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Ausgangstext - Englisch A Possible Anti Pseudomonas Aeruginosa Conjugate Vaccine
Anna Rüdeberg M.D. CFW Medical Advisor
Department of Pediatrics University of Berne, Switzerland
Chronic pulmonary infection with Pseudomonas aeruginosa remains the most important cause of lung disease in patients with Cystic Fibrosis. This infection leads to an acceleration of lung disease, coupled with a deterioration of the function of the lungs. During the last ten years, early and aggressive interventions with antibiotics, given orally, intravenously and or by inhalation, have improved lung function, reduced local lung inflammation and sometimes have eliminated the presence of Pseudomonas aeruginosa from the lungs of patients with CF, at least for some time.
Despite this clear therapeutic success, and in spite of important changes in preventive hygiene and new guidelines designed to avoid contamination in CF Centers, during CF camps and meetings among patients with and without Pseudomonas aeruginosa infection, there is intense interest in the development of vaccines for the prevention of infections of the lungs with P. aeruginosa.
In order to provide a good immunological response, such as is available with other vaccines against bacterial infections, such as diphtheria and tetanus, several parts of the Pseudomonas aeruginosa cell body have been identified as potential candidates for producing an efficient vaccine. The elements of the outer membrane proteins, OMP, the so-called hairs, pili, the proteic part of the locomotion apparatus, the flagellum, and, more recently, translocation proteins related to the secretive activity of P. aeruginosa are of particular interest.
All the above proteins, that are potentially efficient in an antibody stimulating vaccination, are still the objects of preliminary studies.
Another possible vaccine starting point is an element of the P. aeruginosa surface which is called lipo-poly-saccharide (lipo = fat, poly = multiple, saccharide = sugar), LPS. This element of P. aeruginosa is known to stimulate high affinity antibodies which protect the lung against this part of the P. aeruginosa surface. High affinity means that there is a strong attraction between the above-mentioned LPS and the newly stimulated antibodies which will possibly destroy the bacteria (see figure 1).
To achieve induction of these high affinity antibodies (highly efficient antibodies) a team from the company Berna Biotech Ltd. Berne, and the CF Center, Department of Pediatrics, University of Berne initiated a clinical trial in cystic fibrosis patients in 1989. The evaluations of results after 1, 3 and 4 years showed safety and the capacity of the vaccine to stimulate a good antibody-response, that is, the vaccine tested in the trial produced a good immune response in CF patients who received the vaccine.
“ a real effect of the vaccine in preventing and/or delaying a chronic infection with Pseudomonas”
After ten years of follow-up studies the team succeeded in showing complete safety for long term use, and also a real effect of the vaccine in preventing and/or delaying a chronic infection with Pseudomonas aeruginosa in a group of 25 CF-patients in comparison to control patients with CF matched for age, sex and genetic mutations who did not receive the vaccine (figure 2). In 2001, a multicenter, double-blind, placebo controlled (so-called phase III) clinical trial was started. It is still in progress and we are expecting the final results in about 2 years.
As the first vaccine against P. aeruginosa lung-infections in the world, this development may well signify a great advance in the anti-infection therapy of CF. Unfortunately it will not mean that we will definitely be free from this resistant and devastating bacterial infection as a result of using this vaccine. In the best case scenario it may complement the strategy of classical CF lung-therapy, represented by inhalation of bronchodilators, followed by chest-physiotherapy and expectoration (2 -3 times a day) and if necessary coupled with inhalations of DNASE and/or antibiotics (tobramycin). Without these pre-requisites the vaccine approach alone, cannot achieve the best possible outcomes for individuals with CF.
How to use the vaccine in CF patients without P. aeruginosa infection and the timing of the application of booster vaccinations are questions that still remain to be answered. They will not be settled before the end of the ongoing multicenter study, hopefully to be reported in 2006.
Übersetzung - Deutsch Ein möglicher Kombi-Impfstoff gegen Pseudomonas-Aeruginosa
Dr. med. Anna Rüdeberg, medizinische Beraterin des CFW
Pädiatrische Abteilung der Universität Bern in der Schweiz
Die chronische Lungeninfektion mit Pseudomonas aeruginosa Viren bleibt die wichtigste Ursache der Lungenerkrankung bei Patienten mit zystischer Fibrose. Diese Infektion führt zu einer Verstärkung der Lungenerkrankung, verbunden mit einer Verschlechterung der Lungenfunktion. Während der letzten 10 Jahre haben frühzeitiges und intensives Eingreifen mit Antibiotika – oral, intravenös und/oder durch Inhalation verabreicht – die Lungenfunktion verbessert, lokale Lungenentzündungen reduziert und manchmal sogar, wenigstens für eine gewisse Zeit, die Pseudomonas aeruginosa Bakterien in den Lungen von CF-Patienten zerstört.
