Vaccination for people who have recently received normal human immunoglobulin and other blood products

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).

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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 zoster vaccine 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).

BCG vaccine

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 (measles-mumps-rubella), (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.

Table. Recommended intervals between immunoglobulins or blood products, and measles-mumps-rubella, measles-mumps-rubella-varicella or varicella vaccination

Immunoglobulin/blood product	Route	Dose ( or mL)	Dose (estimated mg IgG/kg)	Interval (months)
Blood transfusion: washed red blood cells		10 mL/kg	Negligible	0
Blood transfusion: red blood cells, adenine-saline added		10 mL/kg	10	3
Blood transfusion: packed red blood cells		10 mL/kg	20–60	5
Blood transfusion: whole blood		10 mL/kg	80–100	6
Cytomegalovirus immunoglobulin		3 mL/kg	150	6
Hepatitis B immunoglobulin as hepatitis B prophylaxis		100 or 400	10	3
(intravenous) for treatment of idiopathic thrombocytopenic purpura		na	400	8
(intravenous) for treatment of idiopathic thrombocytopenic purpura		na	1000	10
(intravenous) for treatment of idiopathic thrombocytopenic purpura or Kawasaki disease		na	1600–2000	11
as hepatitis A prophylaxis		0.5 mL (<25 kg), 1.0 mL (25–50 kg), 2.0 mL (>50 kg)	na	3
as measles prophylaxis: standard		0.2 mL/kg (maximum dose 15 mL)	na	5
as measles prophylaxis: immunocompromised		0.5 mL/kg (maximum dose 15 mL)	na	6
Plasma or platelet products		10 mL/kg	160	7
Human rabies immunoglobulin as rabies prophylaxis		20 /kg	22	4
Replacement (or therapy) of immune deficiencies as (intravenous), various doses		na	300–400	9
Rh (D) immunoglobulin (anti-D)		na	na	0
Tetanus immunoglobulin (intramuscular use) as tetanus prophylaxis		250 (given within 24 hours of injury)	10	3
Tetanus immunoglobulin (intramuscular use) as tetanus prophylaxis		500 (>24 hours after injury)	20	3
Zoster immunoglobulin as varicella prophylaxis		200 (0–10 kg), 400 (11–30 kg), 600 (>30 kg)	na	5

= intramuscular; = international units; = intravenous; na = not applicable; = normal human immunoglobulin

View table details

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.

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Last updated:

8 June 2018

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