PRODUCT	COMMENTS
Agents for Active Immunity
Toxoids
Diphtheria and tetanus toxoids and pertussis vaccine, adsorbed Diphtheria and tetanus toxoids, combined Diphtheria, tetanus toxoid, and acellular pertussis	See CDC immunization schedules (see Figure 22-2). The FDA suggests all health care workers should have these immunizations.
Tetanus toxoid	Immunization in adults and children. May produce local reactions, fever, chills, malaise, and myalgia (widespread muscle pain). Tetanus toxoid, adsorbed: 2 doses IM at 2, 4, and 6 mo, again at 12 mo, and no later than 11-12 yr. Booster: Every 10 yr. Tetanus toxoid, fluid: 3 doses IM or SQ at 4- to 8-wk intervals and fourth dose 6-12 mo after third dose. Booster: Every 5-10 yr, depending on risk of wound.
Bacterial Vaccines
Bacille Calmette-Guérin (BCG) vaccine	Tuberculosis protection for international travelers to high-risk areas and high-risk infants and children; use multiple-puncture disk.
Cholera vaccine	Required for travel to certain areas. May produce brief local reactions, fever, headache, and malaise. Vaccine: 2 doses SQ or IM 1 wk to 1 mo apart.
Haemophilus influenzae type b (Hib) conjugate vaccine	Routine immunization. Number of doses and amount injected vary by patient age.
Meningococcal polysaccharide vaccine Group A, Group C Groups A and C Groups A, C, Y, and W-135	Induces formation of antibodies, leading to immunity to specific organisms. Does not provide immunity against all varieties. Vaccine: SQ only. Revaccination may be required in some individuals at high risk, but standards are not specific.
Plague vaccine	Reduces incidence and severity of disease. Vaccine: 2 doses 1 mo apart, followed with third dose 1-3 mo later. Always consult dosage schedule in package insert before administering.
Pneumococcal vaccine, polyvalent	Produces immunity against a variety of pneumococcal infections. Vaccine: IM or SQ; revaccinations necessary in 3 or more yr.
Pneumococcal 7-valent conjugate vaccine (Prevnar)	Provides active immunization for infants and children against Streptococcus pneumoniae. Vaccine: 3 doses administered as IM injection at 2-mo intervals, followed by a fourth dose at 12-15 mo of age. Shake suspension vigorously immediately before use.
Typhoid vaccine	Given when there has been exposure to a known carrier or foreign travel to area where typhoid is endemic. May produce local reactions, fever, chills, malaise, and myalgia. Primary immunization: 2 doses SQ 4 or more wk apart. Booster every 3 yr for children younger than age 10.
Lyme disease vaccine	Given to patients at high risk who live or work in Borrelia burgdorferi–infested grassy or wooded areas. Primary immunization: Give initial dose, repeated in 1 and 12 mo. Vaccination with all three doses is required to achieve optimal protection. Shake container well before drawing dose. Vaccine is a turbid white suspension. Note: administer by IM injection only in the deltoid region.
Viral Vaccines
Hepatitis A vaccine (Havrix)	Given as primary dose and then booster 6-12 mo later. Give in deltoid muscle only. Number of doses and amount injected vary by patient age.
Hepatitis B vaccine (Heptavax-B)	For immunization against all known subtypes of hepatitis B virus. May produce local reactions, malaise, fatigue, nausea, myalgia, and headache. Adults: Give IM, repeated in 1 and 6 mo. Children younger than 10 yr: Give IM, repeated in 1, 6 mo.
Influenza virus vaccine	Annual vaccination of high-risk persons. May produce localized reactions, fever, malaise, and myalgia. Dosage schedule varies from year to year.
Measles, mumps, and rubella virus vaccine, live	Same as measles virus vaccine, live attenuated.
Measles, rubeola, and rubella virus vaccine, live	See CDC immunization schedules.
Mumps virus vaccine, live	See CDC immunization schedules.
Pertussis vaccine (in combination)	See CDC immunization schedules.
Poliomyelitis vaccine, inactivated (IPV), Salk	See CDC immunization schedules.
Poliovirus vaccine, live, oral, trivalent (TOPV), Sabin	See CDC immunization schedules.
Rotavirus	See CDC immunization schedules.
Rubella and mumps virus vaccine, live	See CDC immunization schedules.
