VACCINES & KIDNEY PATIENTS: A COMPREHENSIVE GUIDE


Vaccine Guide for Kidney Patients Cover

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.


RECOMMENDED READ

Vaccine basics page link


WHEN DOES A KIDNEY PATIENT REQUIRE VACCINATION?

Whether a kidney patient needs to be vaccinated depends on three factors:

Vaccine Requirement Bullet 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.

Vaccine Requirement Bullet 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.

Vaccine Guide for Kidney patients Red tick 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.

Vaccine Guide for Kidney patients Red tick 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.

Vaccine Requirement Bullet 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.


RECOMMENDED READ

Vaccine basics page link


 

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:

Vaccine Guide for Kidney patients Red tick Inactivated vaccines are safe for use both pre and post-transplant

Vaccine Guide for Kidney patients Red tick Live vaccines can be taken before a transplant surgery, provided you are not on immune-suppressive therapy. If you get a live vaccine pre-transplant, it is imperative to wait for at least 4 weeks after administration.

Vaccine Guide for Kidney patients Red tick After the transplant surgery, Live Vaccines are UNSAFE and completely off-limits. These can cause seroconversion & infection plus show suboptimal vaccine efficacy

Vaccine Guide for Kidney patients Red tick 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.


RECOMMENDED READ

Vaccine basics page link


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.

 

VACCINESKIDNEY DISEASE & DIALYSIS PATIENTSPOST-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 dosesRecommended, 2 doses
Hepatitis B Vaccine (HBV)Recommended, 3 dosesRecommended, 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 doseAdminister 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 USEDO 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


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