Varicella zoster virus antibody titers after intravenous zoster immune globulin in neonates, and the safety of this preparation

Abstract

Aims: 1) To assess the safety of intravenous varicella zoster virus hyperimmune globulin G (IV‐VZVIG) in neonates; 2) measure varicella zoster virus‐specific IgG antibody (VZVIG) changes in newborn IV‐VZVIG recipients. Methods: Eighteen neonatal intensive care unit (NICU) neonates with varicella exposure were given 1 ml/kg (43 International Units (IU)/kg) Varitect® IV‐VZVIG. Serum VZVIG titers were assayed in neonatal recipients 0, 1, 7, 14, 21, 28, and 35 d after IV‐VZVIG. Also, serum samples for VZV‐IgM antibody determinations were obtained at 4 wk post‐infusion. Results: No varicella developed in the 18 infants. Infusion of 1 ml/kg (43 IU/kg) IV‐VZVIG was generally safe. The IV‐VZVIG dose resulted in seroconversion of a non‐immune newborn. Five infants had low basal VZVIG titers, and two of them had a 0.6‐log10 increase at 24 h post‐infusion. Neonatal VZVIG titers (mean±SEM in log10) before IV‐VZVIG and after by 1, 7, 14, 21, 28, and 35 d were 2.22±0.15, 2.17±0.17, 2.02±0.12, 0.87±0.2, 1.09±0.19, 2.33±0.07, and 2.16±0.1, respectively. Conclusions: One ml/kg (43 IU/kg) IV‐VZVIG was generally safe. Our neonatal mean VZV‐immune status did not significantly increase after the 1 ml/kg (43 IU/kg) IV‐VZVIG dose, although no varicella developed and it caused a VZV‐specific seroconversion.

Varicella Zoster Virus Infection in Pregnancy

“…Presence of anti VZV IgM antibodies at birth and persisting anti VZV IgG 1 -2 years after delivery were markers for expected development of herpes zoster in early childhood. Some authors report (7,11), that intravenous (IV-VZVIG) or intramuscular (IM-VZVIG) varicella zoster immunoglobulin, given within 72 -96 hours after significant exposure to varicella of pregnant women who are seronegative, or with no history of varicella, may prevent or modify the course of disease. But it may not abolish the risk of fetal infection.…”

Infections nosocomiales en néonatologie

“…Des varicelles nosocomiales ont été décrites chez des prématurés et la vérification du statut immunitaire du personnel soignant vis-à-vis de ce virus doit être effectuée dès l'embauche. En cas de contage, l'administration de gammaglobulines spécifiques est recommandée pour tous les nouveau-nés contacts [41]. Le risque de contagion des nouveau-nés en maternité à partir d'un cas index maternel de rougeole est très élevé et suppose un isolement complet et une prévention par les immunoglobulines polyvalentes pour tous les sujets contact.…”