Rubella virus vaccine, live	See CDC immunization schedules.
Varicella (Varivax)	See CDC immunization schedules.
Yellow fever vaccine	Given only at approved World Health Organization centers for people traveling abroad. Vaccine: Give SQ with revaccination in 10 yr as needed.
Agents for Passive Immunity
Antitoxins and Antivenins
Black widow spider species antivenin	Adults and children: Inject 1 vial IM, preferably in the region of the anterolateral thigh so that a tourniquet may be applied in the event of a systemic reaction. Symptoms usually subside in 1-3 hr.
Diphtheria antitoxin	For prevention and treatment of diphtheria. Vaccine: 20,000-120,000 units IM, IV as therapy; 10,000 units IM for prophylaxis.
Immune Serums
Cytomegalovirus immune globulin (CMV-IGIV)	For attenuation of primary CMV disease associated with kidney transplantation. Give IV.
Hepatitis B immune globulin (HBIG; human)	For postexposure or high-risk patient prophylaxis. Produces local reactions, urticaria, and fever. HBIG: Give IM as soon as possible and repeat 28-30 days after exposure.
Immune globulin IV (IGIV)	For maintenance treatment of patients unable to produce sufficient amounts of immunoglobulin G antibodies. Used in patients with immunodeficiency syndrome, idiopathic thrombocytopenic purpura, and beta-cell chronic lymphocytic leukemia. Give IV once a month.
Immune serum globulin, human (HISG)	For hepatitis A, rubeola prophylaxis; immunoglobulin deficiency; passive immunization for varicella in immunosuppressed patients. Give IM.
Lymphocyte immune globulin, antithymocyte globulin	Used in management of allograft rejection in patients who have undergone renal transplant.
Human papilloma virus (HPV) recombinant vaccine	Quadrivalent vaccine with protection against 4 HPV subtypes (6, 11, 16, 18). Trials show 100% efficacy in preventing cervical precancers and nearly 100% efficacy in preventing vulvar and vaginal precancers and genital warts caused by the targeted HPV types. Vaccine: Give IM dose of HPV vaccine in a 3-dose schedule, with initial dose followed by doses 2 mo and 6 mo later. Routine vaccination recommended for girls aged 11-12 years; vaccination series can be started in girls as young as age 9 years; catch-up vaccination recommended for females aged 13-26 years who have not been vaccinated previously or who have not completed the full vaccine series. Ideally, vaccination should begin prior to onset of sexual activity. This is a new recommendation by CDC suggested for boys.
Rh_O(D) immune globulin	Effectively suppresses immune response of nonsensitized Rh-negative mothers after delivery of an Rh-positive infant. Passive immunity: 1 vial IM.
Respiratory syncytial virus (RSV) immune globulin (RespiGam)	Used in prevention of serious lower respiratory tract infection caused by RSV in children less than 24 mo of age with bronchopulmonary dysplasia or a history of premature birth. Given by IV infusion, based on body mass.
Tetanus immune globulin, human (HTIG)	For temporary postexposure prophylaxis: 4 units/kg IM.
Varicella-zoster immune globulin, human (VZIG)	Provides temporary passive immunity to varicella. Given deep IM, according to dosage schedule on package insert.
Rabies Prophylaxis Products
Rabies immune globulin, human (RIG)	Immunization for those thought to be exposed to rabies. May produce fever and soreness at injection site. Usual dose: 20 International Units/kg IM; half the dose may be used to infiltrate the wound.
Rabies vaccine, human diploid cell cultures (HDCV)	For prophylaxis and postexposure treatment. May produce nausea, headache, muscle aches, abdominal pain, and local reactions. See package insert for dosage schedule.
In Vivo Diagnostic Biologic Agents
Coccidioidin	Used to identify people with exposure to the fungus Coccidioides or with active disease (coccidioidomycosis); lowest possible dose given by intradermal injection and response evaluated 24-48 hr later. Positive reaction: Area of erythema (redness) and induration (hardening) 5 mm or greater.
Histoplasmin	Used to identify people with exposure to the fungus. Histoplasma or with active disease (histoplasmosis); 0.1 mL given by intradermal injection and response evaluated 24-48 hr later. Positive reaction: Area of erythema and induration 5 mm or greater.
Mumps skin test antigen