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Te Linde E, Doornekamp L, Daenen KCP, van Gorp ECM, Bruns AHW. Dutch Healthcare Professionals' Opinion on the Allocation of Responsibilities concerning Prescribing and Administering Medically Indicated Vaccines to Immunocompromised Patients. Vaccines (Basel) 2023; 11:vaccines11030686. [PMID: 36992271 DOI: 10.3390/vaccines11030686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/06/2023] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Specific vaccines are indicated for immunocompromised patients (ICPs) due to their vulnerability to infections. Recommendation of these vaccines by healthcare professionals (HCPs) is a crucial facilitator for vaccine uptake. Unfortunately, the responsibilities to recommend and administer these vaccines are not clearly allocated among HCPs involved in the care of adult ICPs. We aimed to evaluate HCPs' opinions on directorship and their role in facilitating the uptake of medically indicated vaccines as a basis to improve vaccination practices. METHODS A cross-sectional survey was performed among in-hospital medical specialists (MSs), general practitioners (GPs), and public health specialists (PHSs) in the Netherlands to assess their opinion on directorship and the implementation of vaccination care. Additionally, perceived barriers, facilitators, and possible solutions to improve vaccine uptake were investigated. RESULTS In total, 306 HCPs completed the survey. HCPs almost unanimously (98%) reported that according to them, the primary treating physician is responsible for recommending medically indicated vaccines. Administering these vaccines was seen as a more shared responsibility. The most important barriers experienced by HCPs in recommending and administering were reimbursement problems, a lack of a national vaccination registration system, insufficient collaboration among HCPs, and logistical problems. MSs, GPs and PHSs all mentioned the same three solutions as important strategies to improve vaccination practices, i.e., reimbursement of vaccines, reliable and easily accessible registration of received vaccines, and arrangements for collaboration among the different HCPs that are involved in care. CONCLUSION The improvement in vaccination practices in ICPs should focus on better collaboration among MSs, GPs, and PHSs, who should know each other's expertise; clear agreement on responsibility; reimbursement for vaccines; and the availability of clear registration of vaccination history.
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Affiliation(s)
- Elsemieke Te Linde
- Department of Infectious Diseases, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Laura Doornekamp
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Katrijn C P Daenen
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Eric C M van Gorp
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Department of Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Anke H W Bruns
- Department of Infectious Diseases, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
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Review of Influenza Virus Vaccines: The Qualitative Nature of Immune Responses to Infection and Vaccination Is a Critical Consideration. Vaccines (Basel) 2021; 9:vaccines9090979. [PMID: 34579216 PMCID: PMC8471734 DOI: 10.3390/vaccines9090979] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 01/06/2023] Open
Abstract
Influenza viruses have affected the world for over a century, causing multiple pandemics. Throughout the years, many prophylactic vaccines have been developed for influenza; however, these viruses are still a global issue and take many lives. In this paper, we review influenza viruses, associated immunological mechanisms, current influenza vaccine platforms, and influenza infection, in the context of immunocompromised populations. This review focuses on the qualitative nature of immune responses against influenza viruses, with an emphasis on trained immunity and an assessment of the characteristics of the host–pathogen that compromise the effectiveness of immunization. We also highlight innovative immunological concepts that are important considerations for the development of the next generation of vaccines against influenza viruses.
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Koc ÖM, Kuypers D, Dupont LJ, Vos R, Van Keer JM, Van Cleemput J, Robaeys G, Oude Lashof A, Kramer M, Verleden G, Verbeek J, Nevens F. The effect of universal infant vaccination on the prevalence of hepatitis B immunity in adult solid organ transplant candidates. J Viral Hepat 2021; 28:105-111. [PMID: 32989861 PMCID: PMC7756211 DOI: 10.1111/jvh.13414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/17/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Hepatitis B virus (HBV) immunity is recommended to optimize outcomes after solid organ transplantation (SOT). This study assessed the prevalence and predictors of HBV immunity at the time patients were placed on transplant waiting list over a period from 1997 to 2019 in a low HBV endemic region. METHODS Data were obtained from the University Hospitals Leuven transplant database. Minors and patients with past/current HBV infection were excluded. From 1986, Belgian patients are covered by the universal infant vaccination; therefore, birth cohort was stratified in those born ≥1986 vs <1986. RESULTS The study population consisted of 3297 SOT candidates. HBV immunity rate was superior in renal transplant candidates (55.3%), and this number was 21.5%, 15.4% and 16.8% for liver, cardiac and pulmonary transplant candidates, respectively, P < .001. Among liver transplant candidates, HBV immunity rate was 14.8% in decompensated cirrhotic patients and 27.9% in those without advanced cirrhosis (P < .001). The overall immunity rate increased from 19.3% in period 1997-2008 to 32.8% in 2009-2019, P < .001. In multivariable analyses, younger age (odds ratio (OR) 95% confidence interval (CI): 0.97-0.98, P < .001) and birth cohort ≥ 1986 (OR 95% CI: 1.18-2.66, P = .006) were associated with increased HBV immunity. CONCLUSION An increase in HBV immunity was observed over a 20-year period related to the introduction of universal infant HBV vaccination. Nevertheless, this study highlights the low overall HBV immunity at the time of listing for organ transplantation and points out the need of an increased awareness and vaccination strategy at an early disease stage.
