Development of antibodies against tetravalent meningococcal polysaccharides in revaccinated complement-deficient patients

Abstract

SUMMARYIndividuals de®cient in C3 or a late complement component are susceptible to recurrent meningococcal infections. Since they experience meningococcal episodes mostly with uncommon meningococcal serogroups, vaccination with a tetravalent vaccine containing A, C, Y and W135 polysaccharides has been suggested. We vaccinated a cohort of two C3 and 17 late complement component-de®cient (LCCD) patients, revaccinated them 7 years later and investigated the development of their IgG antibodies to the capsular polysaccharides of the meningococcal vaccine. Seven years after the ®rst vaccination levels of IgG antibodies declined compared with the levels present at 6 months after the ®rst vaccination, but were still at least four times higher than before vaccination. Levels of antibodies to Y polysaccharide in serum of complement-de®cient patients were rather low but they did not differ signi®cantly from those in serum of healthy non-related controls (P 0´07). Three months after the second vaccination IgG antibodies against all polysaccharides increased, exceeding those measured at 6 months after the ®rst vaccination. In the 8 years of observation after the ®rst vaccination two new meningococcal infections with strains related to the vaccine (serogroup Y strains) occurred in two patients, 3´5 and 5 years after the ®rst vaccination. Our ®ndings show that high IgG antibody levels against the tetravalent meningococcal polysaccharide vaccine were reached after revaccination of two C3 and 17 LCCD individuals 7 years after the ®rst vaccination. Whether revaccination should be required within a period shorter than 7 years is discussed, since two vaccinees developed meningococcal disease to vaccine serogroup Y.

Antibody-Dependent Killing of Meningococci by Human Neutrophils in Serum of Late Complement Component-Deficient Patients

“…Interestingly, revaccination resulted in a more pronounced increase of the leukocyte-mediated meningococcal killing than that produced with the first vaccination. This observation agrees with Drogari-Apiranthitou [33], who found a better increase of anticapsular antibodies measured by EIA after the revaccination of 17 LCCD individuals than after the first vaccination with tetravalent vaccine.…”

Recurrent infections in partial complement factor I deficiency: evaluation of three generations of a Brazilian family

“…Drogari‐Apiranthitou et al . [55] reported a good antibody response to meningococcal vaccine in patients with late complement (C5–C8) components as well as in those with C3 deficiency. Our complete and partial factor I‐deficient patients were all immunized, except one of the homozygous patients who died after fatal meningococcal meningitis.…”

Meningococcal disease and the complement system

“…Fijen et al reported the responses of 53 diverse complement-deficient individuals (7 C3-deficient, 19 properdin-deficient, and 27 terminal component-deficient) to immunization with the tetravalent capsular polysaccharide vaccine 254 . All patients generated functional antibody responses that were comparable to that seen in normal individuals and revaccination of two C3-deficient and 17 late complement-deficient patients resulted in robust increases in antibody titers 255 . Although not statistically different, the rates of disease in the 8 y following the initial vaccination were lower than in the 8 y preceding immunization.…”