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Impfkomplikationen und der Umgang mit Verdachtsfällen

Postvaccinal complications and management of suspected cases

  • Leitthema
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Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

In allen entwickelten Ländern besteht heute die Möglichkeit, sich vor impfpräventablen Infektionskrankheiten zu schützen. Aber nicht alle Menschen nehmen diese Option in Anspruch. Gerade in hoch entwickelten Ländern macht sich ein Trend zur „vaccination hesitancy“ bemerkbar, d. h. zur Zögerlichkeit, sich selbst oder seine Kinder impfen zu lassen. Die Gründe dafür sind vielfältig; der wichtigste Grund aber ist die Furcht vor Impfkomplikationen, v. a. solchen mit bleibendem Schaden oder tödlichem Ausgang.

Während es wenige nachgewiesene Assoziationen zwischen Impfung und unerwünschter Arzneimittelwirkung (UAW) gibt, wie z. B. Fieberkrampf nach einer Impfung gegen Masern, Mumps und Röteln (MMR), konnten andere Hypothesen inzwischen widerlegt werden, wie z. B. Autismus nach MMR-Impfung. Der vorliegende Artikel möchte zum einen eine Übersicht über bekannte Impfkomplikationen mit Hinweis auf einen kausalen Zusammenhang zur Impfung geben und zum andern auf Hypothesen zu potenziellen UAW eingehen, die inzwischen mithilfe von pharmakoepidemiologischen Studien widerlegt wurden.

Nur die wissenschaftliche Auseinandersetzung mit den Hypothesen, die v. a. in den sozialen Medien immer wieder thematisiert werden, kann dazu beitragen, Hinweise auf einen kausalen Zusammenhang entweder zu erhärten oder zu entkräften. Verdichten sich die Hinweise auf einen kausalen Zusammenhang, wie z. B. bei Darminvagination, werden die zuständigen Behörden, das Paul-Ehrlich-Institut (PEI) und die Europäische Arzneimittelagentur (EMA), risikominimierende Maßnahmen ergreifen. Liefern mehrere Studien und Metaanalysen keine Hinweise auf einen kausalen Zusammenhang, ist eine gezielte Kommunikationsstrategie erforderlich, um zu verhindern, dass Mythen weiter kursieren, Impfraten einbrechen und es zu Ausbrüchen von Infektionskrankheiten kommt.

Abstract

In all developed countries there is the possibility to protect oneself from vaccine-preventable diseases. However, not all individuals make use of this option. It is precisely in highly developed countries where a trend to vaccination hesitancy is noticeable, i. e. reluctance to get oneself or one’s children vaccinated. The reasons why this is so are many, but the most important reason is the fear of postvaccinal complications, especially of those that imply sequelae or those with fatal outcomes.

Whereas there are some proven associations between vaccination and adverse drug reaction, for example febrile seizures after the measles-mumps-rubella (MMR) vaccination, other hypotheses can be refuted, for example autism after the MMR vaccination. On one hand, this article gives an overview of known postvaccinal complications with indication of a causal association with vaccination and on the other hand addresses hypotheses of potential adverse drug reactions that have been refuted by pharmacoepidemiological studies.

Only the scientific debate of these hypotheses, which are repeatedly discussed, especially on social media, can contribute to corroborating or refuting a potential causal association. If evidence for a causal association grows, e. g. intussusception, the relevant authorities (e.g. Paul Ehrlich Institute, European Medicines Agency) will take risk-minimizing measures. If studies and meta-analyses do not reveal any evidence of a causal association, a targeted information strategy will be required in order to prevent myths from circulating, vaccination coverages from declining, and infectious diseases from spreading.

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Authors and Affiliations

  1. Paul-Ehrlich-Institut, Bundesinstitut für Impfstoffe und biomedizinische Arzneimittel, Langen, Deutschland

    Doris Oberle MSc., Dirk Mentzer, Fabia Rocha, Renz Streit, Karin Weißer & Brigitte Keller-Stanislawski

  2. Referat Pharmakovigilanz S1, Paul-Ehrlich-Institut, Bundesinstitut für Impfstoffe und biomedizinische Arzneimittel, Paul-Ehrlich-Str. 51–59, 63225, Langen, Deutschland

    Doris Oberle MSc.

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Correspondence to Doris Oberle MSc..

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D. Oberle, D. Mentzer, F. Rocha, R. Streit, K. Weißer und B. Keller-Stanislawski geben an, dass kein Interessenkonflikt besteht.

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Oberle, D., Mentzer, D., Rocha, F. et al. Impfkomplikationen und der Umgang mit Verdachtsfällen. Bundesgesundheitsbl 62, 450–461 (2019). https://doi.org/10.1007/s00103-019-02913-1

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