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

[CIS-PIDD]

Thank you to all…..this has been very helpful.

Regards,
Ron

From: cis-pidd at lyris.dundee.net [mailto:cis-pidd at lyris.dundee.net] On Behalf Of CIS-PIDD
Sent: Sunday, April 16, 2017 2:43 PM
To: CIS-PIDD
Subject: Re: [cis-pidd] Meningococcal B Vaccination in Complement Deficiency (EXTERNAL EMAIL)

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<mailto:anete at grumach.com>
55.11.32845335

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

In red text following is the response from Dr. Manish Sandarangani (msandarangani at bcchr.ubc.ca<mailto: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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