LOW EFFICIENCY OF ACTIVE IMMUNIZATION AGAINST DIPHTHERIA IN CHRONIC-HEMODIALYSIS PATIENTS

Recent epidemiological studies indicate a low immunity to diphtheria i n adults in industrialized countries. In the light of the epidemic inc rease of diphtheria in countries such as Russia and the Ukraine, syste matic vaccination against this disease is recommended. We analyzed the immunity to diphtheria of 228 hemodialysis patients and the efficienc y of single versus triple vaccination against diphtheria. Antibodies a gainst diphtheria toroid were determined by enzyme immunoassay in sera of 228 adult hemodialysis patients. Fifty-four patients were triple v accinated against diphtheria and were followed for six months; 17 pati ents were single immunized and antitoxoid titers were determined 1 and 12 months later. The overall protection rate against diphtheria was 2 2% and equal in male and female patients. After triple immunization, o nly 35% of the patients developed protective antibody concentration (> 0.1 IE/ml) six months after the third vaccination. A single vaccinati on caused protective titres twelve months later in 41% of the patients . There was no difference between responders and non-responders in the duration, intensity or modality of hemodialysis treatment or the resp onse to previous vaccinations against hepatitis-B. We suggest to monit or antibodies against diphtheria toroid in vaccinated hemodialysis pat ients at risk for diphtheria since protective titers are often not att ained by the standard vaccination protocol.