Influenza virus vaccination in children with nephrotic syndrome: insignificant risk of relapse

Abstract

Background Immunization with various vaccines is considered desirable for children with idiopathic nephrotic syndrome (NS) because of their high risk of severe infections. Vaccinations may precipitate relapses of NS, but there is no available data regarding inactivated influenza (flu) virus vaccines. Methods We retrospectively reviewed the medical records of children with NS who had received flu vaccines between 2002 and 2015. The day of flu vaccination was defined as day 0, and the period between the pre-vaccination and the post-vaccination days was defined as − X to + Y. The risk ratios and their 95% confidence intervals for NS relapse rate were estimated by generalized estimating equation (GEE) Poisson regression. Results A total of 104 pediatric patients received 208 flu vaccines. The mean age at onset of NS was at 4.85 ± 3.87 years old. There were 261 NS relapses between days − 180 and + 180. Compared with the relapse rate in the − 180 to 0 interval (1.19 times/person-year), those in 0 to + 30 (1.23), + 31 to + 60 (1.58), + 61 to + 90 (1.41), + 91 to + 120 (1.41), and + 121 to + 180 (1.32) days groups were slightly increased, but without significance. Multivariate analysis using GEE Poisson regression also showed no significant increase in relapse rate in each day group compared with days − 180 to 0. Risk ratios for NS relapse were significantly higher in children who were treated with steroids at the first vaccination. Conclusions Our results suggest that flu vaccines should not be avoided in children with NS based on the potential for NS relapses. Electronic supplementary material The online version of this article (10.1007/s10157-020-01930-8) contains supplementary material, which is available to authorized users.

IPNA clinical practice recommendations for the diagnosis and management of children with steroid-sensitive nephrotic syndrome

“…Evidence and rationale Vaccination with inactivated vaccines should follow the recommended schedule for healthy children, including vaccinating against encapsulated bacteria (especially meningococcal, H. influenza, and pneumococcal). The risk of vaccine-induced relapses has been shown to be low in numerous studies [229][230][231][232]. We recommend annual vaccination against influenza [232][233][234].…”

De Novo and Relapsing Glomerular Diseases After COVID-19 Vaccination: What Do We Know So Far?

“…Acute onset of MCD has been described in adults following the influenza vaccine. 19 , 20 Retrospective 21 and, more recently, prospective 22 cohorts of children with nephrotic syndrome have shown a small rate of relapsing disease post-vaccination that is no different from the relapse rate in unvaccinated children. These kinds of comparative analyses have not been reported in adults with nephrotic syndrome.…”

Nephrotic syndrome with minimal change disease after the Pfizer-BioNTech COVID-19 vaccine: two cases

“…However, the relative risk of a relapse post-vaccine was significantly greater if patients were not in remission at the time of the vaccine. 16 An earlier study from the UK reported significant increases in the relapse rate of idiopathic nephrotic syndrome 12 months after the meningitis C conjugate vaccine. 17 All of these studies are retrospective and have small sample sizes, clearly more research is needed in this area.…”