Trotz des eindeutigen therapeutischen Erfolges und trotz der wichtigen Veränderungen in der präventiven Hygiene und neuer Richtlinien, die dazu ausgelegt sind, Verunreinigungen in CF-Zentren zu vermeiden, herrscht in CF Camps und Meetings unter Patienten mit und ohne Pseudomonas aeruginosa Infektion reges Interesse an der Entwicklung von Impfstoffen für die Vermeidung von Infektionen der Lungenentzündungen durch P. aeruginosa Bakterien.
Um für eine gute Immunabwehr zu sorgen, wie diese bei anderen Impfstoffen gegen Bakterieninfektionen wie Diphterie und Tetanus gegeben ist, wurden einige Teile des Pseudomonas aeruginosa Zellkörpers als potenzielle Kandidaten für die Herstellung eines effizienten Impfstoffes festgelegt. Die Elemente der äußeren Membranproteine, OMP, die sogenannten pili (Haare), der Eiweißanteil im Bewegungsapparat, die Flagelle und dann noch die Translokationsproteine, die mit der unbekannten Aktivität des P. aeruginosa Virus in Beziehung stehen, sind von besonderem Interesse.
Alle oben genannten Proteine, die in einem Antikörper produzierenden Impfstoff hochgradig wirksam sind, sind immer noch Teile vorangehender Studien.
Ein weiterer Ansatz für einen möglichen Impfstoff ist ein Element der Oberfläche des P. aeruginosa Virus, das Lipo-Poly-Saccharid, LPS (Lipo = Fett, Poly = mehrfach,
Saccharid = Zucker) genannt wird. Dieses Element des P. aeruginosa Virus ist dafür bekannt, Antikörper mit hoher Affinität dazu zu stimulieren, die Lungen gegen diesen Teil der P. aeruginosa Oberfläche zu schützen. Hohe Affinität bedeutet, dass eine hohe Anziehungskraft zwischen den oben genannten LPS und den neu stimulierten Antikörpern, die möglicherweise die Bakterien zerstören, besteht (s. Abb. 1).
Um eine Verbindung dieser Antikörper mit hoher Affinität (hochgradig effiziente Antikörper) zu erreichen, haben ein Team von Berna Biotech Ltd. Berne und des CF-Zentrums, Pädiatrische Abteilung der Universität Bern in der Schweiz 1989 einen Klinikversuch bei CF-Patienten gestartet. Die Auswertungen der Ergebnisse nach 1, 3 und 4 Jahren zeigten Sicherheit und die Kapazität des Impfstoffes, eine gute Antikörperreaktion zu fördern. Das bedeutet, dass der Impfstoff, der im Versuch verwendet wurde, eine gute Immunrekation bei CF-Patienten, die diesen Impfstoff erhalten hatten, hervorrief.
“ ein echter Effekt des Impfstoffes zur Vermeidung und/oder Verzögerung einer chronischen Infektion mit Pseudomonas“
Nach 10 Jahren mit Folgestudien konnte das Team erfolgreich die vollständige Sicherheit für die langfristige Einnahme und auch einen echten Effekt des Impfstoffes zur Vermeidung und/oder Verzögerung einer chronischen Infektion mit Pseudomonas aeruginosa bei einer Gruppe von 25 CF-Patienten aufzeigen, verglichen mit CF-Patienten des gleichen Alters, Geschlechts und genetischer Veränderungen, die keinen Impfstoff erhalten haben (Abb. 2). Im Jahr 2001 wurde ein mulitzentrischer, doppelblinder und Placebo-gelenkter Klinikversuch (sogenannte Phase III) begonnen. Dieser Versuch läuft noch und wir erwarten die endgültigen Ergebnisse in etwa 2 Jahren.
