Antivirale Prophylaxe

Zusammenfassung.

Die antivirale Prophylaxe in der pädiatrischen Onkologie und Knochenmarktransplantation (KMT)/Stammzelltransplantation (SZT) richtet sich überwiegend gegen Viren der Herpesgruppe: Herpes-simplex-Virus (HSV), Varicella-Zoster-Virus (VZV) und Zytomegalievirus (CMV). Diese Viren sind verantwortlich für erhebliche Morbidität und Mortalität entweder im Rahmen einer Erstinfektion oder einer Reaktivierung bei Viruslatenz. Die Mehrzahl der in einer Auswahl vorgestellten publizierten Studien zur antiviralen Prophylaxe, insbesondere zur CMV-Prophylaxe, sind Untersuchungen adulter Patienten. Prophylaxe-Empfehlungen liegen vor von der „Deutschen Gesellschaft für pädiatrische Infektiologie” und von folgenden amerikanischen Institutionen: „Centers for Disease Control and Prevention”, „Infectious Diseases Society of America”, „American Society of Blood and Marrow Transplantation”, die zusammengefasst sind in den „Guidelines for Preventing Opportunistic Infections among Hematopoietic Stem Cell Transplant Recipients”. Die Empfehlungen der deutschen Fachgesellschaft und der genannten amerikanischen Institutionen weisen im Hinblick auf die HSV- und VZV-Prophylaxe große Ähnlichkeiten auf, hinsichtlich der Prophylaxe einer CMV-Reaktivierung bzw. einer symptomatischen CMV-Erkrankung unterscheiden sie sich jedoch deutlich. Wünschenswert für die nahe Zukunft sind pädiatrische Studien zur antiviralen Prophylaxe und fachübergreifende, von Onkologen und Infektiologen erarbeitete Konsensusempfehlungen zu derzeit kontroversen Aspekten.

Antiviral prophylaxis in pediatric oncology and pediatric bone marrow transplantation (BMT)/stem cell transplantation (SCT) focusses herpes viruses: herpes simplex virus (HSV), varicella zoster virus (VZV) and cytomegalovirus (CMV) since these viruses cause significant morbidity and mortality due to primary infection or to reactivation in long term latency. The majority of studies on antiviral prophylaxis, especially those on CMV-prophylaxis, have been conducted in adult patients. Recommendations for antiviral prophylaxis have been published recently by the German “Deutsche Gesellschaft für pädiatrische Infektiologie” and by the following American institutions and societies “Centers for Disease Control and Prevention”, “Infectious Diseases Society of America”, “American Society of Blood and Marrow Transplantation” who published the “Guidelines for Preventing Opportunistic Infections Among Hematopoietic Stem Cell Transplant Recipients”. Concerning HSV- and VZV-prophylaxis there are almost no differences between recommendations of the german society and the american institutions, however recommendations for preventing CMV-disease and CMV-recurrence do differ considerably. Controversial aspects of antiviral prophylaxis, e.g. VZV vaccination or CMV prevention, should be studied in oncology and infectious diseases working groups to define consensus in the near future.

Schlüsselwörter

Herpes-simplex-Virus - Varicella-Zoster-Virus - Zytomegalievirus - Expositionsprophylaxe - Postexpositionsprophylaxe - passive Immunprophylaxe - Prophylaxe mit Aciclovir - Ganciclovir

Key words

HSV - VZV - CMV - prevention of exposure - prevention of disease, of disease-recurrence - acyclovir -, ganciclovir-prophylaxis

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