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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

- 16.5% protein; 95% IgG

- IM use only; Cohn Fraction two

· Intravenous Immune Globulin (IVIG)

- Produced from pooled human plasma

- 3-12% protein; >95% IgG

- IV use; further processing after fractionation

· Specific Immune Globulin

- Produced from specific donors

- Screened plasma or immunized donors

- Immunized animals (Equine)

- Both IG and IVIG

- 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:

Varicella:

a) in same 2- to 4-bed room, or adjacent beds in large ward,

b) Face-to-face- contact with an infectious staff member or patient, or

c) Visit by a person deemed contagious.

Zoster: Intimate contact (eg, touching or hugging) with a person deemed contagious.

· 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.