Sex: F
Vaccine: MEN
Symptoms: Death, Meningococcal infection, Vaccination failure
Clinical narrative: Initial unsolicited report received from the literature on 04-Jan-2018. The following is verbatim from the article: The Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts, meets 3 times per year to develop recommendations for vaccine use. The group has 15 voting members, and each member's term is 4 years. ACIP members and Centers for Disease Control and Prevention (CDC) staff discuss the epidemiology of vaccine-preventable diseases and vaccine research, effectiveness, safety data, and clinical trial results. Representatives from multiple agencies are present as liaisons to the ACIP. The ACIP met on June 21 to 22, 2017, to discuss catch-up vaccination for hepatitis A vaccine, influenza surveillance, influenza vaccine effectiveness, herpes zoster vaccine, the effect of varicella vaccination on the incidence of herpes zoster, meningococcal disease in patients taking eculizumab, and considerations for a potential third dose of MMR vaccine to combat ongoing mumps outbreaks. Updates on dengue virus epidemiology, Zika virus vaccines, anthrax vaccine, yellow fever vaccine, and the Vaccine Adverse Event Reporting System were given also. This case involves a 16-year-old female patient who was vaccinated with doses of MENACWY VACCINE and MENB-4C VACCINES (batch number, expiry date, dose, dose in series, route and site of administration were not reported for both the vaccines) on an unspecified date. The patient had medical history of paroxysmal nocturnal hemoglobinuria. Concomitant medication includes eculizumab for paroxysmal nocturnal hemoglobinuria which started on an unknown date approximately one month earlier. On an unspecified date, six months following the vaccinations, the patient experienced fatal meningococcal disease and vaccination failure. Laboratory investigation and corrective treatment were not reported. On an unknown date, the patient died despite apparently strong memory antibody response to the strain. It was unknown if autopsy was performed or not. List of the documents held by sender: none. Sender's Comments: Vaccination failure may be expected with any vaccine, as no vaccine protects all vaccinated individuals. Concomitant medication in this report of fatal meningococcal disease included eculizumab for paroxysmal nocturnal hemoglobinuria. Eculizumab is a terminal complement inhibitor and therefore increases patient risk for meningococcal infections. Patients treated with eculizumab and without a history of prior vaccination are recommended to receive a meningococcal vaccine at least 2 weeks prior to receiving the first dose of eculizumab and be revaccinated according to current medical guidelines for vaccine use. In this case, vaccination with MenACWY and MenB meningococcal vaccines occurred prior to initiating treatment with eculizumab. Importantly, this case does not represent a confirmed vaccine failure to MenACWY because information on the specific serogroup involved was not available. The isolate initially was reported to be serogroup B, but subsequent testing revealed that the strain actually was nongroupable. Reported Cause(s) of Death: Fatal meningococcal disease.