Zusammenfassung.
Pneumokokken verursachen schwere und häufige Krankheiten wie Meningitis, Sepsis und
Pneumonie bzw. Otitis media und Sinusitis. Die Inzidenz der invasiven Pneumokokken-Infektionen
ist am höchsten in den ersten 2 Lebensjahren (Deutschland, 1997 - 1999: 19,5/100 000/Jahr).
Jährlich wird in Deutschland mit ca. 220 - 250 Pneumokokken-Meningitiden, mit 50 000
Pneumokokken-Pneumonien in den ersten 5 Lebensjahren und mit über 1 Mio. Erkrankungen
an akuter Otitis media im Kindesalter gerechnet. Die Letalität der invasiven Pneumokokken-Erkrankungen
ist nach wie vor hoch (1997 - 1999 5,5 %, für die Meningitis sogar 8,3 %). Bleibende
Restschäden nach einer Pneumokokken-Meningitis werden bei 20 - 30 % der Kinder registriert.
Die Impfung mit der 7-valenten konjugierten Pneumokokken-Vakzine kann bei Kindern
in den ersten 2 Lebensjahren ca. 80 % der invasiven Pneumokokken-Erkrankungen sowie
6 % der akuten und 9 - 16 % der rezidivierenden Otitiden verhindern. Wegen des hohen
medizinischen und ökonomischen Nutzeffektes sollten alle Kinder in den ersten 2 Lebensjahren
immunisiert werden. Diese Forderung scheint auch deshalb gerechtfertigt zu sein, weil
aufgrund der hohen Makrolidresistenz in Deutschland und wegen fehlender Zulassung
zahlreicher neuer Antibiotika für das Säuglings- oder Kindesalter die Immunprophylaxe
für junge Kinder eine wertvolle Alternative darstellt und die 23-valente Vakzine für
Kinder in den ersten 2 Lebensjahren nicht eingesetzt werden kann.
Streptococcus pneumoniae is a common cause of meningitis, sepsis, pneumonia, acute
otitis media, and sinusitis in children. Children younger than 24 months have the
highest rates of invasive pneumococcal infections (Germany 1997 - 1999: 19,5/100 000/year).
Pneumococcal infections cause in Germany 220 - 250 cases of meningitis, about 50 000
of pneumonia (children younger than 5 years) and more than 1 million cases of otitis
media (children) annually. The case-fatality rate for invasive pneumococcal diseases
is high (1997 - 1999 5.5 %, meningitis 8.3 %). 20 - 30 % of survivers from meningitis
suffer from CNS-related sequelea. In children up to 2 years vaccination with the heptavalent
pneumococcal conjugate vaccine can reduce invasive pneumococcal diseases by about
80 % and otitis media and recurrent otitis media by 6 % and 9 - 16 %, respectively.
Due to the increased risk of pneumococcal infections in the first two years of live
all children of this age group should be vaccinated. The high rate of resistance of
pneumococci against macrolides in Germany, the high rate of non-licensed antibiotics
in infants and the inefficacy of the 23-valent vaccine in children younger than 2
years makes the new vaccine to a necessary alternative.
Schlüsselwörter:
Impfung - Pneumokokken - Meningitis - Pneumonie - Otitis media
Key words:
Vaccination - pneumococci - meningitis - pneumonia - otitis media
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Dozent Dr. med. Horst Scholz
Institut für Infektiologie, Mikrobiologie und Hygiene im Klinikum Buch
Wiltbergstr. 50
13122 Berlin