Patients with chronic renal failure is a well recognized group on risk for bacterial and virus infections. When vaccination is suitable, the antibody response rate differs from patient to patient and from vaccine to vaccine (poor response to virus B hepatitis vs. good response to polysaccharide neumococcus.
We used a formula of pneumococcus vaccine containing 23 serotypes .
We performed the present study to analyse the rate of response to Pneumo23 vaccination in 33 patients with chronic renal failure in predialysis phase. Ccr<30ml/min/1´73m2, mean age=70,42±9,5 years, 19 (57,5%) male.
The renal function parameters were: Ccr=19±6,8 ml/min/1,73m2, weekly Kt/v 2,26±0,73 and MDRD 15,37±4,7.
Serum albumin was 3,88±0,33, PCR 0,95±1,43 (range 0,1-6,4). At this purpose, the baseline Ab rate and one month after vaccination were measured, using ELISA-protocol /CDC-Workshop,Atlantza), testing for the serotypes more frequent (Srt3, Srt6,Srt14,and Srt23F).
The values are expressed in µgr/ml of IgG (serotype-specific).
Although the protective concentration of Ab to pneumococcus has not been determined, supported by other experiences we have considered as protection rate > 1 µgr/ml of IgG specific (much more accurate >2).
Consequently, we defined the seroconversion index that showing double Ab level after vaccination.
The values for different groups are shown as mean±SD and range.
We found significant differences between the values pre- and post-vaccination in the four groups (p=0,000).
The response rate was different according the four groups of polysacharides and also was different among the patients.
For Srt3 <1 baseline 2 patients did not respond (6,1%) and non duplicate 8 patients. For Srt23F <1 baseline, 18patients (24%) 16 patients did not doubled the Ab rate.
We found a significant correlation between the pre and post rates for the four serotypes. Also between Ab rate and PCR, in some serotypes but not for Ab rate and age, albumin, and renal function (except Srt3 basal with MDRD p<0.05 , and Srt3 post vaccination with Kt/v weekly). 21 of these patients received HBV vaccination (3 doses 40 µgs Recombivax in short schedule, 21 days); the response rate in terms of Hb Ab appeared only in 3 patients with x 32,73±129,3 (range 0-593,5).