Efficacy of Pneumococcal Immunization in Patients with Renal Disease – What Is the Data?

Abstract

Background/Aims: There is an increased incidence of invasive pneumococcal disease in patients with renal allografts, chronic renal insufficiency (CRI), or nephrotic syndrome (NS). Routine pneumococcal immunization (PI) has been recommended for these patients, but the efficacy of PI in this population is not well established. Methods: A review was done of studies that reported the immunologic response, efficacy, or safety of PI in patients with renal allografts, CRI, or NS. Results: On review of 26 published studies of PI in this population, all studies demonstrated a serologic response by the majority of patients to at least some pneumococcal serotypes. Use of steroids did not alter this response. In the studies with a greater than 6-month follow-up, declining antibody titers were consistently reported, and this decline was usually more rapid than in healthy controls. However, because the studies of the efficacy of PI in this population involve small numbers of patients and are not controlled, the significance of this decline in titers is not known. The incidence of serious adverse reactions to PI is very low. Conclusion: Pending more data, patients with renal transplants, CRI, or NS should continue to be offered PI.

Anti-pneumococcal antibody titre measurement: what useful information does it yield?

“…In the studies with .6-month followup, declining antibody titres were consistently reported, and this decline was usually more rapid than in healthy controls. 70 Very few data are available on responses to 7vPCV in this patient group. A small study has shown that, in children .5 years of age, 7VPCV was immunogenic and that immune suppression did not influence the antibody response.…”

Epidemiology of Acute Infections among Patients with Chronic Kidney Disease

“…Vaccine studies in patients with kidney disease have primarily examined antibody response and rate of antibody decline after vaccination as opposed to vaccine efficacy for preventing infection (36). How these alterations in the surrogate outcomes of vaccine responsiveness help to explain observed variation in rates of clinical events as compared with the general population is not well understood.…”

“…Patients who have kidney disease and are vaccinated with the pneumococcal vaccine seem to develop different serotype-specific titers, develop lower levels of antibody titers, and have a more rapid loss of antibody titers as compared with healthy control subjects (36,44,45).…”

“…Between 1999 and2004, an estimated 13% of the US adult population had CKD as compared with 10% in 1988 through 1994 (1). In 2005, approximately 485,000 people received renal replacement therapy, 340,000 of whom were receiving maintenance dialysis (2).…”

Immunizations for renal transplant candidates and recipients

“…42 Although postvaccination antibody titers in renal transplant recipients are lower than in healthy controls, most patients develop protective titers to at least one pneumococcal serotype. 19,43,44 In one study, the opsonophagocytic assay-a functional measure of vaccine response-revealed that 83% and 80% of patients developed protective titers to any serotype after receiving PPV23 and PCV7, respectively. 45 Although reports in healthy children under 2 years of age suggest that PCV7 is more immunogenic than PPV23, 2 PCV7 has not been shown to have significantly greater efficacy than PPV23 in adult transplant recipients.…”