Why is the meningitis vaccine recommended for individuals undergoing immunotherapy?

Meningococcal Vaccination for Immunotherapy Patients

Meningococcal vaccination is required for patients undergoing immunotherapy with complement inhibitors because these medications significantly increase the risk of invasive meningococcal disease by interfering with the complement system, a critical component of immune defense against Neisseria meningitidis. 1

Why Complement Inhibitor Therapy Requires Meningococcal Vaccination

Certain immunotherapies, particularly complement inhibitors like eculizumab (Soliris) and ravulizumab (Ultomiris), dramatically increase susceptibility to meningococcal infection by:

• Blocking the terminal complement pathway that normally destroys invading meningococcal bacteria
• Creating an immune state similar to patients with inherited complement deficiencies, who have 1,000-10,000 times higher risk of meningococcal disease

Vaccination Requirements for Patients on Complement Inhibitors

The Advisory Committee on Immunization Practices (ACIP) has specific recommendations for these high-risk patients:

1. Timing: Meningococcal vaccines should be administered at least 2 weeks before starting complement inhibitor therapy, unless the risk of delaying therapy outweighs the risk of meningococcal disease 1

2. Required vaccines:

   • MenACWY (quadrivalent meningococcal conjugate vaccine covering serogroups A, C, W, and Y)

     • Primary series: 2 doses administered 8 weeks apart
     • Booster doses: Every 5 years if patient remains on therapy

   • MenB (serogroup B meningococcal vaccine)

     • Primary series: Either MenB-FHbp (3 doses at 0,1-2, and 6 months) or MenB-4C (2 doses ≥1 month apart)
     • Booster doses: 1 year after primary series completion and every 2-3 years thereafter 1

Vaccination Schedule and Follow-up

For patients on complement inhibitors:

• Both MenACWY and MenB vaccines must be administered (not just one)
• The vaccines are not interchangeable within their categories (must use same product for all doses in a series)
• Revaccination is critical as antibody levels wane over time
• Patients vaccinated at age ≥7 years should be revaccinated 5 years after their previous meningococcal vaccine 1

Important Clinical Considerations

• Despite vaccination, patients on complement inhibitors remain at risk for meningococcal disease
• Patients should be educated about early signs of meningococcal infection and the need to seek immediate medical attention if they develop fever, headache, stiff neck, or rash
• Prophylactic antibiotics may be considered in addition to vaccination for some high-risk patients
• The vaccination requirement applies specifically to complement inhibitor therapies, not to all forms of immunotherapy 1

Pitfalls to Avoid

• Don't delay vaccination: Ideally, complete vaccination 2 weeks before starting complement inhibitor therapy
• Don't administer just one type: Both MenACWY and MenB vaccines are required
• Don't forget boosters: Antibody levels wane over time, making revaccination essential
• Don't assume vaccination provides complete protection: Patients should remain vigilant for signs of infection despite vaccination

The meningococcal vaccination requirement for patients on complement inhibitor therapy reflects the critical role of the complement system in defending against Neisseria meningitidis and the life-threatening nature of invasive meningococcal disease, which carries high mortality and morbidity rates even with prompt treatment.