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Post-exposure prophylaxis for measles with immunoglobulins revised recommendations of the standing committee on vaccination in Germany

Matysiak-Klose, Dorothea, Santibanez, Sabine, Schwerdtfeger, Christine, Koch, Judith, von Bernuth, Horst, Hengel, Hartmut, Littmann, Martina, Terhardt, Martin, Wicker, Sabine, Mankertz, Annette, Heininger, Ulrich
Vaccine 2018 v.36 no.52 pp. 7916-7922
Measles virus, antibodies, at-risk population, body weight, disease control, humans, immunoglobulin G, infants, intravenous injection, measles, patients, pregnant women, risk, vaccination, vaccines, viruses, Germany
Passive immunisation with immunoglobulins as post-exposure prophylaxis after contact with measles is recommended by the German Standing Committee on Vaccination (STIKO) particularly for unprotected individuals at high risk of complications for whom active immunization is contraindicated, such as infants <6 months of age, immunocompromised patients and pregnant women. The efficacy of passive immunisation in preventing measles depends on how soon after exposure it is administered, the concentration of measles antibodies in the immunoglobulin products and dosage. Since the global introduction of standard active immunisation against measles and the concomitant reduction in virus circulation, the levels of measles virus (MV)-specific IgG antibodies in the population have dropped. Thus, the concentration of MV-specific antibodies in immunoglobulin products derived from human plasma donors has declined as the proportion of vaccinated donors has increased. The MV-neutralizing capacity of immunoglobulin products is not routinely tested in Germany. No official data exist on the concentrations of MV-specific IgG antibodies in individual batches of immunoglobulins available in Germany and the required minimum level for MV-specific IgG is not stipulated.The STIKO re-evaluated available data and measurements of MV-neutralizing capacities of available immunoglobulin (IgG) products in Germany at the National Reference Centre Measles, Mumps, Rubella at the Robert Koch Institute. Based on the findings, STIKO modified its previous recommendations on the post-exposure use of immunoglobulins (2001), especially with respect to risk groups, application and dosage. STIKO now recommends a single intravenous administration of immunoglobulins (400 mg/kg body weight) as soon as possible, preferably within six days, after exposure to measles, specifically for infants aged <6 months, susceptible pregnant women and immunocompromised patients.