What Nephrologists Should Know About Infection Prevention Measures Before and During Eculizumab Administration in Children?

Eculizumab is a recombinant humanized monoclonal antibody that acts as a terminal complement inhibitor. It works by binding to complement protein 5 and inhibiting its cleavage, thereby preventing the production of the complement terminal complex known as C5b-9. Eculizumab has been prescribed by physicians in Iran in both the adult and pediatric fields for the treatment of various diseases. Patients who receive this product are at an increased risk of life-threatening infections, with meningococcal disease being one of the most prevalent threats. Therefore, children receiving eculizumab, should receive meningococcal vaccine. Furthermore, the most effective method to prevent infection in these patients is a combination of vaccination and prophylactic antibiotic usage. Antibiotic prophylaxis should be initiated immediately after the initiation of eculizumab and continued for four weeks after discontinuation of the drug.  This review aims to address physicians' questions particularly pediatric nephrologists regarding any necessary changes in routine vaccinations for children receiving eculizumab. Additionally, the article discusses infections that may occur more frequently in this population and emphasizes the importance of vaccination and preventive measures. The review also aims to introduce the most up- to- date recommendations for infection prevention before and during eculizumab treatment.