Als erster Impfstoff gegen Lungenentzündungen durch den P. aeruginosa Virus weltweit könnte diese Entwicklung einen großen Fortschritt in der Anti-Infektionstherapie bedeuten. Leider bedeutet das nicht, dass wir als Folge des Gebrauchs dieses Impfstoffes definitiv frei sein werden von dieser widerstandsfähigen und zerstörenden Bakterieninfektion. Im besten Fall könnte die Strategie der klassischen CF-Lungentherapie ersetzt werden. Diese stellt sich durch Inhalation von Bronchuserweiterern dar, gefolgt von der physikalischen Therapie des Bruskorbs und einem Abhusten des Schleims (2 – 3 täglich) und ist, falls nötig, verbunden mit Inhalationen von DNASE und/oder Antibiotika (Tobramycin-Präparat). Ohne diese Grundvoraussetzungen kann der Ansatz des Impfstoffes allein nicht die bestmöglichen Ergebnisse für die Einzelnen mit CF erreichen.
Es bleiben aber immer noch Fragen offen bezüglich der Anwendung des Impfstoffes bei CF-Patienten ohne P. aeruginosa Virus Infektion und der Wahl des richtigen Zeitpunkts für Wiederholungsimpfungen. Diese werden nicht vor Ende des multizentrischen Versuchs, über den hoffentlich 2006 berichtet wird, beigelegt werden können.
Englisch > Deutsch: CFWW - Newsletter - Edition 8
Ausgangstext - Englisch COUNTRY CLOSE UP
CF CARE IN DENMARK
By Erik Wendel and Hanne Wendel Tybkjaer
Denmark is one of the three Scandinavian countries, situated in Northern Europe sharing a border to the south with Germany of just under 68 km. The total area is 43,069 square km, excluding the self-governing Faroe Islands and Greenland in the North Atlantic. Denmark has a coastline of 7,314 kms, corresponding to a sixth of the globe‘s circumference and consists of one peninsular and 406 islands, 90 of which are inhabited – the biggest being Zealand (Sjaelland) with the capital Copenhagen (Köbenhavn). The terrain is low and flat with some gentle rolling hills. The highest point, Yding Skovhhöj, is 173 m above sea level.
The fairy-tale writer Hans Christian Andersen (1805-1875) probably remains the best-
known Dane in the world. It is well-deserved that one of the figures which emanated from his imagination, the Little Mermaid, has also become the symbol of the Danish capital, Copenhagen. Cast in bronze, she gracefully receives visitors to the city from her wet stone in Copenhagen harbour.
The Mermaid & Denmark Map
Denmark has a population of around 5.4 million. Lutheran Evangelical Christian is the state religion, practiced by 88.9% of the population. Common to all Danes is their tendency to take the ups and downs of life with a touch of irony, often self-irony. The tone between Danes is relaxed. In the schools, the pupils are on first-name terms with the teachers.
Danish Vikings once took to the seas and ravaged half of Europe, but these days they've filed down their horns and forged a society that stands as a benchmark of civilization, with progressive policies, widespread tolerance and a liberal social-welfare system. The Danish Monarchy – one of the oldest in the world - is a constitutional monarchy, reigned by her majesty Queen Margrethe II. The role of the Queen is mostly ceremonial, and the focal point of the democratic system is the Folketing (Parliament) and the government.
The Danish economy is based on up-to-date small-scale and corporate industry as well as modern high technology agriculture. Denmark is characterized by extensive government welfare measures, comfortable living standards and a high level of foreign trade. In 2004, the total gross domestic product (GDP) was US$ 241.4 billion, equivalent to US$ 44,730 per capita; making Denmark one of the richest countries in the world. The proceeds from this are heavily taxed. The income tax to the state is progressive. In Denmark, there is also a high general value added tax (moms) of 25% on all goods and services. Altogether, this produces one of the heaviest tax loads in the world, in 2002 amounting to 49.2% of GDP.
With the revenue from taxes and duties, the state creates great security for its citizens with free education, medical treatment, hospitalisation, early retirement pension for those with reduced capacity for work and – from the age of 65 – a national pension large enough to live on. In addition, the state subsidises an unemployment benefit, dental costs, and nursing home accommodation for those no longer able to manage on their own.
Sources: visitdenmark.com, visitcopenhagen.com
CF IN DENMARK
January 1, 2006 there were 434 CF-patients in Denmark. The incidence is 12-15 CF children per year. All are in centralized care at two CF-centres; 287 at the Copenhagen CF Centre at Rigshospitalet (Copenhagen University Hospital) and 147 at the Aarhus CF centre at the Aarhus University Hospital.
