Download PDF
Flugmedizin · Tropenmedizin · Reisemedizin - FTR 2014; 21(1): 17-23
DOI: 10.1055/s-0034-1371765
Tropenmedizin
© Georg Thieme Verlag Stuttgart · New York

Gelbfieberimpfung bei medikamentöser Immunsuppression – Aktuelle Empfehlungen für die reisemedizinische Beratung

Yellow fever-vaccination in travelers with drug-induced immunosuppression
Louise Roggelin
1   Sektion Tropenmedizin, I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf und Arbeitsgruppe Klinische Forschung, Bernhard-Nocht-Institut für Tropenmedizin, Hamburg
,
Jakob P Cramer
1   Sektion Tropenmedizin, I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf und Arbeitsgruppe Klinische Forschung, Bernhard-Nocht-Institut für Tropenmedizin, Hamburg
› Author Affiliations
Further Information

Publication History

Publication Date:
26 February 2014 (online)

Also available at
    Permissions and Reprints

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
 

  • Literatur

  • 1 Hochberg NS, Barnett ED, Chen LH et al. International travel by persons with medical comorbidities: understanding risks and providing advice. Mayo Clin Proc 2013; 88: 1231-1240
    CrossrefGoogle Scholar
  • 2 Sanofi Pasteur MSD. Fachinformation Stamaril® .
    Google Scholar
  • 3 Barrett AD, Teuwen DE. Yellow fever vaccine – how does it work and why do rare cases of serious adverse events take place?. Curr Opin Immunol 2009; 21: 308-313
    CrossrefGoogle Scholar
  • 4 Thomas RE, Lorenzetti DL, Spragins W et al. Active and passive surveillance of yellow fever vaccine 17D or 17DD-associated serious adverse events: systematic review. Vaccine 2011; 29: 4544-4555
    CrossrefGoogle Scholar
  • 5 Cottin P, Niedrig M, Domingo C. Safety profile of the yellow fever vaccine Stamaril®: a 17-year review. Expert Rev Vaccines 2013; 12: 1351-1368
    CrossrefGoogle Scholar
  • 6 Centers for Disease Control and Prevention. Yellow fever vaccine. Im Internet: http://www.cdc.gov/yellowfever/vaccine/
    Google Scholar
  • 7 Kirrstetter M. Impfung unter Immunsuppression. Deutsche Gesellschaft für Rheumatologie Im Internet: http://www.dgrh.de/1652.html
    Google Scholar
  • 8 Mota LM, Oliveira AC, Lima RA et al. Vaccination against yellow fever among patients on immunosuppressors with diagnoses of rheumatic diseases. Rev Soc Bras Med Trop 2009; 42: 23-27
    CrossrefGoogle Scholar
  • 9 Azevedo LS, Lasmar EP, Contieri FL et al. Yellow fever vaccination in organ transplanted patients: is it safe? A multicenter study. Transpl Infect Dis 2012; 14: 237-241
    CrossrefGoogle Scholar
  • 10 Scheinberg M, Guedes-Barbosa LS, Mangueira C et al. Yellow fever revaccination during infliximab therapy. Arthritis Care Res (Hoboken) 2010; 62: 896-898
    Google Scholar
  • 11 Avelino-Silva VI, Leal FE, Sabino EC et al. Yellow fever vaccine viremia following ablative BM suppression in AML. Bone Marrow Transplant 2013; 48: 1008-1009
    CrossrefGoogle Scholar
  • 12 Reinhardt B, Jaspert R, Niedrig M et al. Development of viremia and humoral and cellular parameters of immune activation after vaccination with yellow fever virus strain 17D: a model of human flavivirus infection. J Med Virol 1998; 56: 159-167
    CrossrefGoogle Scholar
  • 13 Mateo RI, Xiao SY, Travassos da Rosa AP et al. Yellow fever 17-D vaccine is neurotropic and produces encephalitis in immunosuppressed hamsters. American J Trop Med Hyg 2007; 77: 919-924
    Google Scholar
  • 14 Shinjoh M, Miyairi I, Hoshino K et al. Effective and safe immunizations with live-attenuated vaccines for children after living donor liver transplantation. Vaccine 2008; 26: 6859-6863
    CrossrefGoogle Scholar
