Immunization in end stage renal disease: The perception of waiting list patients

Camargo, Leonardo Figueiredo; Lother, Alessandra Martins; Mazzali, Marilda; Stucchi, Raquel Silveira Bello

doi:10.1111/tid.12831

Cited by 7 publications

(9 citation statements)

References 18 publications

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“…Although vaccination is readily available, it is still underutilized in patients with chronic kidney disease (CKD), and there is a significant gap between guidelines and clinical practice [15,16].…”

Section: Discussionmentioning

confidence: 99%

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Serologic screening and infectious diseases consultation in renal transplant candidates for measles, mumps, rubella and varicella

Seckin

Libertin

Brumble

2021

Romanian Journal of Internal Medicine

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Background: Renal transplant recipients are at increased risk for developing complications of vaccine-preventable diseases. They benefit from a comprehensive pre-transplant evaluation when they might safely receive live vaccines. The primary aim of our study was to investigate the number of renal transplant recipients who were evaluated for serologic status against measles, mumps, rubella (MMR), and varicella. Secondarily, we investigated if pre-transplant Infectious Diseases consultation (IDC) improved vaccination rates.Methods: We retrospectively analyzed 282 kidney-alone and kidney-plus adult transplant recipients who were born in or after 1957. Patients were evaluated at Mayo Clinic, Florida Transplant Center between January 2015 and December 2017. Serologic status evaluation and vaccination rates were compared in two groups created based on IDC and no ID consultation (NIDC).Results: 235 (83%) of a total 282 patients received an IDC pre-transplantation. Varicella IgG levels were screened in all 235 IDC candidates. Among the IDC patients, mumps, measles and rubella IgG serologies were performed in 7 (3%), 143 (61%) and 144 (61%), respectively. Among 44 patients seronegative for any of MMR, 24 (55%) were vaccinated. Ten (66%) of 15 varicella seronegative patients were vaccinated. Zostavax was not given to 18% of IDC patients. Zostavax and MMR were administered more frequently in the IDC group compared to NIDC (p<.001 and p=0.0016, respectively).Conclusion: Although the majority of patients had IDC, the screening rate for MMR serologies was lower than varicella. A protocol-driven serologic screening similar to the one for VZV is required for MMR. Pre-transplant IDC increases vaccination rates.

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Section: Discussionmentioning

confidence: 99%

“…Although the total antibody production remains the same, the amount of IgG produced is decreased in response to vaccination [16]. Furthermore, macrophages cannot properly function and produce immune -mediated cytokines in the uremic environment [19].…”

Section: Discussionmentioning

confidence: 99%

Serologic screening and infectious diseases consultation in renal transplant candidates for measles, mumps, rubella and varicella

Seckin

Libertin

Brumble

2021

Romanian Journal of Internal Medicine

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“…By this simple and inexpensive intervention, we achieved high adherence to the recommended HBV vaccination protocol, with subsequent HBV vaccinations in 80% of patients after the second and 90% after the third vaccine dose. This result is considerably higher than in end-stage renal disease patients listed for kidney transplantation, in whom vaccine recommendation only, but not initiation of HBV vaccination, was performed [31].…”

Section: Discussionmentioning

confidence: 99%

Hepatitis B Vaccination in Patients with Liver Cirrhosis Evaluated for Liver Transplantation – A Simple Intervention Ensures High Adherence

