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Abstract
Vaccinations are among the most successful prophylactic measures in medicine. As they are applied to healthy subjects, regulatory steps before licensing of any vaccination are strictly based on clinically controlled studies as well as on registry data in the further course. The probability and relevance of adverse reactions to vaccinations have to be weighed against any harm through the respective natural infection as well as the vaccination-induced protection against infections. Intolerance reactions to vaccinations are far more suspected than proven and altogether rare. Among these, specific dermatoses like psoriasis, atopic dermatitis and lichen planus are found as well as allergic reactions and a number of more nonspecific skin symptoms. Apart from provocation or exacerbation of an underlying dermatological disease, various intolerance reactions may be encountered which are classically allergologic or anaphylactoid. People with chronic dermatoses, especially those on immunosuppressive and immunomodulatory therapy, should have all recommended standard vaccinations. Vaccinations should not be administered during acute skin manifestations and relevant comedication-especially if immunomodulatory or immunosuppressive-has be taken into account in the decision to vaccinate and to define the time point of any vaccination. Inactivated vaccines may be administered even during ongoing immunosuppressive therapy, but may result in decreased immunological reactions and protection to infection. Live vaccines should be avoided.
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Affiliation(s)
- M Sticherling
- Psoriasiszentrum, Deutsches Zentrum Immuntherapie, Hautklinik Universitätsklinikum Erlangen, Ulmenweg 18, 91045, Erlangen, Deutschland.
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52
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Kleine-Tebbe J, Klimek L, Hamelmann E, Pfaar O, Taube C, Wagenmann M, Werfel T, Worm M. Severe allergic reactions to the COVID-19 vaccine - statement and practical consequences. Allergol Select 2021; 5:26-28. [PMID: 33426427 PMCID: PMC7787363 DOI: 10.5414/alx02215e] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 12/30/2020] [Indexed: 12/12/2022] Open
Abstract
No abstract available.
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Affiliation(s)
| | - Ludger Klimek
- Center for Rhinology and Allergology of the ENT University Clinic Mannheim, Wiesbaden
| | - Eckard Hamelmann
- University Clinic for Pediatrics and Adolescent Medicine, Bethel Children’s Center, Evangelical Hospital Bielefeld gGmbH, Bielefeld
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg
| | - Christian Taube
- Ruhrlandklinik gGmbH, West German Lung Center at the University Hospital Essen – University Hospital
| | | | - Thomas Werfel
- Clinic of Dermatology, Allergology, and Venerology, Hannover Medical School,and
| | - Margitta Worm
- Allergy Center-Charité, Clinic for Dermatology, Venerology, and Allergology, Campus Charité Mitte, University Medicine Berlin, Germany
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53
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Ehren R, Benz MR, Brinkkötter PT, Dötsch J, Eberl WR, Gellermann J, Hoyer PF, Jordans I, Kamrath C, Kemper MJ, Latta K, Müller D, Oh J, Tönshoff B, Weber S, Weber LT. Pediatric idiopathic steroid-sensitive nephrotic syndrome: diagnosis and therapy -short version of the updated German best practice guideline (S2e) - AWMF register no. 166-001, 6/2020. Pediatr Nephrol 2021; 36:2971-2985. [PMID: 34091756 PMCID: PMC8445869 DOI: 10.1007/s00467-021-05135-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/26/2021] [Accepted: 05/12/2021] [Indexed: 01/21/2023]
Abstract
Idiopathic nephrotic syndrome is the most frequent glomerular disease in children in most parts of the world. Children with steroid-sensitive nephrotic syndrome (SSNS) generally have a good prognosis regarding the maintenance of normal kidney function even in the case of frequent relapses. The course of SSNS is often complicated by a high rate of relapses and the associated side effects of repeated glucocorticoid (steroid) therapy. The following recommendations for the treatment of SSNS are based on the comprehensive consideration of published evidence by a working group of the German Society for Pediatric Nephrology (GPN) based on the systematic Cochrane reviews on SSNS and the guidelines of the KDIGO working group (Kidney Disease - Improving Global Outcomes).
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Affiliation(s)
- Rasmus Ehren
- Faculty of Medicine and University Hospital Cologne, Pediatric Nephrology, Children's and Adolescents' Hospital, University of Cologne, Cologne, Germany.
