Immunisation against varicella in end stage and pre-end stage renal failure

Objectives-To investigate the seroconversion rate and duration of persisten ce of protective antibody titres after varicella immunisation in children w ith renal failure. Design-32 children (25 end stage and 7 pre-end stage renal failure) were im munised using 2 x 2000 plaque forming unit doses of varicella vaccine 3 mon ths apart. Varicella antibody titres were measured by enzyme linked immunos orbent assay. Results-All children initially seroconverted after immunisation. At a mean follow up of 20.3 months, 23 of 28 had protective antibody titres, 4 childr en having died of unrelated causes. Two children required a third booster d ose. 11 children underwent renal transplantation; 10 had protective titres at the time of transplantation and, at a mean of 23.4 months after immunisa tion, 6 currently have protective titres. Minor side effects occurred after 11 vaccine doses in 9 children. No child developed varicella, despite 10 c lear episodes of exposure to the wild-type virus. Conclusions-Varicella immunisation in children with end stage and pre-end s tage renal failure results in a high rate of seroconversion and persistence of protective antibody titres. More widespread use of the vaccine before r enal transplantation is recommended.