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Meningococcal B Vaccine Immunogenicity in Children With Defects in Complement and Splenic Function
Federico Martinón-Torres1, Ewa Bernatowska2, Anna Shcherbina3
1Translational Pediatrics and Infectious Diseases, Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
Insights
The quadrivalent meningococcal serogroup B vaccine (4CMenB) shows similar immunogenicity in healthy children and those with asplenia or splenic dysfunction. Lower immune responses were observed in some complement-deficient children, warranting further surveillance.
Area of Science:
- Immunology
- Vaccinology
- Pediatrics
Background:
- The quadrivalent meningococcal group B vaccine (4CMenB) is recommended for at-risk children, including those with complement deficiencies, asplenia, or splenic dysfunction.
- Limited data exist on the immunogenicity of 4CMenB in these specific pediatric populations.
Purpose of the Study:
- To evaluate the immunogenicity of the 4CMenB vaccine in children with complement deficiencies, asplenia, or splenic dysfunction.
- To compare vaccine responses in these at-risk groups with healthy children.
Main Methods:
- A study involving 239 children aged 2-17 years, including those with complement deficiencies (n=40), asplenia/splenic dysfunction (n=112), and healthy controls (n=87).
- Participants received two doses of 4CMenB, and serum bactericidal activity (SBA) was measured using exogenous and endogenous complement against four Neisseria meningitidis serogroup B strains.
- SBA was assessed at baseline and one month post-vaccination.
Main Results:
- After vaccination, high proportions of participants with asplenia/splenic dysfunction and healthy controls achieved serum bactericidal activity (SBA) titers ≥1:5 against all tested strains using exogenous complement.
- Complement-deficient children showed slightly lower SBA titers compared to controls, particularly those with terminal complement deficiencies or on eculizumab therapy.
- Strain-specific bactericidal activity with endogenous complement was limited in participants with severe complement deficiencies.
Conclusions:
- The 4CMenB vaccine demonstrates comparable immunogenicity in healthy children and those with asplenia or splenic dysfunction.
- A trend towards lower SBA responses was noted in some complement-deficient children, highlighting the need for continued surveillance for vaccine effectiveness in these vulnerable groups.
Background:
The capsular group B meningococcal vaccine (4CMenB) is recommended for children with complement deficiencies, asplenia, and splenic dysfunction; however, data on the immunogenicity of 4CMenB in these "at-risk" children are missing.
Methods:
Participants aged 2 to 17 years in Italy, Spain, Poland, the United Kingdom, and Russia with complement deficiencies, asplenia, or splenic dysfunction received 2 doses of 4CMenB 2 months apart, as did healthy children in the control group. Exogenous and endogenous human complement serum bactericidal activity (SBA) was determined at baseline and 1 month after the second immunization against 4 test strains: H44/76 (assessing vaccine antigen factor H binding protein), 5/99 (Neisserial adhesion A), NZ98/254 (Porin A), and M10713 (Neisserial heparin binding antigen).
Results:
Of 239 participants (mean age 10.3 years, 45% female), 40 children were complement deficient (9 eculizumab therapy, 4 terminal-chain deficiencies, 27 "other"), 112 children had asplenia or splenic dysfunction (8 congenital asplenia, 8 functional asplenia, 96 splenectomy), and 87 children were in the control group. After immunization, the proportions of complement-deficient participants with exogenous complement SBA titers ≥1:5 were 87% (H44/76), 95% (5/99), 68% (NZ98/254), and 73% (M10713), compared with 97%, 100%, 86%, and 94%, respectively, for asplenic children and 98%, 99%, 83%, and 99% for children in the control group. When testing with endogenous complement, strain-specific bactericidal activity was evident in only 1 eculizumab-treated participant and 1 terminal chain complement-deficient participant.
Conclusions:
4CMenB administration is similarly immunogenic in healthy children and those with asplenia or splenic dysfunction. The significance of the trend to lower responses of SBA titers in complement-deficient children (especially those with terminal chain complement deficiency or those on eculizumab therapy) must be determined by ongoing surveillance for vaccine failures.
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