Impfungen bei Kindern und Jugendlichen mit rheumatischen und muskuloskelettalen Erkrankungen

Zusammenfassung

Impfungen stellen die effektivste Maßnahme zur Infektionsprophylaxe dar. Bei Kindern und Jugendlichen mit rheumatischen und muskuloskelettalen Erkrankungen wird von einem erhöhten Infektionsrisiko im Allgemeinen und für Erkankungen durch impfpräven-table Erreger im Speziellen ausgegangen. Daher ist ein vollständiger Impfstatus, Indikationsimpfungen im Bedarfsfall eingeschlossen, besonders wichtig. Impfungen sollten, wenn möglich, vor dem Einsatz einer Immunsuppression (IS) erfolgen, um deren Wirksamkeit (inklusive Boosterfähigkeit) sowie – im Hinblick auf Lebendimpfungen – auch Sicherheit zu erhöhen. Die Empfehlung zur schnellen Vervollständigung des Impfschutzes spiegelt auch die Beobachtung wider, dass gerade zu diesem frühen Zeitpunkt der Rheumatherapie eine erhöhte Infektionsrate vorliegt. Für die Planung von Schutzimpfungen bei bereits begonnener IS werden Strategien vorgeschlagen, die – untergliedert nach Tot- und Lebendimpfungen – den individuellen Impferfolg sichern und Risiken minimieren sollen.

Summary

Vaccinations are the most effective measure to prevent infections. Children and adolescents with rheumatic and musculoskeletal diseases are assumed to have an increased risk of infection in general and of infections caused by pathogens preventable by immunization. Therefore the completion of basic, catch-up and if necessary vaccinations for certain indications is especially important. If possible, these should be completed before the use of immunosuppression to increase efficacy and booster capability as well as to increase safety with regard to live vaccinations. The recommendation to rapidly complete vaccine coverage reflects the observation that there is an increased rate of infection especially at this early stage of rheumatology therapy. For the planning of vaccinations during immunosuppression which has already been started strategies are proposed – divided in inactivated and live vaccinations – to ensure individual success of immunization and to minimize risks.

Schlüsselwörter

Impfungen - Kinder und Jugendliche mit rheumatischen und muskuloskelettalen Erkrankungen - Immunsuppression

Keywords

Vaccination - children and adolescents with rheumatic and musculoskeletal diseases - immunosuppression

