Bedeutung der Pneumokokkenimpfung bei Säuglingen und Kleinkindern

Zusammenfassung.

Pneumokokken verursachen schwere und häufige Krankheiten wie Meningitis, Sepsis und Pneumonie bzw. Otitis media und Sinusitis. Die Inzidenz der invasiven Pneumokokken-Infektionen ist am höchsten in den ersten 2 Lebensjahren (Deutschland, 1997 - 1999: 19,5/100 000/Jahr). Jährlich wird in Deutschland mit ca. 220 - 250 Pneumokokken-Meningitiden, mit 50 000 Pneumokokken-Pneumonien in den ersten 5 Lebensjahren und mit über 1 Mio. Erkrankungen an akuter Otitis media im Kindesalter gerechnet. Die Letalität der invasiven Pneumokokken-Erkrankungen ist nach wie vor hoch (1997 - 1999 5,5 %, für die Meningitis sogar 8,3 %). Bleibende Restschäden nach einer Pneumokokken-Meningitis werden bei 20 - 30 % der Kinder registriert. Die Impfung mit der 7-valenten konjugierten Pneumokokken-Vakzine kann bei Kindern in den ersten 2 Lebensjahren ca. 80 % der invasiven Pneumokokken-Erkrankungen sowie 6 % der akuten und 9 - 16 % der rezidivierenden Otitiden verhindern. Wegen des hohen medizinischen und ökonomischen Nutzeffektes sollten alle Kinder in den ersten 2 Lebensjahren immunisiert werden. Diese Forderung scheint auch deshalb gerechtfertigt zu sein, weil aufgrund der hohen Makrolidresistenz in Deutschland und wegen fehlender Zulassung zahlreicher neuer Antibiotika für das Säuglings- oder Kindesalter die Immunprophylaxe für junge Kinder eine wertvolle Alternative darstellt und die 23-valente Vakzine für Kinder in den ersten 2 Lebensjahren nicht eingesetzt werden kann.

Streptococcus pneumoniae is a common cause of meningitis, sepsis, pneumonia, acute otitis media, and sinusitis in children. Children younger than 24 months have the highest rates of invasive pneumococcal infections (Germany 1997 - 1999: 19,5/100 000/year). Pneumococcal infections cause in Germany 220 - 250 cases of meningitis, about 50 000 of pneumonia (children younger than 5 years) and more than 1 million cases of otitis media (children) annually. The case-fatality rate for invasive pneumococcal diseases is high (1997 - 1999 5.5 %, meningitis 8.3 %). 20 - 30 % of survivers from meningitis suffer from CNS-related sequelea. In children up to 2 years vaccination with the heptavalent pneumococcal conjugate vaccine can reduce invasive pneumococcal diseases by about 80 % and otitis media and recurrent otitis media by 6 % and 9 - 16 %, respectively. Due to the increased risk of pneumococcal infections in the first two years of live all children of this age group should be vaccinated. The high rate of resistance of pneumococci against macrolides in Germany, the high rate of non-licensed antibiotics in infants and the inefficacy of the 23-valent vaccine in children younger than 2 years makes the new vaccine to a necessary alternative.

Schlüsselwörter:

Impfung - Pneumokokken - Meningitis - Pneumonie - Otitis media

Key words:

Vaccination - pneumococci - meningitis - pneumonia - otitis media

Literatur

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