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 23 October 2023. View history of updates
People who have had a blood transfusion
Normal human immunoglobulin may inhibit the immune response to some live parenteral viral vaccines. This is because low levels of antibodies may be present in the blood product that may impair the immune response to the live vaccine.
Exceptions are yellow fever, BCG and zoster vaccines.
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).
Live Japanese encephalitis vaccine (Imojev) should not be given within 6 weeks of receiving immunoglobulins or immunoglobulin-containing blood products. It is preferable to wait 3 months.
People who have received a blood transfusion do not need to repeat any of their vaccinations.
Recommended intervals between immunoglobulins or blood products, and measles-mumps-rubella, measles-mumps-rubella-varicella or varicella vaccination:1
| Immunoglobulin/blood product | Route | Dose (IU, mL or mg IgG/kg) | Interval (months) |
|---|---|---|---|
| Blood transfusion: washed red blood cells | IV | 10 mL/kg | 0 |
| Blood transfusion: red blood cells, adenine-saline added | IV | 10 mL/kg | 3 |
| Blood transfusion: packed red blood cells | IV | 10 mL/kg | 6 |
| Blood transfusion: whole blood | IV | 10 mL/kg | 6 |
| Cytomegalovirus immunoglobulin | IV | 3 mL/kg | 6 |
| Hepatitis B immunoglobulin as hepatitis B prophylaxis | IM | 100 IU or 400 IU (10 mg IgG/kg) | 3 |
| NHIG (intravenous) for treatment of idiopathic thrombocytopenic purpura | IV | 400 mg IgG/kg | 8 |
| NHIG (intravenous) for treatment of idiopathic thrombocytopenic purpura | IV | 1000 mg IgG/kg | 10 |
| NHIG (intravenous) for treatment of idiopathic thrombocytopenic purpura or Kawasaki disease | IV | 1600-2000 mg IgG/kg | 11 |
| NHIG as hepatitis A prophylaxis | IM | 0.5 mL (<25 kg), 1.0 mL (25–50 kg), 2.0 mL (>50 kg) | 3 |
| NHIG as measles prophylaxis: standard | IM | 0.2 mL/kg (maximum dose 15 mL) | 5 |
| NHIG as measles prophylaxis: immunocompromised | IM | 0.5 mL/kg (maximum dose 15 mL) | 6 |
| Plasma or platelet products | IV | 10 mL/kg | 7 |
| Human rabies immunoglobulin as rabies prophylaxis | IM | 20 IU/kg | 4 |
| Replacement (or therapy) of immune deficiencies as NHIG (intravenous), various doses | IV | 300-400 mg IgG/kg | 9 |
| Rh (D) immunoglobulin (anti-D) | IM | na | 0 |
| Tetanus immunoglobulin (intramuscular use) as tetanus prophylaxis (given within 24 hours of injury) | IM | 250 IU (10 mg IgG/kg) | 3 |
| Tetanus immunoglobulin (intramuscular use) as tetanus prophylaxis (>24 hours after injury) | IM | 500 IU (20 mg IgG/kg) | 3 |
| Zoster immunoglobulin as varicella prophylaxis | IM | 200 IU (0–10 kg), 400 IU (11–30 kg), 600 IU (>30 kg) | 5 |
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Acronyms used:
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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.
References
- 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
Updates to clinical guidance to remove specific guidance regarding rotavirus, zoster and BCG vaccines, and to include guidance regarding live JE vaccine.
Update to guidance regarding zoster vaccines to include guidance on Shingrix vaccine.
Updates to clinical guidance to remove specific guidance regarding rotavirus, zoster and BCG vaccines, and to include guidance regarding live JE vaccine.
Update to guidance regarding zoster vaccines to include guidance on Shingrix vaccine.