Pneumococcal vaccine in children and young adults with chronic renal disease.
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.
Fuchshuber
A
A
University Children's Hospital of Cologne, Germany.
Kühnemund
O
O
Keuth
B
B
Lütticken
R
R
Michalk
D
D
Querfeld
U
U
D000293:Adolescent; D000328:Adult; D000907:Antibodies, Bacterial / Q000032:analysis; D001428:Bacterial Vaccines / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007117:Immunization, Secondary; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000276:immunology; D011008:Pneumococcal Infections / Q000150:complications / Q000276:immunology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines; D013296:Streptococcus pneumoniae / Q000276:immunology*; D014611:Vaccination / Q000379:methods*
D000907:Antibodies, Bacterial; D001428:Bacterial Vaccines; D022242:Pneumococcal Vaccines