Impfen gegen Echinokokkose (?)

Abstract

Two species of the genus Echinococcus occur sympatrically in central Europe, namely Echinococcus multilocularis, the causative agent of alveolar echinococcosis (AE), and E. granulosus, resulting in cystic echinococcosis (CE) in humans. The endemic area of Europe demonstrates an annual incidence of 0.02 to 1.4 new AE cases per 100000 inhabitants. The importance of the disease refers primarily to the high lethality observed in untreated cases. Therapeutically, radical surgical resection of hepatic lesions followed by continuous benzimidazole-therapy is anticipated. Recently, the strategic control of cystic echinococcosis in humans has considerably been improved by the development of an effective and efficient vaccine that will indirectly prevent humans from infection. The vaccine protects animal intermediate hosts (mainly farm ruminants), thus the lack of hydatid cysts in these animals will prevent dogs to become infected. This on the long-term will result in an abrogation of infection sources (Echinococcus eggs) for humans (and other intermediate hosts). Principally, it has been shown that a similar vaccination is also possible for E. multilocularis. Thus, a 14-3-3 and another Em95-vaccine have successfully been tested in the experimental murine model. As the parasite development mainly focuses on a wildlife cycle (wild rodents), a practical application of the vaccine can hardly be implemented. Nevertheless, AE is a very severe disease in humans, therefore one should discuss about the feasibility and the health-economic impact of large-scale vaccination of humans living in areas of high endemicity and thus being at high infection risk.