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Immunization rates low among kidney transplant candidates
PHILADELPHIA — Immunization rates for common vaccine-preventable infections were low among kidney transplant candidates, according to data presented at IDWeek 2014.
“The best time to vaccinate this population is before transplantation,” Ankit Parikh, MD, of Drexel University College of Medicine, Philadelphia, told Infectious Disease News. “If you vaccinate them, you can prevent post-transplant infections … if you do the right thing at the right time.”
Parikh and colleagues examined the records of 102 transplant candidates at Hahnemann University Hospital to determin vaccination rates for pneumococcus, influenza and tetanus, as well as the presence of hepatitis B antibodies. The median age of the patients was 52 years, 59.8% were male, 70.6% were black and 66.7% were receiving dialysis at the time of the study.
They found that 43% of pre-transplant patients had received influenza vaccine, 30.4% pneumococcal vaccine and 9.8% tetanus vaccine. Patients were more likely to have received pneumococcal vaccine if they had also received influenza vaccine (83.6% vs 5.2%; P<.01) and tetanus vaccine (25.8% vs 2.8%; P<.01). Hepatitis B immunity was found in 41.6%, and was found more often in patients receiving dialysis (70.0% vs 32.3%; P<.01).
Parikh said that the current trend could help increase immunization rates, as health care providers could be automatically alerted when transplant candidates have not yet received commonly available vaccines.
“In a sequential cohort of patients listed for kidney transplantation, we found that the overall immunization rate of commonly vaccine preventable infection was low,” the researchers wrote in the abstract. “This suggests that there remains a significant gap between recommendations and actual vaccination rates for the high risk population.” — by Dave Muoio
For more information:
Parikh A. Abstract 427. Presented at: IDWeek 2014; Oct. 8-12, 2014; Philadelphia.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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The poor vaccination rates for kidney transplant candidates as demonstrated in the poster study by Parikh presented at ID Week 2014 indicate a clear disconnect between the value of prevention and challenges of treating life-threatening diseases in immunocompromised patients. For example, evidence supporting the recent Advisory Committee on Immunization Practices’ recommendation for 13-valent pneumococcal conjugate vaccination for all immunocompromised patients reveals risk of invasive pneumococcal disease in immunocompromised patients to be 20 times higher than in those without high-risk medical conditions.
Kidney transplantation is a carefully planned procedure and adequate immunization must be part of the pre-procedure checklist. The Affordable Care Act’s mandated coverage (without co-pay) of ACIP-recommended vaccines should help alleviate the cost factor for patients. That said, incorporating ACIP recommendations requires time and coordination. All of the vaccines assessed by Dr. Parikh are already indicated for patients with kidney failure, end stage renal disease and those on hemodialysis. This includes vaccinations for influenza, tetanus and diphtheria toxoids, and hepatitis B, as well as tetanus-diphtheria-acellular pertussis vaccine, PCV13 and 23-valent pneumococcal polysaccharide vaccine. ACIP’s annual update of the Adult Immunization Schedule clearly specifies the vaccines needed for patients with kidney disease. The Infectious Diseases Society of America recently published its own set of guidelines for vaccination of immunocompromised patients in the December 4, 2013 issue of Clinical Infectious Diseases.
This study indicates the value of quality improvement efforts in self-assessment, identifying problems, rectifying deficiencies and improving vaccination rates. The American College of Physicians (ACP) is now engaged in immunization quality improvement programs through its ACP Quality Connect Initiative. Appropriate vaccination should also extend to care givers, loved ones and those in close proximity to immunocompromised patients for their own sake and also because they are often infection sources. For immunocompromised patients, these successful vaccination efforts can mean the difference between life and death.