A Clinician’s Handbook for Childhood & Adult Immunizations in Georgia

MMR/VAR/IG and Antibody Table

Recommended intervals between administration of antibody-containing products and measles – or varicella-containing vaccine, by product and indication for vaccination

Product / IndicationDose (mg IgG/kg) and route (a)Recommended interval before measles or varicella-containing vaccine (b) administration (months)(c)
Blood transfusion
- Red blood cells (RBCs), washed10 mL/kg (negligible IgG/kg) IVNone
- RBCs, adenine-saline added10 mL/kg (10 mg IgG/kg) IV3 months
- Packed RBCs (hematocrit 65%) (d)10 mL/kg (60 mg IgG/kg) IV6 months
- Whole blood (hematocrit 35%-50%) (d)10 mL/kg (80-100 mg IgG/kg) IV6 months
- Plasma/platelet products10 mL/kg (160 mg IgG/kg) IV7 months
Botulinum Immune Globulin Intravenous (Human)1.0 mL/kg (50 mg IgG/kg) IV6 months
Cytomegalovirus IGIV150 mg/kg maximum6 months
Hepatitis A IG
- Contact prophylaxis0.1 mL/kg (16.5 mg IgG/kg) IM6 months (e)
- International travel, <1 month stay0.1 mL/kg (16.5 mg IgG/kg) IM6 months (e)
- International travel, ≥1 month stay0.2 mL/kg (33 mg IgG/kg) IM6 months (e)
Hepatitis B IG0.06 mL/kg (10 mg IgG/kg) IM3 months
- Replacement therapy for immune deficiencies (f)300-400 mg/kg IV (e)8 months
- Postexposure measles prophylaxis: immunocompromised contacts400 mg/kg IV8 months
- Postexposure varicella prophylaxis400 mg/kg IV8 months
- Immune thrombocytopenic purpura treatment400 mg/kg IV8 months
- Immune thrombocytopenic purpura treatment1,000 mg/kg IV10 months
- Kawasaki disease2 g/kg IV11 months
Measles prophylaxis IG
- Standard (i.e., nonimmunocompromised) contact0.50 mL/kg (80 mg IgG/kg) IM6 months
Monoclonal antibody to respiratory syncytial virus F protein (e.g., Synagis™ [MedImmune]) (g)15 mg/kg (IM)None
Rabies IG20 IU/kg (22 mg IgG/kg) IM4 months
Tetanus IG (TIG)250 units (10 mg IgG/kg) IM3 months
Varicella IG (VariZIG)125 units/ 10 kg (60 - 200 mg IgG/kg) IM, maximum 625 units5 months

Abbreviations: HIV = human immunodeficiency virus; IG = immune globulin; IgG = immune globulin G; IGIV = intravenous immune globulin; mg IgG/kg = milligrams of immune globulin G per kilogram of body weight; IM = intramuscular; IV = intravenous; RBCs = red blood cells.

(a) This table is not intended for determining the correct indications and dosages for using antibody-containing products. Unvaccinated persons might not be protected fully against measles during the entire recommended interval, and additional doses of IG or measles vaccine might be indicated after measles exposure. Concentrations of measles antibody in an IG preparation can vary by manufacturer’s lot. Rates of antibody clearance after receipt of an IG preparation also might vary. Recommended intervals are extrapolated from an estimated half-life of 30 days for passively acquired antibody and an observed interference with the immune response to measles vaccine for 5 months after a dose of 80 mg IgG/kg. Sources: Mason W, Takahashi M, Schneider T. Persisting passively acquired measles antibody following gamma globulin therapy for Kawasaki disease and response to live virus vaccination [Abstract 311]. Presented at the 32 meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy, Los Angeles, California, October, 1992, AND Siber GR, Werner BG, Halsey NA, et al. Interference of immune globulin with measles and rubella immunization. J Pediatr. 1993;122(2):204-211. DOI: 10.1016/S0022-3476(06)80114-9, AND Mason WH, Schneider TL, Takahashi M. Duration of passively acquired measles antibody and response to live virus vaccination allowing gamma globulintherapy for Kawasaki syndrome. Prog Pediatr Cardiol. 1992;1(1):82. DOI: 10.1016/S1058-9813(06)80067-6. The extrapolation is performed by counting months from 80 mg down to (1-3 mg) (e.g. 80 >>> 40 >> >20 >> >10 >>> 5>>>2.5….equal to FIVE intervals) and adding a grace month, so 80 mg values take a “6 month” interval)

(b) Does not include recombinant zoster vaccine, since this vaccine is non-live.

(c) The interval between blood/passive antibody products and testing for history of dengue infection (which is mandatory
prior to administration of dengue vaccine) should be 12 months.

(d) Assumes a serum IgG concentration of 16 mg/mL.

(e) The reason the interval is 6 months (and not 4 months) is that the quantity of 16.5 IgG/kg does not reflect the upper
ceiling of the quantity of measles IgG in the product.

(f) Measles vaccination is recommended for children with mild or moderate immunosuppression from HIV infection,
and varicella vaccination may be considered for children with mild or moderate immunosuppression from HIV
infection, but both are contraindicated for persons with severe immunosuppression from HIV or any other
immunosuppressive disorder.

(g) Contains antibody only to respiratory syncytial virus.