The impaired immune response to diphtheria vaccination in elderly chronic hemodialysis patients is related to zinc deficiency

Zinc deficiency causes abnormalities of the immuneresponse. In chronic hemodialysis therapyabnormalities in zinc metabolism as well as animpaired immune response to vaccination have beenreported. Therefore we performed a vaccination studyagainst diphtheria and hypothesized that the responseto diphtheria vaccination is related to serum zincdeficiency in hemodialysis patients. Serum zincconcentrations were assayed in 16 chronic hemodialysispatients (10 male, 6 female; mean age 65 years)without a documented vaccination history againstdiphtheria. Nine of these patients were tripleimmunized against diphtheria while seven received asingle vaccination. The response to diphtheriavaccination was measured by ELISA detecting specificantibodies to diphtheria-toxoid. Seroconversion 6 and12 months after vaccination was defined as thedoubling of antibody titers in patients ≥ 0.1IU/ml prior to vaccination or as titers %gt; 0.1 IU/mlin all other patients. Only 6/16 hemodialysispatients responded to immunization against diphtheriaby specific antibody production (> 0.1 IU/ml).Twelve months after the single injection 3/7 patientsseroconverted while six months after the triplevaccination 3/9 patients responded to immunization.This was not age-dependent, whereas in non-responderswe detected significantly decreased serum zinc levels.In contrast, responders showed similar serum zinclevels as age-matched controls. Furthermore, wemeasured a decreased α2-macroglobulinconcentration only in the responders amongst thehemodialysis patients. Protection against diphtheriaand the immune response to diphtheria vaccination inhemodialysis patients is poor. The failure to respondto active diphtheria vaccination is related to asignificantly decreased serum zinc concentration inhemodialysis patients.