Chronic kidney disease in children: Vaccination – strategy, current recommendations and potentialities

Abstract

The Immunization Schedule with additional vaccinations against certain infections is recognized as an effective strategy for preventing complications in children with Chronic Kidney Disease (CKD). The aim of this study is to highlight international experience regarding the immunization status of such patients in order to optimize the vaccinations process in Ukraine. The current Immunization Schedule for pediatric CKD, approved in international practice, is presented and has been compared to the national one. The approaches to the use of live and inactivated vaccines, to the immunization of persons on immunosuppressive therapy and the additional protective measures are clearly outlined. The international experience in the major vaccine-controlled disease prevention in children with CKD includes routine immunization (tuberculosis, hepatitis B, diphtheria, whooping cough, tetanus, poliomyelitis, measles, mumps, rubella, hemophilic infection), additional vaccination of immunocompromised hosts (influenza, pneumococcal infection, chicken pox) and in groups with risk factors (meningococcal, papillomavirus, rotavirus infections, hepatitis A, etc.) are summarized. It is emphasized that the optimal window of opportunity for vaccinations is the early stages of CKD or at least the pre-transplant time. The key principles of vaccine control prior and after kidney transplantation have been given. Increasing knowledge on protection from vaccine-controlled infections involved in children with CKD, including at the immunosuppressive therapy stage and kidney replacement therapy, makes implementation of current recommendations easier and advances the prevention strategy for this sensitive cohort. The process of harmonization of national recommendations on the vaccine status formation in this group of patients based on international experience and Ukrainian capabilities is proposed to initiate.