**3. Respiratory infection in hemodialysis**

Pneumonia is the second most common cause of severe infection in the MHD population. Regarding infectious diseases, it has been reported that approximately 20% of infectious deaths in MHD patients are attributed to pneumonia. The mortality of pulmonary infections in MHD patients has been reported to be 14 to 16 times higher than in the general population [13]. *Streptococcus pneumonia*, seasonal influenza and bacterial pneumonia secondary to influenza have been leading causes for community-acquired pneumonia in MHD. A vaccination is available for the prevention of pneumonia from *Streptococcus pneumonia as is same with the case in* the general population. Current guidelines recommend the vaccination of all MHD patients and revaccination after 5 years since a more rapid decline in the antibody titer was observed compared to that of the general population.
