Vaccines are necessary to boost our immune power to effectively ward-off specific infections. They form a crucial part of medically preparing all patients of Chronic Kidney Disease for a kidney transplant surgery as well.
However, patients with Chronic Kidney Disease (CKD), those with Kidney Failure on Dialysis or Kidney Transplant recipients have a weaker immune system. Since vaccines are basically made of weakened germs or its parts, vaccinating this subset of patients requires caution and clinical supervision.
Continuing from Part 1 of this topic covering the bare basics about Vaccines, this article aims to empower you with all that you must know about Vaccination specifically with Chronic Kidney Disease and/or a Transplant in tow.
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WHEN DOES A KIDNEY PATIENT REQUIRE VACCINATION?
Whether a kidney patient needs to be vaccinated depends on three factors:
AGE
Children upto 5 years of age must be vaccinated as per the Immunization Schedule of their respective countries. The local health advisory body to the Government normally decides on which Vaccines make it to the Schedule. Depending on which infections are common locally and warrant vaccine coverage, specific vaccines can vary from country-to-country.
Hence, in children in the under-5 age group, advanced kidney disease or a transplant interrupts such Vaccination schedules. Therefore, special care is necessary while completing the remaining vaccine courses in this age group.
BLOOD LEVELS OF IMMUNE PROTECTION FOR A SPECIFIC DISEASE
Usually most vaccines serve to provide life-long immunity against a specific disease. However, this “immune-protection” depends on whether the person’s immune system continues to function normally for life.
Those who develop Chronic Kidney Disease due to Diabetes, Cancer or from other immune system disorders have poor immunity. In such cases, the vaccine protection for some infections may “fall short”.
Hepatitis B is a classic example. In all immune-compromised CKD patients awaiting a transplant, a “booster” Hepatitis B vaccination is highly recommended even if they received the vaccine as a child.
Medical teams assess the need for a Hepatitis B Booster vaccine based on a blood test to check for such “immune protection” levels for Hepatitis B.
The ideal blood levels for Hepatitis B protection status for Kidney patients should be above 100 mIU/mL. Patients with levels below 100mIU/mL should get the Booster Dosage or the full course of the Vaccine as necessary.
TRAVEL HISTORY
If a kidney patient needs to travel internationally, they must discuss the need to get specific vaccines necessary for that country, with their medical team. For example, Hepatitis A Vaccine.
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CLINICAL CRITERIA TO VACCINATE KIDNEY PATIENTS
Admittedly, there is lack of sufficient evidence on safety & efficacy of vaccines in solid organ transplant patients more so, for Kidney Transplant Recipients.
Still, based on limited evidence, the Kidney Disease-Improving Global Outcomes (KDIGO) group has come up with certain guidelines for vaccinating patients with Chronic Kidney Disease and Kidney transplant recipients. These guidelines inform day-to-day clinical practice in Nephrology.
We at Team ATK want to help you understand these criteria so you can make better sense of your doctor’s advice.
Hence, we have compiled an easy-to-understand, comprehensive Vaccine Guide for you based on these KDIGO guidelines:
Inactivated vaccines are safe for use both pre and post-transplant
Live vaccines can be taken before a transplant surgery, provided you are not on immune-suppressive therapy. If you get a live vaccine pretransplant, it is imperative to wait for at least 4 weeks after administration.
After the transplant surgery, Live Vaccines are UNSAFE and completely off-limits. These can cause seroconversion & infection plus show sub-optimal vaccine efficacy
The first 3-6 months post transplantation is the period of intense immunosuppression. It is IMPORTANT to AVOID taking any vaccine at all during the first 3-6 months.
