title: Immunogenicity of Human Papillomavirus Recombinant Vaccine in Children with CKD.
abstract: There is a disproportionate burden of human papillomavirus (HPV) -related genital tract disease in patients with CKD and kidney transplantation; therefore, the potential effect of the quadrivalent HPV vaccine (Gardasil; Merck GmbH, Darmstadt, Germany) is profound. Immune abnormalities associated with CKD and immunosuppression may prevent optimal vaccine response. Our objective was to determine antibody response to the HPV vaccine in adolescent girls with CKD.
  
  
  
  This cohort study conducted from 2008 to 2012 included 57 girls aged 9-21 years old with CKD (n=25), on dialysis (n=9), or with status postkidney transplantation (n=23) who received the standard three-dose vaccine series of the HPV vaccine recruited from two pediatric nephrology clinics. Antibody levels to HPV genotypes 6, 11, 16, and 18 were measured before vaccine dose 1 (baseline), <12 months after vaccine dose 3 (blood draw 2), and ≥12 months after vaccine dose 3 (blood draw 3). Seropositivity was defined as antibody level above an established threshold for each HPV genotype. Not all participants completed three blood draws.
  
  
  
  Antibody response to all four HPV genotypes was 100% in the CKD and dialysis groups with samples drawn at <12 and ≥12 months after dose 3 of the HPV vaccine. Among patients with transplants, the percentages of patients achieving seropositivity were significantly lower at blood draw 2 for HPV genotypes 6 (63.6%; P=0.003), 11 (63.6%; P=0.003), and 18 (72.7%; P=0.02) and blood draw 3 for HPV genotypes 6 (62.5%; P=0.02), 11 (50%; P=0.001), 16 (75%; P=0.04), and 18 (50%; P=0.001).
  
  
  
  Antibody response to the quadrivalent recombinant HPV vaccine was robust and sustained in girls and young women with CKD and on dialysis. A less robust response to the vaccine was observed among those with a kidney transplant. Additional study is needed to determine if vaccination before kidney transplantation or an alternative vaccination regimen would benefit transplant recipients.
authors.affiliation: Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Delphine R
authors.initials: DR
authors.lastname: Nelson
authors.affiliation: Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Neu
authors.affiliation: Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Alison
authors.initials: A
authors.lastname: Abraham
authors.affiliation: Division of Pediatric Nephrology, University of Pennsylvania School of Medicine and the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
authors.forename: Sandra
authors.initials: S
authors.lastname: Amaral
authors.affiliation: Division of Pediatric Nephrology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Donald
authors.initials: D
authors.lastname: Batisky
authors.affiliation: Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Fadrowski
mesh_terms: D000293:Adolescent; D000914:Antibodies, Viral / Q000097:blood*; D002648:Child; D005260:Female; D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18 / Q000276:immunology*; D052140:Human papillomavirus 11 / Q000276:immunology*; D052162:Human papillomavirus 16 / Q000276:immunology*; D052161:Human papillomavirus 18 / Q000276:immunology*; D052163:Human papillomavirus 6 / Q000276:immunology*; D006801:Humans; D007115:Immunization Schedule; D007676:Kidney Failure, Chronic / Q000276:immunology* / Q000628:therapy; D016030:Kidney Transplantation; D006435:Renal Dialysis; D013997:Time Factors; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18
keywords: Antibody Formation; Child; Humans; Papillomavirus Infections; Papillomavirus Vaccines; chronic kidney disease; clinical immunology; immunosuppression; kidney transplantation; renal dialysis