Content
Available Vaccines
Passive Immunisation
In this chapter:
Introduction
Passive immunisation refers to the administration of antibodies (immunoglobulins, IgG) pooled from blood donors in order to provide temporary protection in: (i) an unimmunised person exposed to an infection, and (ii) a person who has been infected from a disease for which active immunisation is not available.
The protective effect of the administered immunoglobulin is immediate but the protection may be incomplete and is short lived (lasting for several weeks up to 3-4 months).
There are 2 types of immunoglobulin that will be discussed in this guideline:
A. Normal (nonspecific) human immunoglobulin – from unselected donors.
B. Hyperimmune (specific) immunoglobulin – from selected donors.
Side effects for both immunoglobulins include malaise, chills, fever, headache, nausea, facial flushing and anaphylaxis (rare).
Normal Human Immunoglobulin (NHIg)
This is derived from the pooled plasma of blood donors. It contains antibodies against microbial agents that are prevalent in the general population. It provides antibodies against hepatitis A, rubella, measles and other viruses prevalent in the general population. It is most effective if it is administered within 72 hours or 3 days after exposure and provides immediate protection and will last several weeks. NHIg blocks the response of live vaccine (except for yellow fever) for 3 months. Therefore, live vaccines should ideally be given at least 3 weeks before or 3 months after administration of NHIg. NHIg is administered by intramuscular injection.
Today, passive immunisation with IG still plays an important part in the prevention of measles and hepatitis A among non-immune contacts in countries with low incidences of these diseases. In some cases, passive immunisation is also recommended for non-immune pregnant contacts of rubella.
There are current differences in practice with respect to passive immunisation for measles, hepatitis A and rubella contacts between the high-income countries. In Australia, immunoglobulin has not been demonstrated to be of value post-exposure. In UK and New Zealand, the use of passive immunisation in pregnant women exposed to rubella may be considered if termination of the pregnancy is not an option.
Indication for NHIg
Hepatitis A
it is given for the prevention of infection in close contacts of confirmed cases of hepatitis A, where there has been a delay of more than 7 days in identifying contacts, or for close contacts at high risk of severe disease. It is also recommended to immunocompromised patients whose antibody response to vaccine is unlikely to be adequate. It is preferably given within the first 72 hours of exposure.
Measles
NHIg may be given to prevent or attenuate a measles attack in individuals who do not have adequate immunity (immunocompromised adults and children) who were in close contact with patients infected with measles. It is most effective if given within 72 hours of exposure but can still be given up to 6 days of post exposure.
NHIg should also be considered in the following patients if they have been in contact with a confirmed case of measles or with a person associated with a local outbreak: (i) non-immune pregnant women, and (ii) Infants under 9 months old.
Individuals with normal immunity who are not in the above categories and who have not been fully immunised against measles, can be given measles vaccination.
Rubella
NHIg given after exposure to rubella does not prevent infection in non-immune contact and it is not recommended for protection of pregnant women exposed to rubella. It may, however, reduce the likelihood of clinical attack in pregnant woman which may possibly reduce the risk to the foetus. It should be used ONLY in pregnant women when termination is unacceptable. Serological follow up of recipients is important to determine if the woman has become infected despite receiving NHIg.
- For healthy persons aged 12 months–40 years, single-antigen Hepatitis A vaccine at the age-appropriate dose is preferred to IG because of the vaccine’s advantages, including long-term protection and ease of administration, as well as the equivalent efficacy of vaccine to IG.
- For persons aged 41 years and older, IG is preferred because of the absence of information regarding vaccine performance in this age group and because of the more severe manifestations of Hepatitis A in older adults. The magnitude of the risk of HAV transmission from the exposure should be considered in decisions to use vaccine or IG in this age group.
- Vaccine can be used if IG cannot be obtained.
- IG should be used for children aged less than 12 months, immunocompromised persons, persons with chronic liver disease, and persons who are allergic to the vaccine or a vaccine component.
Summary Table 19.1 Normal Human Immunoglobulin (NHIg)
Summary Table 19.2 Specific Immunoglobulins
Note: Ig – Immune globulin, HBV – Hepatitis B virus
Table 19.3 Notes on Passive Immunisation for Immunocompromised Hosts (ICH)
References
- Baxter, D. (2007). Active and passive immunity, vaccine types, excipients and licensing. Occupational Medicine, 57(8), 552-556.
- Buckley, R. H., & Schiff, R. I. (1991). The use of intravenous immune globulin in immunodeficiency diseases. New England Journal of Medicine, 325(2), 110-117.
- Organization, W. H. (2018). Rabies vaccines: WHO position paper, April 2018–Recommendations. Vaccine, 36(37), 5500-5503.
- Perez, E. E., Orange, J. S., Bonilla, F., Chinen, J., Chinn, I. K., Dorsey, M., El-Gamal, Y., Harville, T. O., Hossny, E., & Mazer, B. (2017). Update on the use of immunoglobulin in human disease: a review of evidence. Journal of Allergy and Clinical Immunology, 139(3), S1-S46.
- Practices, A. C. o. I. (2007). Update: Prevention of hepatitis A after exposure to hepatitis A virus and in international travelers. Updated recommendations of the Advisory Committee.
- Young, M. K., & Cripps, A. W. (2013). Passive immunization for the public health control of communicable diseases: current status in four high-income countries and where to next. Human vaccines & immunotherapeutics, 9(9), 1885-1893.