TETANUS IMMUNIZATION AND ITS ASSOCIATION TO HEPATITIS-B VACCINATION IN PATIENTS WITH CHRONIC-RENAL-FAILURE

A defect in the immune response of patients with chronic renal failure leads to low response rates and insufficient antibody concentrations following a number of highly recommended vaccinations, This has been s hown before for immunization against hepatitis B and influenza. Few da ta are available concerning the efficacy of vaccination with tetanus t oroid in these patients, In a prospective, controlled study we vaccina ted seronegative patients with chronic renal failure not on dialysis, patients on chronic intermittent hemodialysis, and patients after kidn ey transplantation with tetanus toroid, The results were compared with those of a control group consisting of 13 age-matched patients with m ild essential hypertension and normal kidney function, Only 11 of 20 ( 55%) patients in the chronic renal failure group and 16 of 23 (69%) in the dialysis group had a protective antibody response after triple va ccination, In contrast, all the patients in the control group and six of seven transplant patients seroconverted, The response to tetanus to roid was highly associated with the response to a previously administe red vaccination against hepatitis B. Responders to this vaccination al so had a better response rate to tetanus toroid. The antibody concentr ations after vaccination were lower in all patient groups compared wit h the controls; the lowest titers were found in the transplant patient s, Therefore, renal patients will need revaccination much earlier, and tetanus toroid antibody levels should be checked if a patient is inju red and potentially requires vaccination. (C) 1995 by the National Kid ney Foundation, Inc.