Serologic response to meningococcal vaccination in patients with cold agglutinin disease (CAD) in the novel era of complement inhibition. Issue 44 (16th October 2019)

• Record Type: Journal Article
• Authors: Alashkar, Ferras; Vance, Colin; Herich-Terhürne, Dörte; Turki, Amin T.; Schmitz, Christine; Bommer, Martin; Hüttmann, Andreas; Dührsen, Ulrich; Vogel, Ulrich; Röth, Alexander
• Is Part Of: Vaccine. Volume 37:Issue 44(2019)
• Page Start: 6682
• Page End: 6687
• Publication Date: 2019-10-16
• Subjects: Cold agglutinin disease (CAD) -- Eculizumab -- N. meningitidis; AchR anti-acetylcholine receptor -- ANC absolute neutrophil count -- CAs cold agglutinins -- CAD cold agglutinin disease -- CAS cold agglutinin syndrome -- CI complement inhibition -- CMV cytomegalovirus -- DAT direct antiglobulin test -- EBV Epstein-Barr virus -- EC European Commission -- EU European Union -- gMG generalized myasthenia gravis -- GMT geometric mean titer -- Hib Haemophilus influenzae serotype b -- Ig immunoglobulin -- IMD invasive meningococcal disease -- LDH lactate dehydrogenase -- mAb monoclonal antibody -- MAC membrane attack complex -- N. meningitidis Neissera meningitidis -- PNH paroxysmal nocturnal hemoglobinuria -- RKI Robert Koch Institute -- rSBA serum bactericidal antibody (SBA) assay using baby rabbit serum as external complement source -- STIKO Standing Vaccination Committee -- S. pneumoniae Streptococcus pneumoniae; Vaccines -- Periodicals; 615.372
• DOI: 10.1016/j.vaccine.2019.09.033
• Languages: English
• ISSNs: 0264-410X

Abstract

Abstract: Cold agglutinin disease (CAD) is a rare, potentially life-threatening acquired autoimmune hemolytic anemia characterized by hemagglutination and hemolysis due to immunoglobulin-mediated (usually IgMκ) classic complement pathway activation. Complement inhibition (CI) represents a novel treatment option to control hemolysis. Due to CI patients (pts) are susceptible to encapsulated bacteria e.g. N. meningitidis . Therefore, meningococcal vaccination on CI is mandatory. In this study serologic response to the tetravalent conjugate vaccine Menveo® was analyzed in CAD pts on eculizumab treatment (DECADE trial) using rabbit serum as complement source (rSBA). Protective rSBA titers varied for meningococcal serogroups and over time reflecting an early decline to even non-protective rSBA titers. These data highlight the importance of serologic analyses under chronic CI. Currently, re-vaccination with a tetravalent meningococcal conjugate vaccine every 3 years is recommended on chronic CI. However, re-vaccination on CI might further rely on serologic analyses, implying even early booster vaccinations similar to adults with (functional) asplenia.