Suggested interval between immune globulin or blood product and MMR or VZV vaccine*

Product and indication^¶	Suggested interval (months)^Δ
Immune globulin (IG) or monoclonal antibody administered intramuscularly
Hepatitis A prophylaxis (IG)	6
Measles prophylaxis (IG) for nonpregnant, immunocompetent host (ie, standard measles prophylaxis)	6
Tetanus IG (hyperimmune globulin)	3
Hepatitis B IG (hyperimmune globulin)	3
Rabies IG (hyperimmune globulin)	4
Varicella prophylaxis (as Varizig; hyperimmune globulin)	5
RSV prophylaxis (palivizumab [Synagis]) (monoclonal antibody)	None
COVID-19 monoclonal antibody treatment or prophylaxis	None
Intravenous immune globulin (IVIG)
Replacement therapy (IVIG)
300 to 400 mg/kg	8
For ITP (IVIG)
400 mg/kg	8
1000 mg/kg	10
For Kawasaki disease or multisystem inflammatory disease in children^◊ (IVIG)
2000 mg/kg	11
Cytomegalovirus immune globulin	6
Botulinum immune globulin (as BabyBIG)	6
Measles prophylaxis (as IVIG)	8
Varicella prophylaxis (as IVIG)	8
Blood products
Washed RBCs	0
RBCs, adenine-saline added	3
Packed RBCs	6
Whole blood	6
Plasma or platelet products	7

The information in this table does not apply to rubella-nonimmune women who received Rho(D) immune globulin or any other blood product during the last trimester of pregnancy or at delivery. Such women should receive MMR vaccine immediately after delivery and should be tested at least 3 months later for evidence of immunity to rubella and measles. It also does not apply to shingles vaccine. Refer to UpToDate content for details of MMR and VZV immunization and immunizations in patients with primary immunodeficiency.

MMR: measles, mumps, rubella; VZV: varicella-zoster virus; RSV: respiratory syncytial virus; COVID-19: coronavirus disease 2019; ITP: immune thrombocytopenic purpura; RBCs: red blood cells; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2.
* Immune globulins and plasma-containing blood products contain blood antibodies from the donor that may inhibit the response to MMR or VZV vaccines. The duration of inhibition ranges from 3 to 11 months and is related to the amount of antigen-specific antibody contained in the immune globulin or blood product.

If the antibody-containing product is administered before the vaccine is scheduled, the vaccine should be delayed for the suggested interval. If a dose of MMR or VZV vaccine is administered after an antibody-containing product but at an interval shorter than the suggested interval, the vaccine dose should be repeated at the suggested interval unless an antibody response to the vaccine is documented.
If the antibody-containing product is necessary within 14 days after administration of MMR or VZV vaccine, the vaccine dose should be repeated after the suggested interval, unless an antibody response to the vaccine is documented.

¶ For patients with indications other than those provided in the table, consultation with an expert in infectious diseases is suggested.
Δ The suggested intervals may be shortened if exposure to measles is likely or has occurred (eg, during international travel or an outbreak).
◊ Also called pediatric multisystem inflammatory syndrome, pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2, pediatric hyperinflammatory syndrome, or pediatric hyperinflammatory shock.

Data from:

American Academy of Pediatrics. Active immunization after receipt of immune globulin or other blood products. Red Book: 2021-2024 Report of the Committee on Infectious Diseases, 32^nd ed, Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH (Eds), American Academy of Pediatrics, Itasca, IL 2021. p.40.
Kroger A, Bahta L, Hunter P. General Best Practice Guidelines for Immunization. Best practices guidance of the Advisory Committee on Immunization Practices (ACIP). Available at: www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html#t-05 (Accessed on June 5, 2021).

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Suggested interval between immune globulin or blood product and MMR or VZV vaccine*