Archive for July 27, 2017

High risk for invasive meningococcal disease among patients receiving eculizumab (Soliris) despite receipt of meningococcal vaccine

Morbidity and Mortalality Weekly Report July 14,  2017 V.66 N.27 P.734-737.

Lucy A. McNamara, PhD1; Nadav Topaz, MSc1; Xin Wang, PhD1; Susan Hariri, PhD1; LeAnne Fox, MD1; Jessica R. MacNeil, MPH1

Use of eculizumab (Soliris, Alexion Pharmaceuticals), a terminal complement inhibitor, is associated with a 1,000-fold to 2,000-fold increased incidence of meningococcal disease (1). Administration of meningococcal vaccines is recommended for patients receiving eculizumab before beginning treatment (2,3).

Sixteen cases of meningococcal disease were identified in eculizumab recipients in the United States during 2008–2016; among these, 11 were caused by nongroupable Neisseria meningitidis.

Fourteen patients had documentation of receipt of at least 1 dose of meningococcal vaccine before disease onset.

Because eculizumab recipients remain at risk for meningococcal disease even after receipt of meningococcal vaccines, some health care providers in the United States as well as public health agencies in other countries recommend antimicrobial prophylaxis for the duration of eculizumab treatment; a lifelong course of treatment is expected for many patients.

Heightened awareness, early care seeking, and rapid treatment of any symptoms consistent with meningococcal disease are essential for all patients receiving eculizumab treatment, regardless of meningococcal vaccination or antimicrobial prophylaxis status….

PDF

https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6627e1.pdf

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July 27, 2017 at 8:12 am

Measles Outbreak – Minnesota April-May 2017.

MMWR Morb Mortal Wkly Rep. 2017 Jul 14;66(27):713-717.

Hall V, Banerjee E, Kenyon C, Strain A, Griffith J, Como-Sabetti K, Heath J, Bahta L, Martin K, McMahon M, Johnson D, Roddy M, Dunn D, Ehresmann K.

Abstract

On April 10, 2017, the Minnesota Department of Health (MDH) was notified about a suspected measles case. The patient was a hospitalized child aged 25 months who was evaluated for fever and rash, with onset on April 8.

The child had no history of receipt of measles-mumps-rubella (MMR) vaccine and no travel history or known exposure to measles. On April 11, MDH received a report of a second hospitalized, unvaccinated child, aged 34 months, with an acute febrile rash illness with onset on April 10.

The second patient’s sibling, aged 19 months, who had also not received MMR vaccine, had similar symptoms, with rash onset on March 30.

Real-time reverse transcription-polymerase chain reaction (rRT-PCR) testing of nasopharyngeal swab or throat specimens performed at MDH confirmed measles in the first two patients on April 11, and in the third patient on April 13; subsequent genotyping identified genotype B3 virus in all three patients, who attended the same child care center.

MDH instituted outbreak investigation and response activities in collaboration with local health departments, health care facilities, child care facilities, and schools in affected settings.

Because the outbreak occurred in a community with low MMR vaccination coverage, measles spread rapidly, resulting in thousands of exposures in child care centers, schools, and health care facilities.

By May 31, 2017, a total of 65 confirmed measles cases had been reported to MDH (Figure 1); transmission is ongoing.

PDF

https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6627a1.pdf

July 27, 2017 at 8:11 am

Case Report: Benefits and Challenges of Long-term Eculizumab in Atypical Hemolytic Uremic Syndrome

Pediatrics June 2015 V.135 N.6

Noelle Cullinan, Kathleen Mary Gorman, Michael Riordan, Mary Waldron, Timothy H.J Goodship, Atif Awan

Atypical hemolytic uremic syndrome (aHUS) is caused by dysregulation of the complement system, leading to complement overactivation. A humanized anti-C5 monoclonal antibody, eculizumab, has been available for the treatment of aHUS since 2011.

The long-term safety and efficacy of this novel drug in the pediatric population remain under review.

We present a child with a hybrid CFH/CFHR3 gene who, having had multiple disease relapses despite optimal treatment with plasma exchange, commenced eculizumab therapy in August 2010.

She remains relapse free in follow-up at 52 months, and treatment has been well tolerated. The risk of meningococcal disease during this treatment is recognized.

Despite vaccination against meningococcal disease and appropriate antibiotic prophylaxis, our patient developed meningococcal bacteremia 30 months into treatment.

She presented with nonspecific symptoms but recovered without sequelae with appropriate treatment. We recommend that children be vaccinated against invasive meningococcal infection before beginning eculizumab therapy and take appropriate antibiotic prophylaxis during treatment, and we suggest that vaccine responses should be checked and followed annually.

Clinicians need to maintain a high index of suspicion for invasive meningococcal disease. Neither vaccination nor antibiotic prophylaxis provides complete protection in patients on eculizumab therapy.

The appropriate dosage of eculizumab needed to achieve remission in aHUS in the pediatric population is unknown.

Having achieved remission in our patient, we monitor eculizumab and CH50 levels to evaluate ongoing blockade of the terminal complement cascade. Such information may help guide dosing intervals in the future….

FULL TEXT

http://pediatrics.aappublications.org/content/135/6/e1506

PDF

http://pediatrics.aappublications.org/content/pediatrics/135/6/e1506.full.pdf

July 27, 2017 at 8:09 am


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