Nephrol Dial Transplant (1996) 11: 468-473
© 1996 European Renal Association-European Dialysis and Transplant Association
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Pneumococcal vaccine in children and young adults with chronic renal disease
1University Children's Hospital of Cologne, University Hospital of Aachen Germany 2Institute of Medical Microbiology, University Hospital of Aachen Germany
Correspondence and offprint requests to: Correspondence and offprint requests to: Arno Fuchshuber MD, INSERM U423, Hôpital Necker, Enfants Malades, 149, rue de Sevres, 75743 Paris Cedex 15, France
BACKGROUND.: Pneumococcal vaccination has been recommended for immunocompromised children over 2 years including patients with chronic renal disease. However, the effect of vaccination and revaccination is variable and the indication for immunization is a subject of controversy.
METHODS.: Forty children and young adults with chronic renal diseases (including the idiopathic nephrotic syndrome, chronic renal failure, patients undergoing dialysis and after transplantation) were vaccinated with a 23-valent pneumococcal vaccine. The efficacy of the vaccine was evaluated by measuring antibody titres before and 4 weeks, 6 months, and 12 months after vaccination. Twenty-two patients were submitted to a revaccination 1 year after the first vaccination.
RESULTS.: A sufficient immune response, defined as an at least fourfold increase of postvaccinal antibody titres and an antibody titre >200, was observed in 83% of the patients 4 weeks after vaccination, but only in 68% after 6 months, and in 48% after 1 year. Revaccination produced a significant immune response in 11/22 patients (50%) followed by a rapid decline of antibody levels within 6 months. Both vaccinations were well tolerated.
CONCLUSIONS.: 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.
Keywords: renal failure; Streptococcus pneumoniae; vaccination
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