Nelson DR, Fadrowski J, Neu A. Immunogenicity of the meningococcal polysaccharide conjugate vaccine in pediatric kidney transplant patients. Pediatric Nephrology. 2018;33:1037-1043. DOI: 10.1007/s00467-017-3878.
Meningococcal disease is a potentially life-threatening systemic illness with peak incidence in infancy and adolescence. Kidney transplantation is most common in the adolescent years and requires life-long immunosuppression, making recipients more vulnerable to infections and less responsive to vaccination. In this prospective, single-center study of 19 youth 11-22 years old with kidney transplants who received a vaccine against 4 common serogroups of meningococcus, only 41% had seroconverted 4 weeks later (ie, had evidence of antibodies to meningococcal serogroups that they had not had at baseline). Seroprotection declined to 30% 1 year later, and to 15% 3 years later.
For more than 10 years, the CDC has recommended vaccination for adolescents with quadrivalent meningococcal conjugate vaccine that protects against serogroups A, C, W, and Y (MenACWY-D). In this study, following a 3-month period beyond the date of kidney transplantation and without having had an acute rejection episode, participants received one standard dose of MenACWY-D. To measure immunogenicity, blood was drawn at 5 time points: just before vaccination (baseline), and then at 4 weeks, 12 months and annually for two more years. Antibody titers were measured by serum bactericidal assay in standard fashion that allowed comparisons with other studies. As measured by titers to meningococcal serogroups in MenACWY-D, youth with kidney transplants received significantly less seroprotection than 440 otherwise healthy adolescents in a different study of the vaccine, at 4 weeks later and 3 years later. Based on this study, and recommendations by the CDC in 2016 for a booster dose of MenACWY-D for healthy adolescents, it may be beneficial to administer a booster dose of the vaccine to adolescent kidney transplant recipients, but further study is warranted. Meningococcal disease should be considered when youth with kidney transplants develop fever, rash and other potential systemic signs of meningococcal disease, even after vaccination.