{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T16:41:38Z","timestamp":1790959298809,"version":"4.1.0"},"reference-count":33,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T00:00:00Z","timestamp":1786838400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T00:00:00Z","timestamp":1786838400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Complement inhibitor therapy carries a risk of serious infections, including meningococcal disease. Here we provide evidence\u2010based recommendations and expert consensus for immunisation and prophylactic treatment of patients receiving, or planning to receive, complement inhibitors for neurological conditions in the Australian setting. The primary aim of these consensus recommendations is to minimise the risk of vaccine\u2010preventable infections and to outline alternative infection\u2010prevention strategies where vaccination is problematic. We address disease\u2010specific risks and propose timing considerations, including a pragmatic approach to clinical implementation.<\/jats:p>","DOI":"10.1111\/imj.70610","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T04:06:43Z","timestamp":1786939603000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Australian consensus recommendations for the management of increased meningococcal infection risk in adults with neurological diseases treated with complement inhibitors"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4039-9303","authenticated-orcid":false,"given":"Katherine A.","family":"Buzzard","sequence":"first","affiliation":[{"name":"Eastern Health Clinical School Monash University  Melbourne Victoria Australia"},{"name":"Department of Neurosciences Royal Melbourne Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2156-8864","authenticated-orcid":false,"given":"Michael","family":"Barnett","sequence":"additional","affiliation":[{"name":"Brain and Mind Centre University of Sydney  Sydney New South Wales Australia"},{"name":"Department of Neurology Royal Prince Alfred Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3734-4133","authenticated-orcid":false,"given":"Heidi","family":"Beadnall","sequence":"additional","affiliation":[{"name":"Brain and Mind Centre University of Sydney  Sydney New South Wales Australia"},{"name":"Department of Neurology Royal Prince Alfred Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3268-4457","authenticated-orcid":false,"given":"Mirasol","family":"Forcadela","sequence":"additional","affiliation":[{"name":"Department of Neurology Austin Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2266-7465","authenticated-orcid":false,"given":"Lesley\u2010Ann","family":"Hall","sequence":"additional","affiliation":[{"name":"Flinders Medical Centre Southern Adelaide Local Health Network  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9353-0059","authenticated-orcid":false,"given":"Victoria G.","family":"Hall","sequence":"additional","affiliation":[{"name":"Sir Peter MacCallum Department of Oncology University of Melbourne  Melbourne Victoria Australia"},{"name":"Department of Infectious Diseases Peter MacCallum Cancer Centre  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd","family":"Hardy","sequence":"additional","affiliation":[{"name":"Brain and Mind Centre University of Sydney  Sydney New South Wales Australia"},{"name":"Department of Neurology Concord Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9577-5401","authenticated-orcid":false,"given":"Danny","family":"Hsu","sequence":"additional","affiliation":[{"name":"Haematology Department Liverpool Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6167-9366","authenticated-orcid":false,"given":"Paul","family":"Kinsella","sequence":"additional","affiliation":[{"name":"Department of Microbiology Royal Melbourne Hospital  Melbourne Victoria Australia"},{"name":"Department of Microbiology and Immunology University of Melbourne at the Peter Doherty Institute for Infection and Immunity  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6404-9768","authenticated-orcid":false,"given":"Mastura","family":"Monif","sequence":"additional","affiliation":[{"name":"Department of Neuroscience School of Translational Medicine, Monash