Masern – Warum ist die Impfung notwendig und wie gehe ich mit Impfgegnern um?

Masern ist eine hochansteckende Erkrankung mit schweren Komplikationen. Es gibt keine wirksame Therapie; die einzige Möglichkeit, die Infektion und ihre tragischen Folgen zu vermeiden, liegt in einer Impfung. Um einen guten Schutz zu erreichen, müssen mindestens 95 % einer Bevölkerung geimpft sein. Durch Verweigerung einer Masernimpfung aus unterschiedlichsten Gründen kommt es immer wieder zu Masernausbrüchen in zahlreichen zivilisierten Ländern.

Abstract

Measles is a highly contagious disease and one infected patient may transmit it to between 4 and more than 2000 others in a totally susceptible population. Measles virus (MV) is a member of the Paramyxoviridae family as is Mumps virus. These viruses are negative single-stranded enveloped RNA viruses.

The most common serious acute complications of measles infection are pneumonia, otitis media and neurological disorders. Shortly after measles infection, acute disseminated encephalomyelitis (ADEM) may occur and has had a mortality of up to 30 % in the pre- vaccination area. ADEM has an incidence of about 2 in 1000 cases. Between one to nine months after measles an encephalitis, designated as measles inclusion body encephalitis (MIBE) as a consequence of a persistent infection may occur. MIBE has an incidence of about 1 to 3 cases in 1000 measles infections.

The most dreadful and by far most delayed consequence, however, is subacute sclerosing panencephalitis (SSPE) that may occur after less than a year up to almost 35 years after infection. It has a mortality of 100 %. Its reported incidence ranges between 3 to 11 per 100000. Isolated outbreaks in populations with insufficient herd immunity, however suggest an age dependent frequency of 1:1700 to 1:3300 in children contracting measles infection below the age of 5 years. For those infected below the age of 12 months, the incidence of SSPE may be as high as 1:609.

There is no effective antiviral therapy for measles available. The only means to avoid its dire consequences is vaccination. In order to realize complete protection, more than 95 % of a population need to be vaccinated. This percentage is sufficient to prevent infection of the rare ( < 5 %) unvaccinated individual in at least 95 % vaccinated individuals in a given population, an effect named herd immunity. In order to get a sufficient immune response, children have to be vaccinated twice, once at the age between eleven and fourteen months and later at an age between 15 and 23 months.

Vaccination against measles has helped in drastically reducing the worldwide morbidity and mortality of the disease and its complications. Despite tremendous efforts, however, the WHO program for a worldwide eradication of measles through vaccination has failed to achieve a reduction of mortality by > 90 % as compared to the level of 2000. Yet, it has been estimated that between 2000 and 2015 vaccination prevented about 20.3 million deaths. All available evidence shows a drastic reduction of the above mentioned serious immediate and delayed consequences by a factor of 1000 to more than 30000.

Due to erroneous philosophical, theological or ideological misconceptions measles outbreaks have flared up in many civilized countries. The idea of autism being a consequence of measles vaccination is a particular bad example of faked facts put into existence in the early 1990’s. Not surprisingly, the federal constitutional court recently ruled to give a parent who was favoring vaccination the sole power of justice over his child owing to its mother’s refusal to do so because of her uncorroborated fear of vaccination damage.

Kernaussagen

• Masern ist eine hochansteckende Erkrankung. Eine infizierte Person kann zwischen 4 und mehr als 2000 weitere Menschen in einer völlig empfänglichen Bevölkerung infizieren.

• Das Masernvirus ist wie das Mumpsvirus ein Mitglied der Familie der Paramyxoviridae. Bei beiden handelt es sich um negativsträngige, umhüllte Einzelstrang-RNA-Viren.

• Die häufigsten schweren akuten Komplikationen von Masern sind eine Lungenentzündung, Otitis media und neurologische Erkrankungen.

