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Meningococcal Serogroup B Disease in Vaccinated Children.

Abstract

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.

Authors+Show Affiliations

Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain.Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain. Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain. CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain. Red de Investigación Translacional en Infectología Pediátrica, RITIP, Madrid, Spain.Unidad de Neisseria, Listeria y Bordetella, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain. CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain. Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain. Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain. Clinical Immunology Unit Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain.Unidad de Neisseria, Listeria y Bordetella, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain. CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain. Red de Investigación Translacional en Infectología Pediátrica, RITIP, Madrid, Spain. Departament de Medicina, Universitat Internacional de Catalunya, Barcelona, Spain.Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain. Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain. CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain. Red de Investigación Translacional en Infectología Pediátrica, RITIP, Madrid, Spain.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31634404

Citation

Soler-Garcia, Aleix, et al. "Meningococcal Serogroup B Disease in Vaccinated Children." Journal of the Pediatric Infectious Diseases Society, 2019.
Soler-Garcia A, Fernández de Sevilla M, Abad R, et al. Meningococcal Serogroup B Disease in Vaccinated Children. J Pediatric Infect Dis Soc. 2019.
Soler-Garcia, A., Fernández de Sevilla, M., Abad, R., Esteva, C., Alsina, L., Vázquez, J., ... Noguera-Julian, A. (2019). Meningococcal Serogroup B Disease in Vaccinated Children. Journal of the Pediatric Infectious Diseases Society, doi:10.1093/jpids/piz071.
Soler-Garcia A, et al. Meningococcal Serogroup B Disease in Vaccinated Children. J Pediatric Infect Dis Soc. 2019 Oct 21; PubMed PMID: 31634404.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Meningococcal Serogroup B Disease in Vaccinated Children. AU - Soler-Garcia,Aleix, AU - Fernández de Sevilla,Mariona, AU - Abad,Raquel, AU - Esteva,Cristina, AU - Alsina,Laia, AU - Vázquez,Julio, AU - Muñoz-Almagro,Carmen, AU - Noguera-Julian,Antoni, Y1 - 2019/10/21/ PY - 2019/04/09/received PY - 2019/09/27/accepted PY - 2019/10/22/entrez PY - 2019/10/22/pubmed PY - 2019/10/22/medline KW - Neisseria meningitidis group B KW - child KW - infant KW - sepsis KW - vaccine JF - Journal of the Pediatric Infectious Diseases Society JO - J Pediatric Infect Dis Soc N2 - 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. SN - 2048-7207 UR - https://www.unboundmedicine.com/medline/citation/31634404/Meningococcal_Serogroup_B_Disease_in_Vaccinated_Children L2 - https://academic.oup.com/jpids/article-lookup/doi/10.1093/jpids/piz071 DB - PRIME DP - Unbound Medicine ER -