The Benefits of HTIG and Td
ABSTRACT & COMMENTARY
Synopsis: The simulataneous administration of Td and TIG is safe and associated with better immune response.
Source: Forrat R, et al. Antimicrob Agents Chemother 1998; 42:298-305.
While little is known of the pharmacokinetics of tetanus immunoglobulin (HTIG) when administered concurrently with tetanus-diptheria (Td) vaccine, earlier data suggested that administration of this antigen with its antibody could delay the response to vaccine or, possibly, neutralize the antibody response.
Forrat and colleagues in Lyon, France, examined the safety and immunogenicity of a new pasteurized human tetanus immune globulin (P-HTIG, Innovex Biodesign, Freiburg, Germany). Forty-eight adults with a history of tetanus vaccination were randomized to receive one of two different dosages of P-HTIG with either Td vaccine or placebo. Antibody titers were assessed 42 days post-vaccination. Both P-HTIG and Td were well-tolerated. The rate of local reactions at the site of the P-HTIG injection was 27%, and there was no significant difference in the rate of systemic reactions between those who received P-HTIG with Td (33%) or placebo (21%).
Remarkably, antibody titers were significantly higher in patients receiving the combination of P-HTIG and Td compared with those receiving P-HTIG alone. While there was no difference in the immune response between those receiving different dosages of P-HTIG, 83% receiving P-HTIG alone vs. 100% receiving the combination reached the minimum seroprotective level (0.01 IU/mL) by day 1. Approximately 80% in either group reached the 0.1 IU/mL antibody level after day 3 (probably a safer estimate of protection.) Maximal antibody levels of 0.31 ± 2.5 IU/mL occurred at 4.4 days in patients receiving P-HTIG alone, compared with a maximal antibody response of 15.2 ± 2.4 IU/mL at 19 days in patients receiving the combination.
COMMENT BY CAROL A. KEMPER, MD
Because the time to antibody response to Td vaccine alone is approximately six days, the administration of immunoglobulin is crucial for patients with tetanus-prone wounds. These data show that the simultaneous administration of Td and TIG is not only safe, but is associated with better immune response. (Dr. Kemper is Associate Director, AIDS Program, Division of Infectious Diseases, Santa Clara Valley Medical Center.)
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