Invasive Pneumokokken-Erkrankungen in Deutschland im Zeitalter der Pneumokokken-Konjugat-Impfung

 

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Zusammenfassung

Hintergrund: Pneumokokken sind weltweit eine der häufigsten bakteriellen Ursachen von Pneumonie, Sepsis und Meningitis.

Methodik: Das Nationale Referenzzentrum für Streptokokken (NRZS) am Institut für Medizinische Mikrobiologie der Uniklinik RWTH Aachen führt seit 1992 Studien über invasive Pneumokokken-Erkrankungen (IPE) durch. Diesem Bericht liegen Daten der IPE-Fällen von Juli 1992–Juni 2013 bei Erwachsenen und von Juli 1997–Juni 2013 bei Kindern zugrunde.

Ergebnisse: Der prozentuale Anteil von Infektionen durch im 7-valenten Impfstoff enthaltene Serotypen lag von 1997–2006 bei Kindern ≤ 23 Monate bei ca. 65 %. Seit dem Beginn des Impfprogramms 2006 sank er kontinuierlich auf < 5 % 2012 /2013. Aber auch bei den nicht geimpften Erwachsenen sank der Anteil von ursprünglich etwa 40–45 % (1992–2006) auf ca. 8 % (2012 /2013), was als Herdenschutzeffekt bezeichnet wird. Die Resistenzrate gegen Penicillin G lag bei Kindern durchgehend unter 4 %, bei Erwachsenen unter 2,5 %. Die Makrolid-Resistenz ist seit 2005 /2006 recht kontinuierlich gefallen und lag zuletzt bei ca. 5 % (Kinder) bzw. 8 % (Erwachsene).

Folgerung: Der kontinuierliche Rückgang der Impfstoff-Serotypen sowie rückläufige IPE-Inzidenzen seit dem Beginn des Impfprogramms bei Kindern belegen den Erfolg der Pneumokokken-Konjugat-Impfung.

Abstract

Background: Pneumococci remain a major cause of bacterial pneumonia, sepsis and meningitis globally.

Methods: The German National Reference Center for Streptococci at the Institute for Medical Microbiology of the University Hospital RWTH Aachen, Germany, has carried out surveillance studies on invasive pneumococcal disease (IPD) since 1992. This report is based on IPD-cases from adults and children, received between July 1992 and June 2013 and July 1997 and June 2013 respectively.

Results: From 1997–2006 the proportion of infections among children ≤ 23 months of age with serotypes included in the 7-valent vaccine was about 65 %. Since the start of childhood vaccination in 2006 the percentage has continuously decreased, reaching < 5 % in 2012 /2013. Also among adults, for whom conjugate vaccination was not indicated, this percentage decreased from 40–45 % in 1992–2006 to about 8 % in 2012 /2013. This phenomenon is denoted as herd protection. The resistance rate against Penicillin G remained under 4 % among children and under 2.5 % among adults over the whole study period. Since 2005 /2006 macrolide resistance levels have decreased to about 5 % among children and 8 % among adults.

Conclusion: The continuous decrease of vaccine serotypes as well as the decreasing IPD incidence since the beginning of childhood vaccination document the success of pneumococcal conjugate vaccination.

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