Abstract
The prevention of systemic viral and bacterial infections by effective vaccination represents an essential task of pediatric nephrologists caring for children with chronic renal failure (CRF) undergoing renal transplantation (RTPL) with life-long immunosuppression. This review addresses three issues: risk of vaccine-preventable diseases, safety, immunogenicity, and clinical efficacy of available vaccines, and implementation of immunization guidelines. Infections (including vaccine-preventable infections) represent the leading cause of morbidity and mortality in children on dialysis and after RTPL. Vaccination in children with CRF and after RTPL is safe and does not cause reactivation of an immune-related renal disease or rejection after RTPL. Children with CRF generally produce protective serum antibodies to primary vaccinations with killed or component vaccines and live virus vaccines; some children on dialysis and after RTPL may not respond optimally, requiring repeated vaccination. Proof of vaccine efficacy is absence of disease, which can only be confirmed in large cohort studies. A few observational studies provide evidence that vaccination has contributed significantly, at least in the western hemisphere, to the low prevalence of vaccine-preventable diseases among children with CRF. Close cooperation between the local pediatrician/practitioner and the pediatric nephrologist is essential for successful implementation of the vaccination schedule.
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References
Centers for Disease Control and Prevention (2003) Recommended childhood and adolescent immunization schedule. United States, 2003. MMWR Morb Mortal Wkly Rep 52:Q1–Q4
Recommendation of the standing vaccination committee at the Robert Koch-Institut. (2003) Epid Bull 32:24–5260
Aebi C (2002) Update on childhood immunization in Switzerland. Schweiz Rundsch Med Prax 91:508–512
Fivush BA, Furth SL, Neu AM (1995) Immunizations in children on PD: current guidelines and recommendations. Adv Perit Dial 11:270–273
Neu AM, Fivush BA (1998) Recommended immunization practices for pediatric renal transplant recipients. Pediatr Transplant 2:263–269
Fivush BA, Neu AM (1998) Immunization guidelines for pediatric renal disease. Semin Nephrol 18:256–263
Neu AM, Fivush BA (2000) Immunizations for pediatric dialysis patients. Adv Ren Replace Ther 7:239–246
Burroughs M, Moscona A (2000) Immunization of pediatric solid organ transplant candidates and recipients. Clin Infect Dis 30:857–869
Rangel MC, Coronado VG, Euler GL, Strikas RA (2000) Vaccine recommendations for patients on chronic dialysis. The Advisory Committee on Immunization Practices and the American Academy of Pediatrics. Semin Dial 13:101–107
European best practice guidelines for renal transplantation(2002) IV. Long-term management of the transplant recipient. IV.11 Paediatrics (specific problems). Nephrol Dial Transplant 17 [Suppl 4]:55–58
Furth SL, Neu AM, Sullivan EK, Gensler G, Tejani A, Fivush BA (1997) Immunization practices in children with renal disease: a report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol 11:443–446
Drachman R, Schlesinger M, Shapira H, Drukker A (1989) The immune status of uraemic children/adolescents with chronic renal failure and renal replacement therapy. Pediatr Nephrol 3:305–308
Tolkoff-Rubin NE, Rubin RH (1990) Uremia and host defenses. N Engl J Med 322:770–772
Hisano S, Miyazaki C, Hatae K, Kaku Y, Yamane I, Ueda K, Okamua S (1992) Immune status of children on continuous ambulatory peritoneal dialysis. Pediatr Nephrol 6:179–181
