Infektionen mit Pneumokokken, Meningokokken, H. influenzae und Diphtherie in Deutschland: das RKI Referenznetzwerk für Invasive Bakterielle Infektionen (IBI) beim 5. Würzburger Workshop zur Epidemiologie, Prävention und Therapie von invasiven Meningokokkenerkrankung 2010 (Tagungsbericht)

Zusammenfassung

Die epidemiologische Überwachung und Prävention von invasiven bakteriellen Infektionen bedarf einer flexiblen Strategieabstimmung aller Akteure. In diesem Interesse sind in der Bundesrepublik Deutschland die Nationalen Referenzzentren für Meningokokken und Streptokokken sowie die Konsiliarlabore für Haemophilus influenzae und Diphtherie zum Referenznetzwerk für Invasive Bakterielle Infektionen (IBI) zusammengeschlossen. Der fünfte Würzburger Meningokokken-Workshop 2010 bot dem IBI-Netzwerk eine Plattform zum interdisziplinären Austausch zwischen Wissenschaftlern, Vertretern des öffentlichen Gesundheitsdienstes, mikrobiologischen Laboratorien und Kliniken. Neben der Analyse von Surveillancedaten der letzten 10 Jahre zu Meningokokken-Erkrankungen wurden Möglichkeiten der Impferfolgskontrolle, insbesondere der Serum-Bakterizidie-Assay (SBA), und die Entwicklung neuer Impfstoffe beleuchtet, die auch die häufigste Serogruppe B umfassen. Die Darstellung der Diphtherie zeigte, dass die Erkrankung wegen ihrer Seltenheit in Deutschland eine diagnostische Herausforderung geworden ist, bei der neben dem klassischen Erreger auch an toxigene C. ulcerans-Stämme gedacht werden muss. Durch die erfolgreiche Impfung gegen Hib hat sich die H. influenzae-Erkrankung von einer klassischen Kinderkrankheit zur Infektion des älteren Menschen gewandelt, bei der vor allem unbekapselte Stämme eine Rolle spielen. Bedingt durch Impfempfehlungen zeichnen sich Veränderungen im Serotypenverteilungsprofil und in der Antibiotikaresistenz für S. pneumoniae ab. Die epidemiologischen Daten wurden durch klinische Aspekte bei der Impfung von immunsupprimierten Kindern abgerundet.

Abstract

The surveillance and prevention of invasive bacterial infections requires flexible strategic coordination of all involved health-care professionals. For this purpose, the German National Reference Centres for Meningococci, Streptococci and the Consultant Laboratories for Haemophilus influenzae and diphtheria have formed the Reference Network for Invasive bacterial infections (IBI). The 5^th Würzburg Workshop on Meningococcal Diseases 2010 provided the network with a forum for the interdisciplinary exchange between scientists, public health professionals, medical microbiologists and clinicians. The topics covered the analysis of surveillance data for meningococcal disease in the last decade, as well as methods to control for antibody response following vaccination, including a serum bactericidal antibody (SBA) assay, and the development of new vaccines that also include the most common serogroup B. The presentation on diphtheria showed that this rare disease in Germany has become a diagnostic challenge, and that apart from the classical pathogen also toxigenic C. ulcerans strains must be considered. Due to the successful vaccination against Hib, H. influenzae disease has changed from a classical childhood disease to an infection of elderly people mainly caused by unencapsulated strains. Following the introduction of vaccines, changes in the serotype distribution and antibiotic resistance profiles have become apparent for S. pneumoniae infections. The epidemiological data were complemented by clinical aspects concerning the vaccination of immunocompromised children.

Schlüsselwörter

Neisseria meningitidis - Haemophilus influenzae - Streptococcus pneumoniae - Corynebacterium diphtheriae - Epidemiologie

Key words

Neisseria meningitidis - Haemophilus influenzae - Streptococcus pneumoniae - Corynebacterium diphtheriae - epidemiology

