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Published on: March 8, 2012
Immunogenicity of Human Papillomavirus Recombinant Vaccine in Children with CKD
Delphine R Nelson1, Alicia M Neu1, Alison Abraham2
1Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Insights
Adolescent girls with chronic kidney disease (CKD) and on dialysis showed a strong antibody response to the human papillomavirus (HPV) vaccine. Transplant recipients had a weaker response, suggesting a need for further study on optimal vaccination strategies.
Area of Science:
- Immunology
- Nephrology
- Vaccinology
Background:
- Human papillomavirus (HPV) poses a significant health risk for individuals with chronic kidney disease (CKD) and those who have undergone kidney transplantation.
- Immune system dysfunction in CKD and immunosuppression post-transplant may impair vaccine efficacy.
- Understanding the antibody response to HPV vaccination in this vulnerable population is crucial.
Purpose of the Study:
- To evaluate the antibody response to the quadrivalent HPV vaccine in adolescent girls with CKD.
- To compare vaccine response across different stages of kidney disease: CKD, dialysis, and post-kidney transplant.
Main Methods:
- A cohort study involving 57 girls aged 9-21 with CKD, on dialysis, or post-kidney transplant.
- Standard three-dose HPV vaccine administration.
- Measurement of antibody levels against HPV genotypes 6, 11, 16, and 18 at baseline, <12 months, and ≥12 months post-vaccination.
Main Results:
- 100% seropositivity for all four HPV genotypes was observed in CKD and dialysis groups at both follow-up time points.
- Kidney transplant recipients showed significantly lower seropositivity rates for multiple HPV genotypes at both <12 and ≥12 months post-vaccination.
- Specific genotype responses varied, with lower percentages achieving seropositivity in the transplant group.
Conclusions:
- The quadrivalent HPV vaccine elicits a robust and sustained antibody response in girls with CKD and those on dialysis.
- Kidney transplant recipients exhibit a diminished antibody response to the HPV vaccine.
- Further research is warranted to explore pre-transplant vaccination or alternative vaccination schedules for transplant recipients to optimize protection against HPV.
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.
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