Vaccine-preventable infection morbidity of patients with chronic kidney disease and cocoon vaccination strategies

Abstract

Individuals with chronic kidney disease (CKD) are vulnerable to vaccine-preventable infections due to impaired immunity, immunosuppressive treatments and dialysis. Protection of CKD patients by vaccination is hampered by reduced efficacy of vaccines and safety concerns for transplant candidates or recipients. ‘Cocooning’ vaccination policies, targeting the protection of a vulnerable individual through immunization of close contacts, have recently been introduced for infants and, to a lesser degree, for high-risk groups of immunocompromised individuals. In this article, we discuss the potentiality of implementing cocoon strategies for the high-risk group of CKD patients and conclude that this not yet officially recommended policy can substantially contribute to protection against infection and motivate vaccination among families and healthcare workers.

Keywords:

• chronic kidney disease
• cocooning
• dialysis
• renal transplant recipients
• vaccination
• vaccine-preventable disease

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Patients with chronic kidney disease (CKD) are at high risk for infections and vulnerable to vaccine-preventable diseases due to defective immunity, dialysis, immunosuppressive drugs and frequent healthcare visits.

• Despite existing recommendations, vaccination coverage remains low among CKD patients due to vaccine efficacy and safety concerns and limited knowledge of the importance of vaccination among families and healthcare workers.

• Vaccination of close contacts of a vulnerable individual, the so-called ‘cocooning’ vaccination strategy, has already been successfully implemented in population groups such as infants for their protection from pertussis and influenza.

• Cocooning, although not officially recommended for CKD patients, could increase their protection against infection and motivate families and healthcare workers to be vaccinated.

• Cocooning is often regarded as a not cost-effective strategy to be widely implemented; however, the non-measurable implications of cocooning, such as the promotion of vaccine education, the motivation of solidarity and the changing of perspective towards lifelong vaccination, would benefit the expanding CKD population.