The Copenhagen Centre was established as early as 1968 by Dr. E.W. Flensborg. When he retired in 1982, his position at the Copenhagen Centre was taken over by Dr. Christian Koch, who passed away in 2004 and was followed by Dr Tania Pressler. Professor Niels Hoiby is chairman of the Department of Clinical Microbiology at the Copenhagen Centre. The Aarhus Centre was established in 1990, professor P. O. Schiötz being the chairman of the centre.
For over 30 years, the Copenhagen Centre has had a leading international role in CF care. The overall perspective in the care has been that bacterial lung infections are the most important factors responsible for the progression of the lung infections among CF-patients. Consequently, microbiology and infection control have been cornerstones in the “Copenhagen CF treatment” approach.
All patients at the Copenhagen CF Centre are seen for monthly controls which include clinical observation, lung function test, height, weight, microbiological examinations of sputum etc. Bacterial infections of the lower respiratory tract are diagnosed by microscopy and culture of secretions from the respiratory tract.
The Copenhagen principles for treatment of bacteria in CF are:
• Positive bacteria cultures are treated with antibiotics whether there are clinical symptoms or not.
• Bacteria such as Staphylococcus aureus, Haemophilus influenzae and intermittently colonized Pseudomonas aeruginosa (PA) infection should be eradicated when present in the lower respiratory tract whether there are clinical symptoms or not. (S. aureus infection is still the most frequently isolated pathogen in CF children but due to efficient antibiotic treatment it is not considered to be a problem among Danish CF patients).
• Chronic PA infection, defined as persistent presence of PA for at least 6 consecutive months, or less when combined with the presence of 2 or more precipitating antibodies against PA, is treated with antibiotics (IV courses) regularly 4 times/year whether there are clinical symptoms or not, plus daily antibiotic inhalations.
• All patients are offered daily Pulmozyme inhalation.
Milestones in Danish CF Treatment
In 1976, a Danish survey showed that a CF patient had 50% chance of surviving 5 years with chronic PA infection. In consequence, the treatment regime against chronic PA infection was changed radically by Dr. Flensborg and elective IV antibiotic courses were introduced, regardless of clinical symptoms when the level of precipitating antibodies against PA reached 2 or higher or the presence of PA for at least 6 consecutive months. As a result of the new treatment regime, the survival among PA chronically infected CF patients increased tremendously over the years. In 1987 daily antibiotic inhalations were added to the treatment.
In the first years with intensive anti-PA IV treatment the risk of cross-infection was high because the wards with inpatients receiving IV treatment were near the outpatient clinic visited by all CF patients who were also not segregated according to presence or absence of PA in their sputum.
In 1981, the Copenhagen CF Centre was reconstructed, separating the wards and the outpatient clinic. Segregation (cohort isolation) was introduced, segregating PA patients from non-PA patients in the wards, in the outpatient clinic, and during social events.
However, an epidemic spread of a multiresistant PA strain in 1983 led to further segregation of patients infected with PA sensitive strain from patients with multiresistant strain.
After the introduction of cohort isolation in 1981 the incidence and the prevalence of both intermittent PA colonization and of chronic PA infection decreased significantly.
Cross-infection
Today, the Copenhagen CF Centre segregates patients based on identification of the following bacteria from the lower airways:
1) No PA
2) Intermittent PA infection
3) Chronic infection with antibiotic sensitive PA strain
4) Chronic infection with multiply resistant PA strains
5) Intermittent or chronic infection with organisms belonging to the Burkholderia cepacia complex (each patients with B. cepacia complex forms a unique cohort)
6) Achromobacter xylosoxidans infection
The principles of cross infection and segregation are also strictly practised at social events arranged by the Danish CF Association. The overall aim of cohort isolation is not to expose any patient to bacteria which can turn into a chronic infection among CF patients and thereby increase the patients’ need for treatment and a possible reduction of the life expectancy. This policy is well accepted and understood by both CF patients and families, even though the segregation policy may restrict patients in their social activity with other CF patients. (Please see article “Prevention of Cross-Infections in CF” by Claus Moser and Niels Høiby in Issue 7, Volume 1-2006).
Major important changes in Danish CF care:
1976: Elective IV antibiotic courses every 3 months against chronic PA.
1981: Cohort Isolation.
