By Peter Laird, MD
Influenza is a serious illness especially in patients with chronic illnesses such as CKD and ESRD. Influenza causes patients to have an increased susceptibility to pneumonia which is the most common cause of death in patients who have had influenza. The chief reason for giving the influenza vaccine is not so much to prevent the flu itself, but to prevent the subsequent pneumonia and its dire consequences. A recent study compared the immune response to the flu vaccine in dialysis patients and those post renal transplant. Not surprisingly, the renal transplant patients on anti-rejection medications had a poorer response than dialysis patients:
Influenza A/H1N1 vaccine in Patients Treated by Kidney Transplant or Dialysis: A Cohort Study
Results The GM titer ratio was 38 (19 to 78), 9 (5 to 16), and 5 (3 to 6) for controls, HD patients, and RT patients, respectively (P < 0.001). The proportion of responders was 90%, 57%, and 44%, respectively (P < 0.001). In RT patients, the prevalence of histocompatibility leukocyte antigen (HLA) class I, histocompatibility leukocyte antigen class II, and MHC class I-related chain A immunization, was, respectively, 15%, 14%, and 14% before and 14%, 14%, and 11% after vaccination (P = 1, 1, and 0.39).
Conclusions The influenza A/H1N1-adjuvanted vaccine is of limited efficacy but is safe in renal disease populations. The humoral response is lower in transplantedversus hemodialyzed patients. Further studies are needed to improve the efficacy of vaccination in those populations.
Despite the suboptimal immune response in the renal transplant population, renal transplant patients should still get vaccinated since they are at such high risk of all cause infections. Dialysis patients likewise should not decline influenza vaccination since the vaccine does elicit an adequate if not completely robust response to justify its continued use. Although patients may develop fever, chills and muscle aches, with inactivated vaccine there is no risk of actually developing the flu itself. Some that develop these symptoms with the flu vaccine may actually mount a more vigorous immune response.
Single dose vials have no mercury preservatives but the multidose vials have small amounts of mercury. The data on whether this poses a long term health risk are conflicting, but anyone with concerns about this can simply ask for the single dose vial. When you examine all of the evidence, getting your flu shot each makes the most sense.
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