I have a patient with paroxysmal nocturnal hemoglobinuria who is being treated with Soliris (eculizumab). Should he receive meningococcal vaccine?

Eculizumab (Soliris) and related long-acting compounds, such as ravulizumab (Ultomiris) and sutimlimab (Enjaymo), inhibit the terminal complement pathway. People with persistent complement component deficiency due to an immune system disorder or use of a complement inhibitor are at increased risk for meningococcal disease even if fully vaccinated. This patient should be given a 2-dose primary series of MenACWY vaccine (2 doses separated by at least 8 weeks) and a 3-dose series of MenB vaccine (0, 1-2 months, and 6 months). The patient should receive regular booster doses of MenACWY and MenB as long as he remains at risk: a booster dose of MenACWY every 5 years and a booster dose of MenB one year after completion of the primary series, followed by a booster dose of MenB every 2–3 years thereafter. Because MenB products are not interchangeable, all MenB doses should contain the same type of MenB vaccine (either MenB-4C, which is in Bexsero [GSK], or MenB-FHbp, which is in Trumenba and Penbraya [Pfizer]). If the brand of the primary series is not known or not available, CDC recommends restarting the primary series with the available product.

Penbraya (MenABCWY, Pfizer) contains MenB-Fhbp (Trumenba, Pfizer) and is given as two doses, 6 months apart, when vaccination against all 5 serogroups is needed. For people age 10 years or older at increased risk of meningococcal disease, like this patient, Penbraya may be used for MenACWY and MenB (Trumenba) doses (including booster doses) if both vaccines would be given on the same clinic day and at least 6 months have elapsed since most recent Penbraya dose.

Because patients treated with complement inhibitors can develop invasive meningococcal disease despite vaccination, clinicians using these products also may consider antimicrobial prophylaxis for the duration of complement inhibitor therapy.