• Literatur

• 1 Black S, Shinefield H, Fireman B et al. Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children. Northern California Kaiser Permanente Vaccine Study Center Group. Pediatr Infect Dis J 2000; 19: 187-195
• 2 Borgmann S, Jakobiak T, Gruber H et al. Prescriptions of broad-spectrum antibiotics to outpatients do not match increased prevalence and antibiotic resistance of respiratory pathogens in Bavaria. Pol J Microbiol 2009; 58: 105-110
• 3 Clinical and Laboratory Standards Institute Performance Standards for Antimicrobial Susceptibility Testing; Twentieth Informational Supplement. CLSI Standard M100-S20, 201030[1].
• 4 Elias J, Schouls LM, van dP I et al. Vaccine preventability of meningococcal clone, Greater Aachen Region, Germany. Emerg Infect Dis 2010; 16: 465-472
• 5 Europäische Kommission: Antimicrobial Resistance Special Eurobarometer 338/Wave 72 5 2010 http://ec.europa.eu/public_opinion/archives/ebs/ebs_338_en.pdf
• 6 European Centre of Disease Prevention and Control: Public health management of sporadic cases of meningococcal disease and their contacts ECDC Guidance 2010 http://www.ecdc.europa.eu/en/publications/Publications/1010_GUI_Meningococcal_guidance.pdf
• 7 Harris SL, King WJ, Ferris W et al. Age-related disparity in functional activities of human group C serum anticapsular antibodies elicited by meningococcal polysaccharide vaccine. Infect Immun 2003; 71: 275-286
• 8 Imöhl M, Reinert RR, van der Linden M. Serotype-specific penicillin resistance of Streptococcus pneumoniae in Germany from 1992 to 2008. Int J Med Microbiol 2010; 300: 324-330
• 9 Keyserling H, Papa T, Koranyi K et al. Safety, immunogenicity, and immune memory of a novel meningococcal (groups A, C, Y, and W-135) polysaccharide diphtheria toxoid conjugate vaccine (MCV-4) in healthy adolescents. Arch Pediatr Adolesc Med 2005; 159: 907-913
• 10 Konrad R, Berger A, Huber I et al. Matrix-assisted laser desorption/ionisation time-of-flight (MALDI-TOF) mass spectrometry as a tool for rapid diagnosis of potentially toxigenic Corynebacterium species in the laboratory management of diphtheria-associated bacteria. Euro Surveill 2010; 15 (43)
• 11 Kyaw MH, Lynfield R, Schaffner W et al. Effect of introduction of the pneumococcal conjugate vaccine on drug-resistant Streptococcus pneumoniae . N Engl J Med 6-4- 2006; 354: 1455-1463
• 12 Ladhani S, Slack MP, Heath PT et al. Invasive Haemophilus influenzae Disease, Europe, 1996–2006. Emerg Infect Dis 2010; 16: 455-463
• 13 Lee YC, Kelly DF, Yu LM et al. Haemophilus influenzae type b vaccine failure in children is associated with inadequate production of high-quality antibody. Clin Infect Dis 15-1- 2008; (46) 186-192
• 14 Miller E, Salisbury D, Ramsay M. Planning, registration, and implementation of an immunisation campaign against meningococcal serogroup C disease in the UK: a success story. Vaccine 15-10- 2001; 20 (Suppl. 01) S58-S67
• 15 Oster P, O’Hallahan J, Aaberge I et al. Immunogenicity and safety of a strain-specific MenB OMV vaccine delivered to under 5-year-olds in New Zealand. Vaccine 20-4- 2007; 25: 3075-3079
• 16 Perez-Trallero E, Martin-Herrero JE, Mazon A et al. Antimicrobial resistance among respiratory pathogens in Spain: latest data and changes over 11 years (1996–1997 to 2006–2007). Antimicrob Agents Chemother 2010; 54: 2953-2959
• 17 Prelog M, Wilk C, Keller M et al. Diminished response to tick-borne encephalitis vaccination in thymectomized children. Vaccine 30-1- 2008; 26: 595-600
• 18 Prymula R, Schuerman L. 10-valent pneumococcal nontypeable Haemophilus influenzae PD conjugate vaccine: Synflorix. Expert Rev Vaccines 2009; 8: 1479-1500
• 19 Reinert RR. The antimicrobial resistance profile of Streptococcus pneumoniae . Clin Microbiol Infect 2009; 15 (Suppl. 03) 7-11
• 20 Robert Koch-Institut, STIKO. Hinweise zu Impfungen für Patienten mit Immundefizienz. Epidemiologisches Bulletin 2005; [39/2005]
• 21 Robert Koch-Institut, STIKO. Empfehlungen der Ständigen Impfkommission (STIKO) am Robert Koch-Institut/Stand: Juli 2010. Epidemiologisches Bulletin 2010; [30/2010]
• 22 Ruckinger S, van der LM, Reinert RR et al. Reduction in the incidence of invasive pneumococcal disease after general vaccination with 7-valent pneumococcal conjugate vaccine in Germany. Vaccine 24-6- 2009; 27: 4136-4141
• 23 Schuhegger R, Schoerner C, Dlugaiczyk J et al. Pigs as source for toxigenic Corynebacterium ulcerans . Emerg Infect Dis 2009; 15: 1314-1315
• 24 Siberry GK, Williams PL, Lujan-Zilbermann J et al. Phase I/II, open-label trial of safety and immunogenicity of meningococcal (groups A, C, Y, and W-135) polysaccharide diphtheria toxoid conjugate vaccine in human immunodeficiency virus-infected adolescents. Pediatr Infect Dis J 2010; 29: 391-396
• 25 Snape MD, Perrett KP, Ford KJ et al. Immunogenicity of a tetravalent meningococcal glycoconjugate vaccine in infants: a randomized controlled trial. JAMA 9-1- 2008; 299: 173-184
• 26 Trotter CL, Ramsay ME. Vaccination against meningococcal disease in Europe: review and recommendations for the use of conjugate vaccines. FEMS Microbiol Rev 2007; 31: 101-107
• 27 Watt JP, Wolfson LJ, O’Brien KL et al. Burden of disease caused by Haemophilus influenzae type b in children younger than 5 years: global estimates. Lancet 12-9- 2009; 374: 903-911