Pharmacology
Immunoglobulins and Vaccines
Disease specific immunoglobulin is available for all of the following infectious diseases EXCEPT for:
Answer:
Disease specific immunoglobulins are available for:- hepatitis B
- rabies
- tetanus
- varicella-zoster
Passive Immunity
Pharmacology / Immunoglobulins and Vaccines
Last Updated: 1st June 2023
Passive immunity to a disease can be obtained by injected immunoglobulin preparations made from the plasma of immune individuals with adequate levels of antibody to that disease. This confers immediate protection but the duration of immunity varies according to the dose and the type of immunoglobulin; where necessary passive immunity can be repeated.
Two types of human immunoglobulin preparation are available, normal immunoglobulin and disease-specific immunoglobulins:
Normal immunoglobulin for intramuscular administration is available from some regional Public Health laboratories for protection of contacts and the control of outbreaks of:
- hepatitis A
- measles
- rubella (to a lesser extent)
Disease specific immunoglobulins are available for:
- hepatitis B
- rabies
- tetanus
- varicella-zoster
Normal Immunoglobulin
Indications for hepatitis A:
- Prevention of infection in close contacts of confirmed cases of hepatitis A who have/are:
- chronic liver disease
- HIV infection
- immunosuppressed
- over 50 years of age
- Prophylaxis of infection in immunosuppressed people travelling to high risk areas (where antibody response to vaccine may be inadequate)
Indications for measles:
- Prevention or attenuation of an attack of measles in individuals who do not have adequate immunity, in infants under 9 months and in non-immune pregnant women who have been in contact with a confirmed case of measles or who are associated with a local outbreak
Contraindications: people with selective IgA deficiency who have known antibody against IgA
Cautions: agammaglobulinaemia, hypogammaglobulinaemia, when given intravenously in patients at risk of thromboembolic events; it should not be given at the same time as live virus vaccines as it may interfere with the immune response.
Side effects: arthralgia; chills; diarrhoea; dizziness; fever; headache; low back pain; muscle spasms; myalgia; nausea; acute renal failure; anaphylaxis; aseptic meningitis; cutaneous skin reactions; hypotension
Hepatitis B Immunoglobulin (HBIG)
Hepatitis B immunoglobulin (HBIG) may be indicated for the prevention of infection in laboratory and other personnel who have been accidentally inoculated with hepatitis B virus, and in infants born to mothers who have become infected with this virus in pregnancy or who are high-risk carriers. It may be given at the same time, but not the same site as the hepatitis B vaccine.
Tetanus Immunoglobulin
Tetanus immunoglobulin should be used in addition to wound cleansing for tetanus prone wounds and, where appropriate, antibacterial prophylaxis and a tetanus-containing vaccine. Tetanus immunoglobulin, together with metronidazole and wound cleansing, should also be used for the treatment of established cases of tetanus.
Varicella-Zoster Immunoglobulin (VZIG)/Varicella-zoster post-exposure prophylaxis
UKHSA recommends post-exposure prophylaxis to attenuate disease and reduce the risk of complications (such as pneumonitis) in individuals at increased risk of severe chickenpox, such as neonates (especially in the first 7 days of life), children aged under one year, pregnant females, and immunosuppressed individuals, who have had a significant exposure to varicella-zoster virus during the infectious period and who are susceptible to the virus.
Post-exposure prophylaxis is recommended for individuals who have:
- had a significant exposure to varicella (chickenpox) or herpes zoster (shingles)—this depends on the type of varicella-zoster infection in the index case, the timing of the exposure in relation to onset of rash in the index case, and/or closeness and duration of contact; and
- a clinical condition that increases the risk of severe chickenpox (such as immunosuppressed individuals, neonates and pregnant women; and
- no antibodies to varicella-zoster virus (urgent VZV antibody testing can be performed with 24 hrs).
Post-exposure prophylaxis with aciclovir [unlicensed use] is recommended first line for at risk individuals, except for certain susceptible neonates and for individuals for whom antivirals are contraindicated or otherwise unsuitable (e.g. if there are significant concerns about renal impairment or intestinal malabsorption), where varicella-zoster immunoglobulin (VZIG) is recommended instead. Prophylactic intravenous aciclovir [unlicensed use] should also be considered in addition to VZIG for neonates whose mothers develop chickenpox 4 days before and up to 2 days after delivery, as they are at the highest risk of fatal outcome despite VZIG prophylaxis. Valaciclovir [unlicensed use] can be used as an alternative to aciclovir as appropriate.
Anti-D Immunoglobulin
Anti-D (Rh0) immunoglobulin is prepared from plasma taken from rhesus-negative donors who have been immunised against the anti-D antigen. It is used to prevent a rhesus-negative mother from forming antibodies to foetal rhesus-positive cells which may pass into the maternal circulation and thus to prevent haemolytic disease of the newborn.
It should be administered to the mother following any sensitising episode (e.g. abortion, miscarriage and birth); it should be injected within 72 hours of the episode but even if a longer period has elapsed it may still give protection and should be administered. Anti-D immunoglobulin is also given when significant feto-maternal haemorrhage occurs in rhesus-negative women during delivery. The dose of anti-d (Rh0) immunoglobulin is determined according to the level of exposure to rhesus-positive blood.
Use of routine antenatal anti-D prophylaxis should be given irrespective of previous anti-D prophylaxis for a sensitising event early in the same pregnancy. Similarly, postpartum anti-D prophylaxis should be given irrespective of previous routine antenatal anti-D prophylaxis or antenatal anti-D prophylaxis for a sensitising event in the same pregnancy.
Anti-D immunoglobulin is also given to women of childbearing potential after the inadvertent transfusion of rhesus-incompatible blood components.
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
