Segurança e imunogenicidade da vacinação contra a febre amarela em pacientes com doença renal crônica dialítica

Abstract

The immune response and safety of the yellow fever vaccine in chronic kidney disease patients are not known. The immunosuppression characteristic of chronic kidney disease could increase the risk of serious adverse events, in a scenario of no specific recommendation regarding the safety of this vaccine in chronic kidney disease. The outbreak of wild yellow fever in Espírito Santo in 2017, at the time an unprotected area, led to the need for vaccination of an unprotected population. Individuals with chronic kidney disease were vaccinated based on the physician's shared decision with the patient. It is known that, for other vaccines, this population has lower seroconversion rates, lower peak antibody titers, and rapid decline in titers compared to healthy subjects. The aim of this study was to evaluate the safety and immunogenicity of the yellow fever vaccine in chronic kidney disease patients. A cross-sectional study was carried out with 223 chronic patients on dialysis, with 211 patients (94.62%) on hemodialysis and 12 patients (5.38%) in peritoneal dialysis, with a median time of dialysis therapy of 4.5 and 7 years, respectively. Only 11 patientes received the vaccine before 2017, the others being vaccinated during the years 2017 and 2018. From 223 patients interviewed, 205 (91.93%) did not experience any adverse events after vaccination. Local manifestations such as pain and swelling occurred in 13 patients (5.83%), while 6 patients (2.7%) had general systemic manifestations (such as fever and headache). One patient had both manifestations. Severe adverse events attributable to the yellow fever vaccine were not observed. Brown race was the only risk factor for the occurrence of adverse events. A lysis-plaque-reduction neutralization test was performed to assess seroconversion. A neutralization titer of ≥1:20 was considered adequate and protective. Seroconversion was evaluated approximately 35 months after vaccination in 71 patients. Of these, only 27 patients (38%) had sufficient neutralization titer. No clinical feature was considered a predictor for seroconversion. This study suggests that the yellow fever vaccine is safe in chronic kidney disease patients. The vaccine, however, confers a seroconversion rate much lower than expected for the general population. This study cannot predict the ideal dose and/or the number of doses that should be given to maintain adequate antibody levels before the chronic kidney patient undergoes a kidney transplant.