| Abstract |
Background: Chronic kidney disease (CKD) and renal transplant patients although
particularly vulnerable to vaccine-preventable infections due to defective
immunity/immunosuppression, increased exposure to infections, and comorbidities, are often
undervaccinated due to safety concerns. Cocooning strategy, aiming for protection through
immunization of close contacts, although recommended, has not been yet officially adopted
for CKD population.
Aim: In this study we evaluated the vaccination status of patients with CKD and of their
close contacts in order to investigate the premises for implementation of cocooning strategy.
Methods: A multicenter prospective cohort study was conducted on haemodialysed and renal
transplant adult patients and on paediatric patients with CKD. An interview-based survey was
conducted on regular follow-up and vaccination status of patients and their household
contacts was recorded through interview and vaccination records.
Results: Data were obtained from 285 patients CKD, 265 adults (45 transplants and 220
haemodialysed) and 20 paediatric CKD patients. Of the 220 haemodialysed patients, mean
age 66.6 years, 98.6% were vaccinated for hepatitis B (HepB), 79.5% for influenza, 58.6% for
pneumococcal vaccine, tetanus-diphtheria-acellular pertussis (TdaP) 35% and 29.6% for
herpes zoster, measles 29.4% (92.2% were immune due to age). The patients had unknown
history of previous varicella infection and none was vaccinated. The vaccination status of
adult transplant patients, mean age 54.2 years, was inadequate (influenza 31.1%,
pneumococcal 13.3% and TdaP 2%). Of the 20 paediatric patients with CKD mean age 10.9,
100% were fully vaccinated for HepB, 35% for influenza, 100% for the conjugate pneumococcal vaccine PCV13 and 22% for polysaccharide PPSV23, 100% for DTaP and
20% for TdaP, 85% HepA, 75% varicella and 70% measles.
Vaccination rates of the 104 children contacts were high for most recommended vaccines
(Diphtheria-Tetanus-acellular Pertussis, HepB, 100%, measles 85.6%, varicella 87.5%,
pneumococcal 96.1%) even for non-reimbursed ones such as hepatitis A (86.5%), except for
influenza (7.5%) and booster Tdap (63.4%). However, the rates of 182 adult contacts were
low (influenza 28.5%, pneumococcal 12.3%, Tdap 0%, herpes zoster 0%). Vaccination
coverage of 31 adult contacts of paediatric CKD patients was inadequate for all the
recommended vaccines (influenza 3%, TdaP 0%, pneumococcal 0%). Most patients and
families were unaware of vaccination guidelines for CKD patients and the particular interest
of annual influenza vaccination for their family.
Conclusion: Paediatric CKD patients were adequately vaccinated except for influenza and
booster TdaP. Transplant patients were inadequately vaccinated for all recommended
vaccines. Although vaccination rates of haemodialysed patients were higher from those
reported in the literature, were still lower from those recommended. Increasing vaccination
coverage rates in these patients is one of the main preventive measures to be strengthened.
Vaccination coverage of adult close contacts was inadequate. In our area of practice, the
adherence of families to childhood vaccination recommendations confers greatly to the
protection of CKD family-members. Targeted cocooning policies could motivate vaccination
among families and address the weaning of vaccination adherence after childhood and the
confusion regarding influenza vaccination yielding to considerably low immunization rates
among CKD patients and their families.
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