Effectiveness and Safety of an Intravenous Immune Globulin (IVIG) Preparation in Post-exposure Prophylaxis (PEP) Against Measles in Infants

Background: Administration of measles virus (MV)-specific IgG as post-exposure prophylaxis (PEP) is known to effectively prevent measles. Since the introduction of active immunization against measles, the levels of MV-specific IgG antibodies in the population have dropped. Therefore, the concentrati...

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Autores principales:	Benno Kohlmaier, Heidemarie Holzmann, Karin Stiasny, Manuel Leitner, Christoph Zurl, Volker Strenger, Michael Kundi, Werner Zenz
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	measles post-exposure prophylaxis intravenous immunoglobulins measles virus specific neutralizing antibody maternal measles-specific IgG antibodies measles outbreak control Pediatrics RJ1-570
Acceso en línea:	https://doaj.org/article/9e05ada2291e4e3bab72989d38b124dd
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spelling	oai:doaj.org-article:9e05ada2291e4e3bab72989d38b124dd2021-12-02T11:48:46ZEffectiveness and Safety of an Intravenous Immune Globulin (IVIG) Preparation in Post-exposure Prophylaxis (PEP) Against Measles in Infants2296-236010.3389/fped.2021.762793https://doaj.org/article/9e05ada2291e4e3bab72989d38b124dd2021-12-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fped.2021.762793/fullhttps://doaj.org/toc/2296-2360Background: Administration of measles virus (MV)-specific IgG as post-exposure prophylaxis (PEP) is known to effectively prevent measles. Since the introduction of active immunization against measles, the levels of MV-specific IgG antibodies in the population have dropped. Therefore, the concentration of MV-specific antibodies in immunoglobulin products derived from human plasma donors has declined as the proportion of vaccinated donors has increased. Literature on the effectiveness of PEP with current available immunoglobulins is limited. Here we examine the effectiveness of 400 mg/kg intravenous immunoglobulin (IVIG) (IgVena®, Kendrion) as PEP in infants during a measles outbreak in Austria, 2019.Methods: After exposure to a highly contagious measles patient, identified infants were evaluated for eligibility for IVIG PEP. Infants were tested for measles maternal antibodies, if the result was expected to be available within 72 h after exposure. IVIG was administered to eligible infants with negative maternal IgG antibody levels (n = 11), infants with protective levels but result beyond 72 h (n = 2) and infants not tested for maternal IgG antibodies (n = 52). Telephone enquiries were made asking for measles infection. Effectiveness was calculated using exact logistic regression. Samples of four out of seven used IVIG batches were tested for MV-neutralizing antibody capacity.Results: In 63 (96.9%) of 65 infants PEP with IVIG was administered. The parents of two infants declined IVIG PEP. None of the infants with IVIG PEP got measles or symptoms suggestive for measles, but both infants who did not receive PEP were infected. Effectiveness of IVIG PEP was calculated to be 99.3% (CI 95%: 88.7–100%). No serious adverse event of IVIG treatment was observed. The investigation on MV-neutralizing antibody capacity showed a geometric mean titer ranging from 10.0 to 12.7 IU/ml, resulting in a 1.57–2.26-fold higher concentration than postulated as minimum level for immunity.Conclusions: Our findings suggest that the used IVIG preparation provided an at least non-inferior protection rate compared to IVIG preparations derived from donors before the global introduction of standard active immunization against measles.Benno KohlmaierHeidemarie HolzmannKarin StiasnyManuel LeitnerChristoph ZurlVolker StrengerMichael KundiWerner ZenzFrontiers Media S.A.articlemeasles post-exposure prophylaxisintravenous immunoglobulinsmeasles virus specific neutralizing antibodymaternal measles-specific IgG antibodiesmeasles outbreak controlPediatricsRJ1-570ENFrontiers in Pediatrics, Vol 9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	measles post-exposure prophylaxis intravenous immunoglobulins measles virus specific neutralizing antibody maternal measles-specific IgG antibodies measles outbreak control Pediatrics RJ1-570
