Koichi Kamei1, Isao Miyairi2, Kenji Ishikura3, Masao Ogura3, Kensuke Shoji2, Takanori Funaki2, Reiko Ito4, Katsuhiro Arai5, Jun Abe6, Toshinao Kawai7, Masafumi Onodera7, Shuichi Ito8. 1. Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan. Electronic address: kamei-k@ncchd.go.jp. 2. Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan. 3. Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan. 4. Department of General Pediatrics, National Center for Child Health and Development, Tokyo, Japan. 5. Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan. 6. Department of Allergy and Immunology, National Research Institute for Child Health and Development, Tokyo, Japan. 7. Department of Human Genetics, National Research Institute for Child Health and Development, Tokyo, Japan. 8. Department of Pediatrics, Yokohama City University, Yokohama, Japan.
Abstract
OBJECTIVE: To conduct a prospective study to evaluate the immunogenicity and safety of live attenuated vaccines in patients with nephrotic syndrome receiving immunosuppressive agents. STUDY DESIGN: Patients with nephrotic syndrome receiving immunosuppressive agents with negative or borderline antibody titers (virus-specific IgG levels <4.0) against measles, rubella, varicella, and/or mumps fulfilling the criteria of cellular and humoral immunity were enrolled. Virus-specific IgG levels were measured using an enzyme immunoassay. The primary endpoint was the seroconversion rate (ie, achievement of virus-specific IgG levels ≥4.0) at 2 months after vaccination. Virus-specific IgG levels at 1 year, breakthrough infections (wild-type infections), and adverse events were also evaluated. RESULTS: A total of 116 vaccinations were administered to 60 patients. Seroconversion rates were 95.7% for measles, 100% for rubella, 61.9% for varicella, and 40.0% for mumps. More patients with a borderline antibody titer before vaccination achieved seroconversion than those with negative antibody titer, with statistical significance after varicella and mumps vaccination. The rate of patients who maintained seropositivity at 1 year after vaccination was 83.3% for measles, 94.1% for rubella, 76.7% for varicella, and 20.0% for mumps. No patient experienced breakthrough infection. No serious adverse events, including vaccine-associated infection, were observed. CONCLUSION: Immunization with live attenuated vaccines may be immunogenic and is apparently safe in our cohort of patients with nephrotic syndrome receiving immunosuppressive agents if their cellular and humoral immunologic measures are within clinically acceptable levels. TRIAL REGISTRATION: UMIN-CTR UMIN 000007710.
OBJECTIVE: To conduct a prospective study to evaluate the immunogenicity and safety of live attenuated vaccines in patients with nephrotic syndrome receiving immunosuppressive agents. STUDY DESIGN:Patients with nephrotic syndrome receiving immunosuppressive agents with negative or borderline antibody titers (virus-specific IgG levels <4.0) against measles, rubella, varicella, and/or mumps fulfilling the criteria of cellular and humoral immunity were enrolled. Virus-specific IgG levels were measured using an enzyme immunoassay. The primary endpoint was the seroconversion rate (ie, achievement of virus-specific IgG levels ≥4.0) at 2 months after vaccination. Virus-specific IgG levels at 1 year, breakthrough infections (wild-type infections), and adverse events were also evaluated. RESULTS: A total of 116 vaccinations were administered to 60 patients. Seroconversion rates were 95.7% for measles, 100% for rubella, 61.9% for varicella, and 40.0% for mumps. More patients with a borderline antibody titer before vaccination achieved seroconversion than those with negative antibody titer, with statistical significance after varicella and mumps vaccination. The rate of patients who maintained seropositivity at 1 year after vaccination was 83.3% for measles, 94.1% for rubella, 76.7% for varicella, and 20.0% for mumps. No patient experienced breakthrough infection. No serious adverse events, including vaccine-associated infection, were observed. CONCLUSION: Immunization with live attenuated vaccines may be immunogenic and is apparently safe in our cohort of patients with nephrotic syndrome receiving immunosuppressive agents if their cellular and humoral immunologic measures are within clinically acceptable levels. TRIAL REGISTRATION: UMIN-CTR UMIN 000007710.
Authors: Rasmus Ehren; Marcus R Benz; Paul T Brinkkötter; Jörg Dötsch; Wolfgang R Eberl; Jutta Gellermann; Peter F Hoyer; Isabelle Jordans; Clemens Kamrath; Markus J Kemper; Kay Latta; Dominik Müller; Jun Oh; Burkhard Tönshoff; Stefanie Weber; Lutz T Weber Journal: Pediatr Nephrol Date: 2021-06-06 Impact factor: 3.714