PNEUMOCOCCAL VACCINE IN CHILDREN AND YOUNG-ADULTS WITH CHRONIC RENAL-DISEASE

Background. Pneumococcal vaccination has been recommended for immunoco mpromised children over 2 years including patients with chronic renal disease. However, the effect of vaccination and revaccination is varia ble and the indication for immunization is a subject of controversy. M ethods. Forty children and young adults with chronic renal diseases (i ncluding the idiopathic nephrotic syndrome, chronic renal failure, pat ients undergoing dialysis and after transplantation) were vaccinated w ith a 23-valent pneumococcal vaccine. The efficacy of the vaccine was evaluated by measuring antibody titres before and 4 weeks, 6 months, a nd 12 months after vaccination. Twenty-two patients were submitted to a revaccination 1 year after the first vaccination. Results. A suffici ent immune response, defined as an at least fourfold increase of postv accinal antibody titres and an antibody titre >200, was observed in 83 % of the patients 4 weeks after vaccination, but only in 68% after 6 m onths, and in 48% after 1 year. Revaccination produced a significant i mmune 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-e ffects and effective in producing a significant immune response. Antib ody levels should be monitored in vaccinated patients with chronic ren al diseases considering the rapid decline as early as 6 months after v accination. Evaluation of the efficacy of revaccination in these patie nts requires further investigations.