Page 1189 - Basic _ Clinical Pharmacology ( PDFDrive )

Appendix: Vaccines, Immune

Globulins, & Other Complex

Biologic Products

Harry W. Lampiris, MD & Daniel S. Maddix, PharmD

Vaccines and related biologic products constitute an important PASSIVE IMMUNIZATION
group of agents that bridge the disciplines of microbiology, infec-
tious diseases, immunology, and immunopharmacology. A list Passive immunization consists of transfer of immunity to a host
of the most important preparations is provided here. The reader using preformed immunologic products. From a practical stand-
who requires more complete information is referred to the sources point, only immunoglobulins have been used for passive immuniza-
listed at the end of this appendix. tion, because passive administration of cellular components of the
immune system has been technically difficult and associated with
ACTIVE IMMUNIZATION graft-versus-host reactions. Products of the cellular immune system
(eg, interferons) have also been used in the therapy of a wide variety
of hematologic and infectious diseases (see Chapter 55).
Active immunization consists of the administration of antigen Passive immunization with antibodies may be accomplished
to the host to induce formation of antibodies and cell-mediated with either animal or human immunoglobulins in varying degrees
immunity. Immunization is practiced to induce protection against of purity. These may contain relatively high titers of antibodies
many infectious agents and may utilize either inactivated (killed) directed against a specific antigen or, as is true for pooled immune
materials or live attenuated agents (Table A–1). Desirable features globulin, may simply contain antibodies found in most of the
of the ideal immunogen include complete prevention of disease, population. Passive immunization is useful for (1) individuals
prevention of the carrier state, production of prolonged immunity unable to form antibodies (eg, congenital agammaglobulinemia);
with a minimum of immunizations, absence of toxicity, and (2) prevention of disease when time does not permit active immu-
suitability for mass immunization (eg, cheap and easy to admin- nization (eg, postexposure); (3) for treatment of certain diseases
ister). Active immunization is generally preferable to passive normally prevented by immunization (eg, tetanus); and (4) for
immunization—in most cases because higher antibody levels treatment of conditions for which active immunization is unavail-
are sustained for longer periods of time, requiring less frequent able or impractical (eg, snakebite).
immunization, and in some cases because of the development of Complications from administration of human immunoglobu-
concurrent cell-mediated immunity. However, active immuniza- lins are rare. The injections may be moderately painful, and rarely a
tion requires time to develop and is therefore generally inactive sterile abscess may occur at the injection site. Transient hypotension and
at the time of a specific exposure (eg, for parenteral exposure to pruritus occasionally occur with the administration of intravenous
hepatitis B, concurrent hepatitis B IgG [passive antibodies] and immune globulin (IVIG) products, but generally are mild. Indi-
active immunization are given to prevent illness). viduals with certain immunoglobulin deficiency states (IgA defi-
Current recommendations for routine active immunization of ciency, etc) may occasionally develop (text continues on page 1177)
children are given in Table A–2.

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