Comment on: Hemodialysis and Immunization against Swine Flu

Dear Editor

I read the recent publication on immunization against swine flu with great interest.¹ Stavroulopoulos et al.¹ concluded that ‘Our findings indicate that immunization against H1N1 virus in dialysis patients is safe and do not support the concerns about safety of the vaccine that was the main reason for nonvaccination in our study.’ I have some ideas on this report. It is interesting that the rate of adverse effect in dialysis group is significantly lower than that in the control group. Indeed, this result might be limited for further generalization due to few subjects as the author noted. However, there are also other interesting points to be discussed. A simple issue is if this observation is real, the effectiveness of the vaccine among the dialysis patients is in doubt. Whether the lower adverse effect due to vaccination might imply the poorer immune response in the dialysis patients is a big question for further clarification. Indeed, the poor immune response to influenza vaccine is observed in dialysis patients. A recent report indicated that ‘High ferritin is associated with a poor immune response to an influenza vaccine in hemodialysis patients.’²

Viroj Wiwanitkit

Wiwanitkit House, Bangkhae, Bangkok, Thailand 10160

E-mail: [email protected]