Ниже обсуждение вопроса о вакцинации от свиного гриппа для пациентов с почечным трансплантантом в листе переписки - Nephrol, где участвуют многие известные в мире нефрологи.
Резюме такое: большинство нефрологов ежегодно прививает своих пациентов, как трансплантированных, так и ожидающих трансплантант от сезонного гриппа. Вопрос о безопасности вакцины от свиного гриппа обсуждается потому, что это вакцина несколько более сырая в плане проверки безопасности, т.е. она быстрее готовилась и несколько в торопях выпускалась. Однозначно трансплантированным пациентам нельзя прививаться живой вакциной (та которую капают в нос), а вот убитой, скорее всего можно и нужно.

hello all,

is there any evidence that the H1N1 vaccine is good or bad in
transplant patients. we routinely administer the seasonal flu vaccine
to all our pretransplant patients and to transplant patient after
about 6 months post-transplant. there is considerable concern that
the H1N1 vaccine has not been sufficiently tested and may cause
Guillain-Barre syndrome. Witness the nurse's and other professional
demonstrations in NY.

i would appreciate any advice from the transplant folks who read
Nephro-L.

thanks a lot.

Lionel U. Mailloux, MD, FACP

There is not enough data to answer you specifically for the H1N1 vaccine in
any population as I am sure you realize. From a vaccine manufacture and
vaccine biology point of view, however, there is nothing new about this
particular vaccine that should distinguish its risk profile from the risk
profile of the lots of vaccine manufactured each year for whatever antigen
combination is considered optimal for the coming year¹s traditional flu.
That means no safer but no more risky. I think the rest is the usual drama
about any vaccine whenever there is a sense that its administration is being
mandated by external authorities. But until we have a few years of
experience with this particular vaccine, we will not know for sure.

Ironically, if there was no vaccine, another huge public outcry from a
different group, would involve how science and medicine could abandon the
public to the risk of this new flu pandemic without a vaccine!

Finally, what is important for everyone to remember is that transplant
patients should not get the Flumist H1N1 live attenuated nasal vaccination
that is coming available now. In fact, transplant professionals and the
families of transplant patients should not be getting this vaccine from
everything we have been told as persons can shed potentially infectious
virus for up to 4 weeks. So unless the information evolves with experience,
the best plan for transplant patients and others in similar high risk groups
is to wait for the traditional killed H1N1 vaccines to arrive.

Nephrol Dial Transplant. 2006 Sep;21(9):2556-62. Epub 2006 Jun 24.
The pharmacokinetics and tolerability of oseltamivir suspension in patients on haemodialysis and continuous ambulatory peritoneal dialysis.

Robson R, Buttimore A, Lynn K, Brewster M, Ward P.

Christchurch Clinical Studies Trust, Christchurch Hospital, Christchurch, New Zealand. richard.robson@cdhb.govt.nz

BACKGROUND: Oseltamivir dose reduction is recommended for patients with end-stage renal disease (ESRD). However, dosing recommendations are not available for treatment or prophylaxis of influenza in these patients. This study assessed the pharmacokinetics and tolerability of oseltamivir in ESRD patients undergoing maintenance haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). METHODS: In this open-label, multiple-dose study, patients received 30 mg oral oseltamivir suspension over 6.5 weeks. This dose was predicted to be suitable for ESRD patients based on a 2-compartment model. HD patients received 9 doses given 1 h after the completion of alternate HD sessions (three times a week). CAPD patients received 6 doses given once weekly after a dialysate exchange. The primary parameters were peak plasma concentration (C(max)) and the area under the curve (AUC) for oseltamivir and oseltamivir carboxylate. RESULTS: In HD patients, the C(max) for oseltamivir carboxylate after single and repeated dosing were 943 and 1120 ng/ml, respectively. The mean AUC(0-42) was 31 600 ng h/ml for days 1-5 and 38 200 ng h/ml for days 38-43. Similarly, in CAPD patients, mean C(max) after the first and sixth doses were 885 and 849 ng/ml, respectively. The mean AUC(0-48) values for days 1-6 and days 36-43 were 33 400 and 32 400 ng h/ml, respectively. Oseltamivir was well-tolerated in both the patient groups. CONCLUSIONS: A 30 mg dose of oseltamivir given once weekly in CAPD or after alternate sessions in HD patients provides sufficient exposure to oseltamivir carboxylate to allow safe and effective anti-influenza treatment and prophylaxis.

Ниже ещё один абстракт: свиной грипп в диализной популяции
Оценено более 300 случаев, причём 87 % больных лечились противовирусными препаратами, в основном Тамифлю (oseltamivir). Дозы в абстракте не указаны.

Influenza A(H1N1)v pandemic in the dialysis population: first wave results from an international survey.
Nephrol Dial Transplant. 2009 Oct 21. [Epub ahead of print]
Marcelli D, Marelli C, Richards N.

1Fresenius Medical Care, NephroCare Coordination - Clinical Governance Department, Bad Homburg, Germany.

BACKGROUND: After the first cases of influenza A(H1N1)v in Mexico and the USA became public, Fresenius Medical Care established a case-based reporting of cases for all of its dialysis clinics located in Europe, Middle East, Africa and Latin America. This paper aims to describe mortality rates of patients on dialysis and to assess the risk profiles. METHODS: The survey was developed in Lotus Notes with a secure browser-based form. The form was open to 602 Fresenius Medical Care clinics located in Europe, Middle East, Africa and Latin America. RESULTS: As of 3 September 2009, 306 cases have been reported by 85 clinics located in Argentina, Chile, Brazil, UK and Spain. The mean age was 52.7 +/- 17.7 years. The majority of cases (70.6%) were from 20-44- and 45-64-year-old subgroups. Moreover, 35.3% had no associated comorbidity, 20.3% had two and 4.6% three comorbidities, with heart disease being the most frequent. Fever was the most common symptom, present in 94.4% of the cases, followed by cough (78.8%) and muscle and joint pain (69.3%). Eighty-seven percent were treated with antiviral agents, the majority with oseltamivir. One hundred and three patients (34%) were admitted to hospital because of influenza. Pneumonia was reported for 69 cases, out of which 52 patients belonged to a high-risk group. Mortality rate of all the patients (confirmed, probable and suspected cases) was around 5%. CONCLUSION: End-stage renal disease patients should be included in first ranks of the priority list for the influenza A(H1N1)v vaccine, as already advocated by some healthcare authorities.
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