| | - Marcus R Benz
- Faculty of Medicine and University Hospital Cologne, Pediatric Nephrology, Children's and Adolescents' Hospital, University of Cologne, Cologne, Germany
| | - Paul T Brinkkötter
- Department II of Internal Medicine and Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cologne Cluster of Excellence on Cellular Stress Responses in Ageing-Associated Diseases (CECAD), Cologne, Germany
| | - Jörg Dötsch
- Faculty of Medicine and University Hospital Cologne, Pediatric Nephrology, Children's and Adolescents' Hospital, University of Cologne, Cologne, Germany
| | - Wolfgang R Eberl
- Department of Pediatrics, Städtisches Klinikum Braunschweig, Braunschweig, Germany
| | - Jutta Gellermann
- Pediatric Nephrology, Charité Children's Hospital, Berlin, Germany
| | - Peter F Hoyer
- Center for Children and Adolescents, Pediatric Clinic II, University of Duisburg-Essen, Essen, Germany
| | - Isabelle Jordans
- Bundesverband Niere eV (German National Kidney-Patients Association), Mainz, Germany
| | - Clemens Kamrath
- Division of Pediatric Endocrinology & Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany
| | - Markus J Kemper
- Department of Pediatrics, Asklepios Medical School, Hamburg, Germany
| | - Kay Latta
- Clementine Kinderhospital Frankfurt, Frankfurt, Germany
| | - Dominik Müller
- Pediatric Nephrology, Charité Children's Hospital, Berlin, Germany
| | - Jun Oh
- Division of Pediatric Nephrology, Hepatology and Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | - Stefanie Weber
- Department of Pediatrics II, University Children's Hospital, Philipps-University Marburg, Marburg, Germany
| | - Lutz T Weber
- Faculty of Medicine and University Hospital Cologne, Pediatric Nephrology, Children's and Adolescents' Hospital, University of Cologne, Cologne, Germany
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54
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Kucharzik T, Koletzko S, Kannengiesser K, Dignass A. Ulcerative Colitis-Diagnostic and Therapeutic Algorithms. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:564-574. [PMID: 33148393 DOI: 10.3238/arztebl.2020.0564] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/05/2020] [Accepted: 07/25/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ulcerative colitis is a chronic inflammatory bowel disease with an estimated 150 000 patients in Germany alone. METHODS This review is based on publications about current diagnostic and therapeutic strategies for ulcerative colitis that were retrieved by a selective search in PubMed, and on current guidelines. RESULTS The primary goal of treatment is endoscopically confirmed healing of the mucosa. Mesalamine, in various forms of administration, remains the standard treatment for uncomplicated ulcerative colitis. Its superiority over placebo has been confirmed in meta-analyses of randomized, controlled trials. Glucocorticoids are highly effective in the acute treatment of ulcerative colitis, but they should only be used over the short term, because of their marked side effects. Further drugs are available to treat patients with a more complicated disease course of ulcerative colitis, including azathioprine, biological agents, JAK inhibitors (among them TNF antibodies, biosimilars, ustekinumab, vedolizumab, and tofacitinib), and calcineurin inhibitors. Proctocolectomy should be considered in refractory cases, or in the presence of high-grade epithelial dysplasia. Ulcerative colitis beginning in childhood or adolescence is often characterized by rapid progression and frequent comorbidities that make its treatment a special challenge. CONCLUSION A wide variety of drugs are now available for the treatment of ulcerative colitis, enabling the individualized choice of the best treatment for each patient. Regular surveillance colonoscopies to rule out colon carcinoma should be scheduled at intervals that depend on risk stratification.
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Affiliation(s)
- Torsten Kucharzik
- Department of General Internal Medicine and Gastroenterology, University Teaching Hospital Lüneburg; Dr. von Hauner Children's Hospital, LMU Klinikum, University of Munich; Department of Pediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum University of Warmia and Mazury, Olsztyn, Poland; Department of Pediatric Gastroenterology, LMU Klinikum, University of Munich; Medical Clinic I, Agaplesion Markus Krankenhaus, Frankfurt/Main
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55
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Varicella-zoster-virus vaccination of immunosuppressed children with inflammatory bowel disease or autoimmune hepatitis: A prospective observational study. Vaccine 2020; 38:8024-8031. [PMID: 33160754 DOI: 10.1016/j.vaccine.2020.10.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/01/2020] [Accepted: 10/08/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND AIMS Children with inflammatory bowel disease (IBD) and autoimmune hepatitis (AIH) receiving immunosuppressive treatment are at risk for severe varicella zoster virus (VZV)-induced disease. This study evaluated vaccination of susceptible patients with stable disease and documented immunoreactivity without interruption of their current immunosuppression (IS). METHODS This prospective multicentre observational study used a prevaccination checklist to select patients with low-intensity and high-intensity IS for VZV vaccination. Tolerability and safety after immunization were assessed by questionnaire. The immune response was measured by the VZV-IgG concentration, relative avidity index (RAI), and specific lymphocyte proliferative response. RESULTS A total of 29 VZV vaccinations were performed in 17 seronegative patients aged 3-16 years (IBD n = 15, AIH n = 2). Eight patients received high-intensity immunosuppression, another six low-intensity immunosuppression, and three patients interrupted IS before VZV vaccination. All 29 vaccinations were well tolerated; only minor side effects such as fever and abdominal pain, were reported in two patients. One patient experienced a flare of Crohn's disease the day after vaccination. The VZV-IgG-concentration increased significantly (p = 0.018) after vaccination, and a specific lymphocyte response towards VZV in vitro was detected in all tested patients which correlated with the RAI (r = 0.489; p = 0.078). CONCLUSIONS VZV vaccination was well tolerated, safe and immunogenic in children receiving ongoing IS due to IBD and AIH. Ensuring immunoreactivity by clinical and laboratory parameters, rather than the type and dosage of IS, is a reasonable approach to decide on live-attenuated virus vaccinations in immunosuppressed children (German clinical trials DRKS00016357).
