Vaccination in Renal Transplant Patients (VcRtp study)

Sir,

Adverse outcomes of influenza & pneumococcal infections in solid organ transplant recipients have been well documented. Vaccinations are therefore recommended by multiple guidelines. Despite emerging evidence of the safety & effectiveness among immunosuppressed patients, most vaccines are still underutilized, we conducted a survey among the renal transplant patients in Beaumont Hospital to determine the awareness and uptake of vaccinations. Questionnaires were handed to patients during a clinic visit over a span of 2 weeks and 250 questionnaires were posted out to randomly selected transplant patients, The Questionnaire addressed various aspects including the awareness of importance of vaccinations, source of information, if they were up to date with the vaccines & where did they receive it?

A total of 216 patients participated, 65 (30.1%) from clinic and 151 (69.9%) patients returned the Questionnaire by post, of the total participating 125 (58%) were male & 91(42%) were female patients, it was the 1st transplant for 170 (79%), 2nd for 32 (15%) and 3rd for 6 (3%) patients ,8 (3%) patients left this question blank.One hundred and two (89%) of the patients admitted awareness of the importance of the vaccinations whereas 24 (11%) admitted otherwise, 95 (49%) patients got the information from consultant,46 (24%) patients from the GP,29 (15%) from both Consultant and GP, 16 (8%) from other sources,3 (2%) from Consultant and other sources and 1(1%) from consultant GP and other sources,2 (1%) patients left this question blank. One hundred and seventy-two (79.6%) patients had received the influenza vaccine, 43 (19.9%) had not and 1(0.46%) did not know, of those who received 136 (79%) received the vaccination at GP, 2 (1%) in Beaumont Hospital and 32 (19%) in other locations. One (1%) patient left this question blank. One hundred and sixteen (54%) patients had received Pneumococcal vaccine, 73 (34%) had not, 25 (11%) of the patients did not know and 2(1%) left the question blank, of those who received 107 (91%) patients received it at GP 4 (3%) patients at Beaumont Hospital, 5 (4%) in other locations and 2 (2%) patients left this question blank.

We can conclude from this that the majority of the patients are aware of the importance of vaccinations; however there is still a significant percentage that has a poor uptake, especially of pneumococcal vaccine. Our findings with regards to awareness &suboptimal uptake of pneumococcal vaccine in immunocompromised patients are similar to Sowden et al1 but in our survey uptake of influenza vaccine was much higher. Poor uptake of both vaccines has been demonstrated in Irish diabetic Population2, and dialysis patients3 with a tendency of a poorer uptake of pneumococcal vaccine when compared to influenza vaccine in both. We suggest steps should be taken to ensure that Immunocompromised patients are routinely reminded about receiving their vaccinations during clinic & GP visits and periodic reminders should be sent out in form of texts and leaflets through post, emails etc.

F Rathore, E Berzan, C Magee

Department of Renal Medicine, Beaumont Hospital, Dublin 9

References

  1. Evin Sowden and William S Mitchell. An audit of influenza and pneumococcal vaccination in rheumatology outpatients

BMC Musculoskelet Disord. 2007 Jul 4;8:58.

  1. Una Clancy, Joe Moran, Antoinette Tuthill. Prevalence and Predictors of Influenza and Pneumococcal Vaccine Uptake in Patients with Diabetes Ir Med J. 2012 Oct;105:298-300
  2. Wilmore, SM; Philip, KE; Cambiano, V; Bretherton, CP; Harborne, JE; Sharma, A; Jayasena, SD. Influenza and pneumococcal vaccinations in dialysis patients in a London district general hospital. (2014) Influenza and pneumococcal vaccinations in dialysis patients in a London district general hospital. Clin Kidney J, 7:27 – 32.

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