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Passive Immunoprophylaxis for Tetanus, Varicella, HAV, HBV and Uses of IVIG

Immunoglobulin Preparations

Immune Globulin (IG)

- Produced from pooled human plasma

- IM use only; Cohn Fraction two

Intravenous Immune Globulin (IVIG)

- Produced from pooled human plasma

Specific Immune Globulin

- Produced from specific donors

- Monoclonal antibodies

Use Tetanus Prophylaxis -- Tetanus Immune Globulin (TIG)

Type:

with increased anti-tetanus antibody titers.

Indications for TIG Trauma/Wound Prophylaxis:

< 3 doses of tetanus vaccine

Serious or dirty wound (puncture wounds, devitalized tissue; soil, saliva, feces contamination)

AIDS patients with tetanus-prone wounds (regardless of vaccine status)

Unknown tetanus vaccine status

Dose:

Single dose of 3,000 u to 6,000 u

IM injection

Infiltrate part of dose around the wound

TIG is not indicated for minor, clean wounds; all wounds should be properly cleaned and derided and foreign material removed. Booster toxoid vaccine may be indicated if < 3 previous tetanus toxoid doses or >10 years since last tetanus toxoid (clean, minor wound) or >5 years since last toxoid dose for more serious contaminated wounds.

Varicella-zoster Immune Globulin (VZIG)

Type:

Human Immune Globulin with increased levels of anti-VZV antibody.

Decision to use VZIG

Likelihood the individual will develop complications if infected with Varicella.

Probability an exposure will result in a Varicella infection.

Likelihood the exposed person is susceptible.

Indications after Varicella-Zoster exposure:

Immunocompromised children without history of chickenpox. Immunocompromised adolescents and adults are likely to be immune, but if susceptible, they should also receive VZIG.

Susceptible, pregnant women.

Newborn infants whose mothers have the onset of chickenpox within 5 days before delivery or within 48 hours after delivery.

Hospitalized premature infants (> 28 wk gestation) whose mothers have no history of chickenpox.

Hospitalized premature infants (<28 wk gestation or <1,000 g), regardless of maternal history.

Types of Exposure to Varicella or Zoster for Which VZIG is Indicated

Household: Residing in the same household

Playmate: Face-to-face- indoor play

Hospital:

Newborn infant: Onset of Varicella in the mother 5 days or less before delivery or within 48 h after delivery. VZIG is not indicated if the mother has Zoster.