Journal Article (Review Article)

DZNE-2026-00532

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Meningococcal prophylaxis in neurological diseases treated with complement inhibitors: an expert consensus for Germany, Austria, and Switzerland.

Berthele, A. ; Aktas, O. ; Ayzenberg, I. ; Claus, H. ; Lâm, T.-T. ; Löscher, W. N. ; Pröbstel, A.-K.DZNE* ; Prüss, H.DZNE* ; Rademacher, N.Extern* ; Ringelstein, M. ; Rommer, P. ; Schara-Schmidt, U. ; Schoser, B. ; Weber, J. R. ; Zschüntzsch, J. ; Meisel, A. ; Lünemann, J. D.

2026
Sage London [u.a.]

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Please use a persistent id in citations: doi:10.1177/17562864261442558

Abstract: Inhibition of terminal complement activation is an effective therapeutic strategy for acetylcholine receptor antibody-positive generalized myasthenia gravis (gMG) and aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (NMOSD), but it increases the risk of invasive meningococcal infections. Consequently, vaccination against meningococcal serogroups A, C, W, Y, and B is mandatory for all patients receiving complement inhibitors. This article provides expert consensus recommendations for managing meningococcal vaccination in patients with NMOSD and gMG receiving complement-inhibiting therapies in Germany, Austria, and Switzerland. The timing and procedures of vaccination should be adapted to the underlying diagnosis and the individual risk of disease exacerbation in this population. In NMOSD, treatment often must begin promptly, particularly after an acute attack; in such cases, vaccination should be administered at treatment initiation together with antibiotic prophylaxis. By contrast, treatment urgency in gMG is typically lower, allowing vaccination to be completed in advance and thereby avoiding antibiotic exposure, which may worsen gMG symptoms. For both diseases, ceftriaxone is recommended as first-line therapy for suspected infection, rifampicin for prophylaxis, and either rifampicin or intramuscular ceftriaxone for post-exposure chemoprophylaxis. Patients should also carry a standby dose of ciprofloxacin for emergency self-administration at the first signs of meningitis, followed by immediate clinical evaluation. These recommendations should be reviewed regularly and updated as necessary to reflect emerging evidence and new vaccine options.

Keyword(s): NMOSD ; antibiotic prophylaxis ; antibiotic therapy ; complement defect ; complement inhibitors ; eculizumab ; gMG ; generalized myasthenia gravis ; meningococcal infection ; neuromyelitis optica spectrum disorder ; ravulizumab ; standby medication ; vaccination ; vaccination recommendation ; vaccines ; zilucoplan

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Contributing Institute(s):

1. Clinical Neurology and Neuroimmunology (AG Pröbstel)
2. Autoimmune Encephalopathies (AG Prüß)

Research Program(s):

1. 353 - Clinical and Health Care Research (POF4-353) (POF4-353)

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Database coverage:
; ; Article Processing Charges ; Clarivate Analytics Master Journal List ; DOAJ Seal ; Essential Science Indicators ; Fees ; IF >= 5 ; JCR ; National-Konsortium ; SCOPUS ; Science Citation Index Expanded ; Web of Science Core Collection

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