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Development of antibodies against tetravalent meningococcal polysaccharides in revaccinated complement-deficient
M Drogari-Apiranthitou1, C A Fijen, D Van De Beek
1Department of Medical Microbiology, University of Amsterdam, The Netherlands. m.apiranthitou@amc.uva.nl
Abstract:
Individuals deficient 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-deficient (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 first vaccination levels of IgG antibodies declined compared with the levels present at 6 months after the first vaccination, but were still at least four times higher than before vaccination. Levels of antibodies to Y polysaccharide in serum of complement-deficient patients were rather low but they did not differ significantly 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 first vaccination. In the 8 years of observation after the first 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 first vaccination. Our findings 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 first 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.
Insights
Individuals with complement deficiencies are prone to meningococcal infections. Revaccination with a tetravalent meningococcal vaccine after 7 years boosted antibody levels, though some patients still developed disease.
Area of Science:
- Immunology
- Infectious Diseases
- Vaccinology
Background:
- Complement component deficiencies (C3 or late components) increase susceptibility to recurrent meningococcal infections, often with uncommon serogroups.
- Meningococcal vaccination with a tetravalent polysaccharide vaccine (A, C, Y, W135) is recommended for these individuals.
Purpose of the Study:
- To investigate the long-term antibody response and the effect of revaccination with a tetravalent meningococcal polysaccharide vaccine in complement component-deficient (CCD) patients.
- To assess the durability of immune memory and the need for revaccination schedules in this vulnerable population.
Main Methods:
- A cohort of 19 CCD patients (2 C3-deficient, 17 late complement component-deficient) received a primary vaccination and a booster 7 years later.
- Serum IgG antibody levels against meningococcal A, C, Y, and W135 polysaccharides were measured before vaccination, 6 months after the primary vaccination, and at various time points up to 3 months after revaccination.
Main Results:
- Antibody levels declined 7 years after primary vaccination but remained significantly higher than pre-vaccination levels.
- Revaccination 7 years after the primary dose resulted in a substantial increase in IgG antibodies against all vaccine serogroups, exceeding levels seen after the initial vaccination.
- Two patients developed meningococcal disease due to vaccine-related serogroup Y strains, 3.5 and 5 years post-primary vaccination, despite vaccination.
Conclusions:
- Revaccination of complement-deficient individuals 7 years after primary meningococcal vaccination effectively boosts antibody levels.
- The occurrence of meningococcal disease in vaccinees suggests that the 7-year revaccination interval may be too long for some individuals, warranting further investigation into optimal vaccination strategies for this high-risk group.