Canadian Immunization Guide 2006
Canadian Immunization Guide
Seventh Edition - 2006
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Part 1
General Guidelines
Recent Administration of Human
Immune Globulin Products
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.
Table 4. Guidelines for the Interval Between Administration of Immune Globulin Preparation or Blood Products and MMR or Varicella Vaccines*
Product |
Dose |
Interval (months) |
General products† |
Immune globulin (Ig) |
0.02-0.06 mL/kg |
3 |
0.25 mL/kg |
5 |
0.50 mL/kg |
6 |
Intravenous immune globulin (IVIg) |
160 mg/kg |
7 |
320 mg/kg |
8 |
640 mg/kg |
9 |
> 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 |
Agent-specific products |
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
varicella vaccine.
† 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. |
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