- Overview of Immunization
- Chikungunya Vaccine
- COVID-19 Vaccine
- Diphtheria-Tetanus-Pertussis Vaccine
- Ebola Vaccine
- Haemophilus influenzae Type b (Hib) Vaccine
- Hepatitis A (HepA) Vaccine
- Hepatitis B (HepB) Vaccine
- Herpes Zoster Vaccine
- Human Papillomavirus (HPV) Vaccine
- Influenza Vaccine
- Measles, Mumps, and Rubella (MMR) Vaccine
- Meningococcal Vaccine
- Mpox Vaccine
- Pneumococcal Vaccine
- Poliomyelitis Vaccine
- Respiratory Syncytial Virus (RSV) Vaccine
- Rotavirus Vaccine
- Tetanus-Diphtheria Vaccine
- Varicella Vaccine
- Passive Immunization
Topic Resources
Passive immunization involves administering antibodies to a person; these antibodies are directed against an organism or against a toxin produced by an organism.
Passive immunization is provided in the following circumstances:
When people cannot synthesize antibody independently
When people have been exposed to a disease that they are not immune to or that is likely to cause complications
When people have a disease and the effects of the produced toxin must be ameliorated
Passive immunization does not induce natural immunity.
(See table Immune Globulins and Antitoxins.)
Immune Globulins and Antitoxins*
Immunobiologic Agent | Type | Indications |
|---|---|---|
Botulinum antitoxin | Specific equine antibodies | Treatment of botulism |
Botulinum antitoxin (BIG) | Specific human antibodies | Treatment of botulism in infants |
Cytomegalovirus immune globulin, IV (CMV-IGIV)Cytomegalovirus immune globulin, IV (CMV-IGIV) | Specific human antibodies | Prophylaxis in hematopoietic stem cell transplant and kidney transplant recipients |
Diphtheria antitoxin | Specific equine antibodies | Treatment of respiratory diphtheria |
Hepatitis B immune globulin (HBIG)Hepatitis B immune globulin (HBIG) | Specific human antibodies | Prophylaxis for hepatitis B postexposure |
Immune globulin (IG) | Pooled human antibodies | Prophylaxis for hepatitis A preexposure and postexposure, measles postexposure, immunoglobulin deficiency, rubella during the first trimester of pregnancy, varicella (if varicella-zoster immune globulin is unavailable) (if varicella-zoster immune globulin is unavailable) |
Immune globulin, intravenous (IVIG) | Pooled human antibodies | Prophylaxis for and treatment of severe bacterial and viral infections (eg, HIV infection in children), primary immunodeficiency disorders, immune thrombocytopenia, chronic B-cell lymphocytic leukemia, Kawasaki disease, autoimmune disorders (eg, myasthenia gravis, Guillain-Barré syndrome, idiopathic inflammatory myopathies) Prophylaxis for graft-vs-host disease |
Immune globulin, subcutaneous (SCIG) | Pooled human antibodies | Treatment of primary immunodeficiency disorders |
Rabies immune globulin (HRIG)†Rabies immune globulin (HRIG)† | Specific human antibodies | Management of rabies postexposure in people not previously immunized with rabies vaccinein people not previously immunized with rabies vaccine |
Respiratory syncytial virus (RSV) human monoclonal antibody | Recombinant monoclonal antibody (nirsevimab, palivizumab)Recombinant monoclonal antibody (nirsevimab, palivizumab) | Prevention of RSV in infants born to mothers not adequately immunized against RSV |
Tetanus immune globulin (TIG)Tetanus immune globulin (TIG) | Specific human antibodies | Treatment of tetanus Postexposure prophylaxis in people not adequately immunized with tetanus toxoid |
Vaccinia immune globulin (VIG)Vaccinia immune globulin (VIG) | Specific human antibodies | Treatment of eczema vaccinatum, vaccinia necrosum, and ocular vaccinia |
Varicella-zoster immune globulin (VZIG)Varicella-zoster immune globulin (VZIG) | Specific human antibodies | Postexposure prophylaxis in people who have no evidence of immunity, are at increased risk of severe varicella, and have contraindications to the varicella vaccine |
* Immune globulin preparations and antitoxins are administered IM unless otherwise indicated. | ||
† Rabies immune globulin (HRIG) is administered around wounds as well as intramuscularly. | ||
Adapted from Centers for Disease Control and Prevention. Timing and Spacing of Immunobiologics. Accessed April 21, 2025. | ||
Human immune globulin (IG)
IG is a concentrated antibody-containing solution prepared from plasma obtained from healthy donors. It consists primarily of IgG, although trace amounts of IgA, IgM, and other serum proteins may also be present. IG very rarely contains transmissible viruses (eg, hepatitis B or C, HIV) and is stable for many months if stored at 4° C. IG is administered intramuscularly (IM).
Because maximal serum antibody levels may not occur until about 48 hours after IM injection, IG must be administered as soon after exposure as possible. Half-life of the primary IgG component of IG in the circulation is about 3 weeks.
IG may be used for prophylaxis in people exposed to or at risk of:
Varicella (in immunocompromised patients when varicella-zoster IG is unavailable)
Rubella exposure during the first trimester of pregnancy
IG provides only temporary protection; the antibody content against specific agents varies by as much as 10-fold among preparations. Administration is painful, and anaphylaxis can occur.
IV immune globulin (IVIG) was developed to provide larger and repeated doses of human IG. IVIG is used to treat or prevent severe bacterial and viral infections, autoimmune disorders, and immunodeficiency disorders, particularly the following:
Prevention of graft-vs-host disease
Subcutaneous immune globulin (SCIG) is also prepared from pooled human plasma; SCIG is usually intended for home use in patients with a primary immunodeficiency.
Adverse effects of IVIG may include fever, chills, headache, faintness, nausea, vomiting, hypersensitivity, coughing, and volume overload (1). Systemic adverse effects (eg, fever, chills) are less common with SCIG than with IVIG (2). Serious adverse effects, such as anaphylactic reactions, kidney impairment, thrombosis, arrhythmia, aseptic meningitis, hemolytic anemia, and transfusion-related acute lung injury, are rare with either IG formulation.
References
1. Martinez C, Wallenhorst C, van Nunen S. Intravenous immunoglobulin and the current risk of moderate and severe anaphylactic events, a cohort study. Clin Exp Immunol. 2021;206(3):384-394. doi:10.1111/cei.13665
2. Guo Y, Tian X, Wang X, Xiao Z. Adverse Effects of Immunoglobulin Therapy. Front Immunol. 2018;9:1299. Published 2018 Jun 8. doi:10.3389/fimmu.2018.01299
Hyperimmune globulin
Hyperimmune globulin is prepared from the plasma of people with high titers of antibody against a specific organism or antigen. It is derived from people convalescing from natural infections or from donors artificially immunized. Hyperimmune globulin can be administered IM or IV.
Hyperimmune globulins are available for treatment of the following infections:
Anti-Rho(D) hyperimmune globulin is available for the prevention of hemolytic disease of the fetus and neonate and for the treatment of immune thrombocytopenia.
Administration of hyperimmune globulin is usually painful, and anaphylaxis may occur.
