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Impfungen in der Erwachsenenrheumatologie

Vaccination in adult rheumatology

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Zusammenfassung

Patienten mit rheumatischen Erkrankungen unter immunsuppressiver Therapie haben im Vergleich zur Normalbevölkerung ein deutlich erhöhtes Infektionsrisiko und sind damit Kandidaten für präventive Maßnahmen. Gemäß den STIKO-Empfehlungen gehören sie daher in Analogie zu anderen Patienten mit chronischen Erkrankungen zu einer Risikogruppe von Patienten, bei denen eine Pneumokokken- und Influenzaimpfung empfohlen ist. Die bisher publizierten Studien legen nahe, dass eine eingeschränkte Impfantwort bei Patienten unter immunsuppressiver Therapie möglich ist. Dabei scheint Methotrexat insbesondere mit dem Impferfolg einer Pneumokokkenimpfung zu interferieren. Eine eingeschränkte Impfantwort gegen Influenzaantigene wurde andererseits unter Immunsuppression mit MMF, Ciclosporin und Azathioprin beobachtet. Zu bedenken ist außerdem, dass unter einer fortlaufenden Immunsuppression die Zeitdauer einer protektiven Impfantwort verkürzt sein kann.

Neue Studien zu den TNF-Blockern legen erfreulicherweise nahe, dass eine Interferenz mit dem Erfolg einer Pneumokokkenimpfung nicht zu erwarten ist. Der möglicherweise unterschiedliche Impferfolg einer unter TNF-Blockern durchgeführten Influenzaimpfung wird dadurch relativiert, dass die zu erwartenden Impfantworten nach einer Influenzaimpfung in allen Studien als sehr gut angesehen werden können. Unklar ist aktuell noch die Impfstrategie bei geplanter Rituximab- oder Abatazepttherapie.

Abstract

Patients with rheumatic diseases who are undergoing immunosuppressive therapy have a substantially increased risk of infection compared to the normal population, and are thus candidates for preventive measures. In accordance with the recommendations of the Standing Vaccination Commission of the Robert Koch Institute (Ständigen Impfkommission, STIKO), these individuals, in analogy with other patients with chronic diseases, belong to a risk group for which vaccination against pneumococci and influenza is recommended. Published studies indicate that a limited immune response is possible for patients undergoing immunosuppressive therapy. Here, methotrexate in particular appears to interfere with the success of vaccination against pneumococci. However, a limited immune response against influenza antigens was observed under immunosuppression with mycophenolate mufti, cyclosporine und azathioprine. Consideration must be given to the fact that a patient under continual immunosuppression has a reduced duration of protective immune response.

New studies on tumor necrosis factor (TNF) inhibitors indicate that there should be no interference with pneumococcus infection. The possibly variable vaccination success of patients undergoing TNF inhibitor treatment is qualified by the fact that all published results show that the expected immune response after an influenza vaccination is very good. Vaccination strategies in cases in which the use of rituximab and abatacept is planned are currently unclear.

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  1. Medizinische Klinik I, Universitätsklinik Köln, Joseph-Stelzmann-Straße 9, 50924, Köln, Deutschland

    A. Rubbert-Roth

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Rubbert-Roth, A. Impfungen in der Erwachsenenrheumatologie. Z. Rheumatol. 66, 102–110 (2007). https://doi.org/10.1007/s00393-007-0144-x

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