Doses Of Immune Serum Globulin Research Articles

A Shot in the Rear, Not a Shot in the Dark: Application of a Mass Clinic Framework in a Public Health Emergency

An outbreak of foodborne hepatitis A infection compelled two regional health departments in eastern Tennessee to implement an emergency mass clinic for providing hepatitis immune serum globulin (ISG) to several thousand potentially exposed people. For the mass clinic framework, we utilized the smallpox post-event clinic plans of the Centers for Disease Control and Prevention (CDC), although the plans had only been exercised for smallpox. Following CDC's guidelines for staffing and organizing the mass clinic, we provided 5,038 doses of ISG during a total of 24 hours of clinic operation, using 3,467 person-hours, or 1.45 ISG doses per person-hour-very close to the 1.58 doses per person-hour targeted in CDC's smallpox post-event clinic plans. The mass clinic showed that CDC's smallpox post-event clinic guidelines were feasible, practical, and adaptable to other mass clinic situations.

Passive Transfer of Antibody to Hepatitis C

To the Editor.— Passive transfer of antibodies is the usual reason for administering immune serum globulin (ISG). However, the transfer of undesired antibodies may cause concern, especially if a history of recent ISG administration is not elicited prior to serologic testing. Since antigen assays for several viral pathogens are not commercially available, antibody testing must answer critical questions in many situations. Health care workers are especially liable to repeated exposures to blood and body fluids, and thus many courses of ISG can occur. In response to a recent article 1 regarding passive transfer of the hepatitis C virus (HCV) antibody by intravenous administration of ISG, we wish to report a case of documented transient seroconversion to anti-HCV positivity following an intramuscular dose of ISG in a health care worker. Report of a Case.— On November 30, 1990, a healthy 38-year-old Emory University Hospital housekeeping employee splashed blood from a trash

Gamma Globulin Prophylaxis to Reduce Post-Transfusion Non-A, Non-B Hepatitis After Cardiac Surgery with Cardiopulmonary Bypass

A prospective, randomized study of immune serum globulin (ISG) for prevention of post-transfusion hepatitis was performed on 196 patients (100 controls without gammaglobulin or placebo and 96 who received ISG) undergoing valve replacement or coronary artery bypass with extracorporeal circulation. The dose of ISG was 2 ml i.m. at premedication and 2 ml i.m. on postoperative day 3. Probable non-A, non-B hepatitis developed postoperatively in ten of the 100 controls and two of the 96 in the ISG group. Two ISG patients and three controls with non-A, non-B hepatitis still have increased serum aminotransferase values after 3-5 years, but liver biopsy revealed hepatitis, which histologically was very mild, in only two control and two ISG patients. Low-dose gamma globulin thus reduced the incidence of acute, probable non-A, non-B hepatitis in cardiac surgery with cardiopulmonary bypass.

Cutaneous lymphohistiocytic infiltrates in patients with hypogammaglobulinemia

Six patients (5 to 15 years of age) with hypogammaglobulinemia had scattered papular lesions in association with widespread dermatitis. These disfiguring lesions were a portal of entry for secondary infections and led to social withdrawal. Biopsy specimens from the papules demonstrated dense lymphohistiocytic infiltrate limited to the dermis. Infectious causes (bacterial, fungal, and viral) were excluded. The skin lesions failed to respond to conventional treatment, including topical corticosteroids. Replacement therapy with monthly infusions of high doses of immune serum globulin resulted in gradual improvement and ultimate clearing of the lesions. This unusual skin abnormality, which is unresponsive to traditional treatment, may provide the earliest clue to the presence of hypogammaglobulinemia.

Maternal and neonatal neutralizing antibody titers to selected enteroviruses.

Neutralizing antibody titers were determined at term for 98 matched mothers' serum and neonatal cord blood pairs, to coxsackieviruses B2, B3, B4 and B5 and to echovirus 11. The reciprocal of the geometric mean titers of maternal sera were, respectively, 15.3, 18.1, 53.5, 14.1 and 11.4. The geometric mean titers of cord sera were statistically lower for coxsackie B5 and echovirus 11 (P less than 0.031 and p less than 0.005, respectively) than those in maternal sera. The percentage of neonates born with antibody titers less than 1:10 to coxsackieviruses B2, B3, B4 and B5 and echovirus 11 ere 49, 37, 17, 53 and 69%. Thus a large percentage of neonates in our community are born with low titers of enterovirus-neutralizing antibody, which for some infants may be disproportionately lower than maternal titers to selected enteroviruses. Commercially available immune serum globulin contains high titers of antibody to these enteroviruses and may be a useful means of passive antibody acquisition in susceptible neonates at risk for enterovirus infections. However, a single dose of immune serum globulin intramuscularly produced little change in circulating neutralizing antibodies to coxsackie B4 and echovirus 11 in seven neonates.

A Measles Outbreak in a New England Community

Between May 30 and June 29, 1974, 28 cases of measles occurred in schoolchildren in a residential New England community. The index patient probably contracted the disease on a school field trip 11 days before the onset of her illness. Of the other 27 cases, 15 had received live measles vaccine before age 1, and ten had no history of vaccination or disease. Four documented vaccine failures did occur in children vaccinated after age 1, but this was not an unusual number compared with the total number of vaccinees evaluated during the investigation. Control measures for susceptible persons including vaccination or modifying doses of immune serum globulin for exposure occurring more than 24 hours earlier. No additional cases of measles were reported for one month after the epidemic.

Use of Gamma Globulin-Reply

To the Editor:— In reply to a question that concerned the prevention of measles, and was answered by John H. Dingle, M.D. ( JAMA 176 :971 [June 17] 1961), I would like to call Doctor Dingle's attention to the recommendations of the American Academy of Pediatrics, as stated in their 1961 Report of the Committee on the Control of Infectious Diseases. On page 22, under the title of Measles, the following is reported: Measles should be prevented by a large dose of immune serum globulin (gamma globulin) in all infants under 2 or 3 years of age, in chronically ill children, in healthy children whose siblings are ill with other diseases (tuberculosis, pertussis, and rheumatic fever in particular), or when the disease appears in an institution or hospital ward. The dose is 0.25 ml. per kilogram intramuscularly, and should be given as soon as possible after exposure. Gamma globulin should be