[CIS PIDD] [cis-pidd] Meningococcal B Vaccination in Complement Deficiency

[CIS-PIDD]

Hi, Dr. Ferdman:

My 2 cents from reading ... 'have no experience / expertise on this myself.

The AAP / CDC / ACIP / COID recs are actually rather stringent.  While both MenB vaccines are FDA-licensed for ages 10 - 25, the recommendations are limited to the at-risk groups (C' deficiencies, asplenia, outbreak, microbiologists at risk for exposure) within that age group, and maybe extended to all >= 10 y/o in some situations.  It *may* be given to adolescents / adults (16 - 23 y/o) for short-term protection, with preferred administration at ages 16 - 18 y/o.   Children <= 9 y/o are purposefully excluded, even with the risk factors.  Consequently, I think you may have trouble getting an insurance company to pay for this for the two girls.

(Personally, if I had a kid aged 7, and there's a MenB outbreak in her school, guidelines be damned, I'm giving it.)


The European guidelines are different.  Bexsero can be given all the way down to 2 mo/o:  http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Summary_for_the_public/human/002333/WC500137857.pdf

The are differences in number of doses and interval by age.  Volumes (0.5 ml) stay the same:  http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/002333/WC500137881.pdf

For Trumenba, they're sticking with the age 10-and-older limitation:  http://www.ema.europa.eu/docs/en_GB/document_library/Summary_of_opinion_-_Initial_authorisation/human/004051/WC500224394.pdf


So, if I were to choose, it'll be with the Bexsero.

Good luck.

  - K


Karl O. A. Yu, M.D., Ph.D., F.A.A.P.
Section of Infectious Diseases  |  Department of Pediatrics  |  Comer Children's Hospital  |  University of Chicago
5841 S Maryland Ave,  MC 6054,  Chicago  IL  60637
Office phone: 773-702-9281  |  Pager: 773-702-6800 x1744  |  Fax: 773-702-1196

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From: cis-pidd at lyris.dundee.net [cis-pidd at lyris.dundee.net] on behalf of CIS-PIDD [cis-pidd at lists.clinimmsoc.org]
Sent: Friday, April 14, 2017 7:13 PM
To: CIS-PIDD
Subject: [cis-pidd] Meningococcal B Vaccination in Complement Deficiency

Dear All,

I follow two sisters with a C2 deficiency - ages 5 and 7 years.  I would like advice regarding:

1) In the USA, the meningococcal B vaccines are licensed for 10 years and above.  I would like to vaccinate them now and wanted to know if there is any consensus for vaccinating at this younger age?

2) We have two vaccine available in the US - Bexsero and Trumenba.  It seems like there is more worldwide experience using the Bexesero in younger children, but I wanted to know if one vaccine is preferred over the other for < 10 years old, or in patients with complement deficiencies?

3) The dose for each vaccine in >10 year olds is 0.5 mL.  Is a lower dose used for <10 year olds, especially the 5 year old sister?

Thanks for your advice.

Regards,
Ron


Ronald M. Ferdman, MD, MEd
Children's Hospital Los Angeles
Division of Clinical Immunology and Allergy
Associate Professor of Clinical Pediatrics
Keck School of Medicine
University of Southern California



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