New research aims to prevent severe infections among those suffering from chronic kidney disease
A Northern Ontario School of Medicine (NOSM) faculty member is leading a team of researchers to find an optimal strategy to prevent severe pneumococcal infections in First Nations people suffering from chronic kidney disease–research that will be furthered by a $100,086 grant from Pfizer.
Dr. Marina Ulanova, NOSM Professor of Immunology and principal investigator, is heading a team of researchers along with co-investigator Dr. William McCready, NOSM Professor of Internal Medicine and Chief of Staff at the Thunder Bay Regional Health Sciences Centre (TBRHSC).
Pneumococcal infection is particularly common in people suffering from severe kidney disease. This type of infection can cause pneumonia, blood poisoning (sepsis) or, less commonly, meningitis. “To prevent these serious conditions, everyone with severe kidney disease should be immunized against pneumococcal infection. However, even after vaccination, some people remain vulnerable,” says Dr. Marina Ulanova. “The current vaccine, Pneumovax®, is very efficient in building protective immunity in individuals with a normal immune system, but not in those with weakened immune systems, such as people with severe kidney disease.”
“This serious condition develops most commonly as a result of diabetes. In individuals with diabetes, kidney function declines gradually over time resulting in kidney disease,” explains Ulanova. “People suffering from severe kidney disease have to be on hemodialysis or peritoneal dialysis therapy and eventually need to receive a kidney transplant. Kidney disease weakens the immune systems of these patients, causing them to be vulnerable to infections.”
A new, more effective vaccine called Prevnar13® has recently become available. This vaccine is already included among the routine vaccinations young children receive starting at two months of age. This vaccine is also used to immunize adults with HIV infection and people who have received a bone marrow transplant. The Public Health Agency of Canada has recently approved the use of Prevnar13® for the vaccination of adults suffering from chronic kidney disease, but specific recommendations have not yet been developed.
To help determine the optimal vaccination strategy, Ulanova’s team of researchers have recently initiated a clinical trial of this vaccine in patients with severe chronic kidney disease attending the Renal Services at TBRHSC.
Their objective is to develop the optimal protocol for prevention of pneumococcal infection in this vulnerable patient population. As almost 50% of the patient population at TBRHSC’s renal services are First Nations people, the research team is paying special attention to the effectiveness of this vaccine in people of Aboriginal background.
Research conducted in populations of Aboriginal Peoples outside of Northern Ontario, such as Navajo and Alaska Natives, found pneumococcal infection rates three to five times higher compared to the general population in the United States. Importantly, in Navajo people, chronic kidney disease was identified as an important risk factor for pneumococcal infection. While the specific reasons for increased rates of pneumococcal infection among North American Aboriginal Peoples are uncertain, the vaccination strategy must take into account the needs of Aboriginal Peoples.
During the clinical trial, while monitoring the immune response of individual participants to Prevnar13®, Ulanova’s research team will be looking at patients’ ethnic backgrounds. “It is possible the immunization protocol may have to be adjusted to ensure everyone receives adequate protection. We are confident that our research will result in an optimal strategy to prevent severe infections in First Nations people suffering from chronic kidney disease,” says Ulanova.