Haag-Weber M, Horl WH (1993) Uremia and infection: mechanisms of impaired cellular host defense. Nephron 63:125–131
Fivush BA, Case B, May MW, Lederman HM (1989) Hypogammaglobulinemia in children undergoing continuous ambulatory peritoneal dialysis. Pediatr Nephrol 3:186–188
Bouts AH, Davin JC, Krediet RT, Weel MB van der, Schroder CH, Monnens L, Nauta J, Out TA (2000) Immunoglobulins in chronic renal failure of childhood: effects of dialysis modalities. Kidney Int 58:629–637
Ensari C, Ekim M, Ikinciogullari A, Tumer N, Ensari A (2001) Are uraemic children immunologically compromised? Nephron 88:379–381
Kemper MJ, Meyer-Jark T, Muller-Wiefel DE (1997) IgG2 deficiency in uremic children is not restricted to peritoneal dialysis treatment. Pediatr Nephrol 11:684–686
Harmon WE (1991) Opportunistic infections in children following renal transplantation. Pediatr Nephrol 5:118–125
Broyer M, Tete MJ, Guest G, Gagnadoux MF, Rouzioux C (1997) Varicella and zoster in children after kidney transplantation: long-term results of vaccination. Pediatrics 99:35–39
Broyer M, Ehrich J, Jones E, Selwood N (1993) Five year survival of kidney transplantation in children: data from the European (EDTA-ERA) Registry. Kidney Int [Suppl] 43:S22–S25
Seikaly M, Ho PL, Emmett L, Tejani A (2001) The 12th Annual Report of the North American Pediatric Renal Transplant Cooperative Study: renal transplantation from 1987 through 1998. Pediatr Transplant 5:215–231
Neu AM, Ho PL, McDonald RA, Warady BA (2002) Chronic dialysis in children and adolescents. The 2001 NAPRTCS Annual Report. Pediatr Nephrol 17:656–663
Benfield MR, McDonald RA, Bartosh S, Ho PL, Harmon W (2003) Changing trends in pediatric transplantation: 2001 Annual Report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Transplant 7:321–335
Gamperli A, Leumann E, Neuhaus TJ, Schlumpf R, Largiader F (1996) 25 years of dialysis and kidney transplantation in children and adolescents. Schweiz Med Wochenschr 126:77–85
Laube GF, Berger C, Goetschel P, Leumann E, Neuhaus TJ (2002) Immunization in children with chronic renal failure. Pediatr Nephrol 17:638–642
Furth SL, Sullivan EK, Neu AM, Tejani A, Fivush BA (1997) Varicella in the first year after renal transplantation: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Pediatr Transplant 1:37–42
Furth SL, Hogg RJ, Tarver J, Moulton LH, Chan C, Fivush BA (2003) Varicella vaccination in children with chronic renal failure. A report of the Southwest Pediatric Nephrology Study Group. Pediatr Nephrol 18:33–38
Canero-Velasco MC, Mutti JE, Gonzalez JE, Alonso A, Otegui L, Adragna M, Antonuccio M, Laso M, Montenegro M, Repetto L, Brandi M, Canepa J, Baimberg E (1998) HCV and HBV prevalence in hemodialyzed pediatric patients. Multicenter study. Acta Gastroenterol Latinoam 28:265–268
Zwolinska D, Inglot M, Makulska I, Gladysz A, Szprynger K, Szczepanska M, Pietrzyk J, Zachwieja K, Zurowska A, Zachwieja J, Rajkowski T, Jobs K, Lataszynska J, Jander A (2001) Epidemiology of HBV infections and possibilities for therapeutic actions in children and adolescents with end-stage renal failure treated with dialysis. Pol Merkuriusz Lek 10:267–270
Klapper PE, Cleator GM, Clarke MC, Postlethwaite RJ (1991) Measles immunisation. Arch Dis Child 66:369
Kalman S, Bakkaloglu SA, Ozkaya O, Buyan N, Soylemezoglu O (2002) Measles: a rare communicable disease in a child with renal transplantation. Pediatr Transplant 6:432–434
Kidd IM, Booth CJ, Rigden SP, Tong CY, MacMahon EM (2003) Measles-associated encephalitis in children with renal transplants: a predictable effect of waning herd immunity? Lancet 362:832
