Die Perspektive der globalen Ausrottung der Poliomyelitis

 

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Zusammenfassung

Der vor einigen Jahren in Deutschland und der Schweiz vollzogene Wechsel in der Schutzimpfung gegen Kinderlähmung von OPV (Orale Poliovakzine) zu IPV (Inaktivierte Poliovakzine) wurde begründet mit dem Wunsch, das minimale Risiko einer Impfpoliomyelitis für das geimpfte Kind völlig auszuschließen. Hier stellen wir die Frage, welche Folgen die Einführung eines reinen IPV-Schemas in mehreren Ländern für das Ziel der globalen Ausrottung der Poliomyelitis haben könnte. Veröffentlichte Arbeiten zeigen, dass nach dem Abschluss der weltweiten Impfkampagne, die in den Entwicklungsländern nur mit OPV geführt werden kann, von Impfviren abstammende Polioviren eine Zeit lang in der Umwelt überleben können. Nur mit IPV geimpfte Reisende würden diese Viren aufnehmen und in vielfacher Menge wieder ausscheiden. Deshalb plädieren wir für ein Impfschema, bei dem mindestens die letzte Dosis aus OPV besteht und mit dem ein guter Mukosaschutz erhalten wird.

Abstract

In recent years, Germany and Switzerland have changed national policies to recommend vaccination with IPV (inactivated polio vaccine) instead of OPV (oral polio vaccine) for protection against poliomyelitis. An all IPV-schedule in routine childhood polio vaccination eliminates the - albeit minimal - risk of OPV-associated paralytic poliomyelitis. However, the impact of such a vaccination scheme on the goal to eventually eradicate poliomyelitis on a global level remains debatable. Published studies indicate that vaccine-derived poliovirus may persist in the environment for prolonged periods of time even after completion of a global eradication programme that relies on the near-exclusive use of OPV in the developing countries. Travellers vaccinated with IPV only might become silently infected with vaccine-derived virus, shedding it in large quantities. We therefore plead for a vaccination schedule that includes at least one last dose of OPV to induce strong mucosal immunity.

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Urs Candrian

Swissmedic, Schweizerisches Heilmittelinstitut, Abteilung Impfstoffe und Blutprodukte

Erlachstrasse 8

CH-3000 Bern 9

Schweiz