scholar 

  29. Puig-Barberà J, Diez-Domingo J, Hoyos SP et al (2004) Effectiveness of the MF59-adjuvanted influenza vaccine in preventing emergency admissions for pneumonia in the elderly over 64 years of age. Vaccine 23(3):283–289

    Article  PubMed  Google Scholar 

  30. Puig-Barberà J, Díez-Domingo J, Varea AB et al (2007) Effectiveness of MF59-adjuvanted subunit influenza vaccine in preventing hospitalisations for cardiovascular disease, cerebrovascular disease and pneumonia in the elderly. Vaccine 25(42):7313–7321

    Article  PubMed  Google Scholar 

  31. Puig-Barberà J, Natividad-Sancho A, Calabuig-Pérez J et al (2014) Intradermal and virosomal influenza vaccines for preventing influenza hospitalization in the elderly during the 2011–2012 influenza season: a comparative effectiveness study using the Valencia health care information system. Vaccine 32(42):5447–5454

    Article  PubMed  Google Scholar 

  32. Restrepo MI, Mortensen EM, Valez JA et al (2008) A comparative study of community-acquired pneumonia patients admitted to the ward and the ICU. Chest 133(3):610–617

    Article  PubMed  Google Scholar 

  33. Rohde G, Wiethege A, Borg I et al (2003) Respiratory viruses in exacerbations of chronic obstructive pulmonary disease requiring hospitalisation: a case-control study. Thorax 58(1):37–42

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  34. Schembri S, Morant S, Winter JH, MacDonald TM (2009) Influenza but not pneumococcal vaccination protects against all-cause mortality in patients with COPD. Thorax 64(7):567–572

    Article  CAS  PubMed  Google Scholar 

  35. Schnoor M, Hedicke J, Dalhoff K et al (2007) Approaches to estimate the population-based incidence of community acquired pneumonia. J Infect 55(3):233–239

    Article  PubMed  Google Scholar 

  36. Sigurdardottir ST, Center KJ, Davidsdottir K et al (2014) Decreased immune response to pneumococcal conjugate vaccine after 23-valent pneumococcal polysaccharide vaccine in children. Vaccine 32(3):417–424

    Article  CAS  PubMed  Google Scholar 

  37. Upshur RE, Moineddin R, Crighton EJ, Mamdani M (2006) Interactions of viral pathogens on hospital admissions for pneumonia, croup and chronic obstructive pulmonary diseases: results of a multivariate time-series analysis. Epidemiol Infect 134(6):1174–1178

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  38. Welte T, Torres A, Nathwani D (2012) Clinical and economic burden of community-acquired pneumonia among adults in Europe. Thorax 67(1):71–79

    Article  CAS  PubMed  Google Scholar 

  39. Woodhead M, Blasi F, Ewig S et al (2011) Guidelines for the management of adult lower respiratory tract infections – full version. Clin Microbiol Infect 17(Suppl 6):E1–E59

    Article  PubMed  Google Scholar 

  40. Wotton CJ, Goldacre MJ (2012) Risk of invasive pneumococcal disease in people admitted to hospital with selected immune-mediated diseases: record linkage cohort analyses. J Epidemiol Community Health 66(12):1177–1181

    Article  PubMed  Google Scholar 

  41. Wutzler P, Hardt R, Knuf M, Wahle K (2013) Targeted vaccine selection in influenza vaccination. Dtsch Arztebl Int 110(47):793–798

    PubMed Central  PubMed  Google Scholar 

  42. Vesikari T, Pellegrini M, Karvonen A et al (2009) Enhanced immunogenicity of seasonal influenza vaccines in young children using MF59 adjuvant. Pediatr Infect Dis J 28(7):563–571

    Article  PubMed  Google Scholar 

  43. Vesikari T, Knuf M, Wutzler P et al (2011) Oil-in-water emulsion adjuvant with influenza vaccine in young children. N Engl J Med 365(15):1406–1416

    Article  CAS  PubMed  Google Scholar 

  44. Vesikari T, Karvonen A, Korhonen T et al (2006) A randomized, double-blind study of the safety, transmissibility and phenotypic and genotypic stability of cold-adapted influenza virus vaccine. Pediatr Infect Dis J 25(7):590–595

    Article  PubMed  Google Scholar 

  45. Vinograd I, Eliakim-Raz N, Farbman L et al (2013) Clinical effectiveness of seasonal influenza vaccine among adult cancer patients. Cancer 119(22):4028–4035

    Article  PubMed  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. G. Rohde ist Mitglied des europäischen Pfizer Advisory Boards für PCV13 und hat Vorträge für Pfizer, auch zum Thema PCV13, gehalten. Ferner war er beratend oder als Referent tätig für Novartis, Chiesi, Astra-Zeneca, GSK und Takeda. B.M. Hauptmeier gibt an, dass kein Interessenkonflikt besteht. Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Authors and Affiliations

  1. Medizinische Klinik III, Pneumologie, Allergologie, Schlaf- und Beatmungsmedizin, Berufgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland

    B.M. Hauptmeier

  2. Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Niederlande

    G.G.U. Rohde

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  1. B.M. Hauptmeier
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Correspondence to B.M. Hauptmeier.

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Hauptmeier, B., Rohde, G. Impfungen zur Pneumonieprophylaxe. Pneumologe 12, 110–117 (2015). https://doi.org/10.1007/s10405-014-0826-4

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  • DOI: https://doi.org/10.1007/s10405-014-0826-4

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