Schutzimpfungen bei Kindern mit rheumatischen Erkrankungen

Zusammenfassung

Kinder mit rheumatischen Erkrankungen werden aus Sorge vor Impfkomplikationen häufig unzureichend geimpft. Sie sind somit einem erhöhten Infektionsrisiko ausgesetzt, ob-wohl auch bekannt ist, dass insbesondere Wildvirusinfektionen die Autoimmunerkrankung triggern und/oder einen Schub auslösen können. Darüber hinaus bedingen systemisch verlaufende rheumatische Erkrankungen gepaartmit der immunsuppressiven Therapie eine besondere Infektanfälligkeit. Impfprävention erscheint daher bei diesen Kindern besonders wichtig.

Im Folgenden werden die potenziellen Impfrisiken (Schubinduktion der Autoimmunerkrankung, Infektion durch Impfviren insbesondere unter immunsuppressiver Thera-pie), der zu erwartende Impferfolg (Induktion spezifischer Antikörperantwort nach Impfung) bei Patienten mit vermeintlicher Immundefizienz sowie dieImpfindikationen für Tot- und Lebend-Impfungen in Bezug zur Therapie (lokal – antiphlogistisch–immunsuppressiv) nachdemderzeitigen Kenntnisstand diskutiert. Hieraus lassen sich adäquate Impfvorschläge für diese besondere Patientengruppe ablei-ten.

Summary

Vaccination strategies in children with rheumatic diseases have been missed for many years resulting in a lack of preventive vaccines in these sometimes immunocompromized patients. Their risk to get an infectious disease is increased compared to healthy controls. Moreover, it is well known that especially wild-virus infections may trigger autoimmune disease and/or its recurrencies. In addition, both, systemic course of the rheumatic disease and immunosuppressive therapy promotes the susceptibility to infections. Thus, preventive vaccines would be extremely favourable. Aimof thisarticle istodiscussthe safety (induction of recur-rencies, infection due to vaccine virus under immunosuppressive medication) and the efficacy (induction of defending antigen-specific antibodies) of both inactive and/or live vaccines. The current knowledge is reviewed helping to develop adequate vaccination strategies in patients with rheumatic diseases.

Schlüsselwörter

Impfrisiko - Impferfolg - Infektionserkrankung - Autoimmunerkrankung - JIA

Keywords

Safety - efficacy - infectious disease - autoimmunity - JIA

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