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56
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Abstract
In the case of reduced cellular immunity the previously dormant varicella zoster virus (VZV) causes the characteristic belt-shaped vesicular exanthema of herpes zoster. The initial clinical symptoms of herpes zoster are often non-specific and may lead to initial misdiagnosis. A common complication of herpes zoster is postherpetic neuralgia (PHN) but secondary hematogenic dissemination is only rarely observed. In addition to general factors, such as advanced age and female gender, inflammatory rheumatic diseases and their immunosuppressive treatment are important risk factors for the occurrence of herpes zoster. Antiviral therapy initiated in the first 72 h after the onset of exanthema reduces acute symptoms and the risk of complications. The subunit inactivated vaccine, which has been available since 2018, is highly effective and relatively well-tolerated but randomized controlled trials in patients with drug-induced immunosuppression for inflammatory rheumatic diseases are still pending.
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Affiliation(s)
- Boris Ehrenstein
- Klinik und Poliklinik für Rheumatologie/Klinische Immunologie, Asklepios Klinikum Bad Abbach, 93077, Bad Abbach, Deutschland.
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57
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Welzel T, Wörner A, Heininger U. [Travel vaccinations in rheumatic diseases : Specific considerations in children and adults]. Z Rheumatol 2020; 79:865-872. [PMID: 32845394 PMCID: PMC7648002 DOI: 10.1007/s00393-020-00852-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Children and adults with rheumatic diseases (RD) have a higher risk to contract infections due to the underlying disease and the frequently necessary immunosuppressive treatment (IT). The quality of life of the majority of patients with RD has remarkably improved due to IT-related reduction of inflammation. Therefore, RD patients usually have an international travel behavior similar to healthy individuals. An investigation indicated that patients with RD and IT have lower travel vaccination rates and are often less well-prepared for their trip in comparison to healthy travelers, even when visiting high risk destinations. As the risk for general and travel-acquired infections is increased for patients with RD with and without IT, pretravel consultations are important. These pretravel consultations should include recommendations addressing travel cancellation, travel modification and travel vaccinations depending on the patient's risk. Travel vaccinations include vaccinations against hepatitis A, typhoid fever, rabies, cholera, meningococcal diseases, tick-bone encephalitis, Japanese encephalitis, seasonal influenza, poliomyelitis and yellow fever. In patients with RD the indications for vaccination depend on the exposure risks, disease severity, individual travel behavior, and possible complications associated with vaccination. In the further evaluation process it is crucial to include the general health condition of the patient, the underlying RD (type and activity), duration and intensity of the IT. In general, live-attenuated vaccines are contraindicated under IT. In contrast, inactivated vaccines may be administered although reduced immunogenicity with the need for antibody measurement, special vaccine schedules or additional booster vaccinations should be considered under IT.
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Affiliation(s)
- T Welzel
- Pädiatrische Rheumatologie, Universitäts-Kinderspital beider Basel (UKBB), Universität Basel, Spitalstr. 33, CH-4056, Basel, Schweiz.
- Pädiatrische Pharmakologie, Universitäts-Kinderspital beider Basel (UKBB), Universität Basel, Spitalstr. 33, CH-4056, Basel, Schweiz.
| | - A Wörner
- Pädiatrische Rheumatologie, Universitäts-Kinderspital beider Basel (UKBB), Universität Basel, Spitalstr. 33, CH-4056, Basel, Schweiz
| | - U Heininger
- Pädiatrische Infektiologie, Universitäts-Kinderspital beider Basel (UKBB), Universität Basel, Spitalstr. 33, CH-4056, Basel, Schweiz.
- Medizinische Fakultät, Universität Basel, Basel, Schweiz.
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58
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Schreiner D, Zepp F. [General principles of vaccination under immunosuppression]. Z Rheumatol 2020; 79:848-854. [PMID: 33034682 DOI: 10.1007/s00393-020-00891-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 11/25/2022]
Abstract
The number of patients suffering from immunodeficiency is increasing; however, the vaccination rate of these patients is below average. Administration of inactivated vaccines is harmless but does not reliably trigger a persistent immune response. Live vaccines provide a reliable protection but can cause severe disease in immunocompromised patients. Live vaccines can be administered under defined levels of immunosuppression, e.g. against measles, mumps, rubella and varicella (MMRV). In addition, the immunization of the domestic environment plays an important role in preventing infectious diseases.
