Vaccination for people who have recently received normal human immunoglobulin and other blood products
Immunoglobulins may inhibit the immune response to some vaccines. Delay giving some vaccines for a certain time after receiving blood products.
Recently added
This page was added on 09 June 2018.
Updates made
This page was updated on 07 December 2022. View history of updates
Overview
Normal human immunoglobulin may inhibit the immune response to live parenteral viral vaccines. The exceptions are yellow fever and zoster vaccines.
The recommended interval between receipt of immunoglobulin or other blood products and vaccination depends on the type and half-life of the immunoglobulin received. See Table. Recommended intervals between immunoglobulins or blood products, and measles-mumps-rubella, measles-mumps-rubella-varicella or varicella vaccination and Japanese encephalitis).
Rotavirus vaccine
Infants can receive rotavirus vaccine at any time before or after, or with, any blood product, including antibody-containing products.
Follow the routinely recommended schedule for rotavirus vaccine in infants who are eligible for vaccination (see Rotavirus).
Minimal data are available on how blood products affect the immune response to the vaccine in these infants. Completing the full rotavirus vaccine series will optimise protection.1
Zoster vaccine
People ≥50 years of age can receive Zostavax at any time before or after receiving immunoglobulin or any antibody-containing blood product.
This is because people ≥50 years of age (the registered age group for zoster vaccine) have likely been previously infected with varicella-zoster virus. This means that they will already have similar serum antibody levels to those found in blood products (see Zoster [herpes zoster]).
No precautions are required around immunoglobulins and blood product administration and administration of Shingrix in people aged ≥18 years.
BCG vaccine
People can receive BCG (bacille Calmette–Guérin) vaccine at any time before or after receiving immunoglobulin or any antibody-containing blood product (see Tuberculosis).
People with agammaglobulinaemia
Live vaccines are not recommended for people with agammaglobulinaemia who are receiving monthly normal human immunoglobulin. This is because their immune response may be inhibited. Also, these people will have sufficient circulating antibodies (for example, against measles and varicella) from the normal human immunoglobulin to protect them if they are exposed.
Inactivated vaccines are recommended as per the routine schedule. The response may be suboptimal, but these vaccines are safe to receive.
People who have had a blood transfusion
People who have received a blood transfusion do not need to repeat any of their vaccinations.
People who have received any blood product, including plasma or platelets, should wait 3–11 months before they receive an MMR (measles-mumps-rubella), MMRV (measles-mumps-rubella-varicella) or varicella vaccine. The length of time depends on the blood product they received. See Table. Recommended intervals between immunoglobulins or blood products, and measles-mumps-rubella, measles-mumps-rubella-varicella or varicella vaccination).
This is because low levels of antibodies may be present in the blood product that may impair the immune response to the live vaccine.
| Immunoglobulin/blood product | Route | Dose (IU or mL) | Dose (estimated mg IgG/kg) |
Interval (months) |
|---|---|---|---|---|
| Blood transfusion: washed red blood cells | IV | 10 mL/kg | Negligible | 0 |
| Blood transfusion: red blood cells, adenine-saline added | IV | 10 mL/kg | 10 | 3 |
| Blood transfusion: packed red blood cells | IV | 10 mL/kg | 20–60 | 5 |
| Blood transfusion: whole blood | IV | 10 mL/kg | 80–100 | 6 |
| Cytomegalovirus immunoglobulin | IV | 3 mL/kg | 150 | 6 |
| Hepatitis B immunoglobulin as hepatitis B prophylaxis | IM | 100 IU or 400 IU | 10 | 3 |
| NHIG (intravenous) for treatment of idiopathic thrombocytopenic purpura | IV | na | 400 | 8 |
| NHIG (intravenous) for treatment of idiopathic thrombocytopenic purpura | IV | na | 1000 | 10 |
| NHIG (intravenous) for treatment of idiopathic thrombocytopenic purpura or Kawasaki disease | IV | na | 1600–2000 | 11 |
| NHIG as hepatitis A prophylaxis | IM | 0.5 mL (<25 kg), 1.0 mL (25–50 kg), 2.0 mL (>50 kg) | na | 3 |
| NHIG as measles prophylaxis: standard | IM | 0.2 mL/kg (maximum dose 15 mL) | na | 5 |
| NHIG as measles prophylaxis: immunocompromised | IM | 0.5 mL/kg (maximum dose 15 mL) | na | 6 |
| Plasma or platelet products | IV | 10 mL/kg | 160 | 7 |
| Human rabies immunoglobulin as rabies prophylaxis | IM | 20 IU/kg | 22 | 4 |
| Replacement (or therapy) of immune deficiencies as NHIG (intravenous), various doses | IV | na | 300–400 | 9 |
| Rh (D) immunoglobulin (anti-D) | IM | na | na | 0 |
| Tetanus immunoglobulin (intramuscular use) as tetanus prophylaxis | IM | 250 IU (given within 24 hours of injury) | 10 | 3 |
| Tetanus immunoglobulin (intramuscular use) as tetanus prophylaxis | IM | 500 IU (>24 hours after injury) | 20 | 3 |
| Zoster immunoglobulin as varicella prophylaxis | IM | 200 IU (0–10 kg), 400 IU (11–30 kg), 600 IU (>30 kg) | na | 5 |
Acronyms used:
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References
- Centers for Disease Control and Prevention (CDC), Cortese MM, Parashar UD. Prevention of rotavirus gastroenteritis among infants and children: recommendations of the Advisory Committee on Immunization Practices (ACIP). [erratum appears in MMWR Recomm Rep. 2010 Aug 27;59(33):1074]. MMWR. Recommendations and Reports 2009;58(RR-2):1-25.
- American Academy of Pediatrics. Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2015 report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2015.
Page history
Update to guidance regarding zoster vaccines to include guidance on Shingrix vaccine.
Update to guidance regarding zoster vaccines to include guidance on Shingrix vaccine.