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Impfungen in der Pneumologie

Vaccinations in respiratory medicine

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Der Pneumologe Aims and scope

Zusammenfassung

Impfungen gehören zu den erfolgreichsten und kosteneffektivsten Maßnahmen in der Prävention von Infektionen. Wichtige Erreger von respiratorischen Infektionen (Influenzaviren, Pneumokokken) können durch Impfungen wirksam beeinflusst werden. Der saisonale tri- und neuerdings auch quadrivalente Influenzaimpfstoff besteht aus Antigenen von Influenzaviren der Typen A und B, die jährlich auf der Basis zirkulierender Virustypen neu zusammengestellt werden müssen. In höherem Alter werden Konjugatvakzine empfohlen. Die Schutzwirkung der Influenzaimpfung schwankt erheblich (zu kurzer Impfschutz, „mismatch“), weshalb eine möglichst späte Applikation (November/Dezember) sinnvoll ist. Zwei Pneumokokkenimpfstoffe werden für Erwachsene empfohlen: der über 30 Jahre alte 23-valente Polysaccharidimpfstoff (PPV23) und der neuere 13-valente Konjugatimpfstoff (PCV13). Die immunologische und klinische Effektivität von PPV23 ist umstritten, allenfalls wird von einer geringen Reduktion invasiver Infektionen ausgegangen. PCV13 ist wegen der T-Zell-Stimulation immunologisch wirksamer und hat kürzlich in einer überzeugenden Studie (CAPiTA) seine klinische Wirksamkeit bewiesen. Allerdings erfasst PCV13 zurzeit nur knapp die Hälfte der invasiven Pneumokokkenserotypen.

Abstract

Vaccinations are the most successful and cost-effective measures for prevention of infections. Important pathogens of respiratory tract infections (e.g. influenza viruses and pneumococci) can be effectively treated by vaccinations. The seasonal trivalent and recently now quadrivalent influenza vaccines include antigens from influenza A and B type viruses, which have to be modified annually oriented to the circulating strains. The effective protection by influenza vaccination varies considerably (too short protection time, mismatch); therefore, administration late in the year is the best approach (November/December). Two pneumococcal vaccines are recommended for adults: the over 30-year-old 23-valent polysaccharide vaccine (PPV23) and the 4-year-old 13-valent conjugate vaccine (PCV13). The immunological and clinical efficacy of PPV23 is controversially discussed; however, a moderate reduction of invasive pneumococcal infections is widely accepted. The PCV13 stimulates a T-cell response and has currently demonstrated its clinical efficacy in an impressive study (CAPiTA). The problem of PCV13 is the relatively limited coverage of only 47 % of the currently circulating invasive pneumococcal serotypes.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. H.M. Lode war als Berater und/oder Sprecher tätig für Astellas, Basilea, Bayer, GSK, Janssen, Boehringer, MSD, Novartis, Pfizer und Sanofi. R. Stahlmann gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Institut für klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Luisenstr. 7, 10177, Berlin, Deutschland

    H.M. Lode  & R. Stahlmann

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  1. H.M. Lode
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  2. R. Stahlmann
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Correspondence to H.M. Lode .

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Lode , H., Stahlmann, R. Impfungen in der Pneumologie. Pneumologe 12, 159–170 (2015). https://doi.org/10.1007/s10405-014-0867-8

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