Immunogenicity of Human Papillomavirus Recombinant Vaccine in Children with CKD

Abstract

Background and objectives There is a disproportionate burden of human papillomavirus (HPV) -related genital tract disease in patients with CKD and kidney transplantation; therefore, the potential effect of the quadrivalent HPV vaccine (Gardasil; Merck GmbH, Darmstadt, Germany) is profound. Immune abnormalities associated with CKD and immunosuppression may prevent optimal vaccine response. Our objective was to determine antibody response to the HPV vaccine in adolescent girls with CKD.Design, setting, participants, & measurements This cohort study conducted from 2008 to 2012 included 57 girls aged 9-21 years old with CKD (n=25), on dialysis (n=9), or with status postkidney transplantation (n=23) who received the standard three-dose vaccine series of the HPV vaccine recruited from two pediatric nephrology clinics. Antibody levels to HPV genotypes 6, 11, 16, and 18 were measured before vaccine dose 1 (baseline), ,12 months after vaccine dose 3 (blood draw 2), and $12 months after vaccine dose 3 (blood draw 3). Seropositivity was defined as antibody level above an established threshold for each HPV genotype. Not all participants completed three blood draws.Results Antibody response to all four HPV genotypes was 100% in the CKD and dialysis groups with samples drawn at ,12 and $12 months after dose 3 of the HPV vaccine. Among patients with transplants, the percentages of patients achieving seropositivity were significantly lower at blood draw 2 for HPV genotypes 6 (63.6%; P=0.003), 11 (63.6%; P=0.003), and 18 (72.7%; P=0.02) and blood draw 3 for HPV genotypes 6 (62.5%; P=0.02), 11 (50%; P=0.001), 16 (75%; P=0.04), and 18 (50%; P=0.001).Conclusions Antibody response to the quadrivalent recombinant HPV vaccine was robust and sustained in girls and young women with CKD and on dialysis. A less robust response to the vaccine was observed among those with a kidney transplant. Additional study is needed to determine if vaccination before kidney transplantation or an alternative vaccination regimen would benefit transplant recipients.

Multidisciplinary, evidence-based consensus guidelines for human papillomavirus (HPV) vaccination in high-risk populations, Spain, 2016

“…Three papers of HPV vaccination in solid organ or haematopoietic stem cell transplantation were selected [104-106] (Supplementary material Table S6). Epidemiological data show a high risk of gynaecological and other cancers in transplant recipients [102].…”

Human Papillomavirus Vaccination in Male and Female Adolescents Before and After Kidney Transplantation: A Pediatric Nephrology Research Consortium Study

“…In 2014, a study initiated HPV vaccination in 14 pediatric KT recipients; unfortunately six of them developed acute rejection shortly after the initiation of the vaccine series, which lead to an early termination of the study (53). In contrast, in 2016, only two of the 23 pediatric KT recipients of HPV vaccination were reported to have acute rejection episodes (41). In our patient population, we report a similar acute rejection burden; upon chart review, it was felt that our two cases of acute rejection were related to medication non-adherence, as opposed to vaccine administration.…”

The effect of history of abnormal pap smear or preceding HPV infection on the humoral immune response to Quadrivalent Human Papilloma virus (qHPV) vaccine in women with systemic lupus erythematosus

“…23-26 A suboptimal vaccine response to HPV vaccination was seen in kidney and other solid organ transplant recipients. 27 , 28 In children with a variety of immunosuppressive disorders, adequate immune response to vaccine was reported, but with lower GMT titers induced than in normal children. 29 In autoimmune diseases, including SLE, similar findings were noted with HPV vaccine being immunogenic but inducing lower GMTs than seen in the normal population.…”