Passive immunization with products of human origin can interfere with the immune response to live viral vaccines. For measles vaccine and varicella vaccine, the recommended interval between immune globulin (Ig) or other blood products and subsequent immunization varies from 3 to 11 months, depending on the specific product and dose given, as shown in Table 4.
For an optimum response to rubella or mumps vaccine given as individual components, there should be an interval of at least 3 months between administration of Ig or blood products and immunization. If given as combined measles, mumps and rubella (MMR) vaccine, as is the usual circumstance in Canada, longer intervals, as recommended in Table 4, should be followed to ensure that there is an adequate response to the measles component.
For women susceptible to rubella who are given Rh Ig in the peripartum period, MMR should be administered as soon as possible following delivery to increase the likelihood that these susceptible women get vaccinated. Serologic testing should be done 2 months later and non-immune women should be re-vaccinated. After receipt of an Rh Ig product, an interval of 2 months should elapse before varicella vaccine is administered to varicella-susceptible women .
If administration of an Ig preparation becomes necessary after varicella or MMR or any of the individual MMR component vaccines have been given, interference can also occur. If the interval between administration of any of these vaccines and subsequent administration of an Ig preparation is < 14 days, immunization should be repeated at the interval indicated in Table 4, unless a serologic test conducted after this recommended interval (given in the Table) indicates immunity. If the Ig product is given > 14 days after the vaccine, immunization does not have to be repeated.
Studies have found no evidence that Ig administration interferes with the response to inactivated vaccines, toxoids or the live vaccines for yellow fever or polio. Orally administered polio vaccine is no longer used in Canada. Yellow fever vaccine is not affected by either the simultaneous or previous use of Ig preparations. The background antibody level for typhoid is low in Canada, and therefore an Ig preparation produced in Canada is unlikely to interfere with typhoid immunization. Because there is little interaction between Ig preparations and inactivated vaccines or the live vaccines specified above, these vaccines can be given before, concurrently or after an Ig preparation has been used. The vaccine and Ig preparation should be given at different sites. Dukoral™ (oral, inactivated travellers' diarrhea and cholera vaccine) is the only vaccine currently marketed in Canada for protection against cholera and, as noted previously for other inactivated vaccines, no interference should be expected when Ig is administered.
A humanized, monoclonal anti-respiratory syncytial virus (RSV) antibody (palivizumab) is available for prevention of respiratory syncytial virus infection in high-risk infants and young children. This product contains only antibody to RSV and therefore will not interfere with the immune response to vaccines; it can be administered at the same time at a separate site.
|Immune globulin (Ig)||0.02-0.06 mL/kg||3|
|Intravenous immune globulin (IVIg)||160 mg/kg||7|
|> 640-1280 mg/kg||10|
|> 1280-2000 mg/kg||11|
|Plasma and platelet products||10 mg/kg||7|
|Reconstituted RBCs||10 mg/kg||3|
|Washed RBCs||10 mg/kg||0|
|Hepatitis B immune globulin (HBIg)||0.06 mL/kg||3|
|Rabies immune globulin (RabIg)||20 IU/kg||4|
|RSV Ig (palivizumab)||15 mg/kg/month||0|
|Rh immune globulin (RhIg)||300 μ g||2**|
|Tetanus immune globulin(TIg)||250 units||3|
|Varicella immune globulin (VarIg)||12.5 units/kg||5|
|* This table was originally developed
for guidance related to the use of measles vaccines. It has been
generalized to include recommendations related to the use of
† RBC = red blood cells
** Based on expert opinion: for women susceptible to rubella who are given Rh Ig in the peripartum period, MMR should be administered as soon as possible following delivery and serologic testing done 2 months later to assess the immune response.