Anja Gäckler1, Meike Kaulfuß2, Hana Rohn2, Ulrich Vogel3, Heike Claus3, Thorsten Feldkamp4, Andreas Kribben1, Oliver Witzke2. 1. Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany. 2. Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany. 3. Institute for Hygiene and Microbiology, National Reference Laboratory for Meningococci and Haemophilus Influenzae, University of Würzburg, Würzburg, Germany. 4. Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein, Christian Albrechts University Kiel, Kiel, Germany.
Abstract
BACKGROUND: The C5 complement inhibitor eculizumab is a first-line treatment in atypical haemolytic uraemic syndrome (aHUS). Therapy with eculizumab is associated with a highly increased risk for meningococcal infection. Therefore, vaccination is highly recommended before beginning treatment. Efficacy of quadrivalent meningococcal vaccines (MenACWY) in patients treated with the C5 complement inhibitor eculizumab in aHUS has not yet been determined. METHODS: Patients with aHUS received one dose of a MenACWY conjugate vaccine before eculizumab treatment commenced. Bactericidal titres against meningococcal serogroups A, C, W and Y were determined using baby rabbit complement in 25 patients. RESULTS: Full immune response to meningococcal vaccination was detected in five patients (20%), while seven patients (28%) showed no immune response in any of the tested serogroups. The remaining 13 patients showed incomplete immune response with proof of protective antibody titres for one to three serogroups without perceptible preference for any serogroup. Bactericidal titres after re-vaccination were available for 17 patients. Nine patients with incomplete immune response after first vaccinations showed protective antibody titres for all serogroups after re-vaccination. Kidney function had improved in >50% of patients at the time of re-vaccination compared with the time of first vaccination and immunosuppressive therapy was only applied to re-vaccinated patients following kidney transplantation. CONCLUSIONS: Immunogenicity of first quadrivalent meninongococcal vaccination is insufficient in patients with aHUS. Booster response is promising, but incomplete. Therefore, establishing antibiotic prophylaxes seems pivotal.
BACKGROUND: The C5 complement inhibitor eculizumab is a first-line treatment in atypical haemolytic uraemic syndrome (aHUS). Therapy with eculizumab is associated with a highly increased risk for meningococcal infection. Therefore, vaccination is highly recommended before beginning treatment. Efficacy of quadrivalent meningococcal vaccines (MenACWY) in patients treated with the C5 complement inhibitor eculizumab in aHUS has not yet been determined. METHODS:Patients with aHUS received one dose of a MenACWY conjugate vaccine before eculizumab treatment commenced. Bactericidal titres against meningococcal serogroups A, C, W and Y were determined using baby rabbit complement in 25 patients. RESULTS: Full immune response to meningococcal vaccination was detected in five patients (20%), while seven patients (28%) showed no immune response in any of the tested serogroups. The remaining 13 patients showed incomplete immune response with proof of protective antibody titres for one to three serogroups without perceptible preference for any serogroup. Bactericidal titres after re-vaccination were available for 17 patients. Nine patients with incomplete immune response after first vaccinations showed protective antibody titres for all serogroups after re-vaccination. Kidney function had improved in >50% of patients at the time of re-vaccination compared with the time of first vaccination and immunosuppressive therapy was only applied to re-vaccinated patients following kidney transplantation. CONCLUSIONS: Immunogenicity of first quadrivalent meninongococcal vaccination is insufficient in patients with aHUS. Booster response is promising, but incomplete. Therefore, establishing antibiotic prophylaxes seems pivotal.
Authors: Sinan Muldur; Douangsone D Vadysirisack; Sharan Ragunathan; Yalan Tang; Alonso Ricardo; Camil Elie Sayegh; Daniel Irimia Journal: Front Immunol Date: 2021-11-24 Impact factor: 7.561
Authors: Emma Ispasanie; Lukas Muri; Anna Schubart; Christine Thorburn; Natasa Zamurovic; Thomas Holbro; Michael Kammüller; Gerd Pluschke Journal: Front Immunol Date: 2021-10-08 Impact factor: 7.561