  • 15 Borte S, Liebert UG, Borte M, Sack U. Efficacy of measles, mumps and rubella revaccination in children with juvenile idiopathic arthritis treated with methotrexate and etanercept. Rheumatology (Oxford) 2009; 48: 144-148
    Google Scholar
  • 16 Nazi I, Kelton JG, Larché M et al. The effect of rituximab on vaccine responses in patients with immune thrombocytopenia. Blood 2013; 122: 1946-1953
    CrossrefGoogle Scholar
  • 17 Elkayam O, Bashkin A, Mandelboim M et al. The effect of infliximab and timing of vaccination on the humoral response to influenza vaccination in patients with rheumatoid arthritis and ankylosing spondylitis. Semin Arthritis Rheum 2010; 39: 442-447
    CrossrefGoogle Scholar
  • 18 Robert Koch-Institut. Hinweise zu Impfungen für Patienten mit Immundefizienz 2005. Im Internet: http://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2005/Sonderausgaben/Sonderdruck_STlKO-Hinweise_Nov-2005.pdf?_blob=publicationFile
    Google Scholar
  • 19 Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit. Gelbfieber. Im Internet: http://www.dtg.org/gelbfieber.html
    Google Scholar
  • 20 Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit. Aufklärungsblatt Gelbfieber-Impfung 2011. Im Internet: http://www.dtg.org/fileadmin/user_upload/PDF/Aufklaerung_Gelbfieber_01.pdf
    Google Scholar
  • 21 Nelson Kotton C, Freedman DO. Immunocompromised Travelers. CDC Yellow Book 2014. Im Internet: http://www.nc.cdc.gov/travel/yellowbook/2014/chapter-8-advising-travelers-with-specific-needs/immunocompromised-travelers
    Google Scholar
  • 22 World Health Organization. SAGE working group on yellow fever vaccines. Im Internet: http://www.who.int/immunization/sage/SAGE_wg_call_yellow_fever.pdf
    Google Scholar
  • 23 Public Health Agency of Canada. Immunization of Immunocompromised Persons. Im Internet: http://www.phac-aspc.gc.ca/publicat/cig-gci/p03-07-eng.php
    Google Scholar
  • 24 Heijstek MW, Kamphuis S, Armbrust W et al. Effects of the live attenuated measles-mumps-rubella booster vaccination on disease activity in patients with juvenile idiopathic arthritis: a randomized trial. JAMA 2013; 309: 2449-2456
    CrossrefPubMedGoogle Scholar
  • 25 Brenol CV, da Mota LM, Cruz BA et al. 2012 Brazilian Society of Rheumatology Consensus on vaccination of patients with rheumatoid arthritis. Rev Bras Reumatol 2013; 53: 4-23
    Google Scholar
  • 26 van Assen S, Agmon-Levin N, Elkayam O et al. EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2011; 70: 414-422
    CrossrefGoogle Scholar
  • 27 Centers for Disease Control and Prevention. Prevention of Herpes Zoster 2008. Im Internet: http://www.cdc.gov/mmwr/pdf/rr/rr5705.pdf
    Google Scholar
  • 28 Rubin LG, Levin MJ, Ljungman P et al. 2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host. Clin Infect Dis 2014; 58: 309-318
    CrossrefPubMedGoogle Scholar
  • 29 Kuhn S, Twele-Montecinos L, MacDonald J et al. Case report: probable transmission of vaccine strain of yellow fever virus to an infant via breast milk. CMAJ 2011; 183: 243-245
    CrossrefGoogle Scholar
  • 30 Traiber C, Coelho-Amaral P, Ritter VR, Winge A. Infant meningoencephalitis caused by yellow fever vaccine virus transmitted via breastmilk. J Pediatr (Rio J) 2011; 87: 269-272
    Google Scholar
  • 31 Davies K, Woo P. Immunization in rheumatic diseases of childhood: an audit of the clinical practice of British Paediatric Rheumatology Group members and a review of the evidence. Rheumatology (Oxford) 2002; 41: 937-941
    CrossrefGoogle Scholar
  • 32 Jentes ES, Poumerol G, Gershman MD et al. The revised global yellow fever risk map and recommendations for vaccination, 2010: consensus of the Informal WHO Working Group on Geographic Risk for Yellow Fever. Lancet Infect Dis 2011; 11: 622-632
    CrossrefGoogle Scholar