We have a 10-year-old getting renal dialysis. The nephrologist will be starting her on ravulizumab (Ultomiris), which interferes with C5 complement. If we administer meningococcal MenACWY vaccine and pneumococcal conjugate vaccine (PCV) now, will the MenACWY interfere with the PCV?

Recommendations to separate MenACWY and PCV under certain circumstances only applied to MenACWY-D (Menactra, Sanofi), which is no longer available in the United States. So, you may administer any available and recommended MenACWY and PCV vaccines at the same time. A 10-year-old with persistent complement component deficiency also should receive a 3-dose series (the same product for all doses) of MenB vaccine.

As long as the child remains at high risk of meningococcal disease due to complement inhibitor use, booster doses of both MenACWY and MenB are recommended. A MenACWY booster dose should be given every 5 years and a MenB booster dose should be given one year after the completion of the primary series, followed by a booster dose every 2–3 years thereafter. If using MenB-FHbp (Trumenba, Pfizer), you have the option to use MenABCWY (Penbraya, Pfizer) when both MenACWY and MenB vaccinations are due at the same visit, as long as doses of Penbraya are separated by at least 6 months.

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