Influenza virus vaccination in pediatric nephrotic syndrome significantly reduces rate of relapse and influenza virus infection as assessed in a nationwide survey

Shingo Ishimori,Chikako Terano,Riku Hamada,Hitoshi Nakazato,Kenji Ishikura,Masataka Honda,Yuko Hamasaki,Norishige Yoshikawa,Fumiyo Komaki,Yoshinori Araki,Koichi Nakanishi,Yoshimitsu Gotoh,Kaori Kikunaga,Takashi Ando,Mai Sato,Kazumoto Iijima,Takeshi Matsuyama,Shuichi Ito

doi:10.1038/s41598-021-02644-x

Abstract

Although vaccination may precipitate relapses of nephrotic syndrome (NS) in children with idiopathic NS, no data are available regarding NS activity regarding influenza (flu) virus infections and NS relapses after receiving inactivated flu vaccines. We conducted a nationwide study of children aged 6 months to 15 years with idiopathic NS to assess the relationship between NS relapse, flu vaccination, and flu infections. We used a multivariate Poisson regression model (MPRM) to calculate the risk ratio (RR) for flu infection and for NS relapse in children with and without flu vaccination. Data of 306 children were assessed. The MPRM in all 306 children showed a significantly lower RR for flu infection (RR: 0.21, 95% confidence interval CI 0.11–0.38) and for NS relapse (RR: 0.22, 95% CI 0.14–0.35) in children receiving flu vaccination compared with unvaccinated children. In an additional MPRM only among 102 children receiving flu vaccination, they had a significantly lower risk for NS relapse during the post-vaccination period (RR: 0.31. 95% CI 017–0.56) compared with the pre-vaccination period. Although our study was observational, based on the favorable results of flu vaccinations regarding flu infections and NS relapse, the vaccine may be recommended for children with NS.

Highlights

Vaccination may precipitate relapses of nephrotic syndrome (NS) in children with idiopathic NS, no data are available regarding NS activity regarding influenza virus infections and NS relapses after receiving inactivated flu vaccines
We report the findings of a nationwide cohort study among Japanese children with idiopathic NS in which we focus on the relationships among NS relapses, flu vaccines, and flu infections
We conducted a nationwide cohort study comprising 306 children with idiopathic NS, and showed that children who received flu vaccination had significantly fewer flu infections and NS relapses than those who did not receive flu vaccination. The former group showed a significantly lower NS relapse risk during the post-vaccination period compared with the pre-vaccination period

Summary

Introduction

Vaccination may precipitate relapses of nephrotic syndrome (NS) in children with idiopathic NS, no data are available regarding NS activity regarding influenza (flu) virus infections and NS relapses after receiving inactivated flu vaccines. In an additional MPRM only among 102 children receiving flu vaccination, they had a significantly lower risk for NS relapse during the post-vaccination period To prevent NS relapse, these patients require prolonged steroid therapy and immunosuppressive agents[3,4] These children have been the state of immunocompromised, in which they have the potential for recurrent or severe infections. Compared with the NS relapse rate during the pre-vaccination period as a control, the rate within 1 month after receiving flu vaccination was slightly but non-significantly increased (1.19 vs 1.23 times/person-year, risk ratio: 1.04, 95% confidence interval: 0.82–1.89, p=0.88). We report the findings of a nationwide cohort study among Japanese children with idiopathic NS in which we focus on the relationships among NS relapses, flu vaccines, and flu infections

Methods

Results

Conclusion