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Affiliation(s)
- D Schreiner
- Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - F Zepp
- Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
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59
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Pierchalla P. Impfmanagement in der dermatologischen Praxis. AKTUELLE DERMATOLOGIE 2020. [DOI: 10.1055/a-1089-4389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ZusammenfassungDermatologen, die Systemtherapeutika mit immunsuppressiver Wirkung bei chronisch-entzündlichen Dermatosen (z. B. Biologika) in der Praxis verordnen, sollten ein Impfmanagement einführen, um bei der Durchführung notwendiger Impfungen zeitliche Verzögerungen und Probleme bei der Abstimmung mit anderen Fachgruppen zu vermeiden. Auch bei der Betreuung dermatologischer Patienten ohne Immunsuppression kann das Anbieten von Impfungen in der Praxis aus medizinischen und wirtschaftlichen Gründen sinnvoll sein.
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Affiliation(s)
- P. Pierchalla
- Praxis für Dermatologie, Venerologie & Allergologie, Recklinghausen
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60
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Kneitz C. Rheuma und Impfen. Dtsch Med Wochenschr 2020; 145:1490-1494. [DOI: 10.1055/a-1037-5256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Was ist neu?
Empfehlungen zur Impfung von Patienten mit rheumatologischen Erkrankungen Patienten mit rheumatischen Erkrankungen sind durch Infektionen besonders gefährdet. Impfungen sind geeignet, dieses Risiko zu vermindern. Aktuelle Empfehlungen nationaler (STIKO und Wagner et al.) sowie internationaler Gremien (EULAR) stellen eine Basis für die sichere und effektive Anwendung von Impfungen dar.Wichtige neue Entwicklungen, wie die sequenzielle Impfung gegen Pneumokokken oder die Zulassung eines Impfstoffs gegen Herpes Zoster, verbessern die Möglichkeiten eines effektiven Infektionsschutzes. Besonders zu beachten sind die aktuellen Empfehlungen zur Anwendung von Lebendimpfstoffen wie der MMR-Impfung bei Patienten unter immunsuppressiver Therapie.
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61
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Bühler S, Jaeger VK, Eperon G, Furrer H, Fux CA, Jansen S, Neumayr A, Rochat L, Schmid S, Schmidt-Chanasit J, Staehelin C, de Visser AW, Visser LG, Niedrig M, Hatz C. Safety and immunogenicity of a primary yellow fever vaccination under low-dose methotrexate therapy-a prospective multi-centre pilot study1. J Travel Med 2020; 27:5878835. [PMID: 32729905 DOI: 10.1093/jtm/taaa126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/17/2020] [Accepted: 07/24/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND More people on immunosuppression live in or wish to travel to yellow fever virus (YFV)-endemic areas. Data on the safety and immunogenicity of yellow fever vaccination (YFVV) during immunosuppression are scarce. The aim of this study was to compare the safety and immunogenicity of a primary YFVV between travellers on methotrexate and controls. METHODS We conducted a prospective multi-centre controlled observational study from 2015 to 2017 in six Swiss travel clinics. 15 adults (nine with rheumatic diseases, five with dermatologic conditions and one with a gastroenterological disease) on low-dose methotrexate (≤20 mg/week) requiring a primary YFVV and 15 age and sex-matched controls received a YFVV. Solicited/unsolicited adverse reactions were recorded, YFV-RNA was measured in serum samples on Days 3, 7, 10, 14, 28 and neutralizing antibodies on Days 0, 7, 10, 14, 28. RESULTS Patients´ and controls' median ages were 53 and 52 years; 9 patients and 10 controls were female. 43% of patients and 33% of controls showed local side effects (P = 0.71); 86% of patients and 66% of controls reported systemic reactions (P = 0.39). YFV-RNA was detected in patients and controls on Day 3-10 post-vaccination and was never of clinical significance. Slightly more patients developed YFV-RNAaemia (Day 3: n = 5 vs n = 2, Day 7: n = 9 vs n = 7, Day 10: n = 3 vs n = 2, all P > 0.39). No serious reactions occurred. On Day 10, a minority of vaccinees was seroprotected (patients: n = 2, controls: n = 6). On Day 28, all vaccinees were seroprotected. CONCLUSIONS First-time YFVV was safe and immunogenic in travellers on low-dose methotrexate. Larger studies are needed to confirm these promising results.