• Kurz nach Ausbruch der Maserninfektion kann eine akute disseminierte Enzephalomyelitis (ADEM) auftreten, die eine Sterblichkeit von bis zu 30 % in der Zeit vor den Impfungen hatte. Die Inzidenz einer ADEM liegt bei ungefähr 2 auf 1000 Fällen.

• Nach etwa 1 – 9 Monaten kann es als Folge einer persistierenden Maserninfektion zu einer als Masern-Einschlusskörperchen-Enzephalitis (MIBE) bezeichneten Erkrankung kommen. Die Inzidenz einer MIBE liegt etwa bei 1 – 3 von 1000 Fällen.

• Die schwerwiegendste und mit jahre- bis jahrzehntelanger Verzögerung auftretende Komplikation ist die subakut sklerosierende Panenzephalitis (SSPE), die zwischen weniger als 1 Jahr und bis zu fast 35 Jahren nach der Infektion auftreten kann. Ihre Sterblichkeit beträgt 100 %. Isolierte Ausbrüche in Populationen mit unzureichender Herdimmunität legen eine altersabhängige Inzidenz von etwa 1 : 1700 bis 1 : 3300 bei Kindern, die sich unter 5 Jahren infizieren, nahe. Für Kleinkinder, die vor dem 12. Lebensmonat infiziert worden sind, kann die Häufigkeit des Auftretens einer SSPE bei 1 : 609 liegen.

• Es gibt keine wirksame Therapie der Masern. Die einzige Möglichkeit die Infektion und ihre tragischen Folgen zu vermeiden, liegt in einer Impfung. Um einen guten Schutz zu erreichen, müssen mindestens 95 % einer Bevölkerung geimpft sein. Dieser Anteil reicht aus, um eine weitere Ansteckung der wenigen (< 5 %) nicht geimpften Menschen in einer zu > 95 % immunisierten Bevölkerung zu verhindern, er wird als Herdimmunität bezeichnet.

• Dank der Masernimpfung ließen sich weltweite Sterblichkeit und Krankheitsrate sowie die damit zusammenhängenden Komplikationen drastisch senken. Trotz enormer Anstrengungen mittels eines weltweiten Masern-Eradikationsprogramms durch Impfungen hat es die WHO jedoch nicht erreichen können, deren Sterblichkeit um > 90 % im Vergleich zum Niveau des Jahres 2000 zu senken. Dennoch hat die Impfkampagne zwischen 2000 und 2015 ca. 20,3 Millionen Todesfälle verhindert.

• Um eine ausreichende Immunantwort zu erzielen, müssen Kinder zweimal geimpft werden. Einmal sollte die Impfung im Alter zwischen 11 und 14 Monaten, das zweite Mal im Alter von 15 bis 23 Monaten erfolgen.

• Die Impfung führt zu einer drastischen Abnahme der schweren und mit großer zeitlicher Latenz auftretenden Komplikationen um einen Faktor von 1000 bis mehr als 30 000.

• In Folge irriger philosophischer, theologischer oder ideologischer Vorstellungen kommt es immer wieder zu Masernausbrüchen in zahlreichen zivilisierten Ländern. Die Idee, Autismus sei eine Konsequenz einer Masernimpfung, mag als besonders abscheuliches Beispiel von „Faked Facts“ gelten, die in den frühen 1990er Jahren in die Welt gesetzt wurde.

• Konsequenterweise hat der Bundesgerichtshof kürzlich wegen der Weigerung eines Elternteils aufgrund seiner unbegründeten Angst vor vermeintlichen Impfschäden der Vakzination zuzustimmen, dem Elternteil, der die Impfung befürwortet, die Vormundschaft für das Kind überlassen.

Schlüsselwörter

Masern - Vakzinierung - akute disseminierte Enzephalomyelitis - Masern-Einschlusskörperchen-Enzephalitis - subakut sklerosierende Panenzephalitis

Keywords

measles - vaccination - acute disseminated encephalomyelitis - measles inclusion body encephalitis - subacute sclerosing panencephalitis

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