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Interim Guidelines for Smallpox Response and Management in Scotland in the Post-Eradication era

Appendix 13: use of Human Vaccinia Immunoglobulin (VaIG)

1. VaIG is in short supply and should be reserved for individuals with definite indications and prioritised to those who will derive the most benefit:

• To treat vaccine complications.

• To prevent vaccine complications by concurrent administration to those who have known contraindications to vaccination.

• To attenuate smallpox disease in contacts who have not been adequately protected by vaccination.

2. Treatment of vaccine complications should be initiated at the first sign of adverse effects. Complications may be treated by VaIG or cidofuvir (see Appendix 14) depending on supplies.

3. The vaccine complications that may be treated by VaIG are:

• Inadvertent inoculation of the eye or eyelid without vaccinial keratitis.

• Severe generalised vaccinia if patient is toxic.

• Eczema vaccinatum.

• Progressive vaccinia.

4. VaIG is not recommended for treatment of post vaccinial encephalilitis or vaccinal keratitis.

5. The dose of VaIG for treatment of vaccine complications is given below. It may be given IV or IM in divided doses over a 24 to 36 hr period.

• Under 1 year 2000 units

• 1-6 years 4000 units

• 7-14 years 6000 units

• 15 years or over 8000 units.

6. VaIG should be given at the same time as vaccination to prevent vaccine complications in individuals who (see also Appendix 9):

• Have active eczema or a history of eczema, or other acute or chronic skin conditions.

• Are immunosuppressed due to medical disorders (leukaemia, lymphoma, generalised malignancy, hypo-gammaglobulinaemia, chronic neutropenia, granulocytopenia.) or treatments (cyclophosphamide, methotrexate and oral steroids).

• Are pregnant.

7. HIV positive individuals can be vaccinated without VaIG if their CD4 count is above 200, but should be given VaIG if their CD4 count is below 50. Those in between should be assessed according to their HIV disease state.

8. The use of VaIG does not affect the vaccine "take".

9. The dose of VaIG for prevention of vaccine complications is less than for treatment - please contact the SEHD. If given IM at the same time as vaccination, it should be given in a different limb to the vaccine.

10. VaIG may be given, supplies permitting, to attenuate smallpox disease in primary contacts who are vaccinated more than 3 days but less than 8 days after their first exposure to infection. This includes primary contacts in whom the first vaccination shows no sign of a "take" on the third day. VaIG should be given concurrently with (re) vaccination.

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