Passive immunization involves giving antibodies to an organism or to a toxin produced by an organism.
Passive immunization is provided in the following circumstances:
When people cannot synthesize antibody
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 toxin must be ameliorated
Passive immunization does not induce natural immunity.
(See table Immune Globulins and Antitoxins Available in the United States.)
Immune Globulins and Antitoxins* Available in the United States
Immunobiologic Agent | Type | Indications |
|---|---|---|
Botulinum antitoxin | Specific equine antibodies | Treatment of botulism |
Botulinum antitoxin (BIG) | Specific human antibodies | Treatment of botulism in infants |
Specific human antibodies | Prophylaxis in hematopoietic stem cell transplant and kidney transplant recipients | |
Diphtheria antitoxin | Specific equine antibodies | Treatment of respiratory diphtheria |
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 1st trimester of pregnancy, varicella (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, autoimmune thrombocytopenic purpura, chronic B-cell lymphocytic leukemia, Kawasaki disease, autoimmune disorders (eg, myasthenia gravis, Guillain-Barré syndrome, polymyositis/dermatomyositis) Prophylaxis for graft-vs-host disease |
Immune globulin, subcutaneous (SCIG) | Pooled human antibodies | Treatment of primary immunodeficiency disorders |
Specific human antibodies | Management of rabies postexposure | |
Respiratory syncytial virus (RSV) human monoclonal antibody | Prevention of RSV in infants born to mothers not adequately immunized against RSV | |
Specific human antibodies | Treatment of tetanus Postexposure prophylaxis in people not adequately immunized with tetanus toxoid | |
Specific human antibodies | Treatment of eczema vaccinatum, vaccinia necrosum, and ocular vaccinia | |
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 given intramuscularly unless otherwise indicated. | ||
† Rabies immune globulin (HRIG) is given around wounds as well as intramuscularly. | ||
Adapted from Kroger A, Bahta L, Long S, et al: General best practice guidelines for immunization: Best practice guidance of the Advisory Committee on Immunization Practices (ACIP). Accessed on March 27, 2024. | ||
Human immune globulin (IG)
IG is a concentrated antibody-containing solution prepared from plasma obtained from normal donors. It consists primarily of IgG, although trace amounts of IgA, IgM, and other serum proteins may 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 given intramuscularly (IM).
Because maximal serum antibody levels may not occur until about 48 hours after IM injection, IG must be given as soon after exposure as possible. Half-life 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 immune globulin. 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
Adverse effects of IVIG are uncommon, although fever, chills, headache, faintness, nausea, vomiting, hypersensitivity, anaphylactic reactions, coughing, and volume overload have occurred.
Subcutaneous immune globulin (SCIG) is also prepared from pooled human plasma; SCIG is intended for home use in patients with a primary immunodeficiency.
Injection site reactions are common, but systemic adverse effects (eg, fever, chills) are much less common with SCIG than with IVIG.
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 donors artificially immunized.
Hyperimmune globulins are available for
Administration is painful, and anaphylaxis may occur.