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Affiliation(s)
- Özgür M. Koc
- Department of Gastroenterology and HepatologyZiekenhuis Oost‐LimburgGenkBelgium,Faculty of Medicine and Life SciencesHasselt UniversityHasseltBelgium,Department of Medical MicrobiologyMaastricht University Medical CentreMaastrichtthe Netherlands,School of Nutrition and Translational Research in Metabolism (NUTRIM)University MaastrichtMaastrichtthe Netherlands
| | - Dirk Kuypers
- Department of Nephrology and Renal TransplantationUniversity Hospitals LeuvenLeuvenBelgium,Department of MicrobiologyImmunology & TransplantationKU LeuvenLeuvenBelgium
| | - Lieven J Dupont
- Department of Respiratory DiseasesUniversity Hospitals LeuvenLeuvenBelgium
| | - Robin Vos
- Department of Respiratory DiseasesUniversity Hospitals LeuvenLeuvenBelgium
| | - Jan M. Van Keer
- Department of MicrobiologyImmunology & TransplantationKU LeuvenLeuvenBelgium,Department of CardiologyUniversity Hospitals LeuvenLeuvenBelgium
| | | | - Geert Robaeys
- Department of Gastroenterology and HepatologyZiekenhuis Oost‐LimburgGenkBelgium,Faculty of Medicine and Life SciencesHasselt UniversityHasseltBelgium,Department of Gastroenterology and HepatologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Astrid Oude Lashof
- Department of Medical MicrobiologyMaastricht University Medical CentreMaastrichtthe Netherlands
| | - Matthijs Kramer
- Department of Internal MedicineDivision of Gastroenterology and HepatologyMaastricht University Medical CentreMaastrichtthe Netherlands
| | - Geert Verleden
- Department of Respiratory DiseasesUniversity Hospitals LeuvenLeuvenBelgium
| | - Jef Verbeek
- Department of Gastroenterology and HepatologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Frederik Nevens
- Department of Gastroenterology and HepatologyUniversity Hospitals LeuvenLeuvenBelgium
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Determinants of Vaccination Uptake in Risk Populations: A Comprehensive Literature Review. Vaccines (Basel) 2020; 8:vaccines8030480. [PMID: 32867126 PMCID: PMC7563537 DOI: 10.3390/vaccines8030480] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/13/2020] [Accepted: 08/19/2020] [Indexed: 12/14/2022] Open
Abstract
Vaccination uptake has decreased globally in recent years, with a subsequent rise of vaccine-preventable diseases. Travellers, immunocompromised patients (ICP), and healthcare workers (HCW) are groups at increased risk for (severe) infectious diseases due to their behaviour, health, or occupation, respectively. While targeted vaccination guidelines are available, vaccination uptake seems low. In this review, we give a comprehensive overview of determinants-based on the integrated change model-predicting vaccination uptake in these groups. In travellers, low perceived risk of infection and low awareness of vaccination recommendations contributed to low uptake. Additionally, ICP were often unaware of the recommended vaccinations. A physician's recommendation is strongly correlated with higher uptake. Furthermore, ICP appeared to be mainly concerned about the risks of vaccination and fear of deterioration of their underlying disease. For HCW, perceived risk of (the severity of) infection for themselves and for their patients together with perceived benefits of vaccination contribute most to their vaccination behaviour. As the determinants that affect uptake are numerous and diverse, we argue that future studies and interventions should be based on multifactorial health behaviour models, especially for travellers and ICP as only a limited number of such studies is available yet.
