Comment: The quality of evidence is upgraded by large magnitude of effect.
Gamma globulin is recommended for preventing measles within seven days of exposure for non-immune persons.
A Cochrane review [Abstract] 1 included one RCT, two quasi-RCTs and 10 cohort studies with a total of 3 925 subjects. Seven studies assessed cases of measles after immunoglobulin versus no treatment. When given within seven days of exposure, immunoglobulins were effective at preventing measles: gamma globulin (risk ratio RR 0.17), convalescent serum (RR 0.21) and adult serum (RR 0.52) (table T1). The differences in the effectiveness of different blood products were supported by studies not included in the meta-analysis and by two studies (702 participants) that found gamma globulin more effective than serum (RR 0.56, 95% CI 0.46 to 0.69; n=702). Immunoglobulin was effective at preventing death due to measles compared to no treatment (RR 0.24).No serious adverse events were observed in any of the included studies, although reporting of adverse events was poor overall. Non-serious adverse events included transient fever, rash, muscle stiffness, local redness and induration.
| Outcome | Relative effect(95% CI) | Assumed risk - control= no treatment | Corresponding risk -intervention (95 % CI) = immunoglobulin | Number of participants (studies) |
|---|---|---|---|---|
| Measles cases - Gamma globulin | RR 017 (0.08 to 0.36) | 110/1000 | 19/1000 (9 to 40) | 545 (2) |
| Measles cases - Adult serum | RR 0.52 (0.45 to 0.59) | 860/1000 | 447/1000 (387 to 507) | 586 (2) |
| Measles cases - Convalescent serum | RR 0.21 (0.15 to 0.29) | 862/1000 | 181/1000 (129 to 250) | 301 (3) |
| Mortalitity due to measles | RR 0.24 (0.13 to 0.44) | 142/1000 | 343/1000 (8 to 62) | 893 (3) |
| Complications due to measles | RR 0.18 (0.05 to 0.6) | 52/1000 | 9/1000 (3 to 31) | 832 (3) |
Date of latest search: 14 August 2013
Primary/Secondary Keywords