Pneumococcal vaccine in children and young adults with chronic renal disease

BACKGROUND.: Pneumococcal vaccination has been recommended for immunocompromisedchildren over 2 years including patients with chronic renaldisease. However, the effect of vaccination and revaccinationis variable and the indication for immunization is a subjectof controversy. METHODS.: Forty children and young adults with chronic renal diseases(including the idiopathic nephrotic syndrome, chronic renalfailure, patients undergoing dialysis and after transplantation)were vaccinated with a 23-valent pneumococcal vaccine. The efficacyof the vaccine was evaluated by measuring antibody titres beforeand 4 weeks, 6 months, and 12 months after vaccination. Twenty-twopatients were submitted to a revaccination 1 year after thefirst vaccination. RESULTS.: A sufficient immune response, defined as an at least fourfoldincrease 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. Revaccinationproduced 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-effectsand effective in producing a significant immune response. Antibodylevels should be monitored in vaccinated patients with chronicrenal diseases considering the rapid decline as early as 6 monthsafter vaccination. Evaluation of the efficacy of revaccinationin these patients requires further investigations.