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Passive immunization is provided in the following circumstances:

• When people cannot synthesize antibody.
• When people have been exposed to a disease that they are not immune to or that is likely to cause complications
• When people have a disease and the effects of the toxin must be ameliorated.

For immune globulins and antitoxins available in the US, see Table 3: Immunization: Immune Globulins and Antitoxins* Available in the US.

Human immune globulin (IG): IG is a concentrated antibody-containing solution prepared from plasma obtained from normal donors. It consists primarily of IgG, although trace amounts of IgA, IgM, and other serum proteins may be present. IG very rarely contains transmissible viruses (eg, hepatitis B or C, HIV) and is stable for many months if stored at 4°C. IG is given IM. Because maximal serum antibody levels may not occur until about 48 h after IM injection, IG must be given as soon after exposure as possible. Half-life of IG in the circulation is about 3 wk.

IG may be used for prophylaxis in hepatitis A, measles, immunoglobulin deficiency, varicella (in immunocompromised patients when varicella-zoster IG is unavailable), and rubella exposure during the 1st trimester of pregnancy.

IG provides only temporary protection; the antibody content against specific agents varies by as much as 10-fold among preparations. Administration is painful, and anaphylaxis can occur.

Table 3
Immune Globulins and Antitoxins* Available in the US Immunobiologic Agent Type Indication(s) Botulinum antitoxin Specific equine antibodies Treatment of botulism Botulinum antitoxin (BIG) Specific human antibodies Treatment of botulism in infants Cytomegalovirus immune globulin, IV (CMV-IGIV) Specific human antibodies Prophylaxis in hematopoietic stem cell and kidney transplant recipients Diphtheria antitoxin Some Trade Names No US trade name Click for Drug Monograph Specific equine antibodies Treatment of respiratory diphtheria Hepatitis B immune globulin Some Trade Names HEPAGAM B HYPERHEP B S/D NABI-HB Click for Drug Monograph (HBIG) Specific human antibodies Prophylaxis for hepatitis B postexposure Immune globulin (IG) Pooled human antibodies Prophylaxis for hepatitis A preexposure and postexposure, measles postexposure, immunoglobulin deficiency, rubella during the 1st trimester of pregnancy, varicella (if varicella zoster immune globulin is unavailable) Immune globulin, intravenous (IVIG) Pooled human antibodies Prophylaxis for and treatment of severe bacterial and viral infections (eg, HIV infection in children), primary immunodeficiency disorders, autoimmune thrombocytopenic purpura, chronic B-cell lymphocytic leukemia, Kawasaki disease, autoimmune disorders (eg, myasthenia gravis, Guillain-Barré syndrome, polymyositis/dermatomyositis); Prophylaxis for graft-vs-host disease Immune globulin, sc (SCIG) Pooled human antibodies Treatment of primary immunodeficiency disorders Rabies immune globulin (HRIG)† Specific human antibodies Management of rabies postexposure in people not previously immunized with rabies vaccine Respiratory syncytial virus immune globulin (RSV-IGIV) Specific human antibodies Prevention of RSV in infants < 35 wk gestation or children with a chronic lung disorder (eg, bronchopulmonary dysplasia) Respiratory syncytial virus murine monoclonal antibody (RSV-mAb) Murine monoclonal antibody ( palivizumab Some Trade Names SYNAGIS Click for Drug Monograph ) Prevention of RSV in infants < 35 wk gestation or children with a chronic lung disorder (eg, bronchopulmonary dysplasia) Tetanus immune globulin (TIG) Specific human antibodies Treatment of tetanus Postexposure prophylaxis in people not adequately immunized with tetanus toxoid Vaccinia immune globulin (VIG) Specific human antibodies Treatment of eczema vaccinatum, vaccinia necrosum, and ocular vaccinia Varicella-zoster immune globulin (VZIG) Specific human antibodies Postexposure prophylaxis in susceptible immunocompromised people, certain susceptible pregnant women, and perinatally exposed neonates *Immune globulin preparations and antitoxins are given IM unless otherwise indicated. †HRIG is administered around wounds as well as IM. From General Recommendations on Immunization. Recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report 43:1, January 28, 1994. Updated through the Center for Biologics Evaluation and Research of the U.S. Food and Drug Administration, 2008.

IV immune globulin (IVIG) was developed to provide larger and repeated doses of human immune globulin. IVIG is used to treat or prevent severe bacterial and viral infections, autoimmune disorders, and immunodeficiency disorders, particularly the following:

• Kawasaki disease
• HIV infection in children
• Chronic B-cell lymphocytic leukemia
• Primary immunodeficiencies
• Autoimmune thrombocytopenic purpura
• Prevention of graft-vs-host disease

IVIG or a specific monoclonal antibody against RSV is available for prevention of RSV in children who are < 24 mo and have bronchopulmonary dysplasia or a history of premature birth (< 35 wk gestation).

Adverse effects are uncommon, although fever, chills, headache, faintness, nausea, vomiting, hypersensitivity, anaphylactic reactions, coughing, and volume overload have occurred.

Subcutaneous immune globulin (SCIG) is also prepared from pooled human plasma; SCIG is intended for home use in patients with a primary immunodeficiency.

Injection site reactions are common, but systemic adverse effects (eg, fever, chills) are much less common than with IVIG.

Hyperimmune globulin: Hyperimmune globulin is prepared from the plasma of people with high titers of antibody against a specific organism or antigen. It is derived from people convalescing from natural infections or donors artificially immunized.

Hyperimmune globulins are available for hepatitis B, respiratory syncytial virus (RSV), rabies, tetanus, cytomegalovirus, vaccinia, and varicella-zoster. Administration is painful, and anaphylaxis may occur.

Last full review/revision July 2008 by Fred H. Rubin, MD

Content last modified July 2008