Vaccine Recommendations for Patients on Chronic Dialysis

Abstract

Pediatric patients on dialysis should receive all the vaccines currently recommended by the ACIP and the AAP for healthy children, except the oral polio vaccine (34, 35). Adult patients should receive the hepatitis B vaccine series, pneumococcal vaccine, yearly influenza vaccinations, tetanus-diphtheria toxoids, and varicella vaccine, if they are susceptible (33, 48, 69). Vaccines are well tolerated by these patients (33), but higher doses and/or additional boosters may be required periodically to adequately protect dialysis patients from vaccine-preventable diseases (33, 36, 37, 82, 83). Following vaccination, antibody concentrations for hepatitis B vaccine should be measured annually and booster doses administered when antibody concentrations fall below protective levels (33, 38). Although both children and adults on dialysis may show an impaired and/or delayed immunologic response to certain antigens, particularly hepatitis B virus and S. pneumoniae, appropriate immunizations can significantly reduce the risk of serious complications from vaccine-preventable diseases (11, 84). Because the protection these vaccines provide may be incomplete or transient, infection control strategies at hospitals and other health care facilities should be implemented simultaneously. Health care providers are encouraged to assess each patients need for vaccinations individually and formulate immunization strategies early in the course of progressive renal disease, ideally before the patient requires dialysis.

Erythropoietin Use and Immunogenicity of Hepatitis B Virus Vaccine in Chronic Kidney Disease Patients: A Meta-Analysis

“…Adverse reactions are mild and largely confined at the site of injection; systemic reactions are uncommon. Regular monitoring of antibody levels to ensure that antibody concentrations remain above the protective level of 10 mIU/ml and booster vaccination whenever the levels of antibody against hepatitis B surface antigen (anti-HBs titers) fall below 10 mIU/ml have been recommended [40]. Vaccination with recombinant vaccine should be performed in patients on maintenance dialysis irrespective of rHuEPO administration.…”

Improved Immunogenicity of a Novel Third-Generation Recombinant Hepatitis B Vaccine in Patients with End-Stage Renal Disease

“…It has been recommended that dialysis patients receive higher and more frequent doses than healthy adults [24]. Increasing the dose of the recombinant second-generation vaccines from 20 to 40 µg resulted in a dramatically increased response rate [25]. Also, alternative routes of administration such as intradermal vaccination appear to increase responsiveness [26, 27, 28].…”

“…However, there are no data regarding long-term protection following intradermal vaccination. Revaccination is recommended for patients who do not develop protective antibody levels after an initial vaccination series [25]. Postvaccination anti-HBs testing should be performed annually thereafter, and a booster dose is recommended if the anti-HBs titer falls below the seroprotective level of 10 mU/ml.…”

Selected Primary Care Issues and Comorbidities in Children Who Are on Maintenance Dialysis

“…Recommendations for vaccination vary between countries, with most recommending immunization of a child who is on dialysis as per the schedule for the general population (6). In particular, all children who are on dialysis should be immunized against Streptococcus pneumoniae, varicella, and influenza (5), and all live virus vaccines (e.g., measles-mumps-rubella, varicella) with the exception of oral polio are safe, as are inactivated or component vaccines.…”