Zusammenfassung
Bedeutung von Rotaviruserkrankung
Rotavirusinfektionen (RV-Infektionen) sind weltweit die führende Ursache für Gastroenteritiden im Säuglings- und Kleinkindesalter. Nach dem Infektionsschutzgesetz werden seit 2001 fallbasierte Daten zur Epidemiologie der RV-Gastroenteritiden (RVGE) in Deutschland erfasst. Die höchsten jährlichen Inzidenzen werden bei < 2-Jährigen (1.850/100.000) gemessen. In diesem Alter müssen Kinder, die an RV-Infektionen erkranken, häufig zur Flüssigkeitssubstitution stationär aufgenommen werden. Dies geht mit einer erheblichen medizinischen und ökonomischen Belastung des Gesundheitssystems einher.
Rotavirusimpfung
Seit 2006 sind in Deutschland 2 RV-Impfstoffe zugelassen, die ein gutes Sicherheits- und Wirksamkeitsprofil aufweisen. Mit dem Ziel, primär bei Kindern < 5 Jahren eine stationäre Behandlung aufgrund schwerer RVGE zu verhindern, empfahl die STIKO (Ständige Impfkommission am Robert Koch-Institut) 2013 die routinemäßige Rotavirusimpfung von Säuglingen im Alter < 6 Monaten. Zusätzlich wird erwartet, dass über Herdeneffekte auch nicht geimpfte Personengruppen von der Impfung profitieren können. Monitoringsysteme sind implementiert, um die Auswirkungen der RV-Impfung fortlaufend zu evaluieren.
Abstract
Significance of rotavirus infections
Rotavirus (RV) infections are the leading cause of gastroenteritis (GE) in infants and young children worldwide. Since 2001 case-based data on the epidemiology of RVGE in Germany have been recorded according to the German Protection against Infection Act. The highest annual incidences are observed in children under 2 years of age (1,850/100,000). Children in this age group who suffer from RV often need to be hospitalized for fluid substitution. This causes a significant medical and economic burden on the healthcare system.
Rotavirus vaccination
In 2006 a total of 2 RV vaccines were licensed for use in Germany and have proven to have a good safety and efficacy profile. In 2013 the standing vaccination committee of the Robert Koch Institute (STIKO) recommended the routine RV immunization of infants aged < 6 months. The primary goal of this recommendation is to prevent severe RVGE requiring hospital treatment in children under 5 years of age. It is expected that non-vaccinated individuals may also benefit from vaccination by herd effects. Monitoring systems are implemented to continuously evaluate the impact of RV vaccinations.
Abbreviations
- DRG:
-
„Diagnosis-related groups“
- DTaP:
-
Impfstoff gegen Diphtherie, Tetanus, Pertussis
- EKG:
-
Elektrokardiogramm
- ELISA:
-
„Enzyme linked immunosorbent assay“
- EMA:
-
„European Medicines Agency“
- ESPGHAN:
-
„European Society of Pediatric Gastroenterology, Hepatology and Nutrition“
- FDA:
-
„Food and Drug Administration“ (US-amerikanische Zulassungsbehörde)
- Hep B :
-
Impfstoff gegen Hepatitis B
- Hib:
-
Impfstoff gegen Haemophilus influenzae Typ B
- IPV:
-
Poliototimpfstoff
- HUS:
-
Hämolytisch-urämisches Syndrom
- IfSG:
-
Infektionsschutzgesetz
- KG:
-
Körpergewicht
- KI:
-
Konfidenzintervall
- OR:
-
„Odds ratio“
- ORL:
-
Orale Rehydratationslösung
- PCR:
-
Polymerasekettenreaktion
- RCT:
-
Randomisierte kontrollierte Studie
- RKI:
-
Robert Koch-Institut
- RNA:
-
Ribonukleinsäure
- RV:
-
Rotavirus
- RVGE:
-
RV-Gastroenteritis
- STIKO:
-
Ständige Impfkommission am RKI
- VP:
-
Virale Strukturproteine
- WHO:
-
Weltgesundheitsorganisation
Literatur
Adlhoch C, Hoehne M, Littmann M et al (2012) Rotavirus vaccine effectiveness and case-control study on risk factors for breakthrough-infections in Germany. Pediatr Infect Dis J 32(2):e82–89
Anderson EJ, Rupp A, Shulman ST et al (2011) Impact of rotavirus vaccination on hospital-acquired rotavirus gastroenteritis in children. Pediatrics 127:264–270
Ansari SA, Sattar SA, Springthorpe VS et al (1988) Rotavirus survival on human hands and transfer of infectious virus to animate and nonporous inanimate surfaces. J Clin Microbiol 26:1513–1518
Block SL, Vesikari T, Goveia MG et al (2007) Efficacy, immunogenicity, and safety of a pentavalent human-bovine (WC3) reassortant rotavirus vaccine at the end of shelf life. Pediatrics 119:11–18
Buttery JP, Lambert SB, Grimwood K et al (2011) Reduction in rotavirus-associated acute gastroenteritis following introduction of rotavirus vaccine into Australias National Childhood vaccine schedule. Pediatr Infect Dis J 30:S25–S29
Clark HF, Lawley D, Mallette LA et al (2009) Decline in cases of rotavirus gastroenteritis presenting to The Children′s Hospital of Philadelphia after introduction of a pentavalent rotavirus vaccine. Clin Vaccine Immunol 16:382–386
Cortese MM, Parashar UD, Centers for Disease Control and Prevention (CDC) (2009) Prevention of rotavirus gastroenteritis among infants and children: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 58:1–25
Desai R, Cortese MM, Meltzer MI et al (2013) Potential intussusception risk versus benefits of rotavirus vaccination in the United States. Pediatr Infect Dis J 32:1–7
