Immunogenicity of sequential conjugate and non-conjugate pneumococcal vaccination in dialysis patients and kidney transplant recipients: a 12-month serological follow-up

Background Pneumonia is the second most common infection in individuals with end-stage kidney disease and is associated with poor prognosis. The most frequently implicated pathogen is Streptococcus pneumoniae . Vaccine coverage is therefore essential. Different vaccination strategies have been implemented over time, depending on the period and availability of vaccines in each country. Aim In a single-center observational study, we describe the serological response for 7 serotypes in dialysis patients (DP) and kidney transplant recipients (KTR) following a standard vaccination schedule against Streptococcus pneumoniae , consisting of one dose of the 13-valent conjugate vaccine (Prevenar 13 ® ) followed 2 months later by one dose of the 23-valent non-conjugate vaccine (Pneumo 23 ® ). Methods We analyzed 61 participants (DP n=30, KTR n=31) who had completed the full vaccination schedule between January 2015 and December 2016. IgG titers against 7 pneumococcal serotypes (4, 6B, 9V, 14, 18C, 19F, 23F) were measured by ELISA before each vaccine dose and at 3, 6 and 12 months thereafter. We modeled changes in IgG levels over time. We estimated the probability of seroconversion and seroprotection (IgG titers > 1 µg/mL) for each serotype. Results Overall, the immune response was stronger in DP than in KTR. IgG titers and seroconversion rates were higher in DP than in KTR, except for serotypes 6B, 19F and 23F. The cumulative probability of global response in KTR vs. DP was 32.3% vs. 62.2% at 3 months, 35.5% vs. 73.6% at 6 months and 39.3% vs. 73.6% at 12 months. Conclusion The serological response to this pneumococcal vaccination schedule in individuals with end-stage kidney disease was modest overall but tended to be higher in DP than in KTR.