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Affiliation(s)
- Silja Bühler
- Department of Public Health and Global Health/Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland.,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany.,Division of Hygiene and Infectious Diseases, Institute of Hygiene and Environment, Marckmannstrasse 129a, 20539 Hamburg, Germany
| | - Veronika Katharina Jaeger
- Department of Rheumatology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.,Department of Clinical Epidemiology, Institute of Epidemiology and Social Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Gilles Eperon
- Division of Tropical and Humanitarian Medicine, Department of Primary Care, Geneva University Hospitals (HUG), Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland
| | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Christoph A Fux
- Department of Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, Tellstrasse 25, 5001 Aarau, Switzerland
| | - Stephanie Jansen
- Department of Arbovirology, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany
| | - Andreas Neumayr
- Department of Medicine, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland.,University of Basel, Socinstrasse 57, 4051 Basel, Switzerland
| | - Laurence Rochat
- Travel Clinic, Department of Ambulatory Care and Community Medicine, University Hospital Lausanne, Rue du Bugnon 21, 1011 Lausanne, Switzerland
| | - Sabine Schmid
- Department of Public Health and Global Health/Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Jonas Schmidt-Chanasit
- Department of Arbovirology, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany.,Faculty of Mathematics, Informatics and Natural Sciences, University of Hamburg, Bundesstraße 55, 20146 Hamburg, Germany
| | - Cornelia Staehelin
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Adriëtte W de Visser
- Department of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Leonardus G Visser
- Department of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Matthias Niedrig
- Robert Koch Institute (RKI), Seestraße 10, 13353 Berlin, Germany
| | - Christoph Hatz
- Department of Public Health and Global Health/Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland.,Department of Medicine, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland.,University of Basel, Socinstrasse 57, 4051 Basel, Switzerland.,Department of Infectious Diseases and Hospital Hygiene, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland
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62
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Kneitz C, Müller-Ladner U. [Most important vaccinations in patients with rheumatological diseases and why]. Z Rheumatol 2020; 79:855-864. [PMID: 32955610 PMCID: PMC7504870 DOI: 10.1007/s00393-020-00875-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 11/26/2022]
Abstract
Lange Zeit schienen die meisten Infektionen beherrschbar geworden zu sein. Hierzu haben besonders auch Impfungen beigetragen. In den letzten Jahren gefährden neu aufgetretene bakterielle Infektionen durch multiresistente Erreger und Virusinfektionen wie das Chikungunya-Virus, Influenzaepidemien oder aktuell auch COVID-19 die Weltbevölkerung. Dies gilt in besonderer Weise für von rheumatologischen Erkrankungen Betroffene, die oft zusätzlich einer immunsuppressiven Therapie bedürfen und damit besonders durch Infektionen gefährdet sind. Impfungen können die Betroffenen sowohl individuell wie auch durch die Erzeugung einer Herdenimmunität schützen und stellen somit ein wichtiges Instrument dar, um die Morbidität und Mortalität durch Infektionen zu vermindern. Die Kenntnis über Indikation und Anwendung der einzelnen Impfungen ist für eine konsequente Umsetzung der aktuellen Empfehlungen besonders wichtig.
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Affiliation(s)
- C Kneitz
- Rheumatologische Schwerpunktpraxis Schwerin, Beethovenstr. 3, 19053, Schwerin, Deutschland.
| | - U Müller-Ladner
- Abteilung Rheumatologie und Klinische Immunologie, Justus-Liebig Universität Gießen, Campus Kerckhoff, Bad Nauheim, Deutschland
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63
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Braun J, Kiltz U, Müller-Ladner U. [Is complete immunity against measles a realistic target for patients with rheumatic diseases and how can it possibly be achieved?]. Z Rheumatol 2020; 79:922-928. [PMID: 32945951 PMCID: PMC7647971 DOI: 10.1007/s00393-020-00877-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2020] [Indexed: 02/07/2023]
Abstract
Measles outbreaks occur rather frequently in Germany. Patients with chronic inflammatory diseases are often treated with immunosuppressants. A recent study showed that about 7% of such patients are not protected against measles according to the lack of documentation in the vaccination card or the absence of protective antibodies. The Standing Committee on Immunization (STIKO) recommends a first vaccination against measles as a measles-mumps-rubella combined vaccination (MMR) in children aged 11-14 months and a second vaccination at 14-23 months. For adults born after 1970, vaccination against measles is recommended if they have not yet been vaccinated against measles or have only been vaccinated once against measles or if their vaccination status is unclear. In April 2019, STIKO published instructions for vaccinations recommended for immunodeficiency. Since March 1, 2020, measles vaccination have been compulsory in Germany.
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Affiliation(s)
- J Braun
- Rheumazentrum Ruhrgebiet, Herne und Ruhr-Universität Bochum, Claudiusstr 45, 44649, Herne, Deutschland. .,St. Elisabeth Gruppe GmbH, Herne, Deutschland.
