Low efficacy of vaccination against serogroup B meningococci in patients with atypical hemolytic uremic syndrome.
Adult
Antibodies, Monoclonal, Humanized
/ pharmacology
Atypical Hemolytic Uremic Syndrome
/ complications
Bacterial Proteins
/ immunology
Carrier Proteins
Complement Factor H
/ immunology
Female
Germany
Humans
Male
Meningococcal Infections
/ prevention & control
Meningococcal Vaccines
/ pharmacology
Middle Aged
Neisseria meningitidis, Serogroup B
/ immunology
Serogroup
Treatment Outcome
Vaccination
/ methods
atypical hemolytic uremic syndrome
immunosuppression
meningococcal serogroup B
serum bactericidal antibody titers
vaccination
Journal
Bioscience reports
ISSN: 1573-4935
Titre abrégé: Biosci Rep
Pays: England
ID NLM: 8102797
Informations de publication
Date de publication:
27 03 2020
27 03 2020
Historique:
received:
19
01
2020
revised:
28
02
2020
accepted:
10
03
2020
pubmed:
12
3
2020
medline:
26
3
2021
entrez:
12
3
2020
Statut:
ppublish
Résumé
The C5 complement inhibitor eculizumab is first-line treatment in atypical hemolytic uremic syndrome (aHUS) going along with a highly increased risk of meningococcal infections. Serogroup B meningococci (MenB) are the most frequently encountered cause for meningococcal infections in Europe. Efficacy of the protein-based MenB-vaccine Bexsero in aHUS has not been determined and testing is only possible in patients off-treatment with eculizumab as a human complement source is required. Patients with aHUS were vaccinated with two doses of the protein-based MenB-vaccine Bexsero. Serum bactericidal antibody (SBA) titers against factor H binding protein (fHbp) of MenB were determined in 14 patients with aHUS off-treatment with eculizumab. Only 50% of patients showed protective human serum bactericidal antibody (hSBA) titers (≥1:4) against MenB following two vaccinations. Bactericidal antibody titers were relatively low (≤1:8) in three of seven patients with protective titers. While 71% of patients were on immunosuppressive treatment for either thrombotic microangiopathy or renal transplantation at either first or second vaccination, all four patients not receiving any immunosuppressive treatment showed protective bactericidal antibody response. Time between second vaccination and titer measurement was not significantly different between patients with protective titers compared with those with non-protective titers, while time between first and second vaccination was significantly longer in patients with protective titers going along with a tendency for reduction in immunosuppressive treatment. Efficacy of vaccination against MenB is insufficient in patients with aHUS. Response to vaccination seems to be hampered by immunosuppression. Therefore, implementation of adequate antibiotic prophylaxis seems pivotal.
Sections du résumé
BACKGROUND
The C5 complement inhibitor eculizumab is first-line treatment in atypical hemolytic uremic syndrome (aHUS) going along with a highly increased risk of meningococcal infections. Serogroup B meningococci (MenB) are the most frequently encountered cause for meningococcal infections in Europe. Efficacy of the protein-based MenB-vaccine Bexsero in aHUS has not been determined and testing is only possible in patients off-treatment with eculizumab as a human complement source is required.
METHODS
Patients with aHUS were vaccinated with two doses of the protein-based MenB-vaccine Bexsero. Serum bactericidal antibody (SBA) titers against factor H binding protein (fHbp) of MenB were determined in 14 patients with aHUS off-treatment with eculizumab.
RESULTS
Only 50% of patients showed protective human serum bactericidal antibody (hSBA) titers (≥1:4) against MenB following two vaccinations. Bactericidal antibody titers were relatively low (≤1:8) in three of seven patients with protective titers. While 71% of patients were on immunosuppressive treatment for either thrombotic microangiopathy or renal transplantation at either first or second vaccination, all four patients not receiving any immunosuppressive treatment showed protective bactericidal antibody response. Time between second vaccination and titer measurement was not significantly different between patients with protective titers compared with those with non-protective titers, while time between first and second vaccination was significantly longer in patients with protective titers going along with a tendency for reduction in immunosuppressive treatment.
CONCLUSIONS
Efficacy of vaccination against MenB is insufficient in patients with aHUS. Response to vaccination seems to be hampered by immunosuppression. Therefore, implementation of adequate antibiotic prophylaxis seems pivotal.
Identifiants
pubmed: 32159209
pii: 222330
doi: 10.1042/BSR20200177
pmc: PMC7098122
pii:
doi:
Substances chimiques
4CMenB vaccine
0
Antibodies, Monoclonal, Humanized
0
Bacterial Proteins
0
CFH protein, human
0
Carrier Proteins
0
Meningococcal Vaccines
0
Complement Factor H
80295-65-4
eculizumab
A3ULP0F556
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2020 The Author(s).
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