Recommended Timing of Routine Measles Immunization for Children Who Have Recently Received Immune Globulin Preparations

Abstract

Passively acquired antibody can block replication of live viral vaccines and subsequent active immune responses.1-3 The persistence of transplacentally acquired maternal measles antibodies can interfere with the response to measles vaccine in some infants up to 12 months of age.4,5 Simultaneous or prior administration of immune globulin administered through the intramuscular or intravenous route has a similar blunting or blocking effect on the host response to certain live virus vaccines.1,6,7 The American Academy of Pediatrics previously recommended a 3-month interval after administration of immune globulin before parenteral administration of live viral vaccines, including measles, mumps, and rubella vaccines (MMR). This recommendation was based on the half-life of passively administered immune globulin and data from individuals who received low doses of immune globulin.2 However, immune globulin is now used in larger doses for treatment or prevention of several diseases, 8 necessitating a lengthening in the interval between use of immune globulin and the administration of certain live virus vaccines. INTERFERENCE WITH MEASLES IMMUNIZATION In a recent study high doses of immune globulin interfered with the response to measles immunization for more than 3 months.1 Children who received bacterial polysaccharide immune globulin (BPIG), a product under clinical evaluation, in a dose of 0.5 mL/kg (80 mg of IgG per kilogram) intramuscularly had reduced measles antibody response when measles vaccine was given as long as 5 months after administration of BPIG (Figure). The measles antibody concentrations (pen gram of protein) in BPIG were similar to concentrations found in preparations of immune globulin (IG) for intramuscular administration, specific immune globulin preparations (eg, VZIG, HBIG, and TIG), and immune globulin for intravenous administration (IGIV).