[Immunogenicity of the 23-valent pneumococcal vaccine in children with chronic renal disease].

OBJECTIVE: To study the immunogenicity of the 23-valent pneumoccal vaccine in children with chronic renal disease and in those with nephrotic syndrome, and to compare it with the response in healthy children.

METHODS: The vaccine was administered to 150 children aged 2-18 years: 113 with renal diseases (26 with nephrotic syndrome, 23 with severe grades of vesicoureteral reflux, 16 with chronic renal insufficiency, 6 renal transplant recipients, 6 requiring dialysis and 36 with other renal diseases) (group 1) and 37 healthy (group 2). Specific IgG antibodies concentrations were measured by ELISA before and 30 days after vaccination. The results obtained in both groups were compared. We compared too the response observed between the subgroup of children with renal diseases in which pneumococcal vaccine is indicated (nephrotic syndrome, chronic renal insufficiency, renal transplant and those requiring dialysis (group 3) and healthy children.

RESULTS: 87.3% of children showed a 2-fold increase in antibody concentrations after vaccination. No significant differences were observed between the three groups. We considered that the vaccine was immunogenic in 78.4% of healthy children, in 77.9% of group 1 children and in 72.5% of those in the group 3 (p = 0,533). A lower response was observed in children with a kidney transplant and in those requiring dialysis.

CONCLUSIONS: These results suggest that 23-valent pneumococcal vaccine is immunogenic in children with chronic renal diseases or nephrotic syndrome and may protect these patients from invasive pneumococcal disease. The importance of improved vaccine coverage is emphasized.