Impfprophylaxe gegen ETEC-Reisediarrhoe und Cholera: Ist sie sinnvoll und für wen?

Zusammenfassung

Die Reisediarrhoe ist die häufigste Erkrankung bei Fernreisen und wird besonders durch Enterotoxin-bildende Escherichia coli-Stämme (ETEC) hervorgerufen. Die Cholera kommt in einigen tropischen Gebieten endemisch vor, bei Reisenden stellt sie jedoch nur ein marginales Problem dar. Der Pathomechanismus von ETEC ist dem von V. cholerae vergleichbar: Über die Aktivierung von cAMP kommt es zu einer nichtinflammatorisch- sekretorischen Diarrhoe. Da weder die Expositions- noch eine medikamentöse Prophylaxe Diarrhoeepisoden komplett verhindert, kann die Immunprophylaxe eine Alternative darstellen. In Form einer Konsensusempfehlung sehen deutschsprachige Tropen- und Reisemediziner in begründeten Fällen eine Indikation für die Choleraimpfung (Helfer in Flüchtlingslagern, Erfüllung von Einreisebestimmungen). Die ETEC Schutzkomponente kann bei definierten Risikogruppen (fehlende Magensäurebarriere, Immunsupprimierte, chronisch entzündliche Darmerkrankungen etc.) Anlass für die Impfung sein.

Summary

Travellers’ diarrhea is the commonest disease contracted on foreign travel and is most commonly caused by enterotoxin genic E. coli (ETEC). Cholera is endemic in several tropical countries, but it is only a marginal problem for travellers.

The pathological mechanism of ETEC is comparable to that of V. cholerae. Noninflammatory secretory diarrhea occurs via the activation of cAMP. Since neither exposure nor medical prophylaxis can completely prevent episodes of diarrhea, immunological prophylaxis can be an alternative. A Consensus Report by German experts on tropical and travel medicine has recommended that in certain cases (e. g. workers in refugee camps or to comply with conditions) cholera immunization may be indicated. The ETEC prophylactic component may be an indication for immunization of clearly defined groups at risk (absent gastric secretion barrier; immunocompromised state, inflammatory bowel disease).

Schlüsselwörter

ETEC-Reisediarrhoe - Cholera

Key words

travellerŽs diarhea - cholera

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