Abstract
Problem statement: The incidence of infectious diseases is increased in patients with chronic renal failure. Chronic renal failure severely influences the immune functions of the host. Diphtheria is of great epidemiological concern. Although mainly observed during childhood, unvaccinated adults and relatively immunocompromised patients are at increased risk for acquiring diphtheria. Approach: To evaluate the anti-Diphtheria immunity level in southern Iranian patients with end stage renal disease undergoing hemodialysis and to find its association with sex, age, blood hemoglobin, serum albumin and duration of dialysis. This cross sectional study was carried out on a total of 52 patients, who were on hemodialysis and 52 age and sex matched healthy individuals with without any underlying renal disease as a control group. Subjects in the both groups receiving anti-diphtheria toxoid vaccine or immunoglubins a year prior to the study were excluded. The serum anti-diphtheria IgG antibody levels were measured by an ELISA method. Results: Diphtheria protected individuals in the patients and the control groups were 34.6 and 63.30% respectively. Of the evaluating factors just hemodialysis duration found to affect on diphtheria immunity. Conclusion: Diphtheria protected individuals in the patients group were significantly less than diphtheria protected individuals in the control group (p = 0.011). Hemodialysis duration has significant effect on anti-diphtheria immunity level.
Highlights
Infectious diseases are the leading cause of death in End-Stage Renal Disease (ESRD) patients, second only to cardiovascular disease
The tetanus, diphtheria and pertussis vaccination programme in Iran has been running since 1950 using a local vaccine manufactured by Razi Institute (RaziDTwP), Tehran, Iran and the efficacy of the vaccine was confirmed by previous studies. These vaccinations have decreased the incidence and changed the epidemiology of these diseases (Zarei et al, 2007), but there is no routine vaccination for hemodialysis patients and So far only a few studies have focused on seroresponse to tetanus toxoid in these patients in Iran (Sagheb et al, 2009; Jahromi et al, 2009)
Serologic evaluations: Anti-diphtheria toxoid IgG level was determined on serum samples taken from patients before starting hemodialysis
Summary
Infectious diseases are the leading cause of death in End-Stage Renal Disease (ESRD) patients, second only to cardiovascular disease. The incidence of infectious diseases is increased in patients with chronic renal failure (Laube et al, 2002) This is thought to be due to an immunosupressed status in this population (Litjens et al, 2008; Vacher-Coponat et al, 2008; Kaliuzhina et al, 2006). CD4+ T Cells (Litjens et al, 2008), defects in NK cell function (Vacher-Coponat et al, 2008), immunodeficiency status manifested decrease in the number of CD3+, CD4+ and CD72+ cells and phagocytosis intensification (Kaliuzhina et al, 2006), T and B-lymphocyte abnormalities and impaired responses to T cell dependent pathogens such as hepatitis B virus (Argani and Akhtarishojaie, 2006) and endothelial dysfunction (Hussein, 2010) Opportunistic infectious disease such as toxoplasmosis has more prevalence than healthy subjects (solhjoo et al, 2010). These vaccinations have decreased the incidence and changed the epidemiology of these diseases (Zarei et al, 2007), but there is no routine vaccination for hemodialysis patients and So far only a few studies have focused on seroresponse to tetanus toxoid in these patients in Iran (Sagheb et al, 2009; Jahromi et al, 2009)
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