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IVIG for postexposure varicella prophylaxis: use this approach if there's a shortage of varicella zoster immune globulin, CDC advisory panel says.(Clinical Rounds)
ATLANTA -- Intravenous immune globulin should be the primary means of post-exposure prophylaxis among persons at high risk of severe varicella complications if there is a shortage of varicella zoster immune globulin, according to a vote by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.
This decision was made in the face of looming shortages of varicella zoster immune globulin (VZIG), which may begin in January 2006, when the sole U.S. manufacturer, Massachusetts Public Health Biological Laboratories, closes its plasma fractionation facility, said Dorothy Scott, M.D., of the Food and Drug Administration's Office of Blood Research and Review and Center for Biologics Evaluation and Research.
Among the factors favoring the use of intravenous immune globulin (IVIG) for postexposure prophylaxis is the fact that it usually is in ample supply, although there have been some shortages in the past, said Philip LaRussa, M.D., of the division of pediatric infectious diseases, Columbia Presbyterian Medical Center, New York City. Current IVIG has good antivaricella titers, with 3-8 mL/kg required.
The use of IVIG also permits the window for prophylaxis to be extended, because the peak level is reached much more quickly than with VZIG, within 24 hours, Dr. LaRussa said. But there are certain concerns when IVIG is used instead of VZIG. These preparations are not titered for antivaricella antibodies, so there may be some variation in efficacy, he added.
"Also, this is going to be a moving target because as we do a better and better job with immunization, and donations made by adults with natural varicella immunity are replaced by those with vaccine-induced immunity, we may have to use more," he said.
The following groups are recommended for prophylaxis:
* Immunocompromised patients without evidence of immunity to varicella.
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