Safety and Efficacy of Pneumococcal Vaccination in Pediatric Nephrotic Syndrome.

Shamitha Thishakya Goonewardene,Learn-Han Lee,Prithvy Lingham,Bey-Hing Goh,Priyia Pusparajah,Kok-Gan Chan,Calyn Tang,Loh Teng-Hern Tan

doi:10.3389/fped.2019.00339

Abstract

Nephrotic syndrome affects both children and adults. Idiopathic nephrotic syndrome is reported to be one of the most frequent renal pathologies in childhood. Nephrotic children are at high risk for severe pneumococcal infections as one of the life-threatening complications of nephrotic syndrome due to involvement of the immunosuppressive regimen and the acquired immune deficiency induced by nephrotic syndrome including decreased plasma IgG and low complement system components. Aiming to prevent pneumococcal infection is of paramount importance especially in this era of ever-increasing pneumococcal resistance to penicillins and cephalosporins. The pneumococcal vaccines currently available are inactivated vaccines—the two main forms in use are polysaccharide vaccines and conjugated vaccines. However, the data supporting the use of these vaccines and to guide the timing and dosage recommendations is still limited for nephrotic children. Thus, this review discusses the evidences of immunogenicity and safety profile of both vaccinations on nephrotic patients as well as the effect of nephrotic syndrome treatment on vaccine seroresponses.

Highlights

Nephrotic Syndrome (NS)—an important kidney disorder affecting both children and adults [1]—is characterized by heavy proteinuria leading to hypoalbuminemia and oedema [2]
Pneumococcal vaccination provides good protection against strains covered by the vaccine even with concurrent steroid administration
After review of the literature, we would recommend that all children be immunized against S. pneumoniae and agree strongly with the WHO recommendation that pneumococcal vaccination be made part of all national immunization programs

Summary

Introduction

Nephrotic Syndrome (NS)—an important kidney disorder affecting both children and adults [1]—is characterized by heavy proteinuria leading to hypoalbuminemia and oedema [2]. NS has a worldwide prevalence of 16 cases per 100,000 children, while incidence has been recorded to be 2–7 per 100,000 children [3]. NS is most commonly seen among school aged children and adolescents, but there are two subsets based on age of presentation—Congenital Nephrotic Syndrome (presentation within first 3 months of life) and Infantile Nephrotic syndrome (presenting between 3 months to 1 year of age) [4]. Among children with nephrotic syndrome, only a minority (20– 33%) have a single episode, while the majority have multiple relapses. Male gender and young age at initial presentation have been identified as risk factors for frequent relapses [5].

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Conclusion