| | - U Kiltz
- Rheumazentrum Ruhrgebiet, Herne und Ruhr-Universität Bochum, Claudiusstr 45, 44649, Herne, Deutschland
| | - U Müller-Ladner
- Abteilung für Rheumatologie und Klinische Immunologie, Kerckhoff-Klinik, Bad Nauheim, Deutschland
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64
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Kiltz U, Celik A, Tsiami S, Baraliakos X, Andreica I, Kiefer D, Bühring B, Braun J. [How well are patients with inflammatory rheumatic diseases protected against measles?]. Z Rheumatol 2020; 79:912-921. [PMID: 32930874 PMCID: PMC7647965 DOI: 10.1007/s00393-020-00874-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2020] [Indexed: 01/29/2023]
Abstract
Hintergrund Patienten mit entzündlich rheumatischen Erkrankungen haben aufgrund ihrer Autoimmunerkrankung, aber auch bedingt durch die immunsuppressive Medikation ein erhöhtes Infektrisiko. Obwohl Impfungen in der Primärprophylaxe von Infektionen bekanntermaßen effektiv sind, ist die Impfrate in Deutschland generell zu niedrig. Wegen des zuletzt zunehmenden, teils epidemieartigen Auftretens von Masern ist die Lebendimpfung gegen Masern in Deutschland seit Kurzem gesetzlich vorgeschrieben. Fragestellung Wie viele Patienten mit entzündlich rheumatischen Erkrankungen sind aktuell ausreichend gegen Masern geschützt? Methode Patienten mit entzündlich rheumatischen Erkrankungen des Rheumazentrums Ruhrgebiet wurden zwischen Dezember 2017 und Oktober 2018 prospektiv und konsekutiv eingeschlossen. Dabei wurden Daten zu Erkrankung und Therapie auf Ebene von Substanzklassen sowie die Impf- und Infektanamnese erhoben. Alle Angaben zu Impfungen wurden im Impfpass kontrolliert. Antikörpertiter gegen Masern wurden mit ELISA bestimmt. Als Schwellenwert für einen ausreichenden Schutz gegen Masern wurden 150 mIU/ml festgelegt. Ergebnis Von 975 Patienten konnten 540 (55,4 %) einen Impfausweis vorlegen. Bei 201 Patienten mit Ausweis (37,2 %) lagen dokumentierte Impfungen seit Geburt vor. Insgesamt hatten 45 von 267 nach 1970 geborene Patienten (16,9 %) einen suffizienten Impfschutz gegen Masern. Die anamnestischen Angaben zu einer Masernerkrankung in der Kindheit differenzierten nicht zwischen Patienten mit und ohne protektiven Masern-IgG-Antikörpern. Protektive Masern-IgG-Antikörper wurden bei 901 Patienten von 928 Patienten mit Messung der Masern-IgG-Antikörperspiegel (97,1 %) nachgewiesen. Die unterschiedlichen Wirkprinzipien der aktuellen immunsuppressiven Therapie hatten darauf keinen Einfluss. Diskussion Diese Daten zeigen, dass mindestens 2,9 % der Patienten keinen ausreichenden Schutz gegen Masern haben. Interessanterweise hatte die Mehrheit der nach 1970 geborenen Patienten protektive Antikörper trotz fehlenden Impfschutzes gegen Masern. Die Anstrengungen sowohl im primär- als auch im fachärztlichen Bereich sollten dringend verstärkt werden, um eine adäquate Infektionsprophylaxe bei besonders gefährdeten Patienten gewährleisten zu können.
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Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, Herne und Ruhr-Universität Bochum, St. Elisabeth Gruppe GmbH, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - A Celik
- Klinikum Westfalen, Dortmund, Deutschland
| | - S Tsiami
- Rheumazentrum Ruhrgebiet, Herne und Ruhr-Universität Bochum, St. Elisabeth Gruppe GmbH, Claudiusstr. 45, 44649, Herne, Deutschland
| | - X Baraliakos
- Rheumazentrum Ruhrgebiet, Herne und Ruhr-Universität Bochum, St. Elisabeth Gruppe GmbH, Claudiusstr. 45, 44649, Herne, Deutschland
| | - I Andreica
- Rheumazentrum Ruhrgebiet, Herne und Ruhr-Universität Bochum, St. Elisabeth Gruppe GmbH, Claudiusstr. 45, 44649, Herne, Deutschland
| | - D Kiefer
- Rheumazentrum Ruhrgebiet, Herne und Ruhr-Universität Bochum, St. Elisabeth Gruppe GmbH, Claudiusstr. 45, 44649, Herne, Deutschland
| | - B Bühring
- Rheumazentrum Ruhrgebiet, Herne und Ruhr-Universität Bochum, St. Elisabeth Gruppe GmbH, Claudiusstr. 45, 44649, Herne, Deutschland
| | - J Braun
- Rheumazentrum Ruhrgebiet, Herne und Ruhr-Universität Bochum, St. Elisabeth Gruppe GmbH, Claudiusstr. 45, 44649, Herne, Deutschland
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Fiehn C, Ness T, Weseloh C, Specker C, Hadjiski D, Detert J, Krüger K. [Safety management of the treatment with antimalarial drugs in rheumatology. Interdisciplinary recommendations based on a systematic literature search]. Z Rheumatol 2020; 79:186-194. [PMID: 32095892 DOI: 10.1007/s00393-020-00751-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Antimalarial medication (AM) plays an important role in the treatment of rheumatic diseases. OBJECTIVE Updated evidence-based recommendations on the safety management of rheumatological treatment with AM are presented. METHODS A systematic literature search in the databases Medline (PubMed) and Cochrane identified 1160 studies on the safety of treatment with AM in rheumatology. In addition, a manual search was carried out and 67 publications considered