1982: The PEP mask (Positive Expiratory Pressure) – a self-administered lung physiotherapy which gave independence to the patients/families
1984: Diet change from low fat diet to high calorie diet
1989: Early intensive treatment against intermittent PA infection and daily antibiotic inhalation against chronic PA infection.
1994: Pulmozyme inhalation against chronic PA infection
PEP photo
Health care policy in Denmark
Centralized CF care and medical home care is free. However, patients over age 18 make a co-payment of 40 Euro per month. Patients on Early Retirement Pension must pay about 7 Euro per month. Patients and families with CF children under the age of 18 are reimbursed for additional expenditures in their living costs incurred by CF. There are no budget restrictions on prescribed CF drugs.
Flexible working arrangements: If a person’s capacity to work is so reduced that the person cannot get a job or retain a job under normal conditions, it is possible to get a so-called Flexjob with part time employment/reduction in duty due to limitations in working capacity - for full time payment (introduced in 1998). The employer pays the full salary to the employee, and the State reimburses the difference to the employer. The Flexjob regulation seems to be a useful method enabling CF patients to stay on the labour market for a longer period and at the same time allowing them to combine a working life with optimal management of CF.
Early Retirement Pension: Persons who cannot support themselves due to long-term impairment of their capacity for work are entitled to a maintenance benefit from the Danish State in the form of early retirement pension. The average pension level for CF patients is around 1,700 Euro after tax per month.
Danish CF Adults, Education, Job, Pension: A Survey: As result of the improved centralized treatment since the late 1960’s, most Danish CF patients now reach adulthood. From our perspective CF patients’ connection to labour market is important because of the implication it has on CF patients’ social and personal life. A survey was performed in 2002 by Liat Damsbo Lund, social worker at the Copenhagen CF Centre and Erik Wendel of the Danish CF Association to analyse social status among CF adults. The conclusion of the survey is - a large number of Danish CF adults are doing very well during education and working on normal working conditions. However, a considerable portion of the patients have been forced to prolong or drop education and stop or change working conditions due to CF. This indicates that CF has a major impact on education and employment.
Vocational and job guidance has therefore become a dominant issue for the Danish CF Association to identify and avoid potential barriers to education and employment, allowing the CF patients to combine their job with optimal management of CF for as long as possible. For more information, please visit: www.cff.dk and click “English” under “CF-Foreningen m.v.”
CF Schools for Children and Teens
In 1997, CF specialist nurse Vibsen Bregnballe launched a ‘CF school’ at the Aarhus CF Centre. Today, the school offers lessons in CF in combination with some of the monthly outpatient clinic visits for CF children at the ages of 5, 10, 14 and 16-18. The aim of the school is to improve the children’s knowledge about CF, to teach the children how to cope with the disease, and to teach children how to take responsibility for their care. The Copenhagen CF Centre has also established school for their CF children and teenagers.
The Danish CF Association (CFDK)
CFDK was founded in 1967 by a group of parents, grandparents and medical doctors. The first chairman of the association was the founder of the Copenhagen CF Centre Dr. EW Flensborg. Since 2004, Bjarne Hansen, a top executive from the business community is the chairman of the association. The Board of Directors consists of patients, parents and medical doctors. Administration and patient advocacy is carried out by 3 staff members. CFDK’s mission and objectives are the well-known issues: to support the patients, to support the research and to disseminate knowledge of CF.
Racing cyclists in CF shirts exhibiting the words “cystic fibrosis” is a helpful tool to disseminate information on CF and to attract media, in particular when one of the cyclists is a PWCF - here the Dane Henrik Gade (CF, 15 yrs), who raced against Richard Virengue in 116 km RITTER Classic Cycle Race 2005.
In 1998, ”Code of Conduct” regarding donations was introduced by the Danish CF Association (www.cff.dk – Code of Conduct). Besides fundraising, patient camps, continued patient advocacy, guidance, and family courses and information. The agenda includes:
§ Lobbying for continued optimal CF care and social welfare
§ Quality control of CF care
§ Maintaining positive media coverage
§ Fund-raising, participation with local chapters, and recruiting new members to take action
§ Identifying and making a continuous assessment of the patient group’s problems, needs, wishes
§ Supporting the need for biotech research and development
§ Addressing ethical issues such as carrier screening
Erik Wendel has 39 years of “Copenhagen patient experience” behind him. The yearly costs of his treatment are about $275 USD thanks to Danish healthcare policy.
