[PAGID] (PAGID) Menactra vaccination

[Howard Lederman]

Sorry, previous message sent before completion.

We have been using Menactra as a neoantigen for more than 18 months. Most of our data comes from Quest, but we have some from LabCorp. I agree that there is very little, if any, IgG Ab to meningococci in IVIG.  However, there are a few caveats to using Menactra for assessing humoral immunity.

1.  I am unaware of any data on the level of Ab measured by ELISA that is required for protection.  All of the studies looking at protection measured Ab by bactericidal assay.

2.  Single doses of Menactra are not very immunogenic (ELISA measurements) in many nl people and in people who seem able to respond to many other vaccines.

Therefore, Ab response to Menactra is very useful when positive and ruling out Ab deficiency.  But, lack of Menactra response by itself should not be considered diagnostic of Ab deficiency

Howard

________________________________________
From: pagid-bounces at list.clinimmsoc.org [pagid-bounces at list.clinimmsoc.org] On Behalf Of Church, Joseph [JChurch at chla.usc.edu]
Sent: Friday, May 14, 2010 2:27 PM
To: pagid at list.clinimmsoc.org
Subject: Re: [PAGID] (PAGID) Menactra vaccination

I have checked meningococcal antibodies pre and post IVIG in a few
teens.  I am not sure how good the commercial lab is (Quest
Diagnostics), but with their assay there is a little antibody
immediately post infusion, and none pre infusion.

I would be most interested if anyone has a lab they are comfortable
with.

Joe Church
Childrens Hospital Los Angeles

-----Original Message-----
From: pagid-bounces at list.clinimmsoc.org
[mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Kimberly Risma
Sent: Friday, May 14, 2010 11:13 AM
To: pagid at list.clinimmsoc.org
Subject: [PAGID] (PAGID) Menactra vaccination

Dear Colleagues, I have a new patient (teenager) that is already on IVIG
that I would like to test for specific response to vaccination. We do
not have access to a neoantigen so I was wondering if anyone ever tried
using the conjugated Meningitis vaccine (Menactra in the U.S.) and
measuring pre and post titers. My rationale is that I would expect
absent to minimum titers in the IVIG preparations. If you have had any
success, can you indicate which lab will measure titers in an
informative manner? What age child have you used this approach? Thanks,
Kim


Kimberly Risma MD, PhD
Assistant Professor
Allergy Immunology
Childrens Hospital Medical Center
3333 Burnet Ave, mlc 2000
Cincinnati, OH 45229
Kimberly.Risma at cchmc.org