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Defective antibody response to Hemophilus influenzae type b immunization in children receiving peritoneal dialysis
B A Fivush1, B Case, B A Warady
1Division of Pediatric Nephrology, Johns Hopkins University, School of Medicine, Baltimore, Maryland.
Insights
Children on chronic peritoneal dialysis (CPD) often have weakened immune responses. Antibody levels to Hemophilus influenzae type b (Hib) should be monitored post-vaccination to ensure long-term protection.
Area of Science:
- Immunology
- Nephrology
- Pediatrics
Background:
- Pediatric end-stage renal disease patients on chronic peritoneal dialysis (CPD) may exhibit immunological abnormalities.
- These abnormalities can include hypogammaglobulinemia and diminished vaccine responses.
- Assessing specific antibody levels in these patients is crucial for understanding their immune status.
Purpose of the Study:
- To measure antibody levels to Hemophilus influenzae type b (Hib) in pediatric patients undergoing CPD.
- To evaluate the adequacy and durability of Hib immunization in this vulnerable population.
Main Methods:
- Antibody levels to Hib were measured in 24 pediatric patients on CPD.
- Eight children received primary Hib immunization during CPD.
- Sixteen patients, older than 5 years at vaccine licensure, were assessed for existing anti-Hib antibody levels.
Main Results:
- 12% of children primarily immunized during CPD lacked protective Hib antibody levels.
- In one child, protective Hib antibody levels became undetectable within 12 months post-immunization.
- 31% of older, unimmunized patients lacked protective anti-Hib antibody levels, though some responded to vaccination.
Conclusions:
- Childhood immunizations may not confer long-lived immunity in CPD patients.
- Regular monitoring of antibody levels post-immunization is necessary to confirm and maintain immunity.
- This highlights the need for tailored vaccination strategies and follow-up in pediatric renal disease patients.
Abstract:
Pediatric end-stage renal disease patients, maintained on chronic peritoneal dialysis (CPD), may have a variety of immunological abnormalities, including hypogammaglobulinemia and poor responses to vaccines. We measured antibody levels to Hemophilus influenzae type b (Hib) in 24 CPD patients. Eight children received primary Hib immunization while undergoing CPD. Of these, 1 of 8 (12%) lacked protective levels of antibody. In another child, who had an initial protective response, antibody levels were undetectable 12 months after immunization. Sixteen of the patients had not been immunized with Hib vaccine because they were more than 5 years old when the vaccine was licensed. In this group, 5 of 16 (31%) lacked protective levels of anti-Hib antibody. Of those available for follow-up, 3 responded normally to Hib vaccine. It is not sufficient to provide childhood immunizations to CPD patients with the assumption that those immunizations will lead to long-lived immunity. Antibody levels should be measured within a month of immunization and at regular intervals thereafter to document immunity.