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Fetale Infektion mit dem humanen Zytomegalovirus

Strategien zu Prävention und Therapie

Fetal infection with human cytomegalovirus

Strategies for prevention and therapy

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Zusammenfassung

Die fetale Infektion mit dem humanen Zytomegalovirus (HCMV) ist die häufigste kongenitale Infektion (in Deutschland ca. 0,2%). Ungefähr 12% der kongenitalen Infektionen sind symptomatisch, mit hohem Prozentsatz langfristiger erheblicher Beeinträchtigung. Bei asymptomatischen Infektionen entwickeln ca. 13% der Betroffenen eine Hörstörung. Mögliche Präventionsmaßnahmen umfassen derzeit: Hygiene und Expositionsvermeidung, passive und aktive Immunisierung sowie Virostatikagabe. Während bisher nur Hygienemaßnahmen als wirksam galten, mehren sich die Daten, HCMV-Hyperimmunglobulin könne bei infizierten Schwangeren dazu beitragen, sowohl die fetale Infektion zu vermeiden als auch die klinische Manifestation beim Neugeborenen zu reduzieren. Es fehlen aber noch randomisierte Studien. Eine leistungsfähige Aktivimpfung ist derzeit nicht absehbar. Zu Valaciclovir gibt es nur wenige pharmakokinetische Daten.

Abstract

The prevalence of congenital human cytomegalovirus (HCMV) infection is the highest of all congenital infectious diseases and in Germany is approximately 0.2%. Of these congenital infections approximately 12% are symptomatic with a high percentage of long-term severe sequelae and 13% of asymptomatic infants develop hearing loss. For prevention four strategies are presented: hygiene, passive and active immunization and antiviral therapy. For a long time only hygienic intervention measures were considered to be effective but now there is increasing knowledge about the use of HCMV hyperimmunoglobulin for the prevention and therapy of fetal infections in HCMV-infected pregnant women; however, published randomized trials are lacking. A vaccine for active immunization will not be available in the foreseeable future. There are only limited pharmacokinetic data for valaciclovir.

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Abbreviations

HCMV:

Humanes Zytomegalovirus

SSW:

Schwangerschaftswoche

HIG:

Hyperimmunglobulin

ACV:

Aciclovir

GCV:

Ganciclovir

CDC:

Centers for Disease Control and Prevention

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Authors and Affiliations

  1. Abteilung Neonatologie, Universitätsklinik für Kinder- und Jugendmedizin, Calwerstr. 7, 72076, Tübingen, Deutschland

    R. Goelz

  2. Institut für Medizinische Virologie und Epidemiologie der Viruserkrankungen, Universitätsklinikum, Tübingen, Deutschland

    K. Hamprecht

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Goelz, R., Hamprecht, K. Fetale Infektion mit dem humanen Zytomegalovirus. Monatsschr Kinderheilkd 160, 1216–1220 (2012). https://doi.org/10.1007/s00112-012-2728-z

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  • DOI: https://doi.org/10.1007/s00112-012-2728-z

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