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Meningococcal Serogroup B Disease in Vaccinated Children
Aleix Soler-Garcia1, Mariona Fernández de Sevilla1,2,3,4, Raquel Abad5
1Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain.
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.
Insights
Four children developed meningococcal B disease despite vaccination with the 4CMenB vaccine. Vaccine effectiveness may be limited by bacterial antigen variants, highlighting the need for continued clinical suspicion for invasive meningococcal disease.
Area of Science:
- Pediatrics
- Infectious Diseases
- Vaccinology
Background:
- Neisseria meningitidis serogroup B (MenB) is a leading cause of invasive meningococcal disease (IMD) in Spain.
- The 4-component MenB (4CMenB) vaccine was approved in Spain in 2014.
Observation:
- This study reports on four pediatric cases of MenB-associated IMD occurring post-4CMenB vaccination.
- Two patients had pre-existing risk factors for IMD, including recurrent meningitis and eculizumab treatment.
- All patients presented with meningitis, and two experienced septic shock; all recovered without lasting effects.
Findings:
- Immunological work-up ruled out primary or secondary immunodeficiencies in the affected children.
- Molecular analysis identified MenB sequence type 213 in three cases.
- Most isolated strains exhibited vaccine antigen variants that differed from those in the 4CMenB vaccine, with one exception.
Implications:
- The findings suggest that 4CMenB vaccine-induced antibodies may not be effective against certain circulating MenB strains due to antigen variability.
- Maintaining a high clinical suspicion for IMD is crucial, even in vaccinated individuals.
- This highlights the need for ongoing surveillance of MenB strains and vaccine effectiveness.
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