Incomplete vaccination coverage in European children with end-stage kidney disease prior to renal transplantation

Höcker, Britta; Aguilar, Martin; Schnitzler, Paul; Pape, Lars; Strologo, Luca Dello; Webb, Nicholas J.A.; Bald, Martin; Genç, Gürkan; Billing, Heiko; König, Jens; Büscher, Anja; Kemper, Markus J.; Marks, Stephen D.; Pöhl, Martin; Wigger, Marianne; Topaloğlu, Rezan; Rieger, Susanne; Krupka, Kai; Brückner, Thomas; Fichtner, Alexander; Tönshoff, Burkhard

doi:10.1007/s00467-017-3776-3

Cited by 13 publications

(9 citation statements)

References 34 publications

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“…Of note, event rates of pneumonia were higher in federal states with low pneumococcal vaccination coverage [10]. In a study within the framework of the Cooperative European Paediatric Renal Transplant Initiative, the pneumococcal vaccination coverage in 254 European children eligible for transplantation due to end-stage renal disease was also low with 42% [15].…”

Section: Discussionmentioning

confidence: 99%

Pneumococcal vaccination rates in immunocompromised patients—A cohort study based on claims data from more than 200,000 patients in Germany

et al. 2019

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Background The German Committee on Vaccination recommends pneumococcal vaccination for infants, seniors 60+ years and patients at risk with defined underlying diseases. Aim of this study was to assess the pneumococcal vaccination rate (pnc-VR) in patients with certain incident inherited or acquired immunodeficiency or immunosuppression and to understand who vaccinates these patients who are particularly at high risk to develop a pneumococcal infection. Methods We conducted a cohort study in patients aged 2 years or older, with a first episode of a “high-risk” condition between January 2013 and December 2014 based on a representative sample of German claims data. Pnc-VR was calculated as the proportion of patients receiving any pneumococcal vaccine within two years after first episode of “high-risk” condition. Further analyses cover pnc-VR stratified by high risk conditions and region, time to vaccination, and physician specialty administering the pneumococcal vaccination. Results The study population comprised 204,088 incident “high-risk” patients (56% female). The overall pnc-VR within two years was 4.4% (95%-confidence interval: 4.3%-4.5%). Within specific high-risk conditions, we found the highest vaccination rate of 11.5% (10.1%-13.0%) among patients starting immunosuppressants with underlying rheumatoid arthritis followed by 9.9% (7.8%-12.4%) in HIV patients. Stratification by region revealed a slightly higher vaccination rate in Eastern (6.5%: 6.0%-6.9%) compared to Western Germany (4.2%: 4.1–4.3%). Median time to vaccination within the first two years in vaccinated patients was 332.5 days (Q1 142 days, Q3 528 days). The majority of patients (92.6%) got vaccinated by a general practitioner. Conclusion Although these vulnerable patients need protection most, our study suggests that the overall pnc-VR after a first episode of a high-risk condition for pneumococcal disease is very low and vaccination is far too late. To prevent pneumococcal disease in patients at high risk, further efforts are needed to increase awareness and improve the timeliness of pneumococcal vaccination.

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Section: Discussionmentioning

confidence: 99%

Pneumococcal vaccination rates in immunocompromised patients—A cohort study based on claims data from more than 200,000 patients in Germany

et al. 2019

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“…17.6% of patients were also vaccinated with PPSV. Despite the well known risks and vaccine recommendations, other studies in CKD patients have also demonstrated that vaccination rates are below expected and desired [4,[14][15][16][17]. A study analyzing the rate of immunization in 62 children undergoing dialysis and RT between 1987 and 2000, showed that 16 patients (25.8%) either on PD or with nephrotic syndrome were vaccinated with the non-conjugate 23-valent vaccine against S. pneumoniae [4].…”

Section: Discussionmentioning

confidence: 99%

“…Despite the benefits and vaccination recommendations, studies in chronic kidney patients, including dialysis and kidney transplant candidates, show that actual vaccination rates seem to be lower than expected and desired [4,[14][15][16][17]. Since the data about the immunization status against influenza and pneumococcus in children maintained by dialysis is rare, we aimed to evaluate influenza and pneumococcal vaccination and respective infection rates in European pediatric dialysis patients.…”

Section: Introductionmentioning

confidence: 99%

Influenza and pneumococcus vaccination rates in pediatric dialysis patients in Europe: recommendations vs reality A European Pediatric Dialysis Working Group and European Society for Pediatric Nephrology Dialysis Working Group study