University  Melbourne Victoria Australia"},{"name":"Department of Neurology The Alfred Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudarshini","family":"Ramanathan","sequence":"additional","affiliation":[{"name":"Department of Neurology Concord Hospital  Sydney New South Wales Australia"},{"name":"Translational Neuroimmunology Group, ANZAC Research Institute and Kids Neuroscience Centre, Sydney Medical School, Faculty of Medicine and Health University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0169-3350","authenticated-orcid":false,"given":"Stephen W.","family":"Reddel","sequence":"additional","affiliation":[{"name":"Department of Neurology Concord Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"Riminton","sequence":"additional","affiliation":[{"name":"Department of Immunology Concord Repatriation General Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas F.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of General Medicine Royal Melbourne Hospital  Melbourne Victoria Australia"},{"name":"Department of Infectious Diseases Royal Melbourne Hospital  Melbourne Victoria Australia"},{"name":"Department of Medicine Royal Melbourne Hospital, University of Melbourne  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,16]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"734","DOI":"10.15585\/mmwr.mm6627e1","article-title":"High risk for invasive meningococcal disease among patients receiving eculizumab (Soliris) despite receipt of meningococcal vaccine","volume":"66","author":"McNamara LA","year":"2017","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"e_1_2_10_3_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.ekir.2025.11.025","article-title":"Antimeningococcal protection in patients receiving terminal complement inhibitors","volume":"11","author":"Vujovi\u0107 A","year":"2026","journal-title":"Kidney Int Rep"},{"key":"e_1_2_10_4_1","volume-title":"Meningococcal Disease","author":"Department of Health","year":"2025"},{"key":"e_1_2_10_5_1","unstructured":"Therapeutic Goods Administration Australian Government.Australian Public Assessment Report for ULTOMIRIS.2024(cited 2026 May 17). Available from URL:https:\/\/www.tga.gov.au\/sites\/default\/files\/2024-07\/auspar-ultomiris-240708.pdf"},{"key":"e_1_2_10_6_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1004326","article-title":"ACCORD (ACcurate COnsensus Reporting Document): a reporting guideline for consensus methods in biomedicine developed via a modified Delphi","volume":"21","author":"Gattrell WT","year":"2024","journal-title":"PLoS Med"},{"key":"e_1_2_10_7_1","doi-asserted-by":"crossref","first-page":"S21","DOI":"10.1016\/j.cmi.2018.02.002","article-title":"ESCMID Study Group for Infections in Compromised Hosts (ESGICH) consensus document on the safety of targeted and biological therapies: an infectious diseases perspective (soluble immune effector molecules (II): agents targeting interleukins, immunoglobulins and complement factors)","volume":"24","author":"Winthrop KL","year":"2018","journal-title":"Clin Microbiol Infect"},{"key":"e_1_2_10_8_1","unstructured":"Australian Government.National immunisation program schedule.2026(cited 2026 Mar 29). Available from URL:https:\/\/www.health.gov.au\/sites\/default\/files\/2026-01\/national-immunisation-program-schedule.pdf"},{"key":"e_1_2_10_9_1","doi-asserted-by":"crossref","first-page":"7541","DOI":"10.1016\/j.vaccine.2021.11.035","article-title":"Serogroup A, C, W, and Y meningococcal disease in persons previously vaccinated with a serogroup ACWY meningococcal vaccine \u2013 United States, 2014\u20132018","volume":"39","author":"Blain AE","year":"2021","journal-title":"Vaccine"},{"key":"e_1_2_10_10_1","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1136\/pn-2025-004651","article-title":"Ravulizumab\u2010related meningococcal sepsis post rituximab","volume":"25","author":"Kline K","year":"2025","journal-title":"Pract Neurol"},{"key":"e_1_2_10_11_1","doi-asserted-by":"crossref","first-page":"1946","DOI":"10.1182\/blood-2013-04-494096","article-title":"The effect of rituximab on vaccine responses in patients with immune thrombocytopenia","volume":"122","author":"Nazi