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Table of contents :
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: hypervaccination is the subsequent inoculation (one or
more times) of a previously immunized animal (usually horse (Equus
caballus), goat (Capra
hircus) or cow (Bos
taurus)) with enough vaccine to enable it to afford a serum protective
to other animals. Immunogenicity is often reduced by treating heterologous
Igs with pepsin and using only F(ab')2 fragments, that cannot
bind to FcRs nor activate C1q. Anyway they can still cause anaphylaxis
or type III
hypersensitivity. The former can be avoided by immunotherapy
inducing peripheral tolerance.
Measure unit : IU. E.g.
heterologous serum : 20-40 mL
serotypes A, B and E heterologous serum : 10,000 IU
and related gangrene Bacteria heterologous serum : 25,000 IU.
heterologous serum : 3,000-6,000 IU
heterologous serum : 5,000-10,000 IU. 1 unit of diphtheria antitoxin
is approximately the amount that will preserve the life of a guinea pig
weighing 250 g for at least 4 days after it is injected subcutaneously
with a mixture of 100 times the minimum lethal dose of diphtheria toxin
heterologous serum. The U.S. Public Health Service unit for scarlet
fever antitoxin neutralizes 50 skin test doses of scarlet fever toxin
heterologous serum. Felton's unit : a mouse protective unit
of antipneumococcic serum; it is that quantity of antibody capable of protecting
a white Swiss mouse against 1 million fatal doses of a standard pneumococcus
culture of the corresponding type. Frequently, it is considered to be the
equivalent of the National Institutes of Health control serum (P-11).
mAbs are produced by transgenic tobacco (Nicotiana
spp.) plants)as
they could have anti-IgA Ab. As with all plasma-derived products, the risk
of transmission of infectious agents cannot be completely eliminated and
the physician should weigh the risks and benefits of administration.
...
(zoster immunoglobulilin (ZIG) / varicella zoster immunoglobulin (VZIG))
does not effectively prevent VZV infection and is therefore restricted
to high risk individuals (i.e. immunocompromised children and pregnant
women),
lung,
liver,
pancreas
and heart
transplants : in transplants of these organs other than kidney from CMV
seropositive donors into seronegative recipients, prophylactic CMV-IGIV
should be considered in combination with ganciclovir. Clinical studies
have shown a 50% reduction in primary CMV disease in renal transplant patients
given CMV-IGIVref
and a 56% reduction in serious CMV diseaseref
in liver transplant patients given CMV-IGIV. CMV-IGIV prophylaxis was associated
with increased survival in liver transplant recipients. In 2 separate clinical
trials, Cytogam was shown to provide effective prophylaxis in renal-transplant
recipients at risk for primary CMV disease. In the first randomized trialref,
the incidence of virologically confirmed CMV-associated syndromes was reduced
from 60% in controls (n=35) to 21% in recipients of CMV immune globulin
(n=24) (P<0.01); marked leukopenia was reduced from 37% in controls
to 4% in globulin recipients (P<0.01); and fungal or parasitic superinfections
were not seen in globulin recipients but occurred in 20% of controls (P=0.05).
Serious CMV disease was reduced from 46% to 13%. There was a concomitant
but not statistically significant reduction in the incidence of CMV pneumonia
(17% of controls as compared with 4% of globulin recipients. There was
no effect on rate of viral isolation or seroconversion although the rate
of viremia was less in Cytogam recipients. In a subsequent non-randomized
trial in renal transplant recipients (n=36)ref,
the incidence of virologically confirmed CMV-associated syndrome was reduced
to 36% in the globulin recipients in comparison to a 60% incidence in control
patients (n=35) in the randomized trial. The rates of serious CMV disease,
and concomitant fungal and parasitic superinfection were similar to patients
receiving CMV-IGIV in the first trial. In a randomized, double-blind, placebo-controlled
trial in liver transplant recipientsref,
the incidence of serious CMV-associated disease was reduced from 26% in
the 72 control patients to 12% in the 69 CMV-IGIV recipients (p=0.02);
serious CMV-associated disease included CMV disease in 2 or more organs,
CMV pneumonia, or CMV-associated invasive fungal infection, the incidence
of which was 18% in controls and 7% in CMV-IGIV recipients (p=0.04). In
follow-upref
of the liver transplant patients studied in this randomized controlled
trial and a subsequent open-label trialref,
the one year survival of the 72 control patients was 72% versus 86% in
the 90 recipients of CMV-IGIV (p=0.03). In the randomized control trial,
the reduction in serious CMV-associated disease in CMV seronegative recipients
of livers from a CMV seropositive donor (7/19 in the CMB-IGIV group vs.
9/19 in control) was less than in transplants with other donor and recipient
serologic status (1/50 in the CMV-IGIV group vs. 10/53 in the control group).
This finding was similar to that of Merigan et al.ref
in a study of gancyclovir prophylaxis after heart transplantation. In this
study, patients received gancyclovir IV at 5 mg/kg bid for the initial
14 days post-transplant, then at 6 mg/kg each day for 5 days through day
28. Recent studies of combined prophylaxis with CMV-IGIV and gancyclovir
have shown reductions in the incidence of serious CMV associated disease
in CMV seronegative recipients of CMV seropositive organs below that expected
from one drug aloneref.
