Impfprävention

M. Knuf; F. Zepp

doi:10.1055/s-0038-1629421

Kinder- und Jugendmedizin, Table of Contents

Kinder- und Jugendmedizin 2017; 17(04): 217-224
DOI: 10.1055/s-0038-1629421

Infektionskrankheiten und Impfprävention

Schattauer GmbH

Impfprävention

Empfehlungen und aktuelle DatenPrevention through vaccinationRecommendations and an update

M. Knuf

¹Klinik für Kinder und Jugendliche, HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden

²Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin Mainz

,

F. Zepp

²Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin Mainz

› Author Affiliations

Abstract

Zusammenfassung

Erstmalig hat die STIKO evidenzbasierte Hinweise zur Schmerz- und Stressreduktion beim Impfen publiziert. Schmerz und Stress beeinflussen die Akzeptanz von Impfungen. Es liegen Empfehlungen zu Injektionstechniken, altersabhängigen Ablenkungsmethoden und weiteren Verhaltensweisen vor. Langzeitdaten zur Persistenz von anti-HBsKonzentrationen 30 Jahre nach der Grundimmunisierung mit einem Hepatitis-B-Impfstoff belegen die Induktion einer Gedächtnisantwort bzw. die Stabilität der Antikörperspiegel. Anti-HBs-Titer fallen in Abhängigkeit vom Impfalter unterschiedlich aus. Pertussis-Epidemien treten in Ländern mit niedriger Durchimpfungsquote alle 3–4 Jahre zyklisch auf. Neuere Daten aus Deutschland belegen, dass das Erkrankungsalter bei Pertussis zunimmt und die Impfimmunität kürzer andauert als ursprünglich angenommen. Azelluläre Pertussis-Impfstoffe sind allgemein schlechter wirksam als Ganzkeim-Impfstoffe. Säuglinge erkranken am häufigsten. Das Auftreten von Pertactin-defizienten Pertussis-Stämmen scheint für den Wirkungsverlust der Impfstoffe von Bedeutung zu sein. Es werden Daten zur Sicherheit der Rotavirus-, HPV- und MMR-Impfung sowie zum Auftreten von Impfgranulomen besprochen.

Summary

For the first time, STIKO published evidence-based information on pain and stress reduction during vaccination. Pain and stress affect the acceptance of vaccinations. There are recommendations on injection techniques, age-dependent deflection methods and other behaviors.

Long-term data on the persistence of anti-HBs concentrations 30 years after the basic immunization with a hepatitis B vaccine demonstrate the induction of a memory response and the stability of the antibody levels. Anti-HBs titres vary depending on the age of vaccination. Pertussis epidemics occur cyclically every 3 to 4 years in countries with low vaccination rates. Recent data from Germany show that the disease age increases with pertussis and the vaccine immunity is shorter than originally assumed. Accellular pertussis vaccines are generally less effective than whole-seed vaccines. Infants develop most frequently. The occurrence of pertactin-deficient pertussis strains appears to be important for the loss of potency of the vaccines. Data on the safety of rotavirus, HPV and MMR vaccination as well as on the appearance of vaccine granulomas are discussed.

Schlüsselwörter

Schmerz- und Stressreduktion beim Impfen - Langzeitimmunität nach Hepatitis-B-Impfung - Pertussis in Deutschland - Wirksamkeit von Pertussis-Impfstoffen - Impfstoffsicherheit

Keywords

Pain and stress reduction during vaccination - long-term immunity after hepatitis B vaccination - pertussis in Germany - efficacy of pertussis vaccines - vaccine safety