• Literatur

• 1 Beukelman T, Xie F, Chen L. et al SABER Collaboration. Rates of hospitalized bacterial infection associated with juvenile idiopathic arthritis and its treatment. Arthritis Rheum 2012; 64: 2773-2780.
• 2 Danza A, Ruiz-Irastorza G. Infection risk in systemic lupus erythematosus patients: susceptibility factors and preventive strategies. Lupus 2013; 22: 1286-1294.
• 3 Speth F, Wellinghausen N, Haas JP. Medicinal prophylaxis during intensified immunosuppression in children and adolescents; Part 2. Z Rheumatol 2013; 72 (09) 896-909.
• 4 Speth F, Wellinghausen N, Haas JP. Screening investigations during intensified immunosuppression in children and adolescents; Part 1. Z Rheumatol 2013; 72 (08) 814-821.
• 5 Rubin LG, Schaffner W. Clinical practice. Care of the asplenicpatient. N Engl J Med 2014; 371 (04) 349-356.
• 6 Minden K, Speth F, Huppertz I H, Borte M. Immunization in children and adolescents with rheumatic and musculoskeletal diseases. Z Rheumatol 2014; 73 (10) 878-889.
• 7 Warnatz K, Goldacker S. Impfungen bei rheumatischen Erkrankungen. Aktuelle Empfehlung der STIKO und DGRh. Arthritis und Rheuma 2014; 3: 140-149.
• 8 Heijstek MW, Wulffraat NM. EULAR recommendations for vaccination in pediatric paediatric patients with rheumatic diseases. Ann Rheum Dis 2011; 70 (10) 1704-1712.
• 9 STIKO, 2005 Bulletin (Sonderdruck): Hinweise zu Impfungen für Patienten mit Immundefizienz
• 10 Rubin LG, Levin MJ, Ljungman P. et al. Infectious Diseases Society of America. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis 2014; 58 (03) 309-318.
• 11 Ritter ML, Pirofski L. Mycophenolate mofetil: effects on cellular immune subsets, infectious complications, and antimicrobial activity. Transplant Infect Dis 2009; 11 (04) 290-297.
• 12 Boddana P, Webb LH, Unsworth J. et al Hypogammaglobulinemia and bronchiectasis in mycophenolate mofetil-treated renal transplant recipients: an emerging clinical phenomenon?. Clin Transplant 2011; 25 (03) 417-419.
• 13 Impfprinzipien und Empfehlungen für Personen mit rheumatischen Erkrankungen. Bundesamt für Gesundheit und Eidgenössiche Kommission für Impffragen. Februar 2014 http://www.bag.admin.ch/ekif/04423/04429/index.html
• 14 Greenberg JD, Hochberg MC. Association of methotrexate and tumor necrosis factor antagonists with risk of infections outcomes including opportunistic infections in the CORONNA registry. Ann Rheum Dis 2010; 69 (02) 380-386.
• 15 Grijalva CG, Griffin RM. Initiation of rheumatoid arthtritis treatments and risk of serious infections. Rheumatology 2010; 49: 82-90.
• 16 De Keyser F. Choice of biologic therapy for patients with rheumatoid arthritis: the infection perspective. Current Rheumatol Reviews 2011; 7: 77-87.
• 17 Pileggi GS, de Souza CB, Ferriani VP. Safety and immunogenicity of varicella vaccine in patients with juvenile rheumatic diseases receiving methotrexate and corticosteroids. Arthritis Care Res (Hoboken) 2010; 62 (07) 1034-1039.
• 18 Lydick E, Kuter BJ, Zajac BA, Guess HA. Association of steroid therapy with vaccine-associated rashes in children with acute lymphocytic leukaemia who received Oka/Merck varicella vaccine. NIAID Varicella Vaccine Collaborative Study Group. Vaccine 1989; 7 (06) 549-553.
• 19 Brenol CV, da Mota LM, Cruz BA. et al Brazilian Society of Rheumatology. 2012 Brazilian Society of Rheumatology Consensus on vaccination of patients with rheumatoid arthritis. Rev Bras Reumatol 2013; 53 (01) 4-23.
• 20 Kroger AT, Atkinson WL, Mercuse EK, Pickering LK. General Recommendations on Immunization. Advisory Commitee on Immunization Practices (ACIP) 2006; 55 (RR15) 1-48. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5515a1.htm
• 21 Sartori AM. A review of the varicella vaccine in immunocompromised individuals. Int J Infect Dis 2004; 8 (05) 259-270.
• 22 Krüger K, Albrecht K, Rehart S, Scholz R. und die Kommission Pharmakotherapie der DGRh. Empfehlung der DGRh zur perioperativen Vorgehensweise unter Therapie mit DMARDs und Biologika bei entzündlich rheumatischen Erkrankungen. http://dgrh.de/fileadmin/media/Praxis___Klinik/Therapie-Empfehlungen/perioperativ/periop_final230813_ueberarbeitung_kk.pdf
• 23 Papadopoulou D, Sipsas NV. Comparison of national clinical practice guidelines and recommendations on vaccination of adult patients with autoimmune rheumatic diseases. Rheumatol Int 2014; 34 (02) 151-163.
