Vaccination Practices in Pediatric Dialysis Patients Across Europe. A European Pediatric Dialysis Working Group and European Society for Pediatric Nephrology Dialysis Working Group Study

Abstract

Background: Data on the immunization practices in pediatric chronic kidney disease (CKD) patients are scarce. The purpose of this study was to evaluate current vaccination practices for children on dialysis across European pediatric nephrology centers. Methods: A total of 18 tertiary pediatric nephrology centers from 12 European countries were included in the study. The data on universal national immunization programs and immunization practices for children with chronic disease or risk were recorded from European Center for Disease Prevention and Control and the World Health Organization. The immunization practices and center protocols for monitoring antibody titers after vaccination in dialysis patients were obtained through a questionnaire. Results: All centers included in the study recommended immunization against hepatitis B virus (HBV), diphtheria, tetanus, pertussis, Hemophilus influenzae type b (Hib), poliomyelitis, measles, mumps, rubella (MMR), and streptococcus pneumonia in dialysis patients. In 16 centers, dialysis patients were vaccinated against influenza virus annually. HBV protective antibody titers were measured in 17 centers (during dialysis period in 14 centers, during pre-renal transplantation preparations in 14 centers or in both times in 11 centers). Hepatitis A virus (HAV) was reported to be followed in 13 centers, in 8 centers during dialysis period, and in 11 centers during pre-RTx preparations. MMR and varicella-zoster virus (VZV) protective antibody titers were measured during the dialysis period or before renal transplantation (RTx) in 12 and 15 centers, respectively, and in 6 centers both titers were checked both times. Conclusion: There are variations in vaccination practice across Europe. Children with CKD, those undergoing dialysis, and transplant candidates should receive age-appropriate vaccinations before RTx as well as before the transition to adult nephrology clinics and antibody levels should be monitored to evaluate the immunization status before and after RTx.

Preventing tuberculosis in paediatric kidney transplant recipients: is there a role for BCG immunisation pre-transplantation in low tuberculosis incidence countries?

“…BCG is included in the national schedule for some countries for all children and in other countries, only in children at risk of TB infection. In some countries, CKD is considered a risk factor for TB disease in itself and it is therefore recommended for all these children if not previously administered [39][40][41]. A recent survey in 18 tertiary paediatric nephrology centres from 12 European countries showed that BCG was recommended as part of the national schedule in five countries, recommended in CKD in three countries and had no specific recommendation in the remaining four countries [39].…”

“…BCG immunisation for children with CKD or undergoing kidney transplantation has previously been advocated in some low incidence settings [39]. However, some caution for the use has been expressed, in particular for those children who are receiving immunosuppressive therapy or are known to have an underlying immunodeficiency.…”

Kronik Böbrek Yetmezlikli Çocuk Sahibi Olan Ebeveynlerin Aşılar Hakkındaki Bilgi Düzeyi

“…Kronik böbrek yetersizliği (KBY) hastalarında enfeksiyonlar en sık ölüm nedenlerindendir (3). İmmünsüpresif ilaç tedavileri, üremik toksinler, diyaliz tedavisi, malnütrisyon ve aşı sonrası düşük antikor yanıtı KBY hastalarının enfeksiyonlara daha duyarlı olmasının başlıca nedenleridir (4)(5)(6). Bu bakımdan KBY hastalarında ulusal aşı takvimine ek olarak aşı takviminde olmayan aşıların da tamamlanması önerilmektedir.…”

Awareness and Practice of Vaccination of Chronic Hemodialysis Patients by Specialist Nephrology Practitioners in Nigeria: A Cross-Sectional Survey

“…For instance, repeated booster doses of pneumococcal vaccine were found to reduce infection rates among dialysis patients within 2 years, whereas doubling the dosage of hepatitis B vaccine has seen improvements in immunization response against HBV infection [6][7][8]. Vaccination of CKD patients is far advanced in the developed countries with only minor differences in practice and attainment of recommended targets among them [9]. However, the same cannot be said for nephrology practice in Nigeria and many other countries in Sub-Saharan Africa as their dismal performance in this aspect of CKD care is mirrored by a lack of data or research on the subject.…”

“…For instance, repeated booster doses of pneumococcal vaccine were found to reduce infection rates among dialysis patients within 2 years, whereas doubling the dosage of hepatitis B vaccine has seen improvements in immunization response against HBV infection [ 6 – 8 ]. Vaccination of CKD patients is far advanced in the developed countries with only minor differences in practice and attainment of recommended targets among them [ 9 ].…”