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Impfungen bei rheumatischen Erkrankungen des Kindes- und Jugendalters

Immunization in children and adolescents with rheumatic diseases

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Zusammenfassung

Impfungen stellen bei Kindern und Jugendlichen mit rheumatischen Erkrankungen ein besonderes Problem dar. Wirkungen und Nebenwirkungen von Impfungen sind für dieses Patientenkollektiv leider nur unzureichend untersucht, und spezifische Impfempfehlungen fehlen. Die bei diesen Patienten häufig erforderliche immunsuppressive Therapie schafft zusätzliche Unsicherheit. Hinzu kommen Bedenken bezüglich impfassoziierter Reaktivierungen der Grunderkrankung. Die bestehenden Unsicherheiten im Umgang mit Impfungen führen zu einer erheblichen Praxisvariation unter den Kinderärzten und Impflücken bei den betroffenen Kindern und Jugendlichen. So ist jeder dritte Patient mit juveniler idiopathischer Arthritis unzureichend geimpft, was sogar Standardimpfungen mit Totimpfstoffen wie Tetanus/Diphtherie einschließt. Nach aktuellem Stand des Wissens ist der Nutzen vieler Impfungen gerade bei Patienten mit Autoimmunerkrankungen deutlich höher als deren Risiko zu veranschlagen. Gerade Patienten mit immunsuppressiver Therapie benötigen einen besonderen Schutz vor Infektionen. Kinder und Jugendliche mit rheumatischen Erkrankungen sollten deshalb – soweit möglich – nach den STIKO-Empfehlungen geimpft werden. Dabei muss der Zeitpunkt der anstehenden Impfung sorgfältig in Abhängigkeit von der Krankheitsaktivität und Therapie gewählt werden.

Abstract

Vaccinations represent a special problem in children and adolescents with inflammatory rheumatic diseases. There are very limited data on the safety and efficacy of vaccines in these patients, and guidelines for immunization are missing. The immunosuppressive therapy often necessary for these patients gives rise to additional uncertainty. In addition, many colleagues consider vaccination to increase the risk of relapse of the rheumatic illness. As a consequence, there are substantial variations in practicing vaccination in these patients, resulting in insufficient vaccination coverage rates. For example, every third patient with juvenile idiopathic arthritis is incompletely vaccinated; this even includes toxoid vaccines for tetanus and diphtheria. The benefit of vaccinations, which far outweighs their potential risks, is well recognized even in patients with autoimmune diseases. These patients in particular require a special protection from infections due to their immunosuppressive therapies. Therefore, children and adolescents with rheumatic diseases should be immunized according to the Standing Immunization Commission of the Robert Koch Institute recommendations whenever possible. However, the time of vaccination must be carefully selected, taking disease activity and treatment into account.

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Danksagung

Hiermit danken wir den nachfolgend genannten kinderrheumatologischen Einrichtungen für ihre Teilnahme an der GKJR-Impfumfrage im Jahr 2006: Klinikum Amberg; Sozialstiftung Bamberg; Rheumaklinik Bad Bramstedt; Helios Klinikum Berlin-Buch; Universitätskinderklinik Charité, Berlin; LKH Bregenz; Prof. Hess Kinderklinik, Bremen; AKH Celle; Carl-Thiem Klinikum Cottbus; Kinderklinik Datteln; Kinderarztpraxis Tautz, Dresden; Helios Klinikum Erfurt; Universitätskinderklinik Freiburg; Universitätskinderklinik Greifswald; Universitätskinderklinik Hamburg; Medizinische Hochschule Hannover; Universitätskinderklinik Heidelberg; Universitätskinderklinik Innsbruck; Universitätskinderklinik Kiel; Städtisches Klinikum St. Georg, Leipzig; Universitätskinderklinik Leipzig; Universitätskinderklinik Magdeburg; Universitätskinderklinik Mainz; Fach-Krankenhaus Neckargemünd; Kinderklinik Kohlhof, Neunkirchen; Klinik Südharz, Nordhausen; Klinikum Oldenburg; Kinderklinik Ernst von Bergmann, Potsdam; Asklepios Kliniken, Sankt Augustin; Olgahospital Stuttgart; Universitätskinderklinik Tübingen; Praxis Gaissmaier, Ulm; Universitätskinderklinik Würzburg.

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Authors and Affiliations

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

    K. Minden

  2. Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Deutschland

    M. Niewerth

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

    M. Borte

  4. Kinderarztpraxis Goebenstraße, Berlin, Deutschland

    W. Singendonk

  5. Zentrum für Kinder- und Jugendmedizin der Universität Greifswald, Greifswald, Deutschland

    J.-P. Haas

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  1. K. Minden
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  2. M. Niewerth
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  3. M. Borte
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  4. W. Singendonk
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  5. J.-P. Haas
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Correspondence to K. Minden.

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Minden, K., Niewerth, M., Borte, M. et al. Impfungen bei rheumatischen Erkrankungen des Kindes- und Jugendalters. Z. Rheumatol. 66, 111–120 (2007). https://doi.org/10.1007/s00393-007-0150-z

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