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Immunization in children with chronic renal failure
Guido F Laube1, Christoph Berger, Philippe Goetschel
1Nephrology Unit, University Children's Hospital, Zurich, Switzerland.
Insights
Pediatric patients on dialysis or post-renal transplant showed high immunization rates and detectable antibodies. Despite a few infections, vaccination by the renal team proved effective in protecting these vulnerable children.
Area of Science:
- Pediatric Nephrology
- Immunology
- Transplantation
Background:
- Children on immunosuppression, particularly after organ transplantation, are at high risk for infections.
- Routine immunization is crucial for protecting healthy children, but its efficacy in immunocompromised pediatric populations requires careful evaluation.
Purpose of the Study:
- To assess the immunization rate and effectiveness in pediatric patients undergoing dialysis and renal transplantation.
- To analyze the impact of a dedicated renal unit in administering vaccinations and monitoring antibody responses.
Main Methods:
- Retrospective analysis of clinical data, vaccination records, and serum antibody titers in 62 children (1987-2000).
- Vaccinations administered by the renal unit included diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps, rubella, hepatitis B, influenza, Hemophilus influenzae type b, varicella, and Streptococcus pneumoniae.
Main Results:
- All 62 patients received standard vaccinations; influenza and H. influenzae type b vaccines were introduced later. Varicella and S. pneumoniae vaccines were given to specific subgroups.
- All vaccinated patients demonstrated detectable serum antibodies against the administered vaccines.
- Three infections occurred post-vaccination: one varicella case and two peritonitis episodes (H. influenzae, S. pneumoniae) in a patient on peritoneal dialysis.
Conclusions:
- A high immunization rate was achieved through monitoring and administration by the renal team.
- The study suggests vaccination is effective, evidenced by antibody titers and low infection rates, though a few breakthrough infections indicate the need for ongoing vigilance.
Abstract:
Infections jeopardize children on immunosuppression after organ transplantation. Immunization is protective in healthy children. The aims of this study were to analyze the rate and efficacy of immunization in 62 children undergoing dialysis and renal transplantation (RTPL) between 1987 and 2000. The analysis was based on clinical findings, vaccination certificates, and measurement of specific serum antibodies. A member of the renal unit administered vaccinations. All 62 patients were immunized against diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps, rubella, and hepatitis B. Since introduction in 1991 and 1995, 44 and 42 children were also vaccinated against influenza and Hemophilus influenzae type b, respectively. Of 16 patients with a negative history, 14 were given varicella vaccine; 16 children on peritoneal dialysis (PD) or with nephrotic syndrome were immunized against Streptococcus pneumoniae. All vaccinated patients had detectable serum antibodies against measles, mumps, rubella, varicella, hepatitis B, H. influenzae, and S. pneumoniae. There were 3 infections despite vaccination; 1 patient developed varicella after RTPL and 1 patient on PD had 2 episodes of peritonitis caused by H. influenzae and S. pneumoniae. In conclusion, monitoring and administration of the vaccines by the renal team enabled a high immunization rate. Whether vaccines, as documented by antibody titers, or by the low prevalence in the general population promoted the low prevalence of infections remains open, as there were at least a few vaccination failures.