Vaccination rates and the causes of vaccine hesitancy among patients with end stage renal disease

Abstract

Aim: Chronic kidney disease creates a tendency to infections, and infections are the second most common reason for mortality following cardiovascular events in chronic kidney disease. Health authorities recommend vaccination against hepatitis B, annual influenza, pneumonia, zoster, tetanus, and new coronavirus disease for people with end-stage kidney disease. Vaccine-preventable diseases cause mortality in the adult population with chronic diseases. The primary purpose of this study is to investigate vaccination rates and awareness about vaccination among end-stage renal disease patients who were on renal replacement therapies in a single tertiary center in Turkey. Material and Method: 86 hemodialysis patients were included in this cross-sectional study. A questionnaire was used to investigate whether the patients were aware of the immunization schedule or not and whether they were vaccinated against hepatitis B virus, seasonal influenza virus, pneumonia, herpes zoster, tetanus, and SARS-CoV-2 or not. Results: Fifty-eight (67.4%) patients were vaccinated against SARS CoV2. 48(55.8%) patients were vaccinated against the Hepatitis B virus. 31 (36%) patients were vaccinated against Pneumococcus pneumonia. 48 (55.8%) patients have been vaccinated against the influenza virus annually. Only 14 (16.3%) patients were vaccinated against tetanus during the previous 10 years, and only 1 (1.2%) patient was vaccinated against Herpes zoster. Influenza vaccination rates were found to be higher in patients with a longer duration of hemodialysis when compared to the other group(p=0.03). SARS-CoV 2 vaccination rates were higher in patients who were older than 59 years of age when compared to the younger patients(p=0.03). Conclusion: Vaccination rates are far from the targets in patients with end-stage kidney disease. The most common reason to be unvaccinated is a lack of enough knowledge about the subject.

Keywords

• End-stage kidney disease
• adult vaccination
• vaccine hesitancy

References

1. Collins AJ, Foley RN, Herzog C, et al. Excerpts from the US Renal Data System 2009 annual data report. Am J Kidney Dis 2010; 55: 6-7.
2. Saran R, Robinson B, Abbott KC, et al. US Renal Data System 2016 annual data report: epidemiology of kidney disease in the United States Am J Kidney Dis 2017; 69: 7-8.
3. Freedman MS, Ault K, Bernstein H. Advisory committee on immunization practices recommended immunization schedule for adults aged 19 years or older - United States MMWR Morb Mortal Wkly Rep 2021; 70: 193-6.
4. Bitsori M, Galanakis E. Vaccine-preventable infection morbidity of patients with chronic kidney disease and cocoon vaccination strategies. Expert Rev Vaccines 2015; 14: 1385-95.
5. Centers for Disease Control and Prevention (CDC). Noninfluenza vaccination coverage among adults - United States, 2011. MMWR Morb Mortal Wkly Rep 2013; 62: 66-72.
6. Ozisik L, Tanriover MD, Rigby S, Unal S; European Federation of Internal Medicine ADVICE Working Group. ADVICE for a healthier life: Adult vaccination campaign in Europe. Eur J Intern Med 2016; 33: 14-20.
7. Au J. Higher vaccination rates predict reduction in SARS-CoV-2 transmission across the United States. Infection. 2022; 1-12.
8. Kılınçarslan MG , Sarıgül B, Toraman Ç, Şahin EM. Development of valid and reliable scale of vaccine hesitancy in Turkish language. Konuralp Med J 2020; 12: 420-9.

9. Shapiro GK, Tatar O, Dube E, et al. The vaccine hesitancy scale: Psychometric properties and validation. Vaccine 2018; 36: 660-7.
10. Larson HJ, Jarrett C, Schulz WS, et al. Measuring vaccine hesitancy: The development of a survey tool. Vaccine 2015; 33: 4165-75.
11. TC Sağlık Bakanlığı. Aşı portalı. Available online: https://asi.saglik.gov.tr/genel-bilgiler.html. Last Access date: 28.07.2021
12. Favero MS, Alter MJ .The reemergence of hepatitis B virus infection in hemodialysis centers. Semin Dial 1996; 9:373
13. Rangel MC, Coronado VG, Euler GL, Strikas RA. Vaccine recommendations for patients on chronic dialysis. The Advisory Committee on Immunization Practices and the American Academy of Pediatrics. Semin Dial 2000; 13: 101-7.
14. Shen AK, Kelman JA, Warnock R, et al. Beneficiary characteristics and vaccinations in the end-stage renal disease Medicare beneficiary population, an analysis of claims data 2006-2015. Vaccine 2017; 35: 7302-8.
15. Bond TC, Patel PR, Krisher J, et al. Association of standing-order policies with vaccination rates in dialysis clinics: a US-based cross-sectional study. Am J Kidney Dis 2009; 54: 86–94
16. Eder M, Omic H, Gorges J, et al. Influenza vaccination uptake and factors influencing vaccination decision among patients with chronic kidney or liver disease. PLoS One 2021; 16: e0249785.
17. Sarnak MJ, Jaber BL. Pulmonary infectious mortality among patients with end-stage renal disease. Chest 2001; 120: 1883–7
18. Tokars JI, Finelli L, Alter MJ, Arduino MJ: National surveillance of dialysis-associated diseases in the United States, 2001. Semin Dial 2004; 17: 310–9
19. Ahn JH, Waller JL, Baer SL, et al. Mortality risk after herpes zoster infection in end-stage renal disease patients. Clin Kidney J 2019; 12: 101-5
20. Qunaibi EA, Helmy M, Basheti I, Sultan I. A high rate of COVID-19 vaccine hesitancy in a large-scale survey on Arabs. Elife 2021;10:e68038.
21. Gentile A, Pacchiotti AC, Giglio N, et al. Vaccine hesitancy in Argentina: Validation of WHO scale for parents. Vaccine 2021; 39: 4611-9.
22. Akinbodewa AA, Adejumo OA. Awareness and practice of vaccination of chronic hemodialysis patients by specialist nephrology practitioners in Nigeria: a cross-sectional survey. J Epidemiol Glob Health 2019; 9: 204-9
23. Fredrickson DD, Davis TC, Arnould CL, et al. Childhood immunization refusal: provider and parent perceptions. Fam Med 2004; 36: 431-9