*Purpose: Prophylaxis against viral and bacterial infections as outlined by guidelines issued by the 2013 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for Vaccination of the Immunocompromised Host is especially important in transplant recipients. There is a paucity in the literature regarding vaccination rates, especially in indigent, immigrant populations where health beliefs may play a role in medical decisions.

*Methods: A face-to-face survey was conducted in a random convenience sample of patients attending an inner-City Transplant Clinic . If patients stated they had refused any vaccines they were asked to explain why. A chart review of vaccine administration and/or serologic values for vaccines recommended in the IDSA guidelines was then performed. Criteria for the immunization to be considered “valid” were administration within the past 1 year for influenza; 5 years for Tdap, PPSV23 and PCV13; and before transplantation for HPV, MMR, Zostavax and Rotavirus, as they are contraindicated after the start of immunosuppression therapy.

*Results: 31 patients were interviewed. There were 19 (61%) men and 12 (39%) women. Racial breakdown was 26 black, 1 white, 2 Hispanic and 2 other. 13 (56% )had not attending any college courses. 3 pts (10%) were employed with the rest disabled or retired. Mean age was 56+/-2.4 (range 18-79). 17 (55%) pts were born in other countries (mean time in the US 32.6+/-2.7 yrs), mean time since transplant 6.7+/-1.4 yrs. Creatinine was 2.32+0.4 mg/dl. Immunization rates for recommended vaccines were low with 19.51% of patients having received the TDAP vaccine, 19.51% for PPSV23, 17.07% for PCV13, 48.8% for Influenza, 56.1% for Hepatitis B, 2.44% for Meningococcus and 0% for IPV, HIB, Hepatitis A, Zoster, Rotavirus-live and MMR. Patients who had received the TDAP were more likely to have also received PPSV23 (r=0.379,p=0.015), PCV13 (r=0.594,p=0.000) and Meningococcus (r=0.321,p=0.041). Of the 15 patients who did not receive the influenza vaccine, 9 (60%) had refused. All patients who refused believed that the vaccine “made them sick” in the past. Two patients believed it had never been offered to them, although it is clinic policy that all patients are offered the vaccine starting in late September. Older patients were less likely to have received the flu vaccine (r=-0.32, p<0.05).There was no relation of any vaccine rate and education, employment status, time in the US or time since transplant.

*Conclusions: In our population of inner-City KTRs: 1. Vaccination rate is sub-optimal, particularly against influenza and pneumococcus. 2. Patients who received Tdap were more likely to have been vaccinated according to guidelines. 3. Patients who refused the flu vaccine were older and believed that it “makes you sick”. 4. An intensive education campaign for both providers and patients should be created to prevent what can be devastating illnesses in kidney transplant recipients.

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