Full Text

References

Literatur
1 http://www.rki.de/DE/Content/Kommissionen/STIKO/Empfehlungen/Impfempfehlungen_node.html
2 RKI. Epidemiologisches Bulletin, Nr. 34 2016
3 Report to SAGE: on reducing pain and distress at the time of vaccination. Geneva: SAGE Technical Consultation Group on Reducing Pain and Distress at the Time of Vaccination; 2015. Einsehbar www.who.int/immunization/sage/meetings/2015/april/1_SAGE_latest_pain_guidelines_March_24_Final.pdf (zugegriffen: 23.6.2016)
4 Berrang J, Vosschulte P, Zernikow B. Schmerzreduktion bei Blutabnahmen und Injektionen. In Zernikow (Hrsg). B. Schmerztherapie bei Kindern, Jugendlichen und jungen Erwachsenen.. Berlin, Heidelberg: Springer; 2015: 355-367.
5 Boerner KE, Birnie KA, Chambers CT. et al Simple psychological interventions for reducing pain from common needle procedures in adults: systematic review of randomized and quasi-randomized controlled trials. Clin J Pain 2015; 31: 90
6 SAGE. Meeting of the Strategic Advisory Group of Experts on Immunization, April 2015; conclusions and recommendations. WER 2015; 22: 261-280.
7 Taddio A, McMurtry CM, Shah V. et al Reducing pain during vaccine injections: clinical practice guideline. CMAJ 2015; 187: 975-982.
8 WHO. Reducing pain at the time of vaccination WHO position paper -September 2015. Weekly Epidemiological Record 2015; 90: 505-516.
9 Bundeszentrale für gesundheitliche Aufklärung www.Impfen-Info.de
10 Bruce MG, Bruden D, Hurlburt D. et al Antibody levels and protection after Hepatitis B vaccine: results of a 30-year follow-up study and response to a Booster Dose. J Infect Dis 2016; 214: 16-22.
11 Coppola N, Corvino AR, De Pascalis S. et al The long-term immunogenicity of recombinant hepatitis B virus (HBV) vaccine: contribution of universal HBV vaccination in Italy. BMC Infect Dis 2015; 15: 149
12 Dissertation Silvia Klein. Zusammenhang zwischen Impfungen und Inzidenz und Mortalität von Infektionskrankheiten. Zeitreihenanalysen mit Meldedaten zu Diphtherie, Pertussis, Poliomyelitis und Tetanus von 1892 bis 2011 in Deutschland RKI 2013 S. 144 ff. http://www.diss.fu-berlin.de/diss/receive/FUDISS_thesis_000000095132
13 Epidemiologischen Bulletin Nr. 1 2014
14 Infektionsepidemiologisches Jahrbuch meldepflichtiger Krankheiten für 2015, Datenstand: 1. März 2016 S 127 ff
15 Schwartz KL, Kwong JC, Deeks SL. et al Effectiveness of pertussis vaccination and duration of immunity. CMAJ 2016; 188: E399-E406.
16 Klein NP, Bartlett J, Rowhani-Rahbar A. et al Waning protection after fifth dose of acellular pertussis vaccine in children. N Engl J Med 2012; 367: 1012-1019.
17 Baxter R, Bartlett J, Rowhani-Rahbar A. et al Effectiveness of pertussis vaccines for adolescents and adults: case-control study. BMJ 2013; 347: f4249
18 Tartof SY, Lewis M, Kenyon C. et al Waning immunity to pertussis following 5 doses of DTaP. Pediatrics 2013; 131: e1047-1052.
19 McGirr A, Fisman DN. Duration of pertussis immunity after DTaP immunization: a meta-analysis. Pediatrics 2015; 135: 331-343.
20 Tomovici A, Barreto L, Zickler P. et al Humoral immunity 10 years after booster immunization with an adolescent and adult formulation combined tetanus, diphtheria, and 5-component acellular pertussis vaccine. Vaccine 2012; 30: 2647-2653.
21 Martin SW, Pawloski L, Williams M. et al Pertactin-negative Bordetella pertussis strains: Evidence for a possible selective advantage. Clin Infect Dis 2015; 60: 223-227.
22 Hiramatsu Y, Miyaji Y, Otsuka N. et al Significant decrease in pertactin-deficient Bordetella pertussis isolates, Japan. Emerg Infect Dis 2017; 23: 699-701.
23 Zeddeman A, van MGent, Heuvelman CJ. et al. Investigations into the emergence of pertactin-deficient Bordetella pertussis isolates in six European countries, 1996 to 2012 Euro Surveill. 2014; 19 pii 20881
