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Volume 24, Number 8—August 2018
Dispatch

Fatal Nongroupable Neisseria meningitidis Disease in Vaccinated Patient Receiving Eculizumab

Deirdre Nolfi-DoneganComments to Author , Monica Konar, Vianca Vianzon, Jessica MacNeil, James Cooper, Perrianne Lurie, Judi Sedivy, Xin Wang, Dan M. Granoff, and Lucy McNamara
Author affiliations: Children’s Hospital of Pittsburgh, Pittsburgh Pennsylvania, USA (D. Nolfi-Donegan, J. Cooper); The University of California, San Francisco Benioff Children's Hospital Oakland, Oakland, California, USA (M. Konar, V. Vianzon, D.M. Granoff); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (J. MacNeil, X. Wang, L. McNamara); Pennsylvania Department of Health, Harrisburg, Pennsylvania, USA (P. Lurie, J. Sedivy)

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Figure 1

Serum IgG reactivity to 3 recombinant antigens in Neisseria meningitidis serogroup B meningococcal vaccine (MenB-4C) (Bexsero; GlaxoSmithKline, Bellaria Rosia, Sovicille, Italy), determined by ELISA. A postmortem serum sample (3) from a 16-year-old girl with paroxysmal nocturnal hemoglobinuria who died of meningococcal disease after treatment with eculizumab. Reactivity was measured in parallel with stored serum from 10 unvaccinated college students (1) and 10 vaccinated college students (2) 7 m

Figure 1. Serum IgG reactivity to 3 recombinant antigens in Neisseria meningitidis serogroup B meningococcal vaccine (MenB-4C) (Bexsero; GlaxoSmithKline, Bellaria Rosia, Sovicille, Italy), determined by ELISA. A postmortem serum sample (3) from a 16-year-old girl with paroxysmal nocturnal hemoglobinuria who died of meningococcal disease after treatment with eculizumab. Reactivity was measured in parallel with stored serum from 10 unvaccinated college students (1) and 10 vaccinated college students (2) 7 months after vaccination with MenB-4C (8). For the comparison specimens, each data point represents reactivity of an individual person. A) Factor H binding protein. B) Neisseria heparin binding antigen. C) NadA, MenB-4C antigens absent. OD, optical density. Data points for (3) indicate results of replicate assays. OD, optical density.

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References
  1. Loirat  C, Fakhouri  F, Ariceta  G, Besbas  N, Bitzan  M, Bjerre  A, et al.; HUS International. An international consensus approach to the management of atypical hemolytic uremic syndrome in children. Pediatr Nephrol. 2016;31:1539. DOIPubMedGoogle Scholar
  2. Alexion Pharmaceuticals, Inc. Soliris. Revised 1/2016 [package insert] [cited 2016 Dec 2]. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/125166s417lbl.pdf
  3. Alexion Pharmaceuticals, Inc. Soliris REMS (Risk Evaluation and Mitigation Strategy) [cited 2017 Jul 23]. http://www.solirisrems.com
  4. Lebel  E, Trahtemberg  U, Block  C, Zelig  O, Elinav  H. Post-eculizumab meningococcaemia in vaccinated patients. Clin Microbiol Infect. 2018;24:8990. DOIPubMedGoogle Scholar
  5. Cullinan  N, Gorman  KM, Riordan  M, Waldron  M, Goodship  TH, Awan  A. Case report: Benefits and challenges of long-term eculizumab in atypical hemolytic uremic syndrome. Pediatrics. 2015;135:e15069. DOIPubMedGoogle Scholar
  6. Struijk  GH, Bouts  AH, Rijkers  GT, Kuin  EA, ten Berge  IJ, Bemelman  FJ. Meningococcal sepsis complicating eculizumab treatment despite prior vaccination. Am J Transplant. 2013;13:81920. DOIPubMedGoogle Scholar
  7. Partridge  E, Lujan  E, Giuntini  S, Vu  DM, Granoff  DM. The role of anti-NHba antibody in bactericidal activity elicited by the meningococcal serogroup B vaccine, MenB-4C. Vaccine. 2017;35:423644. DOIPubMedGoogle Scholar
  8. Lujan  E, Winter  K, Rovaris  J, Liu  Q, Granoff  DM. Serum bactericidal antibody responses of students immunized with a meningococcal serogroup B vaccine in response to an outbreak on a university campus. Clin Infect Dis. 2017;65:11129. DOIPubMedGoogle Scholar
  9. Beernink  PT, Shaughnessy  J, Braga  EM, Liu  Q, Rice  PA, Ram  S, et al. A meningococcal factor H binding protein mutant that eliminates factor H binding enhances protective antibody responses to vaccination. J Immunol. 2011;186:360614. DOIPubMedGoogle Scholar
  10. Hillmen  P, Hall  C, Marsh  JC, Elebute  M, Bombara  MP, Petro  BE, et al. Effect of eculizumab on hemolysis and transfusion requirements in patients with paroxysmal nocturnal hemoglobinuria. N Engl J Med. 2004;350:5529. DOIPubMedGoogle Scholar
  11. Konar  M, Granoff  DM. Eculizumab treatment and impaired opsonophagocytic killing of meningococci by whole blood from immunized adults. Blood. 2017;130:8919. DOIPubMedGoogle Scholar
  12. Sprong  T, Brandtzaeg  P, Fung  M, Pharo  AM, Høiby  EA, Michaelsen  TE, et al. Inhibition of C5a-induced inflammation with preserved C5b-9-mediated bactericidal activity in a human whole blood model of meningococcal sepsis. Blood. 2003;102:370210. DOIPubMedGoogle Scholar
  13. McNamara  LATN, Topaz  N, Wang  X, Hariri  S, Fox  L, MacNeil  JR. High risk for invasive meningococcal disease among patients receiving eculizumab (Soliris) despite receipt of meningococcal vaccine. MMWR Morb Mortal Wkly Rep. 2017;66:7347. DOIPubMedGoogle Scholar
  14. Yazdankhah  SP, Kriz  P, Tzanakaki  G, Kremastinou  J, Kalmusova  J, Musilek  M, et al. Distribution of serogroups and genotypes among disease-associated and carried isolates of Neisseria meningitidis from the Czech Republic, Greece, and Norway. J Clin Microbiol. 2004;42:514653. DOIPubMedGoogle Scholar
  15. Marsh  JW, Shutt  KA, Pajon  R, Tulenko  MM, Liu  S, Hollick  RA, et al. Diversity of factor H-binding protein in Neisseria meningitidis carriage isolates. Vaccine. 2011;29:604958. DOIPubMedGoogle Scholar

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Page updated: July 18, 2018
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The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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