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Eculizumab Meningococcal Risk Vaccination — ESENeph MCQ

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EasyGlomerulonephritisEculizumab Meningococcal Risk VaccinationESENeph

A 40-year-old man with complement-mediated aHUS on Eculizumab asks about the risk of meningococcal infection. Why is vaccination essential before Eculizumab?

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Correct answer: C — Eculizumab blocks terminal complement (C5), eliminating membrane attack complex (MAC) formation; this specifically impairs defence against encapsulated organisms, particularly Neisseria meningitidis – vaccination and antibiotic prophylaxis are mandatory

Eculizumab (and Ravulizumab) blocks complement C5, preventing MAC (C5b-9) formation. MAC is critical for killing encapsulated bacteria, particularly Neisseria meningitidis. Eculizumab increases meningococcal infection risk approximately 1000-2000 fold. NICE HST1 and the SPC mandate: (1) meningococcal ACWY and B vaccination at least 2 weeks before first dose (if urgent, vaccinate and give prophylactic antibiotics until vaccines take effect); (2) prophylactic antibiotics (Penicillin V or Ciprofloxacin) for the duration of treatment and at least 2 months after stopping; (3) patient education about recognising meningococcal symptoms.

Reference: NICE HST1 2015 – Eculizumab; Eculizumab SPC; KDIGO 2021 – GN