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Table of contents :
)
: hypervaccination is the subsequent
inoculation (one or
more times) of a previously immunized animal (usually horse
(Equus
caballus), goat (Capra
hircus) or cow (Bos
taurus)) with enough vaccine to enable it to
afford a serum
protective
to other animals. Immunogenicity is often reduced by
treating
heterologous
Igs with pepsin and using only F(ab')2 fragments,
that
cannot
bind to FcRs nor activate C1q. Anyway they can still cause anaphylaxis
or type III
hypersensitivity. The former can be avoided by immunotherapy
inducing
peripheral
tolerance.
Measure unit : IU. E.g.
heterologous serum : 20-40 mL
serotypes A, B and E heterologous serum : 10,000 IU
and related gangrene Bacteria heterologous serum
: 25,000 IU.
heterologous serum : 3,000-6,000 IU
heterologous serum : 5,000-10,000 IU. 1 unit of
diphtheria
antitoxin
is approximately the amount that will preserve the life of a
guinea pig
weighing 250 g for at least 4 days after it is injected
subcutaneously
with a mixture of 100 times the minimum lethal dose of
diphtheria toxin
heterologous serum. The U.S. Public Health Service
unit for
scarlet
fever antitoxin neutralizes 50 skin test doses of scarlet
fever toxin
heterologous serum. Felton's unit : a mouse
protective
unit
of antipneumococcic serum; it is that quantity of antibody
capable of
protecting
a white Swiss mouse against 1 million fatal doses of a
standard
pneumococcus
culture of the corresponding type. Frequently, it is
considered to be
the
equivalent of the National Institutes of Health control
serum (P-11).
mAbs are produced by transgenic tobacco (Nicotiana
spp.) plants)as
they could have anti-IgA Ab. As with all plasma-derived
products, the
risk
of transmission of infectious agents cannot be completely
eliminated
and
the physician should weigh the risks and benefits of
administration.
...
(zoster immunoglobulilin (ZIG) / varicella zoster
immunoglobulin
(VZIG))
does not effectively prevent VZV infection and is
therefore restricted
to high risk individuals (i.e. immunocompromised
children and pregnant
women),
lung,
liver,
pancreas
and heart
transplants : in transplants of these organs other than
kidney from CMV
seropositive donors into seronegative recipients,
prophylactic CMV-IGIV
should be considered in combination with ganciclovir.
Clinical studies
have shown a 50% reduction in primary CMV disease in
renal transplant
patients
given CMV-IGIVref
and a 56% reduction in serious CMV diseaseref
in liver transplant patients given CMV-IGIV. CMV-IGIV
prophylaxis was
associated
with increased survival in liver transplant recipients.
In 2 separate
clinical
trials, Cytogam was shown to provide effective
prophylaxis in
renal-transplant
recipients at risk for primary CMV disease. In the first
randomized
trialref,
the
incidence of virologically confirmed CMV-associated
syndromes was
reduced
from 60% in controls (n=35) to 21% in recipients of CMV
immune globulin
(n=24) (P<0.01); marked leukopenia was reduced from
37% in controls
to 4% in globulin recipients (P<0.01); and fungal or
parasitic
superinfections
were not seen in globulin recipients but occurred in 20%
of controls
(P=0.05).
Serious CMV disease was reduced from 46% to 13%. There
was a
concomitant
but not statistically significant reduction in the
incidence of CMV
pneumonia
(17% of controls as compared with 4% of globulin
recipients. There was
no effect on rate of viral isolation or seroconversion
although the
rate
of viremia was less in Cytogam recipients. In a
subsequent
non-randomized
trial in renal transplant recipients (n=36)ref,
the
incidence of virologically confirmed CMV-associated
syndrome was
reduced
to 36% in the globulin recipients in comparison to a 60%
incidence in
control
patients (n=35) in the randomized trial. The rates of
serious CMV
disease,
and concomitant fungal and parasitic superinfection were
similar to
patients
receiving CMV-IGIV in the first trial. In a randomized,
double-blind,
placebo-controlled
trial in liver transplant recipientsref,
the
incidence of serious CMV-associated disease was reduced
from 26% in
the 72 control patients to 12% in the 69 CMV-IGIV
recipients (p=0.02);
serious CMV-associated disease included CMV disease in 2
or more
organs,
CMV pneumonia, or CMV-associated invasive fungal
infection, the
incidence
of which was 18% in controls and 7% in CMV-IGIV
recipients (p=0.04). In
follow-upref
of the liver transplant patients studied in this
randomized controlled
trial and a subsequent open-label trialref,
the
one year survival of the 72 control patients was 72%
versus 86% in
the 90 recipients of CMV-IGIV (p=0.03). In the
randomized control
trial,
the reduction in serious CMV-associated disease in CMV
seronegative
recipients
of livers from a CMV seropositive donor (7/19 in the
CMB-IGIV group vs.
9/19 in control) was less than in transplants with other
donor and
recipient
serologic status (1/50 in the CMV-IGIV group vs. 10/53
in the control
group).
This finding was similar to that of Merigan et al.ref
in a study of gancyclovir prophylaxis after heart
transplantation. In
this
study, patients received gancyclovir IV at 5 mg/kg bid
for the initial
14 days post-transplant, then at 6 mg/kg each day for 5
days through
day
28. Recent studies of combined prophylaxis with CMV-IGIV
and
gancyclovir
have shown reductions in the incidence of serious CMV
associated
disease
in CMV seronegative recipients of CMV seropositive
organs below that
expected
from one drug aloneref.
