Meningococcal Serogroup B Disease in Vaccinated Children

Abstract

Background Neisseria meningitidis serogroup B (MenB) is the most frequent cause of invasive meningococcal disease (IMD) in Spain. The multicomponent vaccine against MenB (4CMenB) was approved in Spain in January 2014. Methods We present 4 cases of children who developed MenB-associated IMD despite previous vaccination with 4CMenB. Extensive immunologic diagnostic work-up was performed in order to rule out any immunodeficiency. Also, molecular characterization of the MenB strain was conducted to determine whether bacterial antigens matched vaccine antigens. Results Among the 4 patients (2 girls), 2 had previous risk factors for IMD (recurrent bacterial meningitis of unknown origin and treatment with eculizumab). All patients developed meningitis, but only 2 developed septic shock; they were all cured without sequelae. No other primary or secondary immunodeficiencies were detected. MenB sequence type 213 was identified in 3 cases. With the exception of neisserial heparin-binding antigen peptide 465 present in 1 isolate, the rest of the isolated strains harbored vaccine antigen variants that did not match antigen variants included in the vaccine. Conclusions We present 4 children who developed MenB-associated IMD despite previous vaccination with 4CMenB. In 2 cases, the antibodies induced by 4CMenB likely were not effective against the isolated strains. A high level of suspicion for IMD seems advisable regardless of the patient’s vaccination history.

Pediatric NMOSD: A Review and Position Statement on Approach to Work-Up and Diagnosis

“…A report from the Centers for Disease Control and prevention in the United States (CDC) identified 16 cases of meningococcal disease occurring in eculizumab-treated patients between 2008 and 2016, primarily meningococcal sepsis without meningitis ( 105 ). Another recent report described four children who developed Neisseria meningitidis serogroup B (MenB)-associated invasive meningococcal disease despite previous vaccination with a multicomponent vaccine against MenB; two of them had been previously treated with eculizumab ( 106 ). Therefore, the risk of severe and potentially fatal infection with these organisms remains a concern during eculizumab treatment.…”

Potential Cross-Reactive Immunity to SARS-CoV-2 From Common Human Pathogens and Vaccines

“…Likewise, MenB vaccines can also induce some substantial cross-reactive T cell immunity against SARS-CoV-2. However, MenB vaccines are unlikely responsible for the observed resilient of children to SARS-CoV-2 worldwide; MenB vaccines have been introduced very recently, in the last decade, and not everywhere ( 58 , 59 ). In contrast, combination DTP vaccines are included in every single vaccination program since the 1940–50 ( 50 ).…”

The Diverse Spectrum of Invasive Meningococcal Disease in Pediatric and Adolescent Patients: Narrative Review of Cases and Case Series

“…A total of 4.3% of patients had breakthrough infections, that is, they were infected with a serogroup against which they had previously been immunized (serogroup B, 50.0%; serogroup C, 37.5%; serogroup W, 12.5%) (Table 3). For example, a 16-month-old infant in Spain with serogroup B meningococcal infection had been vaccinated with three doses of the four-component meningococcal serogroup B vaccine (4CMenB), with the last dose 7 months before presentation [28]; a 12-year-old child in Spain with serogroup B meningococcal infection had been fully vaccinated against this serogroup, including two doses of 4CMenB at age 12 years and the second one 5 months before the meningitis episode [28]; an 18-yearold adolescent in the UK with serogroup W meningococcal infection had previously completed the full course of MenACWY vaccination [22].…”