Meningococcal prophylaxis in neurological diseases treated with complement inhibitors: an expert consensus for Germany, Austria, and Switzerland - PubMed
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- #meningococcal prophylaxis
- #complement inhibitors
- #neurological diseases
- Inhibition of terminal complement activation effectively treats acetylcholine receptor antibody-positive generalized myasthenia gravis (gMG) and aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (NMOSD).
- Complement inhibitors increase the risk of invasive meningococcal infections, making vaccination against meningococcal serogroups A, C, W, Y, and B mandatory for all patients receiving these therapies.
- Expert consensus from Germany, Austria, and Switzerland provides tailored recommendations for meningococcal vaccination timing and procedures based on the underlying disease and individual risk of exacerbation.
- For NMOSD, treatment often requires prompt initiation after an acute attack; vaccination should be administered at treatment start alongside antibiotic prophylaxis.
- In gMG, treatment urgency is typically lower, allowing vaccination to be completed before therapy begins to avoid antibiotic exposure, which may worsen symptoms.
- Recommended first-line therapy for suspected infection is ceftriaxone, rifampicin for prophylaxis, and either rifampicin or intramuscular ceftriaxone for post-exposure chemoprophylaxis.
- Patients should carry a standby dose of ciprofloxacin for emergency self-administration at early signs of meningitis, followed by immediate clinical evaluation.
- Recommendations should be regularly reviewed and updated to reflect emerging evidence and new vaccine options.