NMOSD – Eculizumab and Meningococcal Vaccination — SCE Neurology MCQ

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ModerateMultiple Sclerosis & CNS InflammationNMOSD – Eculizumab and Meningococcal VaccinationSCE Neurology

A 40-year-old man with AQP4-positive NMOSD is being started on eculizumab. What essential vaccination must be administered at least 2 weeks before starting treatment?

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Correct answer: A — Meningococcal ACWY and B vaccines

Explanation lettering: B = shown as A · C = shown as B · E = shown as C · A = shown as E

Eculizumab is a monoclonal antibody that inhibits terminal complement component C5, blocking the formation of the membrane attack complex (MAC). This creates a significant risk of meningococcal infection (Neisseria meningitidis). Patients MUST be vaccinated against meningococcus (serogroups A, C, W, Y, and B) at least 2 weeks before starting eculizumab. If urgent treatment is needed before vaccination can take effect, prophylactic antibiotics (penicillin V or ciprofloxacin) should be given. A: Influenza vaccination is routine but not mandatory for eculizumab. C/D/E: These are not specifically mandated before eculizumab.

Reference: Eculizumab SmPC; NICE TA928 Eculizumab for NMOSD; Green Book Immunisation Guidance