Immune globulins

The immune globulins are generally felt to be safe to administer during pregnancy. In the list below are come case reports that may give reason for caution. In most cases when one is considering the use of these globulins, however, the risk of disease in question outweighs theoretical concerns regarding the vaccine. This would certainly be true of rabies and likely equally so in the case of tetanus.

The one exception to this might be the instance where one is seeking to prevent Hepatitis A. Majority opinion among Travel Medicine specialists is that use of the Hepatitis A vaccine is almost always preferable in this case, even when the vaccine is being given shortly before or after exposure. Data in support of this position is presented below.

1. Ross JL. Dermatoglyphics on offspring of women given gammaglobulin prophylaxis during pregnancy. Teratology 1996; 53:285–291. Although immune globulin preparations have been used for years in pregnant women, a 1996 report showed an increase in fingertip dermatoglyphic changes in infants whose mothers received >5 mL.

2. Ross L. Congenital anomalies in two infants born after gestational gamma-globulin prophylaxis. Acta Paediatr 1995 Dec;84(12):1436-7. The offspring of two women given prophylactic gamma-globulin 50 and 54 days after their last menstrual periods had congenital duodenal stenosis and a paraoesophageal hiatus hernia, respectively. The possibility that gamma-globulin may have contributed to these malformations is discussed.

3. Koren G; Money D; Boucher M; et al. Serum concentrations, efficacy, and safety of a new, intravenously administered varicella zoster immune globulin in pregnant women. J Clin Pharmacol 2002 Mar;42(3):267-74

4. Sagliocca L, Amoroso P, Stroffolini T, et al. Efficacy of hepatitis A vaccine in prevention of secondary hepatitis A infection: a randomised trial. Lancet. 1999 Apr 3;353(9159):1136-9. INTERPRETATION: Hepatitis A vaccine is effective in the prevention of secondary infection of HAV and should be recommended for household contacts of primary cases of HAV infection.

5. Irwin D J, Millership S. Antibody responses to Hepatitis A vaccine in healthy adults. Commun Dis Public Health 2001; 4:139-140 Conclusions: Even with a sensitive assay an antibody response to hepatitis A vaccine wasnot detectable until 12-15 days post vaccination. Responses were variable, but all were lower than those from naturally acquired infection.... The Shanghai experience of an incubation period ranging from 12-36 days with a mean of 22 days may explain why a single dose of HAV vaccine before or soon after exposure appears to be effective prophylaxis.

6. Taliani G, Gaeta GB. Hepatitis A: post-exposure prophylaxis. Vaccine. 2003 Jun 2;21(19-20):2234-7. We report on the findings of an exploratory review of evidence published in English from 1945 to identify the best post-exposure prophylaxis treatment and the longest acceptable interval after exposure for prophylaxis to be effective. We found no evidence that post-exposure administration of currently available immunoglobulins is effective in preventing hepatitis A infection and disease. The use of immunoglobulins for immunoprophylaxis should not be widely recommended until a systematic review of the evidence has been conducted. We recommend that active immunization to secondary contacts of exposed and vaccinated subjects be offered.