Immunizations in children on PD: current guidelines and recommendations.

Antibody responses to currently recommended immunizations in pediatric patients on chronic peritoneal dialysis (CPD) have been measured and the results have been variable. Although the incidence of vaccine-preventable disease in pediatric CPD patients is not known, it appears that protection from these diseases may be reduced. The explanation for the abnormal response to vaccines might include lower seroconversion rates in these patients, with lower antibody titers or levels. Also a rapid decline of antibody levels or titers may occur as a consequence of continuous peritoneal dialysis. Specific vaccines that may result in a less than optimal response in pediatric CPD patients include hepatitis B virus, hemophilus influenza type b, measles, mumps, rubella and pneumococcal vaccine. Patients who receive these immunizations should be monitored closely. Increased vaccine dosage, reinforced vaccination schedules, as well as concomitantly administered adjuvant immuno-modulators may play an important role in more effective vaccination of pediatric CPD patients. It is important that vaccine response be monitored in these patients by measuring specific antibody titers or levels to ensure adequate protection from vaccine-preventable illness.