Immunization guidelines for pediatric renal disease.

It is imperative that pediatric nephrologists monitor the immunization status of pediatric chronic renal insufficiency, dialysis and transplantation patients closely to reduce the risk of vaccine-preventable disease. Pediatric patients with chronic renal insufficiency and those on dialysis should receive all the standard immunizations according to the schedule as deliniated by the Red Book. In addition to these standard vaccines, these patients will also benefit from influenza and pneumococcal vaccine. Pediatric renal transplant recipients should also be immunized with standard and special vaccines; however, all live viral vaccines should be avoided in this population. Because patients with renal disease may not respond optimally to all immunizations, it is important to study antibody response to MMR and varicella in patients before transplantation. If these patients are unprotected, they should be immunized before transplantation. It seems that pediatric dialysis and transplantation patients may not respond optimally to hepatitis B vaccine. Therefore, if at all possible, this vaccine should be administered before these therapies. Doubling the recommended dose of hepatitis B vaccine may improve response. Antibody levels to hepatitis B should be monitored every other year, and this vaccine should be readministered when the antibody level decreases to less than 10 mIU/mL. Hopefully the morbidity and mortality associated with vaccine-preventable disease can be reduced in this population by ensuring that pediatric patients with chronic renal disease are adequately immunized.