Immune Response to Meningococcal Serogroup C Conjugate Vaccine in Asplenic Individuals

Abstract

Asplenic individuals are known to be at increased risk of infection with encapsulated bacteria. Recent United Kingdom recommendations stated that this at-risk group should receive one dose of the meningococcal serogroup C conjugate (MCC) vaccine. However, the immune response of asplenic individuals to MCC vaccine is unknown. The immune response of asplenics (n ‫؍‬ 130) to immunization with the MCC vaccine was investigated. Asplenic individuals had a significantly lower geometric mean titer (GMT) (157.8; 95% confidence interval [CI], 94.5 to 263.3) of bactericidal antibody in serum (SBA) than an age-matched control group (n ‫؍‬ 48) (1448.2; 95% CI, 751.1 to 2792.0). However, 80% of asplenic individuals achieved the proposed protective SBA titer of >8. No differences were observed between the two groups in the serogroup C-specific immunoglobulin G geometric mean concentration. A significant reduction in SBA GMT or the number of responders achieving an SBA titer of >8 was observed if the reason for splenectomy was a medical cause or if MCC vaccination occurred <10 years after splenectomy. Individuals (n ‫؍‬ 29) who did not achieve an SBA titer of >16 were offered a second dose of MCC vaccine. Analysis of the SBA response revealed that 61% (14 of 23) of the individuals who received a second dose achieved a protective titer. In total, 93% of asplenic individuals achieved a titer of >8 following MCC vaccination (one or two doses combined). We recommend that, following vaccination of asplenics, either the level of functional antibody should be determined, with a second dose of MCC vaccine offered to nonresponders, or two doses of MCC vaccine should be routinely offered.Asplenic individuals are at an increased risk of infection from encapsulated bacteria, including Neisseria meningitidis (9, 15). Overwhelming postsplenectomy infection has a high mortality rate, between 40% and 70% (7). Immunization with the 23-valent pneumococcal plain polysaccharide and Haemophilus influenzae type b (Hib) conjugate (29) vaccines is recommended for individuals with functional or anatomic asplenia. In 2001, the United Kingdom Department of Health extended this recommendation to include vaccination with meningococcal serogroup C conjugate (MCC) vaccine, although no data on immune responses are available to date for MCC vaccines in this group (6).Various studies have provided conflicting evidence on the immune response to polysaccharide antigens in asplenic individuals (12, 21), and the limitations of plain polysaccharide vaccines are well documented (13,17,18,29). Meningococcal serogroup C plain polysaccharide vaccines are not immunogenic in those under the age of 2 years (13, 17), and repeated doses can lead to hyporesponsiveness (2,13,18,29). MCC vaccines that have been shown to be highly immunogenic and to generate immune memory in all age groups from infants to adults are now available (10, 25-29). MCC vaccines have been shown to be efficacious in all the age groups targeted during the vaccination campaign initiated in 1999 in the Uni...

Notes from the Field:Outbreak of Serogroup B Meningococcal Disease at a University — California, 2016

“…All 5,232 undergraduate students, as well as graduate students and faculty and staff members at increased risk for meningococcal disease, were advised to receive vaccine. Persons at increased risk were defined as persons with underlying health conditions as recommended by ACIP (3,5,6) and persons living in on-campus housing at the time of the outbreak (208 persons other than undergraduate students). During four vaccination clinics held February 4-8, a total of 4,921 persons received the first vaccine dose.…”

Practical review of immunizations in adult patients with cancer

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Background Paper for the update of meningococcal vaccination recommendations in Germany: use of the serogroup B vaccine in persons at increased risk for meningococcal disease

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“…However, the titers attained were lower than in healthy vaccinees. Persons with splenectomy due to medical conditions had lower vaccine responses than those with splenectomy due to trauma [69]. A review [71] To what extent this ability can be extrapolated to 4CMenB, however, currently remains unclear.…”