to be particularly relevant by the authors were analyzed in more detail. These publications served as a basis for consensus-based recommendations. RESULTS Treatment with AM in rheumatology should be carried out with hydroxychloroquine (HCQ) with a dosage not exceeding 5 mg/kg body weight/day. Patients should undergo a basic ophthalmological examination within the first 6 months of AM treatment. Pre-existing maculopathy, renal insufficiency (glomerular filtration rate, GFR <60 ml/min), tamoxifen comedication, a daily dose of >5 mg/kg HCQ or treatment with chloroquine (CQ) show an increased risk for AM-induced retinopathy. These patients should undergo an annual ophthalmological check from the beginning of the treatment, whereas patients with no risk factors are recommended to start this only after 5 years of taking the medication. The ophthalmological examination should comprise at least both an appropriate subjective and an objective method and these are usually an automated visual field test and optical coherence tomography (OCT). A visual field test revealing a parafoveal sensitivity loss and an OCT showing a parafoveal circumscribed loss of the photoreceptor layer or focal interruptions of the structural line of the outer segment are signs of a possible AM retinopathy. Determination of creatine kinase (CK) and lactate dehydrogenase (LDH) in blood is appropriate to screen for cardiomyopathy and myopathy and should be checked before starting the treatment and then ca. every 3 months. The use of cardiac biomarkers, such as brain natriuretic peptide (BNP) or troponin in serum, electrocardiograph (ECG) or cardiac imaging should be considered depending on the situation. An intake of HCQ is safe during pregnancy and breastfeeding according to the current state of knowledge and is protective for mother and child in patients with systemic lupus erythematosus. CONCLUSION The updated recommendations on AM treatment in rheumatology in particular include a more rigorous measuring of doses, risk stratification in monitoring and defined ophthalmological examination methods to detect a possible retinopathy.
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Affiliation(s)
- C Fiehn
- Rheumatologie Baden-Baden GbR, Tätigkeitsschwerpunkt Klinische Immunologie und Belegarzteinheit der ViDia-Kliniken Karlsruhe, Medical Center Baden-Baden, Beethovenstr. 2, 76530, Baden-Baden, Deutschland.
| | - T Ness
- Klinik für Augenheilkunde, Universitätsklinik Freiburg, Freiburg, Deutschland
| | - C Weseloh
- Deutsche Gesellschaft für Rheumatologie, Berlin, Deutschland
| | - C Specker
- Klinik für Rheumatologie und Klinische Immunologie, Kliniken Essen-Mitte, Essen, Deutschland
| | - D Hadjiski
- Rheumatologie Baden-Baden GbR, Tätigkeitsschwerpunkt Klinische Immunologie und Belegarzteinheit der ViDia-Kliniken Karlsruhe, Medical Center Baden-Baden, Beethovenstr. 2, 76530, Baden-Baden, Deutschland
| | - J Detert
- Rheumatologisch-immunologische Arztpraxis, Templin, Deutschland
| | - K Krüger
- Praxiszentrum St. Bonifatius, München, Deutschland
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Mohme S, Schmalzing M, Müller CSL, Vogt T, Goebeler M, Stoevesandt J. Immunizations in immunocompromised patients: a guide for dermatologists. J Dtsch Dermatol Ges 2020; 18:699-723. [PMID: 32713146 DOI: 10.1111/ddg.14156] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/05/2020] [Indexed: 12/11/2022]
Abstract
The increasingly frequent use of immunomodulatory agents in dermatology requires the observance of specific recommendations for immunization. These recommendations are developed and regularly updated by the German Standing Committee on Vaccination (STIKO), an independent advisory group at the Robert Koch Institute. Dermatological patients on immunosuppressive treatment should ideally receive all vaccinations included in the standard immunization schedule. Additionally, it is recommended that they also undergo vaccination against the seasonal flu, pneumococci, and herpes zoster (inactivated herpes zoster subunit vaccine for patients ≥ 50 years). Additional immunizations against Haemophilus influenzae type B, hepatitis B and meningococci may be indicated depending on individual comorbidities and exposure risk. Limitations of use, specific contraindications and intervals to be observed between vaccination and immunosuppression depend on the immunosuppressive agent used and its dosing. Only under certain conditions may live-attenuated vaccines be administered in patients on immunosuppressive therapy. Given its strong suppressive effect on the humoral immune response, no vaccines - except for flu shots - should be given within six months after rituximab therapy. This CME article presents current recommendations on immunization in immunocompromised individuals, with a special focus on dermatological patients. Its goal is to enable readers to provide competent counseling and to initiate necessary immunizations in this vulnerable patient group.
