Chronic kidney disease and pneumococcal disease: do you know the facts?

If you have chronic kidney disease (CKD) you already know that you need to take special care of your body. Many things you need to do to maintain good health can be challenging, but getting your vaccines should be easy. There are several vaccines people with CKD need. One vaccine you may not know about is the vaccine for pneumococcal disease.

Dr. Joseph A. Vassalotti, Chief Medical Officer of the National Kidney Foundation and Dr. William Schaffner, Past-President of the National Foundation for Infectious Diseases, have teamed up to share important information about this disease and how it can be prevented. Dr. Vassalotti also serves as Clinical Associate Professor of Medicine in the Division of Nephrology at Mount Sinai School of Medicine in New York City, and Dr. Schaffner is Chairman of the Department of Preventive Medicine and Professor of Infectious Diseases in the Department of Medicine at the Vanderbilt University School of Medicine in Nashville, Tennessee.

Pneumococcal disease is an infection caused by bacteria called "pneumococcus" [noo-muh-kok-uhs] that can lead to serious, potentially deadly illnesses such as pneumonia, sepsis (blood infection) and meningitis. Anyone can get it but some people are at a particularly high risk for it. This includes the very young, people 65 years and older and adults of any age with certain health conditions such as all stages of CKD, including those treated with dialysis and kidney transplant recipients.1

One reason people with CKD are at greater risk for pneumococcal disease is because kidney disease can weaken the immune system and make the body more susceptible to infection.2 Doctors and researchers have found that infections in people with CKD such as those caused by pneumococcal disease are worse and can be more serious than in people who don't have CKD.3 In some people, infection can cause death.3 The good news is that vaccination can help protect you against pneumococcal disease.

If you have CKD, here are facts you should know about pneumococcal disease.

Pneumococcal disease causes several different illnesses.
Pneumococcal bacteria can get into the lungs and cause pneumonia. If they enter the bloodstream, they can cause sepsis. They can also cause infection of the covering of the heart, or they can invade the central nervous system and cause meningitis.

Pneumococcal disease is dangerous and deadly.
All forms of pneumococcal disease can be serious, even deadly, but sepsis and meningitis are the most serious. Those who survive either of these often face hospitalization, long recovery time and devastating health problems such as hearing loss, seizures, blindness and paralysis. Pneumococcal pneumonia is also dangerous; it carries a fatality rate of 5 to 7 percent and in some patients can cause heart attack or heart failure.4-6

You can get pneumococcal disease from a person who appears healthy.
Pneumococcal bacteria live in the throat and spread through coughing, sneezing, or through direct contact such as kissing. Not everyone who carries the bacteria gets sick from it, so it's possible to "catch" pneumococcal disease from someone who seems to be healthy.

Symptoms of pneumococcal disease are not the same for everyone.
Symptoms can vary from person to person and can appear very suddenly and without warning. Depending on whether the infection causes pneumonia, sepsis or meningitis, people may have some combination of the following:

  • Abrupt onset of fever
  • Shaking/chills
  • Cough
  • Shortness of breath
  • Chest pain
  • Stiff neck
  • Disorientation

If you develop any of these symptoms, seek medical help immediately.

Health authorities recommend pneumococcal vaccination for people with CKD and other risk factors.
For adults, the Centers for Disease Control and Prevention (CDC) recommends pneumococcal vaccination for:

  • Anyone 65 years of age and older
  • Adults with any of the following conditions:
    • Chronic illnesses such as lung, heart, liver or kidney disease; asthma; diabetes; or alcoholism
    • Conditions that weaken the immune system; cochlear implants; or cerebro-spinal fluid (CSF) leaks; asplenia (loss of the spleen)
  • Adults who smoke cigarettes

There are two types of pneumococcal vaccines available for adults: a pneumococcal polysaccharide vaccine (PPSV23) and a pneumococcal conjugate vaccine (PCV13).1 Adults with CKD need to receive both vaccines.

Most adults need only one vaccination, but adults with CKD need to be revaccinated.
Most adults only need to be vaccinated one time, but some people at high risk, including those with all stages of CKD, dialysis-treated patients, and those with kidney transplants, need to receive two pneumococcal vaccines initially followed by revaccination in 5 years. Ask your doctor about your specific circumstances.

Kids with CKD also need protection against pneumococcal disease.
Infants and young children in the United States are routinely vaccinated for pneumococcal disease because there is a pneumococcal vaccine that is part of the standard infant immunization schedule. Pneumococcal vaccine is also recommended for older children and adolescents with CKD even if they received the vaccine as infants.1 If your child hasn't been vaccinated, talk to your doctor.

People with CKD also need influenza vaccination.
Flu or influenza is also a serious infection that people with CKD need to be protected against. In addition, having influenza increases your risk of pneumococcal disease. So people with CKD need both influenza vaccine and pneumococcal vaccine. You should get vaccinated for flu every year, preferably before the flu season starts, but vaccination remains useful throughout the season. Pneumococcal vaccine can be given any time of the year.

For more information, speak with your health care professional or visit Adultvaccination.org or the CDC website.

Joseph A. Vassalotti, MD, is Chief Medical Officer, National Kidney Foundation and also serves as Clinical Associate Professor of Medicine in the Division of Nephrology at Mount Sinai School of Medicine in New York City.

William Schaffner, MD, is Past-President-, National Foundation for Infectious Diseases and Chairman of the Department of Preventive Medicine and Professor of Infectious Diseases in the Department of Medicine at the Vanderbilt University School of Medicine, Nashville, Tennessee.

References:

  1. Centers for Disease Control and Prevention. Use of 13-Valent Pneumococcal Conjugate Vaccine (and 23-Valent Pneumococcal Polysaccharide Vaccine for Adults with Immunocompromising Conditions: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2012; 61:816-819.
  2. Choudhury D, Luna-Salazar, C. Preventive health care in chronic kidney disease and end-stage renal disease. Nature Clinical Practice Nephrology 2008; 4:194-206
  3. Naqvi SB, Collins AJ. Infectious complications in chronic kidney disease. Adv Chronic Kidney Dis. 2006; 13:199-204.
  4. File TM. Community-acquired pneumonia. Lancet. 2003; 362:1991-2001.
  5. Tsai JC, Griffin MR, Nuorti JP, Grijalva CG. Changing epidemiology of pneumococcal meningitis after the introduction of pneumococcal conjugate vaccine in the United States. Clin Infect Dis. 2008; 46:1664-1672.
  6. Atkinson W, Wolfe S, Hamborsky J and McIntyre L, eds. Centers for Disease Control and Prevention: The Pink Book. Epidemiology and Prevention of Vaccine-Preventable Diseases. 11th ed. Washington, DC: Public Health Foundation 2009.

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© 2014 National Kidney Foundation. All rights reserved. This material does not constitute medical advice. It is intended for informational purposes only. Please consult a physician for specific treatment recommendations.