Gelbfieberimpfung bei medikamentöser Immunsuppression – Aktuelle Empfehlungen für die reisemedizinische Beratung

Die Zahl der Fernreisenden mit medikamentöser Immunsuppression dürfte in den kommenden Jahren zunehmen. Insofern ist die Frage nach Gelbfieberimpfungen in dieser Bevölkerungsgruppe für den Reisemediziner von zunehmender praktischer Relevanz. Während eine Gelbfieberimpfung unter einer Behandlung mit stark bis mittelstark wirksamen Immunsuppressiva nicht durchgeführt werden darf, stellen andere Medikamente mit immunsuppressiver Wirkung sowie auch niedriger dosierte, kurzfristige oder lokale Kortisongaben keine generelle Kontraindikation dar. Ob beziehungsweise wann eine Gelbfieberimpfung nach Absetzen der immunsuppressiven Therapie möglich ist, hängt ebenfalls vom eingesetzten Immunsuppressivum ab. Es liegen insgesamt wenig Daten zu Lebendimpfungen unter medikamentöser Immunsuppression vor. Generell ist es ratsam, das Gelbfieberinfektionsrisiko und das Risiko für Nebenwirkungen individuell abzuwägen und gegebenenfalls auch den immunsuppressiv behandelnden Kollegen in eine abschließende Entscheidung einzubinden.

The number of international travelers under drug-induced immunosuppression is likely to further increase in the near future.

Information on risks and contraindications of the yellow fever-vaccination in this population is, therefore, of practical relevance. While drugs of high and medium immunosuppressive potency are a general contraindication against yellow fever vaccination, this vaccine can be considered in other medications with immunosuppressive efficacy as well as low-dose, short-term or local steroids. If and when yellow fever-vaccination can be given after the immunosuppressive therapy has been stopped also depends on the specific medication. Up to now, little data are available on live attenuated vaccines in patients with medical immunosuppression. Geographical infection risks as well as potential safety issues should be considered. It is advisable to involve the physician who has initiated the immunosuppressive therapy in the final decision.

Key words

yellow fever - vaccination - drug-induced immunosuppression

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