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Affiliation(s)
- Sophia Mohme
- Department of Dermatology, Venereology and Allergology, University Hospital, Würzburg, Germany
| | - Marc Schmalzing
- Department of Medicine II, Rheumatology/Clinical Immunology, University Hospital, Würzburg, Germany
| | - Cornelia S L Müller
- Department of Dermatology, Venereology and Allergology, Saarland University, Homburg/Saar, Germany
| | - Thomas Vogt
- Department of Dermatology, Venereology and Allergology, Saarland University, Homburg/Saar, Germany
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital, Würzburg, Germany
| | - Johanna Stoevesandt
- Department of Dermatology, Venereology and Allergology, University Hospital, Würzburg, Germany
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Impfschutz für medizinisches Personal*. INFO HÄMATOLOGIE + ONKOLOGIE 2020. [PMCID: PMC7474325 DOI: 10.1007/s15004-020-8218-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mohme S, Schmalzing M, Müller CSL, Vogt T, Goebeler M, Stoevesandt J. Impfen bei Immunsuppression: ein Leitfaden für die dermatologische Praxis. J Dtsch Dermatol Ges 2020; 18:699-725. [PMID: 32713144 DOI: 10.1111/ddg.14156_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/05/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Sophia Mohme
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg
| | - Marc Schmalzing
- Medizinische Klinik und Poliklinik II, Rheumatologie/Klinische Immunologie, Universitätsklinikum Würzburg
| | - Cornelia S L Müller
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universität des Saarlandes, Homburg/Saar
| | - Thomas Vogt
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universität des Saarlandes, Homburg/Saar
| | - Matthias Goebeler
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg
| | - Johanna Stoevesandt
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg
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Jahn S, Föhr J, Herbst M. Impfen bei dermatologischen Patienten vor und unter immunmodulierenden Therapien – Erfahrungen aus einer ambulanten Spezialsprechstunde. AKTUELLE DERMATOLOGIE 2020. [DOI: 10.1055/a-1131-1873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
ZusammenfassungImpfen heißt, durch Auslösen einer aktiven Immunität den entsprechenden (Infektions-)Krankheiten vorzubeugen. Dem kommt durch die immer zahlreicher verfügbaren immunmodulierenden Therapien für dermato-onkologische, Autoimmun- und allergische Erkrankungen eine zunehmende Bedeutung zu. Wir möchten darstellen, vor welche Herausforderungen wir uns beim Aufbau eines Impfmanagements für die derzeit über 80 Patientinnen und Patienten unserer Spezialsprechstunde „Immundermatologie“ gestellt sehen.
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Affiliation(s)
- S. Jahn
- Praxis Dr. Herbst & Kollegen, Darmstadt
| | - J. Föhr
- Praxis Dr. Herbst & Kollegen, Darmstadt
| | - M. Herbst
- Praxis Dr. Herbst & Kollegen, Darmstadt
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Laws HJ, Baumann U, Bogdan C, Burchard G, Christopeit M, Hecht J, Heininger U, Hilgendorf I, Kern W, Kling K, Kobbe G, Külper W, Lehrnbecher T, Meisel R, Simon A, Ullmann A, de Wit M, Zepp F. Impfen bei Immundefizienz. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:588-644. [PMID: 32350583 PMCID: PMC7223132 DOI: 10.1007/s00103-020-03123-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Hans-Jürgen Laws
- Klinik für Kinder-Onkologie, -Hämatologie und Klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Ulrich Baumann
- Klinik für Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Christian Bogdan
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen, Friedrich-Alexander Universität FAU Erlangen-Nürnberg, Erlangen, Deutschland
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
| | - Gerd Burchard
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
- Bernhard-Nocht-Institut für Tropenmedizin, Hamburg, Deutschland
| | - Maximilian Christopeit
- Interdisziplinäre Klinik für Stammzelltransplantation, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Jane Hecht
- Abteilung für Infektionsepidemiologie, Fachgebiet Nosokomiale Infektionen, Surveillance von Antibiotikaresistenz und -verbrauch, Robert Koch-Institut, Berlin, Deutschland
| | - Ulrich Heininger
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
- Universitäts-Kinderspital beider Basel, Basel, Schweiz
| | - Inken Hilgendorf
- Klinik für Innere Medizin II, Abteilung für Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Jena, Deutschland
| | - Winfried Kern
- Klinik für Innere Medizin II, Abteilung Infektiologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Kerstin Kling
- Abteilung für Infektionsepidemiologie, Fachgebiet Impfprävention, Robert Koch-Institut, Berlin, Deutschland.
| | - Guido Kobbe
- Klinik für Hämatologie, Onkologie und Klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Wiebe Külper
- Abteilung für Infektionsepidemiologie, Fachgebiet Impfprävention, Robert Koch-Institut, Berlin, Deutschland
| | - Thomas Lehrnbecher
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | - Roland Meisel
- Klinik für Kinder-Onkologie, -Hämatologie und Klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Arne Simon
- Klinik für Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Andrew Ullmann
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Maike de Wit
- Klinik für Innere Medizin - Hämatologie, Onkologie und Palliativmedizin, Vivantes Klinikum Neukölln, Berlin, Deutschland
- Klinik für Innere Medizin - Onkologie, Vivantes Auguste-Viktoria-Klinikum, Berlin, Deutschland
| | - Fred Zepp
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
- Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin Mainz, Mainz, Deutschland
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Varicella-zoster- und Herpes-zoster-Impfindikation bei Multipler Sklerose: aktuelle Situation. DER NERVENARZT 2019; 90:1254-1260. [DOI: 10.1007/s00115-019-00806-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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