• 24 Kumagai T, Chiba Y, Fujiwara M. et al Humoral and cellular immune response to varicella-zoster virus in children inoculated with live attenuated varicella vaccine. Biken Journal 1980; 23: 135-141.
• 25 Harpaz R, Ortega-Sandoz IR, Seward JF. Prevention of Herpes Zoster. Recommendations of the Advisory Commitee on Immunization Practices (ACIP) 2008; 57: 1-30.
• 26 Lacki JK, Mackiewicz SH, Leszczynski P, Müller W. The effect of intravenous cyclophosphamidepulse on peripheral blood lymphocytes in lupus erythematosus patients. Rheumatol Int 1997; 17 (02) 55-60.
• 27 Campos LM, Silva CA, Aikawa NE. et al High disease activity: an independent factor for reduced immunogenicity of the pandemic influenza a vaccine in patients with juvenile systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2013; 65: 1121-1127.
• 28 Warnatz K, Goldacker S, Gause AM. die Kommission Pharmakotherapie der, DGRh Vaccination recommendations of the Commission for Pharmacotherapy of the German Society of Rheumatology. Z Rheumatol 2013; 72 (07) 687-689.
• 29 Dengler TJ, Strnad N, Bühring I. et al Differential immune response to influenza and pneumococcal vaccination in immunosuppressed patients after heart transplantation. Transplantation 1998; 66 (10) 1340-1347.
• 30 Smets F, Bourgois A, Vermylen C. et al Randomised revaccination with pneumococcal polysaccharide or conjugate vaccine in asplenic children previously vaccinated with polysaccharide vaccine. Vaccine 2007; 25 (29) 5278-5282.
• 31 Crnkic Kapetanovic M, Saxne T, Truedsson L, Geborek P. Persistence of antibody response 1.5 years after vaccination using 7-valent pneumococcalconjugate vaccine in patients with arthritis treated with different antirheumatic drugs. Arthritis Res Ther 2013; 15 (01) R1.
• 32 Enke BU, Bökenkamp A, Offner G. et al Response to diphtheria and tetanus booster vaccination in pediatric renal transplant recipients. Transplantation 1997; 64 (02) 237-241.
• 33 Siegrist CA, Aspinall R. B-cell responses to vaccination at the extremes of age. Nat Rev Immunol 2009; 9 (03) 185-194.
• 34 Liakou CD, Askiti V, Mitsioni A. et al Safety and immunogenicity of booster immunization with 7-valent pneumococcal conjugate vaccine in children with idiopathic nephrotic syndrome. Vaccine 2014; 32 (12) 1394-1397.
• 35 Crnkic Kapetanovic M, Saxne T, Jönsson G. et al Rituximab and abatacept but not tocilizumab impair antibody response to pneumococcal conjugate vaccine in patients with rheumatoid arthritis. Arthritis Res Ther 2013; 15 (05) R171.
• 36 Farmaki E, Kanakoudi-Tsakalidou F, Spoulou V. et al The effect of anti-TNF treatment on the immunogenicity and safety of the 7-valent conjugate pneumococcal vaccine in children with juvenile idiopathic arthritis. Vaccine 2010; 28 (31) 5109-5113.
• 37 Rehnberg M, Brisslert M, Amu S. et al Vaccination response to protein and carbohydrate antigens in patients with rheumatoid arthritis after rituximab treatment. Arthritis Res Ther 2010; 12 (03) R111.
• 38 Arad U, Tzadok S, Amir S. et al The cellular immune response to influenza vaccination is preserved in rheumatoid arthritis patients treated with rituximab. Vaccine 2011; 29 (08) 1643-1648.
• 39 Buda K, Tubergen DG, Levin MJ. The frequency and consequences of varicella exposure and varicella infection in children receiving maintenance therapy for acute lymphoblastic leukemia. J Pediatr Hematol Oncol 1996; 18 (02) 106-112.
• 40 Dougados M, Betteridge N, Burmester GR. et al EULAR. EULAR standardised operating procedures for the elaboration, evaluation, dissemination, and implementation of recommendations endorsed by the EULAR standing committees. Ann Rheum Dis 2004; 63 (09) 1172-1176.
• 41 Borte S, Liebert UG, Borte M. Efficacy of measles, mumps and rubella revaccination in children with juvenile idiopathic arthritis treated with methotrexate and etanercept. Rheumatology (Oxford) 2009; 48: 144-148.
• 42 Adam D. Grippeimpfung bei Kindern: Adjuvantierte Vakzine ist hochwirksam und sicher. Dtsch Arztebl 2011; 108 (48) A-2607/B-2178/C-2150.
• 43 Sengler C, Niewerth M, Kallinich T. et al Survey about tolerance of the AS03-adjuvanted H1N1 influenza vaccine in children with rheumatic diseases. Clin Rheumatol 2014; 33 (01) 137-139.