, Volume 26, Issue 10, pp 1919-1920,
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Insufficient protection by Neisseria meningitidis vaccination alone during eculizumab therapy

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Sirs,

Spurred by the reported spectacular results of eculizumab treatment in atypical hemolytic uremic syndrome (aHUS) due to aberrations in the complement system, an increasing number of children will receive this treatment in future. The main adverse effect of this therapy is an increased susceptibility to meningococcal infection due to inhibition of the complement system’s membrane-attack complex. In patients with paroxysmal nocturnal hemoglobinuria treated with eculizumab, the reported occurrence of meningococcal infection is between 0% and 1.5% [13]. These data, concerning adult patients, cannot be extrapolated to children because the age-specific incidence of meningococcal disease is much higher in children.

According to the medication guide of the U.S. Food and Drug Administration, a tetravalent unconjugated polysaccharide vaccine (serogroups A, C, Y, W135) has to be provided at least 2 weeks before the first dose of eculizumab. In our opinion, this approach is not sufficient for