The impaired immune response to diphtheria vaccination in elderly chronic hemodialysis patients is related to zinc deficiency

Zinc deficiency causes abnormalities of the immune response. In chronic hem odialysis therapy abnormalities in zinc metabolism as well as an impaired i mmune response to vaccination have been reported. Therefore we performed a vaccination study against diphtheria and hypothesized that the response to diphtheria vaccination is related to serum zinc deficiency in hemodialysis patients. Serum zinc concentrations were assayed in 16 chronic hemodialysis patients (10 male, 6 female; mean age 65 years) without a documented vacci nation history against diphtheria. Nine of these patients were triple immun ized against diphtheria while seven received a single vaccination. The resp onse to diphtheria vaccination was measured by ELISA detecting specific ant ibodies to diphtheria-toxoid. Seroconversion 6 and 12 months after Vaccinat ion was defined as the doubling of antibody titers in patients greater than or equal to 0.1 IU/ml prior to vaccination or as titers > 0.1 IU/ml in all other patients. Only 6/16 hemodialysis patients responded to immunization against diphtheria by specific antibody production ( > 0.1 IU/mL). Twelve m onths after the single injection 3/7 patients seroconverted while six month s after the triple vaccination 3/9 patients responded to immunization. This was not age-dependent, whereas in non-responders we detected significantly decreased serum zinc levels. In contrast, responders showed similar serum zinc levels as age-matched controls. Furthermore, we measured a decreased a lpha2-macroglobulin concentration only in the responders amongst the hemodi alysis patients. protection against diphtheria and the immune response to d iphtheria vaccination in hemodialysis patients is poor. The failure to resp ond to active diphtheria vaccination is related to a significantly decrease d serum zinc concentration in hemodialysis patients.