Influenza and pneumococcal vaccinations in dialysis patients

Sir, the report on influenza and pneumococcal vaccinations in dialysis patients is very interesting [1]. Wilmore et al. [1] noted that ‘most dialysis patients were not up-todate with both vaccinations.’ Of interest, there are many problems preventing the success of vaccination programs for dialysis patients. The attitude of the practitioner seems to be very important [2]. Sometimes, the practitioners do not promote but act against vaccination. In addition, McGrath et al. recently reported that hospitalization and skilled nursing care were two important predictors of vaccination [3]. It was reported that ‘patients with long hospitalizations or skilled nursing stays were less likely to be vaccinated suggesting evidence of the healthy-user effect [3].’ To manage the problem of vaccination coverage, those factors should be carefully considered.