Q & A: Pneumococcal vaccination

Q: Hi Donal, can you help to clarify the issue with regards to Pneumococcal vaccination in patients with CKD: I read with interest the question and response on this on a previous blog. However, the general guidance available on vaccinations still suggests the use of the PPV vaccine in patients with CKD rather than the PCV vaccine. I am not clear on a couple of things: - What is the rationale behind using PCV rather than PPV in high risk CKD patients? My understanding is that the PPV is more effective at preventing serious or invasive pneumococcal disease, and this should offset the slight increase risk of an adverse reaction to this vaccine compared to the PCV.

• Will there be/is there some guidance on antibody testing before initial immunisation, or prior to subsequent boosters?
• Do CKD patients need 2 doses of the PCV vaccine, and if so, how far apart should they be given?
• I presume that pneumococcal vaccination of any kind is not recommended in CKD 1 or 2 patients (unless they have another reason for being considered “high risk”)?

Best wishes, Craig Gradden, Aintree University Hospitals NHS Foundation Trust

A: Hi Craig and thank you for this question. The JCVI reviewed the evidence on vaccine efficacy in February 2009. The minutes of the meeting can be downloaded.

The Pneumococcal chapter in the Green Book – Immunisation against infectious diseases is currently undergoing a major revision and the advice below is not in the currently available chapter. People who have chronic renal disease should receive two doses of PCV (with the second dose being given at least two months after the first) followed by a booster dose every five years. As per the current Green Book, page 304 of Chapter 25 on Pneumococcal, testing of antibody levels prior to vaccination is not required. In line with the Renal Association guidance your presumption that pneumococcal vaccination of any kind is not recommended in CKD 1 or 2 patients (unless they have another reason for being considered “high risk”) is correct. Best wishes, Donal