Lynfield R, Herrin JT, Rubin RH (1992) Varicella in pediatric renal transplant recipients. Pediatrics 90:216–220
Mauch TJ, Bratton S, Myers T, Krane E, Gentry SR, Kashtan CE (1994) Influenza B virus infection in pediatric solid organ transplant recipients. Pediatrics 94:225–229
Federal Office of Public Health (1998) Immunization rate in Switzerland. Swiss Bull BAG 20:356–361
Kleinknecht C, Margolis A, Bonnissol C, Gaiffe M, Sahyoun S, Broyer M (1977) Serum antibodies before and after immunisation in haemodialysed children. Proc Eur Dial Transplant Assoc 14:209–214
Enke BU, Bokenkamp A, Offner G, Bartmann P, Brodehl J (1997) Response to diphtheria and tetanus booster vaccination in pediatric renal transplant recipients. Transplantation 64:237–241
Ghio L, Pedrazzi C, Assael BM, Panuccio A, Foti M, Edefonti A (1997) Immunity to diphtheria and tetanus in a young population on a dialysis regimen or with a renal transplant. J Pediatr 130:987–989
Pedrazzi C, Ghio L, Balloni A, Panuccio A, Foti M, Edefonti A, Assael BM (1999) Duration of immunity to diphtheria and tetanus in young kidney transplant patients. Pediatr Transplant 3:109–114
Balloni A, Assael BM, Ghio L, Pedrazzi C, Nebbia G, Gridelli B, Melada E, Panuccio A, Fati M, Barbi M, Luraschi C (1999) Immunity to poliomyelitis, diphtheria and tetanus in pediatric patients before and after renal or liver transplantation. Vaccine 17:2507–2511
La Manna A, Polito C, Foglia AC, Opallo A, Cafaro MR, Di Toro R (1991) Normal response to anti-HBV vaccination in children with chronic renal insufficiency. Child Nephrol Urol 11:203–205
Vazquez G, Mendoza-Guevara L, Alvarez T, Aguilar A, Morales A, Rodriguez F, Solorzano F, Garcia-Lopez E, Munoz O (1997) Comparison of the response to the recombinant vaccine against hepatitis B virus in dialyzed and nondialyzed children with CRF using different doses and routes of administration. Adv Perit Dial 13:291–296
Watkins SL, Alexander SR, Brewer ED, Hesley TM, West DJ, Chan IS, Mendelman P, Bailey SM, Burns JL, Hogg HJ (2002) Response to recombinant hepatitis B vaccine in children and adolescents with chronic renal failure. Am J Kidney Dis 40:365–372
Schulman SL, Deforest A, Kaiser BA, Polinsky MS, Baluarte HJ (1992) Response to measles-mumps-rubella vaccine in children on dialysis. Pediatr Nephrol 6:187–189
Flynn JT, Frisch K, Kershaw DB, Sedman AB, Bunchman TE (1999) Response to early measles-mumps-rubella vaccination in infants with chronic renal failure and/or receiving peritoneal dialysis. Adv Perit Dial 15:269–272
Furth SL, Neu AM, McColley SA, Case B, Steinhoff M, Fivush B (1995) Immune response to influenza vaccination in children with renal disease. Pediatr Nephrol 9:566–568
Edvardsson VO, Flynn JT, Deforest A, Kaiser BA, Schulman SL, Bradley A, Palmer J, Polinsky MS, Baluarte HJ (1996) Effective immunization against influenza in pediatric renal transplant recipients. Clin Transplant 10:556–560
Brydak LB, Roszkowska-Blaim M, Machala M, Leszczynska B, Sieniawska M (2001) Immunological response to influenza vaccination in children with renal failure. Nephrol Dial Transplant 16:643–644
Fivush BA, Case B, Warady BA, Lederman H (1993) Defective antibody response to Hemophilus influenzae type b immunization in children receiving peritoneal dialysis. Pediatr Nephrol 7:548–550
Neu AM, Lederman HM, Warady BA, Fivush BA (1996) Haemophilus influenzae type b immunization in infants on peritoneal dialysis. Pediatric Peritoneal Dialysis Study Consortium. Pediatr Nephrol 10:84–85