Ham et alref
used CMV-IGIV with a dosage schedule of 150 mg/kg CMV-IGIV within 72 hours
of transplant; 100 mg/kg at 2, 4, 6 and 8 weeks following liver transplant
and then 50 mg/kg at 12 and 16 weeks post-transplant in combination with
ganciclovir (10 mg/kg/day for 14 days). The incidence of CMV disease was
reduced from an expected 60-80% rate to 7% in 15 seronegative recipients
of a seropositive organ. Snydman using the CMV-IGIV dosage schedule listed
under DOSAGE and ADMINISTRATION Section in combination with ganciclovir
(10 mg/kg/day for 14 days) reduced the incidence of serious CMV disease
in D+R- liver transplant recipients receiving placebo or one drug from
16/47 (34%) to 3/41 (7%) in patients receiving both drugs for prophylaxis.
Martin using CMV-IGIV 100 mg/kg every 2 weeks for 6 weeks followed by 50
mg/kg every 2 weeks with a final dose at week 16, in combination with ganciclovir
10 mg/kg/dat for 14 days after transplantation, observed severe CMV disease
in 1/74 (1%) of CMV seronegative recipients of a kidney from a CMV seropositive
donor, in 0/14 (0%) of CMV seronegative recipients of a kidney-pancreas
transplant from a CMV seropositive donor and in 1/12 (8%) of CMV seronegative
recipients of a liver from a CMB seropositive donor. The incidence of serious
CMB disease with combined CMV-IGIV and ganciclovir prophylaxis was lower
than the previous experience with single drug prophylaxis. Valantine and
Luikart compared prophylaxis with CMV-IGIV (biweekly for 3 months) in combination
with ganciclovir prophylaxis (IV at 5 mg/kg bid for the initial 14 days
post-transplant, then at 6 mg/kg through day 28) in 16 CMV seronegative
recipients of heart from CMV seropositive donors with 16 matched controls
receiving ganciclovir alone. The actuarial incidence of CMV disease was
reduced from 55% in ganciclovir group to 46% in heart-lung or lung transplant
patients in whom either the donor or recipient was CMV seropositive, the
actuarial incidence of CMV disease in patients receiving ganciclovir alone
(n=25) was 85% as compared to 36% of the 33 patients receiving both CMV-IGIV
and ganciclovir (p< 0.05). Survival was 60% in the ganciclovir group
and 80% in patients receiving CMV-IGIV and ganciclovir (p<0.01).
: tested immune globulins show higher effectiveness than placebo or do-nothing
against infectious hepatitis both in pre-exposure and post-exposure prophylaxis
(effectiveness 83%; RR: 0.17; 95% CI: 0.15-0.19; and effectiveness 69%;
RR: 0.31; 95% CI: 0.20-0.47, respectively). Immune globulins are efficacious
in preventing infectious hepatitis and hepatitis A, but included studies
do not report data about their safety. Average length of passive protection
was three months. Given the notable heterogeneity of performance of immune
globulins, short protection conferred and absence of trial safety data,
the only indications for the use of immune globulins may be in situations
in which inadequate supplies of vaccine are available or when the 8-day
window of opportunity for vaccine use is pastref.
Experimental or epidemiological evidence that immune globulin [IG] is only
effective if given within a 2-week period after exposure to the disease"
is not available, given the vagaries of dose and exposure conditions that
lead to acquisition of the virus, resulting in longer incubation periods.
From a public health standpoint, the CDC avoids this controversy by stating
that efficacy when administered >2 weeks after exposure has not been established,
which is an appropriate statement based on analysis of the dataref.
Routine vaccination of children is an effective way to reduce hepatitis
A incidence in the United States. These updated recommendations represent
the final step in the childhood hepatitis A immunization strategy (see:
MMWR, 19 May 2006). But physicians and other healthcare workers should
appreciate the fact that immune globulin given >2 weeks after exposure
might still modulate or abort the infection in some individuals. It
(rabies immunoglobulin (RIG))
(vaccina immune globulin intravenous (VIGIV)) (source : DynPort)
was manufactured from plasma donations of military personnel previously
vaccinated with vaccinia, the virus used to vaccinate against the smallpox
virus. The therapeutic contains purified antibodies specific to the vaccinia
virus that assist in recovery of persons suffering from rare complications
of vaccination against smallpox. VIGIV might be used in cases of generalized
vaccinia, eczema vaccinatum or progressive vaccinia.
due to Rh incompatibility beween mother and fetus.
hyperimmune homologous serum from subjects infected with Escherichia
coli O111:H15.
hyperimmune homologous serum (in burnt subjects)
hyperimmune homologous serum : purified imrnunoglobulin obtained from plasma
of healthy human donors known to have high titres of botulinum antitoxin
after active immunisation with a vaccine containing botulinum toxoids A,
B. C, D and E. Store at 2-8 ºC. Do not freeze. Protect from light.
hyperimmune homologous serum (tetanus immune globulin (TIG))
: a panel of Fabs that neutralize anthrax toxin in vitro was selected
from libraries generated from human donors vaccinated against anthrax.
At least 2 of these antibodies protect rats from anthrax intoxication in
vivo. Fabs 83K7C and 63L1D bind with subnanomolar affinity to PA63,
and Fab 63L1D neutralizes toxin substoichiometrically, inhibits LF interaction
with PA63 and binds to a conformational epitope formed by PA63ref.)
mAbs :
mAbs :
mAbs :
mAbs :
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