ATİKEL,

BAKKALOĞLU,

PAGLIALONGA

et al. 2021

Turk J Med Sci

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Background/aim: Children on dialysis are under increased risk of influenza and invasive pneumococcal disease. Although, vaccination against these microorganisms are recommended in dialysis patients and despite the fact that these vaccines can reduce disease burden and rates of hospitalization due to infection, vaccination rates are below expected and desired. We aimed to evaluate influenza and pneumococcal vaccination and infection rates in European pediatric dialysis centers. Materials and Methods: In 16 centers from 11 countries, 357 pediatric dialysis patients were evaluated retrospectively during one year of observation period between 01.01.2014 and 01.01.2015.Results: In all centers, vaccination policy included immunization of dialysis patients with inactive influenza vaccine and pneumococcal conjugate vaccine (PCV). 50% of centers recommended pneumococcal polysaccharide vaccine following routine PCV series.Significantly higher pneumococcal vaccination rate (43.9 %) was seen in PD patients compared to those on HD (32.9 %) (p=0.035), while the rates for influenza were similar (42.4 % and 46.1 respectively, p=0.496). Among all dialysis patients, 2,2 % (n=8) developed pneumonia and 6.4 % (n=23) infected by influenza. Pneumococcic pneumonia rate was 5 % for 140 patients who received anti-pneumococcal vaccine, while only one pneumonia episode was recorded out of 2 217 unvaccinated patients (p=0.007). The influenza virus infection rates were similar for patients vaccinated and non-vaccinated (7 % and %, respectively). Conclusions:Although influenza and pneumococcal vaccines are highly recommended in pediatric dialysis patients, vaccination rates were lower than expected. Pneumococcal vaccination rates were higher in PD compared to the patients on HD. The rate of children with influenza infection was higher than pneumonia. The efficacy of influenza and pneumococcal vaccines was highlighted by the low infection rates. Higher pneumonia rates in patients vaccinated against pneumococcus compared to unvaccinated ones might be due to coexisting risk factors.

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“…Some vaccine-hesitant parents have children with organ failure who need a transplant. Despite recommendations for universal vaccination, non-vaccination and under-vaccination are common among pediatric kidney transplant candidates and recipients [24][25][26]. A 2011 survey of pediatric organ transplant centers found that 39% had experienced situations involving caregiver refusal of vaccination for nonmedical reasons [27].…”

Section: Parental Vaccine Hesitancy and Pediatric Transplantmentioning

confidence: 99%

Considering a COVID-19 vaccine mandate for pediatric kidney transplant candidates

2022

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The world continues to face the effects of the SARS-CoV-2 pandemic. COVID-19 vaccines are safe and effective in protecting recipients, decreasing the risk of COVID-19 acquisition, transmission, hospitalization, and death. Transplant recipients may be at greater risk for severe SARS-CoV-2 infection. As a result, transplant programs have begun instituting mandates for COVID-19 vaccine for transplant candidacy. While the question of mandating COVID-19 vaccine for adult transplant candidates has garnered attention in the lay and academic press, these discussions have not explicitly addressed children who may be otherwise eligible for kidney transplants. In this paper we seek to examine the potential ethical justifications of a COVID-19 vaccine mandate for pediatric kidney transplant candidacy through an examination of relevant ethical principles, analogous cases of the use of mandates, differences between adult and pediatric kidney transplant candidates, and the role of gatekeeping in transplant vaccine mandates. At present, it does not appear that pediatric kidney transplant centers are justified to institute a COVID-19 vaccine mandate for candidates. Finally, we will offer suggestions to be considered prior to the implementation of a COVID-19 vaccine mandate.

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Incomplete vaccination coverage in European children with end-stage kidney disease prior to renal transplantation

Abstract: The vaccination coverage in paediatric kidney transplant candidates is incomplete. Paediatric nephrologists, together with primary-care staff and patients' families, should therefore make every effort to improve vaccination rates before kidney transplantation.

Cited by 13 publications

References 34 publications

Pneumococcal vaccination rates in immunocompromised patients—A cohort study based on claims data from more than 200,000 patients in Germany

Pneumococcal vaccination rates in immunocompromised patients—A cohort study based on claims data from more than 200,000 patients in Germany

Influenza and pneumococcus vaccination rates in pediatric dialysis patients in Europe: recommendations vs reality A European Pediatric Dialysis Working Group and European Society for Pediatric Nephrology Dialysis Working Group study

Considering a COVID-19 vaccine mandate for pediatric kidney transplant candidates

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