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VACCINATION GUIDE FOR KIDNEY PATIENTS
Find below, a name-wise list of vaccines and how safe these are with Chronic Kidney Disease (CKD) and after a kidney transplant.
| VACCINES | KIDNEY DISEASE & DIALYSIS PATIENTS | POST-TRANSPLANT |
|---|---|---|
| Diphtheria-Pertussis-Tetanus (DPT) | Recommended as per Schedule | Recommended as per Schedule |
| Haemophilus Influenza B (HiB) | Recommended, 1 or 3 doses as per Schedule | Recommended, 1 or 3 doses as per Schedule |
| Hepatitis A Vaccine (HAV) (For travel, occupational & other specific risk and in endemic regions) | Recommended, 2 doses | Recommended, 2 doses |
| Hepatitis B Vaccine (HBV) | Recommended, 3 doses | Recommended, 3 doses |
| Pneumovax Consider providing Booster Polysaccharide Pneumococcal Vaccine every 3-5 years | Recommended, Ask your healthcare provider about the timing & spacing | Recommended, Ask your healthcare provider about the timing & spacing |
| Meningococcal Vaccine (To prevent infection of tissue layers that cover the brain by Neisseria species of bacteria, also called Neisseria Meningitis) | Administer only if kidney patient is at high risk of getting this infection, 1 dose | Administer only if kidney patient is at high risk of getting this infection, 1 dose |
| Human Papilloma Virus (HPV) To prevent genital infections (both genders) and Cancer of the Cervix in females | Recommended, Females upto age 26, Males upto age 21 | Recommended, Females upto age 26, Males upto age 21 |
| Tetanus Toxoid (TT) | Recommended as per schedule or as needed | Recommended as per schedule or as needed |
| Influenza Types A & B vaccine (Injection) To protect against Seasonal Flu, different from HiB) | Recommended, 1 dose every year | Recommended, 1 dose every year or as per local clinical guidelines |
| Intra-nasal Influenza vaccine (Inhaling via nose) | DO NOT USE | DO NOT USE |
| Typhoid Vi (Against Typhoid or Stomach Flu from Salmonella typhii bacteria) | Recommended especially before travel to countries with high prevalence of Typhoid | Safe for use in kidney transplant patients if clinically indicated |
| Live Oral Typhoid y21a and newer vaccines (Against Typhoid or Stomach Flu from Salmonella typhii bacteria) | DO NOT USE | DO NOT USE |
| Oral Polio Vaccine (OPV) | Recommended as per schedule unless immuno-suppressed Do not use in patients upto 5 years age group if the child is under immuno-suppressive therapy or has a weak immune system | DO NOT USE |
| Inactivated Polio Vaccine (Injectable) | Safer option for use in patients with poor immune systems at the age group normally scheduled for an Oral Polio Vaccine | Safe for use in Kidney Transplant Recipients |
| Measles | Recommended for those who have not received this vaccine as per schedule | DO NOT USE (Except during an outbreak and with suitable adjustments to transplant medicine doses) |
| Mumps-Measles-Rubella (MMR) | Consider vaccinating those who have not received this vaccine as per schedule | DO NOT USE |
| Bacillus-Calmette-Guerin (BCG) (To prevent complications of childhood Tuberculosis (TB)) | As per schedule at birth | DO NOT USE |
| Varicella Zoster (Chickenpox) | Recommended, 1 dose | DO NOT USE |
| Herpes Zoster (Shingles) | DO NOT USE IF ON IMMUNO-SUPPRESSIVE THERAPY (Such as on Steroids like Prednisone, Celcept, Prograf, Immuran, Endoxan etc) | DO NOT USE |
| Smallpox | DO NOT USE WITH IMMUNO-SUPPRESSION (Such as on Steroids like Prednisone, Celcept, Prograf, Immuran, Endoxan etc) | DO NOT USE |
| Live Japanese B Encephalitis Vaccine | DO NOT USE WITH IMMUNO-SUPPRESSION (Such as on Steroids like Prednisone, Celcept, Prograf, Immuran, Endoxan etc) | DO NOT USE |
| Yellow Fever | DO NOT USE WITH IMMUNO-SUPPRESSION (Such as on Steroids like Prednisone, Celcept, Prograf, Immuran, Endoxan etc) | DO NOT USE |
Information Source
1. KDIGO Guidelines for Vaccination in Kidney Disease and Post Kidney Transplant
2. Centres for Disease Control & Prevention (CKD)
3. National Kidney Foundation, USA