title: Influenza vaccination in patients with end-stage renal disease.
abstract: BACKGROUND
  Patients with end-stage renal disease (ESRD) are considered at higher risk of influenza-related complications and are listed worldwide among the subjects for whom yearly influenza vaccination is strongly recommended. However, influenza vaccination coverage of patients with ESRD is significantly lower than desired.
  
  
  METHODS
  This paper explores why compliance with official recommendations for influenza vaccination is poor in patients with ESRD and analyzes the true risk of infection as well as the immunogenicity, the effectiveness and the safety of influenza vaccination in these patients.
  
  
  CONCLUSIONS
  Epidemiological and clinical data support the importance of influenza in conditioning clinical deterioration of patients with ESRD, particularly in relation to their level of immunosuppression. However, the variable levels of immunodeficiency detected in patients with ESRD may reduce the immune response to influenza vaccination, which appears to be lower than that usually found in healthy subjects. However, few studies are available, and they are difficult to compare for several reasons. Additionally, limited data have been collected on influenza vaccine effectiveness, although the available studies support positive results of vaccination on outcomes of severe disease. Despite such limitations, it is important to highlight that all the available studies have confirmed the good safety and tolerability of inactivated influenza vaccines. These findings, together with the risks associated with influenza in these patients, support annual influenza vaccination in patients with ESRD as well as vaccination of their close contacts and should be presented in educational programs organized for nephrologists and patient associations.
authors.affiliation: Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation , Via Commenda 9 20122, Milano , Italy +39 02 55032203 ; +39 02 50320206 ; nicola.principi@unimi.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Principi
authors.forename: Susanna
authors.initials: S
authors.lastname: Esposito
mesh_terms: D006801:Humans; D016867:Immunocompromised Host; D007252:Influenza Vaccines / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D007251:Influenza, Human / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000150:complications*; D010349:Patient Compliance
chemical_list: D007252:Influenza Vaccines
keywords: end-stage renal disease; influenza; influenza prevention; influenza vaccination; influenza vaccine; vaccine safety