Hanne Wendel Tybkjaer is the CEO of the Danish CF Association.
Übersetzung - Deutsch NAHAUFNAHME EINES LANDES
CF-PFLEGE IN DÄNEMARK
Von Erik Wendel und Hanne Wendel Tybkjaer
Dänemark ist eines der drei skandinavischen Länder in Nordeuropa mit der Grenze im Süden des Landes zu Deutschland von knapp 68 km Länge. Die Gesamtfläche umfasst ohne die selbstverwaltenden Faröer-Inseln und Grönland im Nordatlantik 43.069 km2. Die Küste Dänemarks hat eine Länge von 7.314 km, was 1/6 des Umfangs der Erde ausmacht und besteht aus einer Halbinsel und 406 Inseln, von denen 90 bewohnt sind - die größte ist Seeland (Sjaelland) mit der Hauptstadt Kopenhagen (Köbenhavn). Das Gebiet ist tief und eben mit ein paar kleineren Hügeln. Der höchste Punkt, Yding Skovhhöj liegt 173 m über NN.
Der Märchenerzähler Hans Christian Andersen (1805-1875) bleibt vermutlich der bekannteste Däne der Welt. So ist es wohlverdient, dass eine aus seiner Phantasie hervorgegangenen Figuren, die Kleine Meerjungfrau, auch das Symbol der Hauptstadt Dänemarks, Kopenhagen, geworden ist. In Bronze gegossen, empfängt sie Besucher der Stadt graziös von ihrem nassen Stein im Hafen Kopenhagens.
Die Meerjungfrau & Karte von Dänemark
Dänemark hat eine Bevölkerung von etwa 5,4 Millionen Einwohnern. Die Staatsreligion ist evangelisch-lutherisch und wird von 88,9 % der Bevölkerung gelebt. Die Neigung der Dänen, die Höhen und Tiefen des Lebens mit einem Hauch von Ironie, oft auch Selbstironie, zu nehmen, ist verbreitet. Der Ton unter Dänen ist entspannt. In den Schulen sprechen die Schüler die Lehrer mit dem Vornamen an.
Die dänischen Wikinger fuhren einst zur See und verwüsteten halb Europa, aber heutzutage haben sie ihre Hörner niedergelegt und formten eine Gesellschaft, die Maßstab für eine Zivilisation mit aufstrebenden Strategien, weit verbreiteter Toleranz und einem liberalen Sozialsystem ist. Die dänische Monarchie – eine der ältesten der Welt – ist eine verfassungsmäßige Monarchie, die von Ihrer Majestät Königin Margrethe II regiert wird. Die Rolle der Königin ist hauptsächlich zeremoniell und der Schwerpunkt des demokratischen Systems sind das Folketing (Parlament) und die Regierung.
Die dänische Wirtschaft basiert auf moderner Klein- und Konzernindustrie sowie moderner, hoch technologischer Landwirtschaft. Charakteristisch für Dänemark sind die umfangreichen Sozialmaßnahmen der Regierung, die komfortablen Lebensstandards und ein hohes Maß an Außenhandel. 2004 lag das gesamt Bruttoinlandsprodukt (BIP) bei 241,4 Milliarden US $, was 44.730 US $ pro Kopf entspricht. Dies machte Dänemark zu einem der reichsten Länder der Welt. Die Erlöse hieraus werden stark besteuert. Die Einkommenssteuer, die an den Staat gezahlt wird, ist progressiv. Die Mehrwertsteuer (moms) in Dänemark ist mit 25 % auf alle Waren und Dienstleistungen ebenfalls hoch. Alles in allem, ergibt dies eine der höchsten Steuerbelastungen der Welt. 2002 machte diese 49,2 % des BIP aus.
{0>Mit den Einnahmen aus Abgaben und Steuern schafft der Staat eine große Sicherheit für seine Bürger. Dies beinhaltet kostenlose Bildung, medizinische Behandlung, Krankenhausaufenthalt, Vorruhestand für Personen mit verminderter Arbeitsfähigkeit und – ab einem Alter von
65 Jahren – eine staatliche Rente, die hoch genug ist, um davon leben zu können.Alle befinden sich in zentraler Betreuung in zwei CF-Zentren; 287 am
CF-Zentrum in Kopenhagen im Rigshospitalet (Universitätskrankenhaus Kopenhagen) und 147 am Aarhus CF-Zentrum im Universitätskrankenhaus Aarhus.
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