Infection | Indications | Preparations, vial content | Dose (by intramuscular injection) |
Hepatitis A | Household and other close contacts Outbreaks where there is a clearly defined exposure if there has been delay in identifying cases | Human normal immunoglobulin (HNIG) 250 mg and 750 mg | < 10 years 250 mg
= 10 years 500 mg |
| | Vaccine is preferred to HNIG,except if there has been delay of one week or more in identifying cases and/or an individual is at high risk of severe disease because of coexisting liver disease or patient is immunosuppressed, or the outbreak is in a population likely to experience morbidity. HNIG is no longer recommended for travel prophylaxis. |
Tetanus | High-risk wounds in immunised individuals or any tetanus-prone wound in incompletely immunised or unimmunised individuals | Human tetanus immunoglobulin (HTIG) 250 iu | 250 iu (500 iu if > 24 hours since injury, risk of heavy contamination, or following burns) |
| | Administer with a full course of combined tetanus/low dose diphtheria vaccine (Td) in the following: (i) unimmunised/incompletely immunised subjects
(ii) immunisation history unknown/uncertain. |
Measles | Immunosuppressed contacts, pregnant women, infants < 10 months | Human normal immunoglobulin (HNIG) 250 mg and 750 mg | 250 mg < 1 year
500 mg 1−2 years
750 mg = 3 years |
| | HNIG is most effective if given within 72 hours, but can be effective even if given within 6 days. Immunocompromised patients should be given HNIG as soon as possible. Infants from 9 months should be given MMR vaccine. HNIG may not be required for infants < 6 months as they are likely to have maternal antibody. Seek further advice from HPA. |
Rubella | Pregnant women only | Human normal immunoglobulin (HNIG) 750 mg | 750 mg |
| | HNIG should be used when termination is not acceptable to a non-immune pregnant woman. HNIG does not prevent infection, but may reduce the likelihood of clinical symptoms. Neither MMR nor rubella vaccine are effective for post-exposure prophylaxis. |
Mumps | Not recommended | − | − |
| | HNIG and MMR vaccine are not effective for post-exposure protection, and there is no mumps-specific immunoglobulin. |
Polio | Immunosuppressed persons, or contacts of, inadvertently given live polio vaccine | Human normal immunoglobulin (HNIG) 750 mg | 250 mg < 1 year
500 mg 1−2 years
750 mg = 3 years |
| | HNIG should be given as soon as possible after exposure. History of prior vaccination should be taken and serum for antibody determination obtained. |
Hepatitis B | Accidental exposure, including needlestick, or mucosal/non-intact skin exposure Sexual exposure | Human hepatitis B immunoglobulin (HBIG) 200 iu or 500 iu | 200 iu 0−4 years
300 iu 5−9 years
500 iu = 10 years |
| | Administer with hepatitis B vaccine preferably within 12 hours and not later than 1 week after exposure. Individuals who have been successfully vaccinated (= 10mlU/ml 3 months after the third dose) require a booster dose of vaccine ONLY, unless booster given in the past year. Vaccine non-responders (< 10 iu) should be given a second dose of HBIG 1 month after the first unless the source is shown to be HBsAg negative. |
Hepatitis B | Newborn babies of high-risk mothers | Hepatitis B immunoglobulin (HBIG) 100 iu | 200 iu |
| | Administer with hepatitis B vaccine as soon as possible and within 48 hours to babies born to mothers who either had acute hepatitis B in pregnancy, or are persistent carriers of HBsAg, where HBsAg is detectable or anti HBe is not. |
Chickenpox | Immunosuppressed patients, pregnant women and neonates who are significantly exposed to chickenpox or herpes zoster and have no antibodies to varicella-zoster virus | Varicella-zoster immunoglobulin (VZIG) 250 mg and 500 mg vials | 250 mg 0−5 years
500 mg 6−10 years
750 mg 11−14 years
1000 mg = 15 years Give second dose if further exposure and 3 weeks have lapsed since first dose. |
| | Immunosuppressed patients are defined as: (i) undergoing (or within 6 months of) chemotherapy or generalised radiotherapy; (ii) organ recipients on immunosuppressive treatment; (iii) bone marrow recipients, who are considered to be immunosuprressed; (iv) patients on (or within 3 months of) daily high-dose steroids for more than a week (e.g. children: 2 mg/kg/day, adults: 40 mg/kg/day of prednisolone); (v) patients on lower dose steroids, given in combination with cytotoxic drugs; (vi) patients with evidence of impaired cell-mediated immunity; (vii) symptomatic HIV-positive patients or asymptomatic with low CD4+ counts. Patients with gammaglobulin deficiencies who are receiving replacement therapy with IV HNIGdo not require VZIG. Pregnant women: VZ-antibody-negative pregnant contacts at any stage of pregnancy, providing VZIG can be given < 10 days of contact (count days from onset of rash for household contacts). Pregnant contacts with a positive history do not require VZIG; those with a negative history must be tested for VZ antibody before VZIG is given. Neonates: (i) VZIG should be given to infants whose mothers develop chickenpox (but not zoster) in the period 7 days before to 7 days after delivery, with or without antibody testing. It should also be given to VZ-antibody-negative infants (based on antenatal/infant blood sample) exposed to chickenpox or zoster in first 7 days of life. (ii) Infants who are premature, low birth weight or on SCBU: VZIG should be given to infants born < 28 weeks, weighing < 1 kg and had repeated blood sampling, or > 60 days old and exposed to chickenpox or herpes zoster. |
Rabies | Bite or mucous membrane exposure to potentially rabid animals or an animal unavailable for observation | Human rabies immunoglobulin (HRIG) 500 iu | 20 iu/kg |
| | Administer with rabies vaccine according to country risk and immunisation status. See HPA rabies protocol available at:
www.hpa.org.uk |
Sources of supply | The following preparations for intramuscular use are issued by Immunisation Department of HPA Communicable Disease Surveillance Centre (020 8327 7773) and certain local Health Protection Agency and NHS public health laboratories: - human normal immunoglobulin (HNIG)
- human varicella-zoster immunoglobulin (VZIG)
- human hepatitis B immunoglobulin (HBIG)
- human rabies immunoglobulin (HRIG).
Or contact your local pharmacy or blood transfusion centre. |