Furth SL, Neu AM, Case B, Lederman HM, Steinhoff M, Fivush B (1996) Pneumococcal polysaccharide vaccine in children with chronic renal disease: a prospective study of antibody response and duration. J Pediatr 128:99–101
Fuchshuber A, Kuhnemund O, Keuth B, Lutticken R, Michalk D, Querfeld U (1996) Pneumococcal vaccine in children and young adults with chronic renal disease. Nephrol Dial Transplant 11:468–473
Campins Marti M, Rodrigo Anoro MJ, Callis Bracons L, Pinart Pons N, Cruz Carmona MJ, Gracia Roldan J de, Miravitlies Fernandez M (2000) Immunogenicity of the 23-valent pneumococcal vaccine in children with chronic renal disease. An Esp Pediatr 52:220–224
Webb NJ, Fitzpatrick MM, Hughes DA, Brocklebank TJ, Judd BA, Lewis MA, Postlethwaithe RJ, Smith PA, Corbitt G (2000) Immunisation against varicella in end stage and pre-end stage renal failure. Trans-Pennine Paediatric Nephrology Study Group. Arch Dis Child 82:141–143
Zamora I, Simon JM, Da Silva ME, Piqueras AI (1994) Attenuated varicella virus vaccine in children with renal transplants. Pediatr Nephrol 8:190–192
Rand EB, McCarthy CA, Whitington PF (1993) Measles vaccination after orthotopic liver transplantation. J Pediatr 123:87–89
Abeyagunawardena AS, Goldblatt D, Andrews N, Trompeter RS (2003) Risk of relapse after meningococcal C conjugate vaccine in nephrotic syndrome. Lancet 362:449–450
Federal Office of Public Health (1998) Immunization rate in Switzerland. Swiss Bull BAG 20:356–361
Yawn BP, Kurland M, Boloton R, Martin AR (1995) Immunization compliance outside the health plans. A non-HMO report card. Minn Med 78:25–32
Marty-Nussbaumer A, Frey D, Takken-Sahli C, Christen S (1997) Immunization rate as indicator of public health care in children and adolescents: rate among pupils in Zurich (abstract). Schweiz Med Wochenschr 127 [Suppl 87]:23S
Recommendations of the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians (1998) Use of reminder and recall by vaccination providers to increase vaccination rates. MMWR Morb Mortal Wkly Rep 47:715–717
Schaefer F, Klaus G, Muller-Wiefel DE, Mehls O (1999) Intermittent versus continuous intraperitoneal glycopeptide/ceftazidime treatment in children with peritoneal dialysis-associated peritonitis. The Mid-European Pediatric Peritoneal Dialysis Study Group (MEPPS). J Am Soc Nephrol 10:136–145
Chawla PG, Nevins TE (2000) Management of hemodialysis catheter-related bacteremia -a 10-year experience. Pediatr Nephrol 14:198–202
Sheth RD, Brandt ML, Brewer ED, Nuchtern JG, Kale AS, Goldstein SL (2002) Permanent hemodialysis vascular access survival in children and adolescents with end-stage renal disease. Kidney Int 62:1864–1869
Poole-Warren LA, Hallett MD, Hone PW, Burden SH, Farrell PC (1991) Vaccination for prevention of CAPD associated staphylococcal infection: results of a prospective multicentre clinical trial. Clin Nephrol 35:198–206
Fattom AI, Naso R (1996) Staphylococcus aureus vaccination for dialysis patients—an update. Adv Ren Replace Ther 3:302–308
Shinefield H, Black S, Fattom A, Horwith G, Rasgon S, Ordonez J, Yeoh H, Law D, Robbins JB, Schneerson R, Muenz L, Fuller S, Johnson J, Fireman B, Alcorn H, Nase R (2002) Use of a Staphylococcus aureus conjugate vaccine in patients receiving hemodialysis. N Engl J Med 346:491–496
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Neuhaus, T.J. Immunization in children with chronic renal failure: a practical approach. Pediatr Nephrol 19, 1334–1339 (2004). https://doi.org/10.1007/s00467-004-1597-7
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DOI: https://doi.org/10.1007/s00467-004-1597-7