Immunogenicity and Safety of Meningococcal C Conjugate Vaccine in Children and Adolescents Infected and Uninfected with HIV in Rio de Janeiro, Brazil

Abstract

Background We aimed to evaluate the Neisseria meningitidis C conjugated vaccine (MCC) seroconversion and adverse events (AE) in HIV-infected and uninfected children and adolescents in Rio de Janeiro, Brazil. Methods HIV-infected or uninfected subjects, 2–18 years old, with CD4+ T-lymphocyte cell (CD4) percentage >15%, without active infection or antibiotic use, were enrolled. All patients were evaluated before and 1–2 months after immunization for seroconversion (defined as ≥4-fold titer increase in human serum bactericidal activity), and for AEs at 20 minutes, 3 and 7 days after immunization. Factors associated with seroconversion among HIV-infected group were studied. Results 204 subjects were enrolled: 154 HIV-infected and 50 HIV-uninfected. Median age was 12 years and 53% were female. Among the HIV-infected group, 82 (53%) had a history of at least one C clinical category Centers for Diseases Control and Prevention event, and 134 (87%) were using combination antiretroviral therapy (cART). The median nadir CD4 percentage was 13% (0%–47%). 76(37.3%) experienced mild AEs. Seroconversion occurred in 46/154 (30%) of the HIV-infected group, and in 38/50 (76%) of the uninfected group (p<0.01). Factors associated with seroconversion in the HIV-infected group were: Never had a C clinical category event (OR=2.1, 95%CI=1.0–4.4); undetectable viral load at immunization (OR=2.4, 95%CI=1.1–5.2), and higher CD4 nadir/100 cells (OR=1.1, 95%CI=1.0–1.2). Conclusion MCC vaccine should be administered to HIV-infected children and adolescents after maximum immunologic and virologic benefit has been achieved with cART. Our data suggest that a single dose of MCC vaccine is insufficient for HIV-infected individuals 2–18 years of age.

Risk of invasive meningococcal disease in children and adults with HIV in England: a population-based cohort study

“…Future studies on the immunogenicity of the recently licensed MenB vaccine in HIV-positive children and adolescents at different stages of immunosuppression and antiretroviral treatment could potentially support recommendations for MenB vaccination in these age groups. Our results also indicate that newly diagnosed adults with HIV may benefit from MenACWY conjugate vaccination [ 19 , 35 ]. However, the wide range of CD4 counts, including a significant proportion with very low counts, and the variable duration and combinations of ART at the time of IMD diagnosis suggest that these parameters may not be useful criteria for recommending the most appropriate timing for meningococcal vaccination.…”

Bacterial agents causing meningitis during 2013–2014 in Turkey: A multi-center hospital-based prospective surveillance study

“…[13][14][15] There are 12 recognized serogroups of N. meningitidis, however, 6 meningococcal serogroups including (Men) A, B, C, W-135, X and Y are associated with the majority of invasive disease with serogroups B and C are causing most cases in industrialized countries and elsewhere. [16][17][18][19] Before the widespread use of a conjugate meningoccoccal group A vaccine, seasonal meningitis epidemics caused by group A caused high toll of morbidity and mortality in the African meningitis belt countries. 20 Serogroup W-135 causes outbreaks in some parts of the world, primarily in Saudi Arabia and Africa.…”

Vaccination in the person with newly diagnosed HIV

“…37 Low CD4 count and non-suppressed HIV viral load were predictors of a poorer response. 38 No clinical data for individuals with HIV are available for MenB vaccine immunogenicity. Therefore, it is recommended that two doses of both MenACWY and MenB be administered eight weeks apart to adults living with HIV.…”