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- Title
Serologic response to meningococcal vaccination in patients with paroxysmal nocturnal hemoglobinuria (PNH) chronically treated with the terminal complement inhibitor eculizumab.
- Authors
Alashkar, Ferras; Vance, Colin; Herich-Terhürne, Dörte; Preising, Nicole; Dührsen, Ulrich; Röth, Alexander; Herich-Terhürne, Dörte; Dührsen, Ulrich; Röth, Alexander
- Abstract
Eculizumab is indicated for the therapy of patients with symptomatic paroxysmal nocturnal hemoglobinuria (PNH). Due to inhibition of terminal complement cascade, patients on eculizumab are susceptible to Neisseria meningitidis infections. The two mainstays to reduce the risk of infection are vaccination and antibiotic prophylaxis. In this retrospective study, serologic response was analyzed after vaccination with a meningococcal vaccine in 23 PNH patients (median age 36 years; range 25 - 88 years; 15 males, 8 females) by measuring serum bactericidal assay (SBA) using rabbit complement (rSBA) titers against meningococcal serogroups A, C, W, and Y. Serologic protection was defined by an rSBA titer ≥1:8. Forty-three percent (10/23) were vaccinated more than once due to chronic eculizumab treatment. Overall serologic response for the meningococcal serogroups was A: 78% (18/23), C: 87% (20/23), W: 48% (11/23), and Y: 70% (16/23). No meningococcal infections have been observed. As immunological response to vaccines varies, the use of serologic response analyses is warranted. Re-vaccination with a tetravalent conjugate vaccine under eculizumab therapy every 3 years is essential or should be based on response rates. If meningococcal infection is suspected, standby therapy with ciprofloxacin and immediate medical evaluation are recommended. The novel vaccines covering serogroup B may even further reduce the risk for infection.
- Subjects
MENINGOCOCCAL vaccines; PAROXYSMAL hemoglobinuria; SEROLOGY; COMPLEMENT (Immunology); ECULIZUMAB; PATIENTS; THERAPEUTICS; HEMOLYTIC anemia diagnosis; HEMOLYTIC anemia treatment; DRUG administration; HEMOLYTIC anemia; LONGITUDINAL method; MICROBIAL sensitivity tests; MONOCLONAL antibodies; SERODIAGNOSIS; NEISSERIA meningitidis; TREATMENT effectiveness; RETROSPECTIVE studies; DIAGNOSIS; PREVENTION
- Publication
Annals of Hematology, 2017, Vol 96, Issue 4, p589
- ISSN
0939-5555
- Publication type
journal article
- DOI
10.1007/s00277-017-2924-y