Two types of trivalent poliovirus vaccines are currently licensed for distribution in the United States: an enhanced inactivated vaccine and a live attenuated, oral vaccine. inactivated vaccine is the recommended vaccine for the primary series and booster dose for children in the United States, whereas oral vaccine is recommended in areas of the world that have circulating poliovirus.
- inactivated vaccine is given to children aged 2, 4, and 6 to 18 months and 4 to 6 years. Primary poliomyelitis immunization is recommended for all children and young adults up to age 18 years. Allergies to any component of inactivated vaccine, including streptomycin, polymixin B, and neomycin, are contraindications to vaccine use.
- Oral vaccine is not recommended for persons who are immunodeficient or for normal individuals who reside in a household where another person is immunodeficient. Oral vaccine should not be given during pregnancy because of the small but theoretical risk to the fetus.
Rubella vaccine
- The vaccine is given with measles and mumps vaccines at 12 to 15 months of age, then at 4 to 6 years.
- The vaccine should not be given to immunosuppressed individuals, although measles, mumps, and rubella vaccine should be administered to young children with HIV without severe immunosuppression as soon as possible after their first birthday. The vaccine should not be given to individuals with anaphylactic reaction to neomycin.
- Although the vaccine has not been associated with congenital rubella syndrome, its use in pregnancy is contraindicated. Women should be counseled not to become pregnant for 4 weeks following vaccination.
Varicella vaccine
- Varicella virus vaccine is recommended for all children 12 to 18 months of age and for persons above this age if they have not had chickenpox. Persons aged 13 years and older should receive two doses separated by 4 to 8 weeks.
- The vaccine is contraindicated in immunosuppressed or pregnant patients.
- Children with asymptomatic or mildly symptomatic HIV should receive two doses of varicella vaccine 3 months apart.
Varicella-zoster immune globulin
- Varicella-zoster immune globulin is used for passive immunization of susceptible immunodeficient patients exposed to varicella-zoster infection.
- Use of Varicella zoster immune globulin should be considered in exposed children and certain adults who are immunocompromised and susceptible to varicella-zoster. Conditions warranting consideration of Varicella zoster immune globulin after varicella-zoster virus exposure are as follows:
- Children with primary or acquired immunodeficiency, neoplastic disease, or who require immunosuppressive therapy
- Neonates whose mothers develop varicella within 5 days before or 2 days after delivery
- Preterm infants (less than 28 weeks’ gestation or who weigh less than 1000 g) who are exposed to varicella while hospitalized
- Susceptible pregnant women
- Immunosuppressed adults and adolescents
- For maximum effectiveness, Varicella zoster immune globulin must be given within 48 hours and not more than 96 hours following exposure.
- Administration of Varicella zoster immune globulin is by the intramuscular route (never intravenously).
Immune globulin
- Immune globulin is available as both intramuscular (IGIM) and intravenous (IGIV) preparations.
| TABLE. Indications and Dosage of Intramuscular Immune Globulin in Infectious Diseases |
| Primary immunodeficiency states |
1.2 mL/kg intramuscularly, then 0.6 mL/kg every 2-4 wk |
| Hepatitis A exposure |
0.02 mL/kg intramuscularly within 2 wk |
| Hepatitis A prophylaxis |
0.02 mL/kg intramuscularly for exposure <3 months’ duration |
| 0.06 mL/kg intramuscularly for exposure up to 5 months’ duration |
| Hepatitis B exposure |
0.06 mL/kg (hepatitis B immune globulin preferred in known exposures) |
| Measles exposure |
0.25 mL/kg (maximum dose 15 mL) as soon as possible |
| 0.5 mL/kg (maximum dose 15 mL) as soon as possible for immunocompromised individuals |
| Varicella exposure |
0.6-1.2 mL/kg as soon as possible when Varicella zoster immune globulin not available |
|
- Table Indications and Dosage of Intramuscular Immune Globulin in Infectious Diseases lists the suggested dosages for IGIM in various disease states.
- The uses for IVIG are as follows:
- Primary immunodeficiency states including both antibody deficiencies and combined deficiencies
- Idiopathic thrombocytopenic purpura
- Chronic lymphocytic leukemia in patients who have had a serious bacterial infection
- Kawasaki disease (mucocutaneous lymph node syndrome)
- Bone marrow transplant
- Varicella-zoster
Rho(D) Immune globulin (RDIg)
- RDIg suppresses the antibody response and formation of anti-Rho(D) in Rho(D)-negative, Du-negative women exposed to Rho(D)-positive blood and prevents the future chance of erythroblastosis fetalis in subsequent pregnancies with a Rho(D)-positive fetus.
- RDIg, when administered within 72 hours of delivery of a full-term infant, reduces active antibody formation from 12% to between 1 and 2%.
- RDIg is also used in the case of a premenopausal woman who is Rho(D) negative and has inadvertently received Rho(D)-positive blood or blood products.
- RDIg may be used after abortion, miscarriage, amniocentesis, or abdominal trauma.
- RDIg is administered intramuscularly only.
