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Evidence summaries

Post-Exposure Gamma Globulin (Passive Immunisation) for Preventing Measles

Passive immunisation with gamma globulin within seven days of exposure appears to be effective at preventing measles in non-immune people, with a risk reduction of 83% compared to no treatment. Level of evidence: "B"

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.

Summary

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.

Table 1. Immunoglobulin compared to no treatment to prevent measles

OutcomeRelative effect(95% CI)Assumed risk - control= no treatmentCorresponding risk -intervention (95 % CI) = immunoglobulinNumber of participants (studies)
Measles cases - Gamma globulinRR 017 (0.08 to 0.36)110/100019/1000 (9 to 40)545 (2)
Measles cases - Adult serumRR 0.52 (0.45 to 0.59)860/1000447/1000 (387 to 507)586 (2)
Measles cases - Convalescent serumRR 0.21 (0.15 to 0.29)862/1000181/1000 (129 to 250)301 (3)
Mortalitity due to measlesRR 0.24 (0.13 to 0.44)142/1000343/1000 (8 to 62)893 (3)
Complications due to measlesRR 0.18 (0.05 to 0.6)52/10009/1000 (3 to 31)832 (3)

Clinical comments

Note

Date of latest search: 14 August 2013

References

  • Young MK, Nimmo GR, Cripps AW et al. Post-exposure passive immunisation for preventing measles. Cochrane Database Syst Rev 2014;(4):CD010056. [PubMed]

Primary/Secondary Keywords