Ham
et alref
used CMV-IGIV with a dosage schedule of 150 mg/kg
CMV-IGIV within 72
hours
of transplant; 100 mg/kg at 2, 4, 6 and 8 weeks
following liver
transplant
and then 50 mg/kg at 12 and 16 weeks post-transplant in
combination
with
ganciclovir (10 mg/kg/day for 14 days). The incidence of
CMV disease
was
reduced from an expected 60-80% rate to 7% in 15
seronegative
recipients
of a seropositive organ. Snydman using the CMV-IGIV
dosage schedule
listed
under DOSAGE and ADMINISTRATION Section in combination
with ganciclovir
(10 mg/kg/day for 14 days) reduced the incidence of
serious CMV disease
in D+R- liver transplant recipients receiving placebo or
one drug from
16/47 (34%) to 3/41 (7%) in patients receiving both
drugs for
prophylaxis.
Martin using CMV-IGIV 100 mg/kg every 2 weeks for 6
weeks followed by
50
mg/kg every 2 weeks with a final dose at week 16, in
combination with
ganciclovir
10 mg/kg/dat for 14 days after transplantation, observed
severe CMV
disease
in 1/74 (1%) of CMV seronegative recipients of a kidney
from a CMV
seropositive
donor, in 0/14 (0%) of CMV seronegative recipients of a
kidney-pancreas
transplant from a CMV seropositive donor and in 1/12
(8%) of CMV
seronegative
recipients of a liver from a CMB seropositive donor. The
incidence of
serious
CMB disease with combined CMV-IGIV and ganciclovir
prophylaxis was
lower
than the previous experience with single drug
prophylaxis. Valantine
and
Luikart compared prophylaxis with CMV-IGIV (biweekly for
3 months) in
combination
with ganciclovir prophylaxis (IV at 5 mg/kg bid for the
initial 14 days
post-transplant, then at 6 mg/kg through day 28) in 16
CMV seronegative
recipients of heart from CMV seropositive donors with 16
matched
controls
receiving ganciclovir alone. The actuarial incidence of
CMV disease was
reduced from 55% in ganciclovir group to 46% in
heart-lung or lung
transplant
patients in whom either the donor or recipient was CMV
seropositive,
the
actuarial incidence of CMV disease in patients receiving
ganciclovir
alone
(n=25) was 85% as compared to 36% of the 33 patients
receiving both
CMV-IGIV
and ganciclovir (p< 0.05). Survival was 60% in the
ganciclovir group
and 80% in patients receiving CMV-IGIV and ganciclovir
(p<0.01).
: tested immune globulins show higher effectiveness than
placebo or
do-nothing
against infectious hepatitis both in pre-exposure and
post-exposure
prophylaxis
(effectiveness 83%; RR: 0.17; 95% CI: 0.15-0.19; and
effectiveness 69%;
RR: 0.31; 95% CI: 0.20-0.47, respectively). Immune
globulins are
efficacious
in preventing infectious hepatitis and hepatitis A, but
included
studies
do not report data about their safety. Average length of
passive
protection
was three months. Given the notable heterogeneity of
performance of
immune
globulins, short protection conferred and absence of trial
safety data,
the only indications for the use of immune globulins may
be in
situations
in which inadequate supplies of vaccine are available or
when the 8-day
window of opportunity for vaccine use is pastref.
Experimental
or epidemiological evidence that immune globulin [IG] is
only
effective if given within a 2-week period after exposure
to the
disease"
is not available, given the vagaries of dose and exposure
conditions
that
lead to acquisition of the virus, resulting in longer
incubation
periods.
From a public health standpoint, the CDC avoids this
controversy by
stating
that efficacy when administered >2 weeks after exposure
has not been
established,
which is an appropriate statement based on analysis of the
dataref.
Routine
vaccination of children is an effective way to reduce
hepatitis
A incidence in the United States. These updated
recommendations
represent
the final step in the childhood hepatitis A immunization
strategy (see:
MMWR, 19 May 2006). But physicians and other healthcare
workers should
appreciate the fact that immune globulin given >2 weeks
after
exposure
might still modulate or abort the infection in some
individuals. It
(rabies immunoglobulin (RIG))
(vaccina immune globulin intravenous (VIGIV))
(source :
DynPort)
was manufactured from plasma donations of military
personnel previously
vaccinated with vaccinia, the virus used to vaccinate
against the
smallpox
virus. The therapeutic contains purified antibodies
specific to the
vaccinia
virus that assist in recovery of persons suffering from
rare
complications
of vaccination against smallpox. VIGIV might be used in
cases of
generalized
vaccinia, eczema vaccinatum or progressive vaccinia.
due to Rh incompatibility beween mother and fetus.
hyperimmune homologous serum from subjects infected with
Escherichia
coli O111:H15.
hyperimmune homologous serum (in burnt subjects)
hyperimmune homologous serum : purified imrnunoglobulin
obtained from
plasma
of healthy human donors known to have high titres of
botulinum
antitoxin
after active immunisation with a vaccine containing
botulinum toxoids
A,
B. C, D and E. Store at 2-8 ºC. Do not freeze.
Protect from light.
hyperimmune homologous serum (tetanus immune globulin
(TIG))
: a panel of Fabs that neutralize anthrax toxin in
vitro was
selected
from libraries generated from human donors vaccinated
against anthrax.
At least 2 of these antibodies protect rats from anthrax
intoxication in
vivo. Fabs 83K7C and 63L1D bind with subnanomolar
affinity to PA63,
and Fab 63L1D neutralizes toxin substoichiometrically,
inhibits LF
interaction
with PA63 and binds to a conformational epitope formed
by PA63ref.)
mAbs :
mAbs :
mAbs :
mAbs :
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2001-2010 Daniele
Focosi.
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