Pneumococcal vaccine in children and young adults with chronic renal disease

Abstract

The currently available vaccine is without major side-effects and effective in producing a significant immune response. Antibody levels should be monitored in vaccinated patients with chronic renal diseases considering the rapid decline as early as 6 months after vaccination. Evaluation of the efficacy of revaccination in these patients requires further investigations.

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

“…In four of the five studies that included a control group [11, 12, 13, 14, 17], post-immunization titers were lower in renal allograft recipients, but the difference was usually only statistically significant for individual serotypes. Follow-up serology was performed in six of the studies 1–3.5 years later [7, 11, 13, 15, 17, 18], with two of these studies also having follow-up data on controls [11, 17]. There was always a drop in antibody titers in the renal allograft recipients at follow-up.…”

“…Antibody titers tended to be lower in CRI patients than in controls at baseline [11, 18, 21]. Responses were less robust than were those of controls in four studies [11, 14, 17, 21], but the differences were not always statistically significant.…”

“…In a fourth study with controls, response was reported to be equivalent to controls [22]but no data was presented. Follow-up serology was obtained 6 months to 3.5 years later in six of the studies [7, 11, 15, 17, 18, 21]. The titers in patients with CRI continued to rise between 1 and 6 months post-immunization in one study [21], were stable at 12 months in another study [7], and declined by 6 months in a third study [18].…”

“…Follow-up serology was obtained 6 months to 3.5 years later in six of the studies [7, 11, 15, 17, 18, 21]. The titers in patients with CRI continued to rise between 1 and 6 months post-immunization in one study [21], were stable at 12 months in another study [7], and declined by 6 months in a third study [18]. Antibody titers in patients on hemodialysis showed a marked decline at 1 year [17]and 2 years [15]post-immunization, with less of a decline in patients with CRI who were not on dialysis [17].…”

“…One study reported that 2 children on cyclophosphamide and chlorambucil respectively did not respond to PPV [28], and none of the other studies reported data separately for children on immunosuppressive agents other than corticosteroids. Two studies had long-term follow-up, with one reporting that 78% of patients maintained a response to PPV for 6 months, and 56% for 12 months [18]. The other study reported that all 9 patients with minimal change NS maintained presumptive protective titers to 12 serotypes after 5 years, but the 9 patients with other types of NS did not [27].…”