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Write-up: Initial unsolicited report received from a literature on 03 Jan 2018. The following is the abstract from the article: We report on the case of fatal "purpura fulminans" caused by Neisseria meningitidis W135 that occurred in a young soldier vaccinated a few months earlier with the tetravalent conjugate vaccine ACYW135. Biological investigations revealed adequate titers of postvaccination antibodies against serogroups A, C, and W135 and led to the post-mortem diagnosis of a complete C7 complement deficiency. Late complement component deficiency is a well-known risk factor of meningococcal diseases, but usually exposes to recurrent mild infections, whereas severe invasive meningococcal diseases are more likely to occur among properdin-deficient patients. Awareness of the potentially life-threatening nature of late complement component deficiency should lead to improved diagnosis among young people, especially when past medical history reveals recurrent mild infections. This case involves 20 years old male patient who was injected with dose of MENINGOCOCCAL VACCINE (TETRAVALENT ACYW135 CONJUGATE MENINGITIS VACCINE) (batch number, expiry date, route and site of administration were not reported) on an unspecified date according to the immunization schedule. His past medical history was significant for several infectious diseases (nondocumented meningitis during childhood, measles and acute otitis media) and a recent case of cellulitis on the face. He had never been sent on any mission outside his country since his integration. Concomitant medication was not reported. On an unspecified date, post vaccination patient had, purpura fulminans caused by Neisseria meningitidis W135. In October 2012, the health authorities notified the Center for Epidemiology and Public Health that a young person had died from purpura fulminans a few hours earlier in a hospital. It was also a case of vaccination failure. Human serum bactericidal activity tests were performed by the Institute laboratory. The patient had an undetectable CH50 level: C3, C4, C5, C6, and C8 levels were normal, but C7 was undetectable. Further biological investigations confirmed the diagnosis of a complete homozygous deficiency in C7 complement, which led to screening among his family (results not available). No sample before the vaccination was available, but post-mortem immunological analysis suggested that the vaccine injection had been followed by an immune response and an increase of antibody titers, except against serogroup Y (human serum bactericidal activity titer at 2). Corrective treatment was not reported. Outcome of event was not reported. Upon internal review the case was considered as serious because of important medical event: Neisseria meningitidis infection NOS. List of documents held by sender: none.; Sender''s Comments: Vaccination failure may be expected with any vaccine, as no vaccine protects all vaccinated individuals. This report of fatal purpura fulminans caused by meningococcemia represents a confirmed vaccine failure to serogroup W135. The patient was an employee (congregate housing such as dorms, etc. is known to increase the risk of contracting Neisseria meningitidis) who had a significant history for several infectious diseases including but not limited to nondocumented meningitis during childhood. Importantly, additional testing revealed complement deficiency (complete homozygous deficiency in C7 complement). Persons who have persistent (i.e., genetic) deficiencies in the common complement pathway have an increased risk for meningococcal disease and can experience recurrent disease. A point of further consideration is that the name of the manufacturer of the specific Meningococcal ACYW135 vaccine was unknown.; Reported Cause(s) of Death: purpura fulminans caused by Neisseria meningitidis W135; Autopsy-determined Cause(s) of Death: purpura fulminans caused by Neisseria meningitidis W135.
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