BNF for Children 2011-2012

BNFC 2011–2012 14.5.1 Normal Immunoglobulin 623pressed; normal immunoglobulin should be given assoon as possible, preferably within 14 days of exposureto the primary case. However, normal immunoglobulincan still be given to contacts at risk of severe disease upto 28 days after exposure to the primary case. HepatitisA vaccine can be given at the same time, but it should begiven at a separate injection site.Measles Intravenous or subcutaneous normalimmunoglobulin may be given to prevent or attenuatean attack of measles in children with compromisedimmunity. Children with compromised immunity whohave come into contact with measles should receiveintravenous or subcutaneous normal immunoglobulinas soon as possible after exposure. It is most effective ifgiven within 72 hours but can be effective if given within6 days.Subcutaneous or intramuscular normal immunoglobulinshould also be considered for the following individuals ifthey have been in contact with a confirmed case ofmeasles or with a person associated with a local outbreak:. non-immune pregnant women. infants under 9 monthsFurther advice should be sought from the Centre forInfections, Health Protection Agency (tel. (020) 82006868).Children with normal immunity who are not in theabove categories and who have not been fully immunisedagainst measles, can be given MMR vaccine(section 14.4) for prophylaxis following exposure tomeasles.Rubella Intramuscular immunoglobulin after exposureto rubella does not prevent infection in non-immunecontacts and is not recommended for protection ofpregnant females exposed to rubella. It may, however,reduce the likelihood of a clinical attack which maypossibly reduce the risk to the fetus. Risk of intrauterinetransmission is greatest in the first 11 weeks ofpregnancy, between 16 and 20 weeks there is a minimalrisk of deafness only, after 20 weeks there is noincreased risk. Intramuscular normal immunoglobulinshould be used only if termination of pregnancy wouldbe unacceptable to the pregnant individual—it shouldbe given as soon as possible after exposure. Serologicalfollow-up of recipients is essential.For routine prophylaxis, see MMR vaccine (p. 612).NORMAL IMMUNOGLOBULINCautions hypo- or agammaglobulinaemia with orwithout IgA deficiency; interference with live virusvaccines—see p. 622Intravenous use Thrombophilic disorders, or risk factors forarterial or venous thromboembolic events; obesity; ensureadequate hydration, renal insufficiencyContra-indications patients with selective IgA deficiencywho have known antibody against IgARenal impairment monitor for acute renal failure;consider discontinuation if renal function deteriorates.Intravenous preparations with added sucrose havebeen associated with cases of renal dysfunction andacute renal failureSide-effects nausea, diarrhoea, chills, fever, headache,dizziness, arthralgia, myalgia, muscle spasms,low back pain; rarely hypotension, anaphylaxis,cutaneous skin reactions, aseptic meningitis, acuterenal failure; also reported with intravenous use,injection site reactions, abdominal pain and distension,blood pressure fluctuations, haemolytic anaemia,thromboembolic events including myocardialinfarction, stroke, pulmonary embolism, and deepvein thrombosisNote Adverse reactions are more likely to occur in patientsreceiving normal immunoglobulin for the first time, or followinga prolonged period between treatments, or when adifferent brand of normal immunoglobulin is administered.Side-effectsNote Adverse reactions are more likely to occur in patientsreceiving normal immunoglobulin for the first time, or followinga prolonged period between treatments, or when adifferent brand of normal immunoglobulin is administeredIndication and doseSee under preparationsNote Antibody titres can vary widely between normalimmunoglobulin preparations from different manufacturers—formulationsare not interchangeable; patientsshould be maintained on the same formulation throughoutlong-term treatment to avoid adverse effectsFor intramuscular useNormal Immunoglobulin ANormal immunoglobulin injection. 250-mg vial; 750-mg vialDoseTo control outbreaks of hepatitis A (see notes above). By deep intramuscular injectionChild under 10 years 250 mgChild 10–18 years 500 mgRubella in pregnancy, prevention of clinical attack. By deep intramuscular injection750 mgAvailable from the Centre for Infections and other regional HealthProtection Agency offices (for contacts and control of outbreaksonly, see above)For subcutaneous useNote Preparations for subcutaneous use may be administeredby intramuscular injection if subcutaneous route notpossible; intramuscular route not recommended for patientswith thrombocytopenia or other bleeding disordersGammanorm c (Octapharma) TANormal immunoglobulin (protein 16.5%) injection,net price 10-mL vial = £113.85, 20-mL vial = £227.70Electrolytes Electrolytes: Na + 1.09 mmol/10-mL vialDoseAntibody deficiency syndromes. By subcutaneous infusionConsult product literatureSubcuvia c (Baxter) ANormal immunoglobulin (protein 16%) injection, netprice 5-mL vial = £32.56, 10-mL vial = £65.12DoseAntibody deficiency syndromes. By subcutaneous infusionConsult product literature (not licensed for use in childrenunder 12 years)14 Immunological products and vaccines