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

[CIS-PIDD]

Dear All,

We have Bexsero in private clinics in Brazil. As you know, meningococcal
meningitis is still a problem here.
It is recommended to vaccinate after 2 months old, following the previous
recommendation used in Canada and Europe.
In addition to complement deficient patients, we also vaccinate contactants
here; probably due to our epidemiologic situation.
Considering the different structure of meningococcus B in comparison with
the other serogroups, maybe this would influence its occurrence in
complement deficient patients.

Best regards

Anete



Anete S Grumach, MD, PhD
Center of Reference for Rare Diseases
Laboratory of Clinical Immunology
Prof Livre Docente
Faculdade de Medicina ABC, São Paulo
anete at grumach.com
55.11.32845335

2017-04-16 12:55 GMT-03:00 CIS-PIDD <cis-pidd at lists.clinimmsoc.org>:

> In red text following is the response from Dr. Manish Sandarangani (
> msandarangani at bcchr.ubc.ca) the head of our Vaccine Evaluation Center,
> Vancouver, British Columbia
>
> Anne Junker, MD; Associate Professor, Pediatrics (Clinical Immunology): BC
> Children's Hospital and University of British Columbia
>
>
>
> Sent: Friday, April 14, 2017 5:13 PM
>
> To: CIS-PIDD
>
> 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?
>
> Bexsero is not licensed or approved <10 years in the US for any indication
> (don’t really know why). In Canada and in the UK, Bexsero IS recommended in
> this situation (2 doses, at least 2 months apart). A study in this
> population has been done in Europe – results have been posted on
> Clinicaltrials.gov (https://www.clinicaltrials.gov/ct2/results?term=
> NCT02141516&Search=Search) but not yet published as far as I can find.
> Interestingly, published case reports/case series suggest that children
> with complement deficiency rarely get infected with MenB, but usually other
> serogroups and particularly less common serogroups, although no one really
> knows why – I would still vaccinate, but it is an interesting observation.
>
> 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?
>
> Trumenba is not licensed in any jurisdiction in younger children – the
> early phase I/II studies had very high rates of adverse events in this age
> group, so later trials were focussed on adolescents and adults only. So
> Bexsero is really the only option in this age.
>
> 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?
>
> Use standard dose of 0.5 ml in all ages groups – this is the dose used in
> the UK, where Bexsero is included in the routine childhood immunization
> program from 2 months of age.
>
> The only final point I would add is that no one knows how frequently
> booster doses should be given in this age for those children at ongoing
> increased risk. Studies are ongoing. I have just had a paper accepted
> showing significant waning of immunity by 4 years of age in children
> immunized at 12-24 months, but a good response to the booster (should be
> published in CMAJ very soon). Also I don’t know where things stand in the
> US if you want to give vaccines out of the licensed age group, but I
> presume Ron would know that.
>
> 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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