Recommendations for vaccination against pneumococcus in patients with kidney diseases in Spain

Invasive pneumococcal disease (IPD) is a serious problem in some risk groups: patients with stage 4 and 5 chronic kidney disease, stage 3 CKD undergoing immunosuppressive treatment, nephrotic syndrome or diabetes. These individuals are more susceptible to acquire the infection and are more prone to suffering more severe episodes with worse outcome. Vaccination is one of the strategies for preventing IPD, although vaccination coverage in this group at present is lower than desired. Currently, there are two vaccinations available for adults. The polysaccharide vaccine (PPSV23), used for decades in patients over the age of 2, includes a higher number of serotypes (23), but it does not generate immune memory, causing an immune tolerance phenomenon and it does not act on nasopharyngeal colonization. The conjugate vaccine (VNC13) can be used from infancy until adulthood (advice in patients over 18 years old received approval from the European Medicines Agency in July 2013) and generates a more powerful immune response than PPSV23 against the majority of the 13 serotypes that are included. The 16 scientific societies most directly involved with the groups at risk of IPD have discussed and drafted a series of vaccination recommendations based on scientific evidence related to pneumococcal vaccination in adults with underlying conditions and pathologies, which are the subject of the document “Consensus: Pneumococcal vaccination in adults with underlying pathology”. This text sets out the vaccination recommendations for the chronic kidney disease population.