Aims Chronic kidney disease is a major risk factor of vaccine preventable infectious diseases due to the altered immune system and the natural evolution of the disease. There are differences in the prescription of some vaccines for this population. The aim of this study is to elaborate a vaccination protocol for chronic kidney disease and haemodialysis patients for a better immunization coverage, care and prevention against preventable infectious diseases.

Methods The study was conducted by a multidisciplinary team composed by pharmacists, infectious disease paediatrician and nephrology paediatricians. After a literature research (in Medline with MeSH terms: ‘Kidney Failure, Chronic’, ‘Renal Dialysis’ and ‘Vaccines’)^{1 2}, we compared the French immunization schedule³ for the general population with patient with chronic kidney disease or haemodialysis patients and confront it to the physician practice in our nephrology unit. For each vaccine, we collected the following data: indication, any difference concerning dose, schedule, re-administration, antibody titration and reason for these differences.

Results The literature analysis showed disparate practices among countries and even medical centres. The most concerned vaccines were: hepatitis A and B virus vaccine, pneumococcal vaccine, flu and measles vaccines. The difference between vaccine scheduled concerned the indication (meningococcus A, B, C, Y and W135, papillomavirus), dose (hepatitis B), the schedule (hepatitis B, hepatitis A, pneumococcal, measles), re-administration (hepatitis B, varicella), antibody titration (hepatitis B, varicella). Patients with chronic kidney disease are more susceptible to develop hepatitis B infection. As for adult population, the haemodialysis patients are vaccinated with double dose⁴ of hepatitis B vaccine. The antibodies titration at our hospital is made twice a year and anti-HBs level needed are 30 to 50 UI/mL. Hepatitis A is a recommended vaccine for risk population including haemodialysis patients and chronic kidney disease patients. The vaccination schedule is the same for haemodialysis patients with two doses but the second dose is administered earlier, i.e. six months after the first with an antibody screening. For the pneumococcal vaccine, an additional dose is administered at 3 month of age for premature and at risk children and the conjugated vaccine potentiates the polyosidic vaccine. For measles, the second dose may be omitted if the antibody titration confirms the protection to allow the patient to be registered earlier on the renal transplant list. Flu vaccination is recommended with the same dose and schedule that the other patients, but tetravalent vaccines should always be chosen.

Conclusions Children with chronic kidney disease or on haemodialysis are more at risk of vaccine preventable infectious diseases and should be vaccinated earlier before beginning dialysis. The specific immunization schedule will be presented and may be used by other hospital and countries for concerned patients.

References

1. Bakkaloğlu SA, et al. Vaccination Practices in Pediatric Dialysis Patients Across Europe. A European Pediatric Dialysis Working Group and European Society for Pediatric Nephrology Dialysis Working Group Study. Nephron 2018;138:280–286.

2. Costa NCP, da Canhestro MR, Soares CMBM & Rodrigues JS. Monitoring of post-vaccination anti-HBs titles vaccine in children and adolescents in the pre-dialysis of chronic kidney disease. Braz. J. Nephrol. 2017;39:296–304.

3. DGS_Anne.M, DICOM_Jocelyne.M, DGS_Anne.M & DICOM_Jocelyne.M. Le calendrier vaccinal. Ministère des Solidarités et de la Santé (2019). Available at: https://solidarites-sante.gouv.fr/prevention-en-sante/preserver-sa-sante/vaccination/calendrier-vaccinal (Accessed: 28th June 2019)

4. Misurac JM, et al. Immunogenicity of augmented compared with standard dose hepatitis B vaccine in pediatric patients on dialysis: a midwest pediatric nephrology consortium study. Clin. J. Am. Soc. Nephrol 2017;12:772–778.