I","year":"2013","journal-title":"Blood"},{"key":"e_1_2_10_12_1","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1136\/annrheumdis-2021-220435","article-title":"B cell depletion impairs vaccination\u2010induced CD8+ T cell responses in a type I interferon\u2010dependent manner","volume":"80","author":"Graalmann T","year":"2021","journal-title":"Ann Rheum Dis"},{"key":"e_1_2_10_13_1","doi-asserted-by":"crossref","first-page":"2624","DOI":"10.1182\/bloodadvances.2021004629","article-title":"Vaccine response following anti\u2010CD20 therapy: a systematic review and meta\u2010analysis of 905 patients","volume":"5","author":"Vijenthira A","year":"2021","journal-title":"Blood Adv"},{"key":"e_1_2_10_14_1","doi-asserted-by":"crossref","first-page":"644","DOI":"10.3899\/jrheum.211152","article-title":"Time since rituximab treatment is essential for developing a humoral response to COVID\u201019 mRNA vaccines in patients with rheumatic diseases","volume":"49","author":"Troldborg A","year":"2022","journal-title":"J Rheumatol"},{"key":"e_1_2_10_15_1","doi-asserted-by":"crossref","first-page":"1446","DOI":"10.3390\/vaccines11091446","article-title":"Vaccination in the era of immunosuppression","volume":"11","author":"Alnaimat F","year":"2023","journal-title":"Vaccine"},{"key":"e_1_2_10_16_1","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1002\/acr.25045","article-title":"2022 American College of Rheumatology guideline for vaccinations in patients with rheumatic and musculoskeletal diseases","volume":"75","author":"Bass AR","year":"2023","journal-title":"Arthritis Care Res"},{"key":"e_1_2_10_17_1","doi-asserted-by":"crossref","DOI":"10.3390\/vaccines11071165","article-title":"Mycophenolate interruption restores anti\u2010SARS\u2010CoV\u20102 vaccine immunogenicity in unresponsive liver transplant recipients","volume":"11","author":"Toniutto P","year":"2023","journal-title":"Vaccine"},{"key":"e_1_2_10_18_1","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2021.690328","article-title":"B\u2010cell immunophenotyping to predict vaccination outcome in the immunocompromised \u2013 a systematic review","volume":"12","author":"Diks AM","year":"2021","journal-title":"Front Immunol"},{"key":"e_1_2_10_19_1","unstructured":"MavilleC.Guidelines for the prevention of meningococcal disease in adult patients receiving eculizumab or ravulizumab or pre\u2010approved to receive eculizumab at point of renal transplantation.2022(cited 2026 May 27). Available from URL:https:\/\/www.atypicalhus.co.uk\/wp-content\/uploads\/2022\/12\/Guidelines-for-the-prevention-of-meningococcal-disease-in-adult-patients-receiving-eculizumab-or-ravulizumab-FINAL-WEBSITE.pdf"},{"key":"e_1_2_10_20_1","unstructured":"Australian Government.Table. Recommendations for MenB vaccine for people with a specified medical condition that increases their risk of invasive meningococcal disease. The Australian Immunisation Handbook.2024. (cited 2026 May 03) Available from URL:https:\/\/immunisationhandbook.health.gov.au\/resources\/tables\/table-recommendations-for-menb-vaccine-for-people-with-a-specified-medical-condition-that-increases-their-risk-of-invasive-meningococcal-disease"},{"key":"e_1_2_10_21_1","unstructured":"Australian Government.Table. Recommendations for MenACWY vaccine for people with a specified medical condition that increases their risk of invasive meningococcal disease. The Australian Immunisation Handbook.2022. (cited 2026 May 03) Available from URL:https:\/\/immunisationhandbook.health.gov.au\/resources\/tables\/table-recommendations-for-menacwy-vaccine-for-people-with-a-specified-medical-condition-that-increases-their-risk-of-invasive-meningococcal-disease"},{"key":"e_1_2_10_22_1","unstructured":"Centre for Disease Control.Clinical Guidance for Managing Menigococcal Disease Risk in Patients Receiving Complement Inhibitor Therapy. (Internet).2024(cited 2026 Mar 29). Available from:https:\/\/www.cdc.gov\/meningococcal\/hcp\/clinical-guidance\/complement-inhibitor.html"},{"key":"e_1_2_10_23_1","unstructured":"Australian Government.Pneumococcal disease. Australian Immunisation Handbook.2026(cited 2026 May 3). 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