Herta¹,

Petroff

Engelmann³

et al. 2019

Ann Transplant

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BackgroundThere is an unmet need to improve the HBV vaccination status in patients with chronic liver diseases. Primary care physicians and outpatient hepatologists often fail to vaccinate as recommended. Thus, new strategies to improve the HBV vaccination rate are required.Material/MethodsThis study was performed in a cohort of patients with chronic liver diseases evaluated for liver transplantation. Vaccination status was taken from the patients’ vaccination cards. HBsAg-, anti-HBc-, and anti-HBs-negative individuals were vaccinated against HBV at hospital discharge, and subsequent outpatient completion of the standard vaccination protocol was recommended in detail in the discharge letter. At months 2 and 8, titer controls were performed, and completion of vaccination was evaluated.ResultsWe prospectively recruited 37 patients. At baseline, the vaccination rate against HBV was 24% (N=9/37), and 3/9 HBV vaccinated patients presented with an anti-HBs-titer >10 IU/L. Thus, N=34 were vaccinated with Engerix® or Twinrix®. We evaluated 26/34 patients at month 2 and 10/26 again at month 8. The second vaccine dose was obtained by 21/26 (80%) of the patients seen at month 2, and 9/10 (90%) seen at month 8 obtained the third vaccine dose by primary care physicians or ambulant hepatologists. Only 2 patients presented with an anti-HBs-titer >10 IU/L at month 8.ConclusionsInitiation of HBV vaccination during hospitalization and detailed recommendations on subsequent vaccinations in the discharge letter improve previously inadequate vaccination rates in the outpatient setting. Similar measures should be implemented at earlier time points of chronic liver diseases to achieve higher immune response rates.

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“…Therefore, application of the second dose of Bexsero should not strictly be carried out 1 month following the first dose, but scheduled individually considering current and planned immunosuppressive treatment. Additionally, evidence for lowering of immunogenicity under immunosuppressive treatment emphasized the advantage of systematic implementation of vaccinations for transplant candidates on the waiting list in order to obtain higher immunization rates which are often neglected despite clear consensus and strong recommendations regarding pre-transplant immunization [39][40][41].…”

Section: Protective Titers 50%mentioning

confidence: 99%

Low efficacy of vaccination against serogroup B meningococci in patients with atypical hemolytic uremic syndrome

et al. 2020

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Background: The C5 complement inhibitor eculizumab is first-line treatment in atypical hemolytic uremic syndrome (aHUS) going along with a highly increased risk of meningococcal infections. Serogroup B meningococci (MenB) are the most frequently encountered cause for meningococcal infections in Europe. Efficacy of the protein-based MenB-vaccine Bexsero in aHUS has not been determined and testing is only possible in patients off-treatment with eculizumab as a human complement source is required. Methods: Patients with aHUS were vaccinated with two doses of the protein-based MenB-vaccine Bexsero. Serum bactericidal antibody (SBA) titers against factor H binding protein (fHbp) of MenB were determined in 14 patients with aHUS off-treatment with eculizumab. Results: Only 50% of patients showed protective human serum bactericidal antibody (hSBA) titers (≥1:4) against MenB following two vaccinations. Bactericidal antibody titers were relatively low (≤1:8) in three of seven patients with protective titers. While 71% of patients were on immunosuppressive treatment for either thrombotic microangiopathy or renal transplantation at either first or second vaccination, all four patients not receiving any immunosuppressive treatment showed protective bactericidal antibody response. Time between second vaccination and titer measurement was not significantly different between patients with protective titers compared with those with non-protective titers, while time between first and second vaccination was significantly longer in patients with protective titers going along with a tendency for reduction in immunosuppressive treatment. Conclusions: Efficacy of vaccination against MenB is insufficient in patients with aHUS. Response to vaccination seems to be hampered by immunosuppression. Therefore, implementation of adequate antibiotic prophylaxis seems pivotal.

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Immunization in end stage renal disease: The perception of waiting list patients

Cited by 7 publications

References 18 publications

Serologic screening and infectious diseases consultation in renal transplant candidates for measles, mumps, rubella and varicella

Serologic screening and infectious diseases consultation in renal transplant candidates for measles, mumps, rubella and varicella

Hepatitis B Vaccination in Patients with Liver Cirrhosis Evaluated for Liver Transplantation – A Simple Intervention Ensures High Adherence

Low efficacy of vaccination against serogroup B meningococci in patients with atypical hemolytic uremic syndrome

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