Immunisation against varicella in end stage and pre-end stage renal failure

Webb, Nicholas J.A.; Fitzpatrick, Mark; Hughes, David; Brocklebank, Trevor J; Judd, B. D.; Lewis, Malcolm; Postlethwaite, R J; Smith, Patricia A; Corbitt, Gerald

doi:10.1136/adc.82.2.141

Cited by 62 publications

(62 citation statements)

References 15 publications

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“…The results of the present study together with those of others reported so far [6, 7, 8, 9, 10, 11, 12, 14]suggest that children with CRF are not immunocompromised, though the effects of uraemia may change various components of their immune system.…”

Section: Discussionsupporting

confidence: 63%

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Are Uraemic Children Immunologically Compromised?

Ensari¹,

Ekı̇m²,

İkincioğulları³

et al. 2001

Nephron

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Background: Various immunological abnormalities leading to impaired immune status have been described in uraemic adults; however, few data are available for uraemic children. Methods: In this study, peripheral blood total lymphocyte count and lymphocyte subsets (CD3+, CD4+, CD8+, CD16+, CD20+) were evaluated, skin tests with PPD and Candida antigens were performed, and serum immunoglobulin (IgG, IgA, IgM) and complement (C3, C4) levels were measured in 30 children with end-stage renal failure (10 before dialysis, 10 on continuous ambulatory peritoneal dialysis, and 10 on haemodialysis) and the results compared with those of 15 healthy controls. Results: The data showed significant lymphopenia in predialysis and haemodialysis groups. No significant change was observed in the CD4+/CD8+ ratio or in the percentages of lymphocyte subsets in either group studied, while the absolute values of some lymphocyte subsets were significantly lower in all groups as compared with controls. In skin test evaluation, only the patients in the predialysis group showed a significantly decreased response to Candida antigen. The serum immunoglobulin levels were significantly decreased in the continuous ambulatory peritoneal dialysis group as compared with the control group. Conclusion: Our results, together with those of other paediatric studies, reported in the literature, suggest that uraemic children are not immunocompromised, though the effects of uraemia may cause some variation in their immune status.

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Section: Discussionsupporting

confidence: 63%

“…According to these studies, adults with chronic renal failure (CRF) showed an impaired immune status and a poor immunological response to vaccination [1, 2, 3, 4, 5]. However, in uraemic children, these findings appear to be different from those of adults [2, 6, 7, 8, 9, 10, 11, 12]. …”

Section: Introductionmentioning

confidence: 95%

Are Uraemic Children Immunologically Compromised?

Ensari¹,

Ekı̇m²,

İkincioğulları³

et al. 2001

Nephron

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“…Reduced serum immunoglobulin concentrations have been found in children on peritoneal dialysis (PD) [8,9,10,11]. Standard vaccination schedules generally induce an antibody response in children with CRF [12,13,14,15,16,17], although specific revaccination is recommended [17]. The completion of the vaccination program before RTPL is particularly important, as immunosuppressed infants and young children without specific protection -either after immunization or wild-type infection -are at high risk that benign childhood infections are severe and life threatening [12,18].…”

Section: Introductionmentioning

confidence: 98%

Immunization in children with chronic renal failure

et al. 2002

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Infections jeopardize children on immunosuppression after organ transplantation. Immunization is protective in healthy children. The aims of this study were to analyze the rate and efficacy of immunization in 62 children undergoing dialysis and renal transplantation (RTPL) between 1987 and 2000. The analysis was based on clinical findings, vaccination certificates, and measurement of specific serum antibodies. A member of the renal unit administered vaccinations. All 62 patients were immunized against diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps, rubella, and hepatitis B. Since introduction in 1991 and 1995, 44 and 42 children were also vaccinated against influenza and Hemophilus influenzae type b, respectively. Of 16 patients with a negative history, 14 were given varicella vaccine; 16 children on peritoneal dialysis (PD) or with nephrotic syndrome were immunized against Streptococcus pneumoniae. All vaccinated patients had detectable serum antibodies against measles, mumps, rubella, varicella, hepatitis B, H. influenzae, and S. pneumoniae. There were 3 infections despite vaccination; 1 patient developed varicella after RTPL and 1 patient on PD had 2 episodes of peritonitis caused by H. influenzae and S. pneumoniae. In conclusion, monitoring and administration of the vaccines by the renal team enabled a high immunization rate. Whether vaccines, as documented by antibody titers, or by the low prevalence in the general population promoted the low prevalence of infections remains open, as there were at least a few vaccination failures.

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“…Following screening, eligible subjects received Vivaglobin weekly for 8 weeks followed by Hizentra weekly for 24 weeks, with weeks 9-20 as a transition period and a final 12-week period (weeks [21][22][23][24][25][26][27][28][29][30][31][32]. Study visits took place at screening, entry and at 8, 12, 20 and 32 weeks.…”

Section: Methodsmentioning

confidence: 99%

Efficacy and tolerability of 16% subcutaneous immunoglobulin compared with 20% subcutaneous immunoglobulin in primary antibody deficiency

Niebur

Duff

Shear

et al. 2015

Clinical and Experimental Immunology

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Summary Multiple subcutaneous immunoglobulin (SCIG) products are available to treat primary antibody deficiency (PAD). The efficacy and tolerability of 16% SCIG (Vivaglobin®) was compared with 20% SCIG (Hizentra®) in PAD subjects. The study was a prospective, single‐centre, open‐label study of PAD subjects transitioning Vivaglobin to equivalent Hizentra doses, rounded to the nearest vial size. Comparisons included immunoglobulin (Ig)G levels; tetanus, varicella and Streptococcus pneumoniae titres; adverse events (AEs), annual infection rate and quality of life during 8 weeks of Vivaglobin and 24 weeks of Hizentra. Thirty‐two subjects (aged 2–75 years) participated. Rounding to the nearest Hizentra vial size resulted in a 12·8% (± 2·9%) increase in SCIG dose. Median immunoglobulin (Ig)G level following 8 weeks of Vivaglobin was similar to 24 weeks of Hizentra (1050 versus 1035 mg/dl, respectively; P = 0·77). Both products had similar protective titres to tetanus, varicella and serotypes of S. pneumoniae, which were variable but well above protective levels. After 12 weeks of Hizentra, subjects reported fewer local site reactions compared with Vivaglobin. Switching products resulted in increased systemic AEs in some subjects but, overall, not significantly higher than during Vivaglobin treatment. Average infusion time decreased from 104·7 min (3·3 sites) with Vivaglobin to 70·7 min (2·2 sites) with Hizentra (P = 0·0005). Acute serious bacterial infections were similar. Treatment satisfaction was superior with Hizentra. Hizentra and Vivaglobin have similar pharmacokinetics and efficacy. Although transition to a different SCIG product initially increased AEs, Hizentra is well tolerated and can be infused more rapidly and with fewer sites compared to Vivaglobin.

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Immunisation against varicella in end stage and pre-end stage renal failure

Cited by 62 publications

References 15 publications

Are Uraemic Children Immunologically Compromised?

Are Uraemic Children Immunologically Compromised?

Immunization in children with chronic renal failure

Efficacy and tolerability of 16% subcutaneous immunoglobulin compared with 20% subcutaneous immunoglobulin in primary antibody deficiency

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