Appendix A

A

Appendix A-23

Recommended intervals between administration of antibody-containing products and 

measles- or varicella-containing vaccine, by product and indication for vaccination

Product/Indication Dose (mg IgG/kg) and route(a)

Recommended interval 

before measles- or live 

varicella-containing vaccine(b)

administration

Blood transfusion—RBCs, washed 10 mL/kg, negligible IgG/kg IV None

Blood transfusion—RBCs, adenine-saline added 10 mL/kg (10 mg IgG/kg) IV 3 months

Blood transfusion—Packed RBCs (hematocrit 65%)(c) 10 mL/kg (60 mg IgG/kg) IV 6 months

Blood transfusion—Whole blood (hematocrit 35%-50%)(c) 10 mL/kg (80-100 mg IgG/kg) IV 6 months

Blood transfusion—Plasma/platelet products 10 mL/kg (160 mg IgG/kg) IV 7 months

Botulinum Immune Globulin Intravenous (Human) 1.0 mL/kg (50 mg IgG/kg) IV 6 month

Cytomegalovirus IGIV 150 mg/kg maximum 6 months

Hepatitis A IG—Contact prophylaxis 0.1 mL/kg (16.5 mg IgG/kg) IM 6 months (

Hepatitis A IG—International travel, <1 month stay 0.1 mL/kg (16.5 mg IgG/kg) IM 6 months (

Hepatitis A IG—International travel, ≥1 month stay 0.2 mL/kg (33 mg IgG/kg) IM 6 months (d

Hepatitis B IG 0.06 mL/kg (10 mg IgG/kg) IM 3 month

IGIV—Replacement therapy for immune deficiencies(e) 300-400 mg/kg IV 8 months

IGIV—Immune thrombocytopenic purpura treatment 400 mg/kg IV 8 months

IGIV—Postexposure varicella prophylaxis 400 mg/kg IV 8 months

IGIV—Postexposure measles prophylaxis for 

immunocompromised contacts 400 mg/kg IV 8 months

IGIV—Immune thrombocytopenic purpura treatment 1000 mg/kg IV 10 months

IGIV—Kawasaki disease 2 g/kg IV 11 months

Measles prophylaxis IG—Standard 

(i.e., nonimmunocompromised) contact 0.50 mL/kg (80 mg IgG/kg) IM 6 month

Monoclonal antibody to respiratory syncytial virus F 

protein (e.g., Synagis [MedImmune])(f) 15 mg/kg IM None

Rabies IG 20 IU/kg (22 mg IgG/kg) IM 4 months

Tetanus IG 250 units (10 mg IgG/kg) IM 3 months

Varicella IG 125 units/10 kg (60-200 mg IgG/kg) IM, 

maximum 625 units 5 months

Abbreviations: HIV = human immunodeficiency virus; IG = immune globulin; IgG = immune globulin G; IGIV = intravenous immune globulin; mg IgG/kg = milligrams of 

immune globulin G per kilogram of body weight; IM = intramuscular; IV = intravenous; RBCs = red blood cells.

(a) This table is not intended for determining the correct indications and dosages for using antibody-containing products. Unvaccinated persons might not be protected fully 

against measles during the entire recommended interval, and additional doses of IG or measles vaccine might be indicated after measles exposure. Concentrations of measles 

antibody in an IG preparation can vary by manufacturer’s lot. Rates of antibody clearance after receipt of an IG preparation also might vary. Recommended intervals are 

extrapolated from an estimated half-life of 30 days for passively acquired antibody and an observed interference with the immune response to measles vaccine for 5 months after 

a dose of 80 mg IgG/kg. Sources: Mason W, Takahashi M, Schneider T. Persisting passively acquired measles antibody following gamma globulin therapy for Kawasaki disease and 

response to live virus vaccination [Abstract 311]. Presented at the 32 meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy, Los Angeles, California, 

October, 1992, AND Siber GR, Werner BG, Halsey NA, et al. Interference of immune globulin with measles and rubella immunization. J Pediatr. 1993;122(2):204-211. DOI: 10.1016/

S0022-3476(06)80114-9, AND Mason WH, Schneider TL, Takahashi M. Duration of passively acquired measles antibody and response to live virus vaccination allowing gamma 

globulin therapy for Kawasaki syndrome. Prog Pediatr Cardiol. 1992;1(1):82. DOI: 10.1016/S1058-9813(06)80067-6. The extrapolation is performed by counting months from 80 

mg down to (1-3 mg) (e.g. 80 >>> 40 >> >20 >> >10 >>> 5>>>2.5....equal to FIVE intervals) and adding a grace month, so 80 mg values take a “6 month” interval).

(b) Does not include zoster vaccine recombinant because this vaccine is non-live.

(c) Assumes a serum IgG concentration of 16 mg/mL.

(d) The reason the interval is 6 months (and not 4 months) is that the quantity of 16.5 IgG/kg does not reflect the upper ceiling of the quantity of measles IgG in the product.

(e) Measles vaccination is recommended for children with mild or moderate immunosuppression from HIV infection, and varicella vaccination may be considered for children with mild

or moderate immunosuppression from HIV infection, but both are contraindicated for persons with severe immunosuppression from HIV or any other immunosuppressive disorder.

(f) Contains antibody only to respiratory syncytial virus.

Adapted from Table 3-5, ACIP General Best Practice Guidelines for Immunization. January 2021

Revised February 2021