Desselberger U, Huppertz HI (2011) Immune responses to rotavirus infection and vaccination and associated correlates of protection. J Infect Dis 203:188–195
Estes MK, Cohen J (1989) Rotavirus gene structure and function. Microbiol Rev 53:410–449
European Medicines Agency (20 October 2011 – last update) Rotarix. EMA, London. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Scientific_Discussion/human/000639/WC500054589.pdf. Zugegriffen: 30.03.2012
European Medicines Agency (23 March 2012 – last update) RotaTeq. EMA, London. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Scientific_Discussion/human/000669/WC500054183. Zugegriffen: 30.03.2012
Flewett TH (1983) Rotavirus in the home and hospital nursery. Br Med J (Clin Res Ed) 287:568–569
Guarino A, Albano F, Ashkenazi S et al (2008) European Society for Paediatric Gastroenterology, Hepatology, and Nutrition/European Society for Paediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: executive summary. J Pediatr Gastroenterol Nutr 46:619–621
Hanquet G, Ducoffre G, Vergison A et al (2011) Impact of rotavirus vaccination on laboratory confirmed cases in Belgium. Vaccine 29:4698–4703
Hauer AC (2013) Akute Gastroentritis. In: Rodeck B, Zimmer P (Hrsg) Pädiatrische Gastroenterologie, Hepatologie und Ernährung. Springer, Berlin Heidelberg New York, S 292–294
Kawamura N, Tokoeda Y, Oshima M et al (2011) Efficacy, safety and immunogenicity of RIX4414 in Japanese infants during the first two years of life. Vaccine 29:6335–6341
Koch J, Wiese-Posselt M (2011) Epidemiology of rotavirus infections in children less than 5 years of age: Germany, 2001–2008. Pediatr Infect Dis J 30:112–117
Koch J, Wiese-Posselt M, Remschmidt C et al (2013) Background paper to the recommendation for routine rotavirus vaccination of infants in Germany. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 56:957–984
Krause G, Altmann D, Faensen D et al (2007) SurvNet electronic surveillance system for infectious disease outbreaks, Germany. Emerg Infect Dis 13:1548–1555
Matthijnssens J, Ciarlet M, McDonald SM et al (2011) Uniformity of rotavirus strain nomenclature proposed by the Rotavirus Classification Working Group (RCWG). Arch Virol 156:1397–1413
Matthijnssens J, Heylen E, Zeller M et al (2010) Phylodynamic analyses of rotavirus genotypes G9 and G12 underscore their potential for swift global spread. Mol Biol Evol 27:2431–2436
Oberle D, Weisser K, Keller-Stanislawski B (2010) Aktuelle Erkenntnisse zum Risiko für Invagination und Kawasaki-Syndrom nach Rotavirusimpfung. Arzneimittel im Blick. Bull Arzneimittelsicherheit 4:8–13
Parashar UD, Gibson CJ, Bresse JS, Glass RI (2006) Rotavirus and severe childhood diarrhea. Emerg Infect Dis 12:304–306
Patel MM, Haber P, Baggs J et al (2009) Intussusception and rotavirus vaccination: a review of the available evidence. Expert Rev Vaccines 8:1555–1564
Paulke-Korinek M, Rendi-Wagner P, Kundi M et al (2010) Universal mass vaccination against rotavirus gastroenteritis: impact on hospitalization rates in Austrian children. Pediatr Infect Dis J 29:319–323
Phua KB, Lim FS, Lau YL et al (2009) Safety and efficacy of human rotavirus vaccine during the first 2 years of life in Asian infants: randomised, double-blind, controlled study. Vaccine 27:5936–5941
Piescik-Lech M, Shamir R, Guarino A, Szajewska H (2013) Review article: the management of acute gastroenteritis in children. Aliment Pharmacol Ther 37:289–303
Poggensee G, Benzler J, Eckmanns T et al (2006) On the 2007 edition of case definitions for the surveillance of notifiable infectious diseases in Germany. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 49:1189–1194
Robert Koch-Institut (RKI) (2011) Allgemeine Aspekte meldepflichtiger Krankheiten. In: RKI (Hrsg) Infektionsepidemiologisches Jahrbuch für 2010. RKI, Berlin, S 35–36
Ruiz-Palacios GM, Perez-Schael I, Velazquez FR et al (2006) Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis. N Engl J Med 354:11–22
Vesikari T, Karvonen A, Prymula R et al (2007) Efficacy of human rotavirus vaccine against rotavirus gastroenteritis during the first 2 years of life in European infants: randomised, double-blind controlled study. Lancet 370:1757–1763
Vesikari T, Matson DO, Dennehy P et al (2006) Safety and efficacy of a pentavalent human-bovine (WC3) reassortant rotavirus vaccine. N Engl J Med 354:23–33
WHO (2009) Meeting of the Strategic Advisory Group of Experts on immunization, October 2009 – conclusions and recommendations. Wkly Epidemiol Rec 84:517–532
Einhaltung ethischer Richtlinien
Interessenkonflikt. J. Koch und B. Rodeck geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Koch, J., Rodeck, B. Rotaviruserkrankung und ihre Impfprävention in Deutschland. Monatsschr Kinderheilkd 161, 1154–1162 (2013). https://doi.org/10.1007/s00112-013-2921-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00112-013-2921-8