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Valour F, Conrad A, Ader F, Launay O. Vaccination in adult liver transplantation candidates and recipients. Clin Res Hepatol Gastroenterol 2020; 44:126-134. [PMID: 31607643 DOI: 10.1016/j.clinre.2019.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 08/26/2019] [Indexed: 02/07/2023]
Abstract
In patients with chronic liver disease and liver transplant recipients, cirrhosis-associated immune dysfunction syndrome and immunosuppressant drug regimens required to prevent graft rejection lead to a high risk of severe infections, associated with acute liver decompensation, graft loss and increased mortality. In addition to maintain their global health status, vaccination represents a major preventive measure against specific infectious risks of particular concern in this population, such as invasive pneumococcal diseases, influenza or viral hepatitis A and B. However, immunization in this setting raises several issues: i) recommended vaccination schedules rely on sparse immunogenicity data without clinical efficacy and effectiveness trials designed for this specific population; ii) dynamics of immunosuppression makes timing of immunization challenging; iii) live attenuated vaccines are contraindicated after transplantation; and iv) vaccines tolerance is poorly known in cirrhotic patients. This review outlines the rational for vaccination in adult liver transplant candidates and recipients and available data regarding immunization in this specific population.
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Affiliation(s)
- Florent Valour
- Service des maladies infectieuses et tropicales, Hospices Civils de Lyon, 69004 Lyon, France; Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude-Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Univ Lyon, 69007, Lyon, France; Université Claude-Bernard Lyon 1, 69008 Lyon, France
| | - Anne Conrad
- Service des maladies infectieuses et tropicales, Hospices Civils de Lyon, 69004 Lyon, France; Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude-Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Univ Lyon, 69007, Lyon, France; Université Claude-Bernard Lyon 1, 69008 Lyon, France
| | - Florence Ader
- Service des maladies infectieuses et tropicales, Hospices Civils de Lyon, 69004 Lyon, France; Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude-Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Univ Lyon, 69007, Lyon, France; Université Claude-Bernard Lyon 1, 69008 Lyon, France
| | - Odile Launay
- Inserm, CIC 1417, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), 75014 Paris, France; Université de Paris, 75014 Paris, France; Assistance Publique-Hôpitaux de Paris, CIC Cochin Pasteur, Hôpital Cochin Paris, 75014 Paris, France.
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Jonker EFF, Uijlings MAC, Visser LG, Soonawala D. Comparison of the immunogenicity of Dukoral® oral cholera vaccine between renal transplant recipients on either a calcineurin inhibitor or mycophenolate - A controlled trial. Vaccine 2019; 37:3133-3139. [PMID: 31029516 DOI: 10.1016/j.vaccine.2019.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND The evidence for recommendations regarding vaccination in solid organ transplant recipients is sparse. There is little data comparing vaccine responses between groups on different immunosuppressive drugs. This study was conducted to evaluate the antibody response to Dukoral® oral cholera vaccine in renal transplant recipients (RTR). METHODS In a single-center non-randomized controlled clinical trial, healthy volunteers (n = 21) and renal transplant recipients (n = 30) were vaccinated with the oral whole cell/recombinant B subunit cholera vaccine Dukoral® (Valneva Inc., Vienna, Austria). The RTR were stratified according to their maintenance immunosuppressive therapy: either prednisone and a calcineurin inhibitor (cyclosporine A or tacrolimus; P/CNI group; n = 15) or prednisone and mycophenolate (P/MMF group; n = 15). All volunteers ingested Dukoral® at baseline and at day 14. Serum samples were drawn at day 0 and day 21. The primary outcome was seroconversion, defined as either a 3-fold IgA serum titer increase in anti-cholera toxin B antibodies and/or a 4-fold rise in the serum vibriocidal titer. RESULTS Follow-up was complete. Seroconversion after vaccination was 57% (standard error, SE 9%) in RTR and 81% (SE 9%) in healthy controls (Relative Risk, RR 0.70; 95% CI 0.48-1.02). When stratified according to maintenance immunosuppression, the seroconversion rate was 67% (SE 12%) in the P/CNI group (RR compared with controls 0.82; 95% CI 0.55-1.25) and 47% (SE 13%) in the P/MMF group (RR compared with controls 0.58; 95% CI 0.32-1.03). CONCLUSION Adverse events were mild to moderate and transient. The response to Dukoral was weaker and the seroconversion rate was lower in renal transplant recipients than in healthy controls. In particular, those using mycophenolate had a poor response. Nevertheless, more than half of the transplant recipients seroconverted. Therefore oral vaccines should not be discarded as a potential tool for protection of solid organ transplant recipients. This trial is registered in clinicaltrials.gov under NCT01109914.
