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Dear Editor, We thank Avasarala et al. for their editorial on meningococcal infection prevention in patients with neuromyelitis optica spectrum disorder (NMOSD) receiving eculizumab. While we appreciate the authors’ concerns and agree that its manufacturers (Alexion) have a responsibility to promote optimal patient safety, it is critical that clinicians treating patients with eculizumab adhere to the latest vaccination recommendations, consider individual risk profiles, and monitor patients for early signs of meningococcal disease. The authors suggest that Alexion should determine which meningococcal vaccine should be used for patients receiving eculizumab; however, it would be inappropriate for Alexion to promote another manufacturer’s product. The Advisory Committee on Immunization Practices (ACIP; part of the Centers for Disease Control and Prevention [CDC]) does not make recommendations on which vaccine is preferred in this setting, and therefore it is the prescribing clinician’s decision as to which vaccine they decide is best and available for the individual needs of their patient. The authors mention that clinicians are referred to external vaccination recommendations in the prescribing information rather than to the Risk Evaluation and Mitigation Strategy Prescriber Safety Brochure or a schedule provided in the package insert. While this may be burdensome for clinicians, no manufacturer can produce unilateral recommendations in the package insert; thus, it is appropriate to consult the ACIP’s recommendations. Also, if clinicians were directed to the particular vaccination recommendations used during the phase 3 Prevention of Recurrent Episodes of Depression with Venlafaxine for Two Years (PREVENT) study, which the Food and Drug Administration used to approve eculizumab, they would be directed to a potentially outdated source, because ACIP recommendations have since been updated. Multiple vaccination recommendations can be confusing, and references may become redundant with new findings. Use of the ACIP’s recommendations ensures that best practice is up to date. Clinicians should be referred to the most recent vaccination schedules, given the potential for new vaccine development. The ACIP has recently updated their recommendations on meningococcal serogroup B booster schedules. The authors state that there was no clear meningococcal vaccination protocol used for PREVENT. This is incorrect. Patients in the United States included in PREVENT were vaccinated according to the ACIP recommendations available at the time, receiving meningococcal vaccination ≥2weeks before their first dose of eculizumab or treatment with appropriate antibiotics until 2weeks after vaccination. Moreover, rituximab was discontinued 3months before PREVENT, owing to its impact on vaccine efficacy and incompatibility with eculizumab. Patients enrolled in PREVENT could use other concomitant immunotherapies throughout the study, which may have impacted meningococcal vaccine efficacy. For clarity, Alexion provides clinicians with these vaccination recommendations for patients aged ≥19 years with NMOSD receiving eculizumab. The authors provided a figure summarizing the serogroups most commonly responsible for meningococcal infection in the United States. While interesting, serogroup distribution trends for the general United States population may not apply to patients in other countries, or to patients with complement disorders who are receiving immunomodulatory drugs. The authors cite publisheddata for 16 eculizumab-treated patientswith invasivemeningococcal disease, of whom 11 were infected with nonencapsulated strains. As current meningococcal vaccines are directed against serogroups ACWY and B, which are encapsulated strains, it is CNS Spectrums