24 Burdin N, Handy LK, Plotkin SA. What is wrong with pertussis vaccine immunity? The problem of waning effectiveness of pertussis Vaccines. Cold Spring Harb Perspect Biol 2017; Mar 13 pii a029454. [Epub ahead of print]
25 Koch J, Harder T, von Kries R. et al The risk of intussusception after rotavirus vaccination - a systematic literature review and meta-analysis. Dtsch Arztebl Int 2017; 114: 255-262.
26 Andrews N, Stowe J, Miller E. No increased risk of Guillain-Barré syndrome after human papilloma virus vaccine: A self-controlled case-series study in England. Vaccine 2017; 35: 1729-1732.
27 Gerber JS, Offit PA. Vaccines and Autism: A Tale of shifting hypotheses. CID 2009; 48: 456-461.
28 Knuf M, Kieninger-Baum D, Habermehl P. et al Sicherheit und Verträglichkeit von Impfstoffen. Pädiatrische Praxis 2017; 87: 409-429.
29 Fombonne E, Chakrabarti S. No evidence for a new variant of measles-mumps-rubella-induced autism. Pediatrics 2001; 108: E58
30 Madsen KM, Hviid A, Vestergaard M. et al A population-based study of measles, mumps, and rubella vaccination and autism. The N Engl J Med 2002; 347: 1477-1482.
31 Uchiyama T, Kurosawa M, Inaba Y. MMR-vaccine and regression in autism spectrum disorders: negative results presented from Japan. J Autism Dev Disord 2007; 37: 210-217.
32 Jain A, Marshall J, Buikema A. et al Autism occurrence by MMR vaccine status among US children with older siblings with and without autism. JAMA 2015; 313: 1534-1540.
33 DeStefano F, Bhasin TK, Thompson WW. et al Age at first measles-mumps-rubella vaccination in children with autism and schoolmatched control subjects: a population-based study in metropolitan Atlanta. Pediatrics 2004; 113: 259-266.
34 Mrozek-Budzyn D, Kiełtyka A, Majewska R. Lack of association between measles-mumps-rubella vaccination and autism in children: a case-control study. Pediatr Infect Dis J 2010; 29: 397-400.
35 Smeeth L, Cook C, Fombonne E. et al MMR vaccination and pervasive developmental disorders: a case-control study. Lancet 2004; 364: 963-969.
36 Uno Y, Uchiyama T, Kurosawa M. et al The combined measles, mumps, and rubella vaccines and the total number of vaccines are not associated with development of autism spectrum disorder: the first case-control study in Asia. Vaccine 2012; 30: 4292-4298.
37 Uno Y, Uchiyama T, Kurosawa M. et al Early exposure to the combined measles-mumps-rubella vaccine and thimerosal-containing vaccines and risk of autism spectrum disorder. Vaccine 2015; 33: 2511-2516.
38 Honda H, Shimizu Y, Rutter M. No effect of MMR withdrawal on the incidence of autism: a total population study. J Child Psychol Psychiatry 2005; 46: 572-579.
39 Fombonne E, Zakarian R, Bennett A. et al Pervasive developmental disorders in Montreal, Quebec, Canada: prevalence and links with immunizations. Pediatrics 2006; 118: e139-50.
40 Taylor B, Miller E, Farrington CP. et al Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association. Lancet 1999; 353: 2026-2029.
41 Bergfors E, Hermansson G, Nyström Kronander U. et al How common are long-lasting, intensely itching vaccination granulomas and contact allergy to aluminium induced by currently used pediatric vaccines? A prospective cohort study. Eur J Pediatr 2014; 173: 1297-1307.
42 Mäkelä A, Nuorti JP, Peltola H. Neurologic disorders after measles-mumps-rubella vaccination. Pediatrics 2002; 110: 957-963.
43 Demicheli V, Rivetti A, Debalini MG. et al. Vaccines for measles, mumps and rubella in children. Cochrane Database Syst Rev 2005; Oct 19 (04) CD004407
44 Taylor LE, Swerdfeger AL, Eslick GD. et al Vaccines are not associated with autism: an evidence- based meta-analysis of case-control and cohort studies. Vaccine 2014; 32: 3623-3629.