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Affiliation(s)
- Emile F F Jonker
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Marjolein A C Uijlings
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Leonardus G Visser
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Darius Soonawala
- Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands; Department of Internal Medicine, Haga Teaching Hospital, The Hague, the Netherlands.
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Vaccinations in pediatric kidney transplant recipients. Pediatr Nephrol 2019; 34:579-591. [PMID: 29671067 DOI: 10.1007/s00467-018-3953-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 03/16/2018] [Accepted: 03/22/2018] [Indexed: 12/16/2022]
Abstract
Pediatric kidney transplant (KT) candidates should be fully immunized according to routine childhood schedules using age-appropriate guidelines. Unfortunately, vaccination rates in KT candidates remain suboptimal. With the exception of influenza vaccine, vaccination after transplantation should be delayed 3-6 months to maximize immunogenicity. While most vaccinations in the KT recipient are administered by primary care physicians, there are specific schedule alterations in the cases of influenza, hepatitis B, pneumococcal, and meningococcal vaccinations; consequently, these vaccines are usually administered by transplant physicians. This article will focus on those deviations from the normal vaccine schedule important in the care of pediatric KT recipients. The article will also review human papillomavirus vaccine due to its special importance in cancer prevention. Live vaccines are generally contraindicated in KT recipients. However, we present a brief review of live vaccines in organ transplant recipients, as there is evidence that certain live virus vaccines may be safe and effective in select groups. Lastly, we review vaccination of pediatric KT recipients prior to international travel.
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Immunogenicity and safety of double versus standard dose of the seasonal influenza vaccine in solid-organ transplant recipients: A randomized controlled trial. Vaccine 2018; 36:6163-6169. [PMID: 30181045 DOI: 10.1016/j.vaccine.2018.08.057] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/16/2018] [Accepted: 08/22/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The use of vaccines with higher doses of antigen is an attractive strategy to improve the immunogenicity of influenza vaccination in transplant recipients. However, the effect of vaccination with a double-dose (DD) containing 30 µg of antigen in this population remains unknown. METHODS We performed a randomized controlled trial to compare the immunogenicity and safety of DD (30 µg) vs. standard dose (SD, 15 µg) of a trivalent inactivated influenza vaccine in kidney and liver transplant recipients. Immunogenicity was assessed by hemagglutination-inhibition assay. Vaccine response was defined as seroconversion to at least one viral strain 2 weeks after vaccination and seroprotection as a titer ≥40. RESULTS Sixty-three kidney and 16 liver transplant recipients were enrolled. Forty patients received the DD and 39 the SD vaccine. Overall, 40% of patients in the DD compared to 26% in the SD group (P = 0.174) responded to vaccine. In the DD arm, more patients were seroprotected to all viral strains after vaccination (88% vs 69%, P = 0.048). Post vaccination geometric mean titers of antibodies were 131.9 vs. 89.7 (P = 0.187) for H1N1, 185.4 vs. 138.7 (P = 0.182) for H3N2, and 96.6 vs. 68.8 (P = 0.081) for influenza B with the DD vs. SD. In both groups, most of the adverse events were mild and no vaccine-related severe adverse events were observed. CONCLUSION Double-dose influenza vaccine is safe and may increase antibody response in transplant recipients. In this population, DD vaccination could be an alternative when high-dose vaccine is not available. NCT02746783.
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9
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Camargo LF, Lother AM, Mazzali M, Stucchi RSB. Immunization in end stage renal disease: The perception of waiting list patients. Transpl Infect Dis 2018; 20:e12831. [PMID: 29337400 DOI: 10.1111/tid.12831] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 11/08/2017] [Accepted: 12/15/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND The number of patients with chronic kidney disease is increasing worldwide, as well as the number of patients in kidney transplant waiting lists. In order to prevent infections related to immunosuppressive therapy, immunization guidelines for CKD patients before transplantation have been proposed. The aim of the present study was to evaluate adherence to immunization in a cohort of CKD patients in transplant waiting list and their renal replacement therapy clinics. METHODS CKD patients older than 18 years old, receiving renal replacement therapy longer than 12 months and included in kidney transplant waiting list at University of Campinas (Unicamp) were enrolled. RESULTS From February 2014 to December 2015, 105 patients fulfilled the inclusion criteria. Complete hepatitis B vaccination was observed in 73% and influenza vaccine in 67%. None of the other vaccine protocols reached 50% of coverage. Patients receiving immunization at primary health units presented higher coverage for diphtheria, tetanus (dT), measles, mumps, rubella (MMR), and hepatitis B vaccines, while patients immunized at renal replacement therapy clinics showed higher prevalence of pneumococcus (pneumo23). CONCLUSION The low rates of immunization could reflect the RRT's clinics knowledge about the vaccines guidelines and its application on daily care. We suggest an integration between transplant center and RRT clinics, through lectures, periodic checking of vaccination cards, and easy to follow guidelines in order to provide a better vaccine coverage and to obtain higher immunization rates.