spellingShingle	measles post-exposure prophylaxis intravenous immunoglobulins measles virus specific neutralizing antibody maternal measles-specific IgG antibodies measles outbreak control Pediatrics RJ1-570 Benno Kohlmaier Heidemarie Holzmann Karin Stiasny Manuel Leitner Christoph Zurl Volker Strenger Michael Kundi Werner Zenz Effectiveness and Safety of an Intravenous Immune Globulin (IVIG) Preparation in Post-exposure Prophylaxis (PEP) Against Measles in Infants
description	Background: Administration of measles virus (MV)-specific IgG as post-exposure prophylaxis (PEP) is known to effectively prevent measles. Since the introduction of active immunization against measles, the levels of MV-specific IgG antibodies in the population have dropped. Therefore, the concentration of MV-specific antibodies in immunoglobulin products derived from human plasma donors has declined as the proportion of vaccinated donors has increased. Literature on the effectiveness of PEP with current available immunoglobulins is limited. Here we examine the effectiveness of 400 mg/kg intravenous immunoglobulin (IVIG) (IgVena®, Kendrion) as PEP in infants during a measles outbreak in Austria, 2019.Methods: After exposure to a highly contagious measles patient, identified infants were evaluated for eligibility for IVIG PEP. Infants were tested for measles maternal antibodies, if the result was expected to be available within 72 h after exposure. IVIG was administered to eligible infants with negative maternal IgG antibody levels (n = 11), infants with protective levels but result beyond 72 h (n = 2) and infants not tested for maternal IgG antibodies (n = 52). Telephone enquiries were made asking for measles infection. Effectiveness was calculated using exact logistic regression. Samples of four out of seven used IVIG batches were tested for MV-neutralizing antibody capacity.Results: In 63 (96.9%) of 65 infants PEP with IVIG was administered. The parents of two infants declined IVIG PEP. None of the infants with IVIG PEP got measles or symptoms suggestive for measles, but both infants who did not receive PEP were infected. Effectiveness of IVIG PEP was calculated to be 99.3% (CI 95%: 88.7–100%). No serious adverse event of IVIG treatment was observed. The investigation on MV-neutralizing antibody capacity showed a geometric mean titer ranging from 10.0 to 12.7 IU/ml, resulting in a 1.57–2.26-fold higher concentration than postulated as minimum level for immunity.Conclusions: Our findings suggest that the used IVIG preparation provided an at least non-inferior protection rate compared to IVIG preparations derived from donors before the global introduction of standard active immunization against measles.
format	article
author	Benno Kohlmaier Heidemarie Holzmann Karin Stiasny Manuel Leitner Christoph Zurl Volker Strenger Michael Kundi Werner Zenz
author_facet	Benno Kohlmaier Heidemarie Holzmann Karin Stiasny Manuel Leitner Christoph Zurl Volker Strenger Michael Kundi Werner Zenz
author_sort	Benno Kohlmaier
title	Effectiveness and Safety of an Intravenous Immune Globulin (IVIG) Preparation in Post-exposure Prophylaxis (PEP) Against Measles in Infants
title_short	Effectiveness and Safety of an Intravenous Immune Globulin (IVIG) Preparation in Post-exposure Prophylaxis (PEP) Against Measles in Infants
title_full	Effectiveness and Safety of an Intravenous Immune Globulin (IVIG) Preparation in Post-exposure Prophylaxis (PEP) Against Measles in Infants
title_fullStr	Effectiveness and Safety of an Intravenous Immune Globulin (IVIG) Preparation in Post-exposure Prophylaxis (PEP) Against Measles in Infants
title_full_unstemmed	Effectiveness and Safety of an Intravenous Immune Globulin (IVIG) Preparation in Post-exposure Prophylaxis (PEP) Against Measles in Infants
title_sort	effectiveness and safety of an intravenous immune globulin (ivig) preparation in post-exposure prophylaxis (pep) against measles in infants
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/9e05ada2291e4e3bab72989d38b124dd
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Effectiveness and Safety of an Intravenous Immune Globulin (IVIG) Preparation in Post-exposure Prophylaxis (PEP) Against Measles in Infants

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