Adequate Seroresponse to Influenza Vaccination in Dialysis Patients

Abstract

Background: Hemodialysis (HD) patients are immunocompromised, and they have been shown to react suboptimally to recommended vaccinations. Advances in dialysis therapy and other supportive measures may theoretically result in better immune system functions. Clinical evidence supporting this theory has, however, not been presented. With influenza vaccination response, we tried to address this question. Methods: 42 HD and 15 continuous ambulatory peritoneal dialysis (CAPD) patients were vaccinated with a trivalent influenza vaccine, and the seroresponses at 5 weeks were measured. The results were compared with those of similarly vaccinated 20 nephrology outpatient clinic patients with varying degrees of renal insufficiency and those of 31 cardiac patients with normal renal function. Results: The dialysis patients had higher prevaccination titers of hemagglutination-inhibiting (HI) antibodies to all three vaccine virus antigens than the other groups due to more frequent previous vaccinations. The dialysis patients exhibited lower antibody increases, but an almost comparable proportion of them reached a protective antibody level (HI titers ≧40) 5 weeks after vaccination [A/H3N2: 61% (cardiac patients), 35% (nephrology outpatient clinic patients), 67% (CAPD), and 36% (HD); A/H1N1: 71, 70, 80 and 60; B: 97, 90, 80, and 76%, respectively]. Among the HD group, all patients receiving parenteral calcitriol except 1 (83%), but only 50% of the other HD patients produced protective antibody titers at least to two out of three vaccine virus antigens. No other patient- or HD treatment-associated parameter was significantly related to the vaccination-induced antibody response. Conclusions: We conclude that influenza vaccination of dialysis patients according to current recommendations may be effective. Additionally, our results suggest that parenteral calcitriol treatment may augment the immune response of HD patients even in a clinically relevant way, an effect so far shown only in in vitro studies.

Vitamin D, leptin and impact on immune response to seasonal influenza A/H1N1 vaccine in older persons

“…51,52 Finally, the strategy of vitamin D supplementation or use as a vaccine adjuvant needs to be explored further, instead of merely optimizing "homeostatic" 25-(OH) D status. [10][11][12][13]26,53,54 Several studies involving mature adult mice that were immunized subcutaneously or intramuscularly with inactivated vaccine (inactivated polio vaccine, 53 Haemophilus influenzae type b oligosaccharide conjugated to diphtheria toxoid vaccine, 54 and hepatitis B surface antigen (HBsAg) 55 ), co-administered with 1,25-(OH) 2 D3 demonstrated production of antigen-specific mucosal immunity (IgA and IgG antibodies), as well as enhanced systemic immune responses. It is likely that vitamin D is not an independent predictor of a binary outcome, but may be influential through its complex immune physiological interactions.…”

“…Few studies have included subjects already on vitamin D supplementation. [9][10][11][12][13] Epidemiological studies have demonstrated a higher incidence of vitamin D deficiency in elderly and obese populations. 14,15 Recent findings from a longitudinal study of older adults suggest leptin may mediate obesity-related vitamin D deficiency.…”

Efficacy and safety of the H1N1 monovalent vaccine in renal-transplant recipients and dialysis patients

“…Quantitative detection of antibodies against the (H1N1)v was performed by a hemagglutination inhibition test modified from Kendal et al Briefly, after treatment with receptor destroying enzyme (RDE), two-fold We found the response to vaccination was similar in hemodialysis and peritoneal dialysis patients, as was also found in another study. 28 It has been suggested that the immune response in PDPs is better than that of HDs because continuous ambulatory peritoneal dialysis improves the clearance of middle molecules. 15 Different parameters influence the response to the (H1N1)v vaccine.…”

Cumplimiento de las actividades preventivas y de promoción de la salud en un centro de hemodiálisis

“…Hay que resaltar que cerca del 20% de las mujeres que se dializan en nuestro centro y con criterio de screening de cáncer de mama y cérvix, no se han hecho ninguna mamografía ni citología cervicovaginal, datos que se asemejan a los observados en otros estudios (7) . Las infecciones en los pacientes en diálisis revisten mayor gravedad y a pesar de la baja respuesta que los pacientes con insuficiencia renal crónica manifiestan ante las vacunaciones, se ha demostrado la efectividad de éstas (8) . La importancia de las inmunizaciones reside en lograr la prevención de la enfermedad a través de la vigilancia epidemiológica e inmunización efectiva, y no tenemos que olvidar que las vacunas constituyen una de las actividades preventivas más eficientes.…”