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Affiliation(s)
- Leonardo Figueiredo Camargo
- Division of Nephrology, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.,Renal Transplant Unit, Clinics Hospital, University of Campinas, Campinas, SP, Brazil
| | | | - Marilda Mazzali
- Division of Nephrology, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.,Renal Transplant Unit, Clinics Hospital, University of Campinas, Campinas, SP, Brazil
| | - Raquel S B Stucchi
- Division of Infectious Diseases, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
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10
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Maldonado AQ, Johnson D, Trofe-Clark J. Barriers to vaccination in renal transplant recipients. Transpl Infect Dis 2017; 19. [DOI: 10.1111/tid.12749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 04/05/2017] [Accepted: 04/21/2017] [Indexed: 12/19/2022]
Affiliation(s)
| | - David Johnson
- Department of Pharmacy Services; Hospital of the University of Pennsylvania; Philadelphia PA USA
| | - Jennifer Trofe-Clark
- Department of Pharmacy Services; Hospital of the University of Pennsylvania; Philadelphia PA USA
- Renal, Electrolyte Hypertension Division; Perelman School of Medicine; University of Pennsylvania; Philadelphia PA USA
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11
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Lee DH, Boyle SM, Malat G, Sharma A, Bias T, Doyle AM. Low rates of vaccination in listed kidney transplant candidates. Transpl Infect Dis 2016; 18:155-9. [PMID: 26461052 DOI: 10.1111/tid.12473] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 09/17/2015] [Accepted: 10/01/2015] [Indexed: 11/29/2022]
Abstract
Despite clear consensus and strong recommendations, vaccination rates of kidney transplant (KT) recipients have remained below targets. As vaccination is most effective if it is given prior to transplantation and the initiation of immunosuppression, patients should ideally have their vaccination status assessed and optimized in the pre-transplant period. We performed a retrospective chart review to characterize vaccination rates and factors associated with gaps in vaccination in a single-center population of waitlisted patients being evaluated for kidney transplantation. We evaluated 362 KT patients. Three-quarters were receiving dialysis at the time of evaluation. Immunization rates were low with 35.9% of patients having completed vaccination for Pneumococcus, 55% for influenza, 6.9% for zoster, and 2.5% for tetanus. On multivariable analysis, patients who received other vaccines, including influenza, tetanus, or zoster vaccine (odds ratio [OR] 10.55, 95% confidence interval [CI] 5.65-19.71) were more likely to receive pneumococcal vaccine. Blacks (OR 0.24, 95% CI 0.12-0.47) were less likely to receive pneumococcal vaccine compared to whites. Patients on dialysis, and those active on the waiting list were more likely to receive pneumococcal vaccine than other groups (OR 2.81, 95% CI 1.44-5.51, and OR 1.84, 95% CI 1.08-3.14, respectively). We found that the overall immunization rate against common vaccine-preventable infections was low among patients evaluated for kidney transplantation. A significant gap remains between recommendations and vaccine uptake in clinical practice among this high-risk population.
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Affiliation(s)
- D H Lee
- Division of Infectious Diseases and HIV Medicine, Drexel University, Philadelphia, Pennsylvania, USA
| | - S M Boyle
- Division of Nephrology and Hypertension, Drexel University, Philadelphia, Pennsylvania, USA
| | - G Malat
- Department of Surgery, Drexel University, Philadelphia, Pennsylvania, USA.,Department of Pharmacy, Hahnemann University Hospital, Philadelphia, Pennsylvania, USA
| | - A Sharma
- Division of Nephrology and Hypertension, Drexel University, Philadelphia, Pennsylvania, USA
| | - T Bias
- Division of Infectious Diseases and HIV Medicine, Drexel University, Philadelphia, Pennsylvania, USA.,Department of Pharmacy, Hahnemann University Hospital, Philadelphia, Pennsylvania, USA
| | - A M Doyle
- Division of Nephrology and Hypertension, Drexel University, Philadelphia, Pennsylvania, USA
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