Aktueller Stand der Pneumokokkenerkrankungen in Deutschland und der Nutzung der konjugierten Pneumokokkenvakzine

Zusammenfassung

Die überzeugenden Ergebnisse der allgemeinen Säuglingsimpfung mit konjugierten Pneumokokkenimpfstoffen vier Jahre nach Einführung in den USA machen eine Neubeurteilung der Empfehlung in Deutschland erforderlich. Die epidemiologische Situation in Deutschland und die bisherige Strategie werden beschrieben. Die Wirksamkeit der allgemeinen Pneumokokkenimpfung mit konjugierten Impfstoffen wird anhand der klinischen Studien und der Erfahrungen mit Bevölkerungsprogrammen dargestellt. Dabei zeigt sich eine rasche und nachhaltige Reduktion von Todes- und Krankheitsfällen durch Pneumokokkeninfektionen. Durch das Erzeugen einer Herdenimmunität stellt sich auch die Kosten-Nutzen-Relation insgesamt positiv dar. Die Auswertung der gesundheitsökonomischen Untersuchungen weist selbst aus der Krankenkassenperspektive die generelle Säuglingsimpfung als kostensparend aus. Sowohl die Effekte auf Mortalität und Morbidität als auch die Ökonomie lassen die Pneumokokkenimpfung als präventivmedizinische Maßnahme von vergleichbarem Nutzen mit den eingeführten Routineimpfungen einordnen. Die Übersicht über die Impfempfehlungen macht die Notwendigkeit einer Fortschreibung der deutschen Regelungen deutlich.

Abstract

Convincing results of conjugated pneumococcal vaccination since introduction as universal infant immunization in the United States makes it inevitable to reconsider current recommendation of its use in Germany. The epidemiological situation in Germany is described as well as the control strategy in place. Vaccine efficacy is demonstrated by outcome of clinical trials and results from population-based epidemiological surveillance data which demonstrate early and sustained reduction of mortality and morbidity due to pneumococcal infections. Health economic analyses reveal positive cost-effectiveness and cost-benefit relations due to the herd-immunity induced by universal immunization. Even from perspective of German health insurances a cost saving scenario can be expected. Impact on reduction of disease burden and attractive health economic effects make pneumococcal vaccination as preventive tool absolute comparable with well accepted routine childhood vaccinations. The review of existing recommendations and hurdles to implementation in the German system show potential for improvement.

Schlüsselwörter

Konjugierte Pneumokokkenimpfstoffe - Krankheitslast - Impfwirksamkeit - Gesundheitsökonomie - STIKO-Empfehlungen

Key words

Conjugated pneumococcal vaccine - disease burden - vaccine efficacy - health economy - STIKO-recommendations

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