Active Influenza Immunization in Hemodialysis Patients: Comparison between Single-Dose and Booster Vaccination

Abstract

Background/Aims: Hemodialysis (HD) patients are recommended to be immunized against influenza annually, but the immune response after vaccination is known to be weakened in these patients. We intended to compare the efficacy of influenza vaccines in HD patients with that in healthy people, and we also evaluated the additive effect of a booster vaccination in HD patients. Methods: During the 2003–2004 influenza season, 100 patients on HD and 50 age-matched healthy controls were recruited from the Korea University Guro Hospital. The HD patients were divided into two groups: single-dose group (50 patients) and booster group (50 patients). Eight weeks following the influenza vaccination, the serum antibody responses were compared. Results: Although the antibody response of the HD patients was impaired in comparison with that of healthy controls, more than 90% of the HD patients showed protective antibody levels. Booster vaccination did not significantly increase the immune response in HD patients. Conclusions: Influenza vaccination in HD patients should be encouraged, but the immune response was comparatively impaired in subpopulations, including patients with a long-term HD history (>2.5 years), with a higher urea reduction rate, or with underlying diabetes. There was no effect of a booster vaccine dose on the antibody titers.

Influenza A/H1N1 Vaccine in Patients Treated by Kidney Transplant or Dialysis

“…Previous asymptomatic infection with the new influenza A/H1N1 2009 virus, as well as some minor degree of false-positive assays, might contribute to the presence at baseline of low titers in a small proportion of patients (4). Our seroconversion rates are similar to those reported with the seasonal influenza vaccine both in RT (8 -11,26,27) and HD (12,28) patients. As compared with seroconversion rates recorded previously with seasonal H1N1 vaccines, such as A/New Caledonia/20/99 (H1N1), the proportion of responders among our RT patients seems to be higher.…”

“…Either a single dose of 3.75 g of adjuvanted or 15 g of nonadjuvanted vaccine resulted in sero-conversion in approximately 75% to 90% of healthy volunteers (6,7). In solid organ recipients (8)(9)(10)(11) and dialysis patients (12), the overall rate of seroconversion to the seasonal flu vaccine is in the range of 30% to 50%. The use of adjuvanted vaccine has raised concerns for immunocompromised patients, because of possible induction of allo-immune responses, such as anti-human histocompatibility leukocyte antigen (HLA) antibodies (Abs) or MHC class I-related chain A (MICA) Abs (13)(14)(15)(16).…”

Seasonal influenza vaccination is associated with reduced morbidity and mortality in peritoneal dialysis patients

“…Booster vaccination may not enhance the immune response [22,23]. The humoral immune response to influenza vaccination is better in PD patients than HD patients, probably because of better clearance of middle molecules [20,25].…”

“…The humoral immune response to influenza vaccination is better in PD patients than HD patients, probably because of better clearance of middle molecules [20,25]. Influenza vaccination is safe without serious side effects in ESRD patients and the number of minor adverse reactions is low [22,23].…”

Analyzing Pathogen Transmission in the Dialysis Unit

“…Attempts to change antimicrobial prescribing practices in hopes of limiting the induction or spread of resistance have not proved as effective as hoped, and such interventions do not address horizontal transmission of existing resistant organisms. Similarly, antiviral agents may be of limited efficacy, effective vaccines are not always available, compliance with vaccination programs can be limited, and the quality of the immunologic response to vaccination in patients with ESRD can be poor (9,10).…”