[Efficiency of use of immunoglobulin preparations for the postexposure prevention of tick-borne encephalitis in Russia (a review of semi-centennial experience)]

Abstract

Along with regenerated interest in passive immunization during flavivirus infections, there is an increase in the number of reports with negative opinions as to the expediency of postexposure immunoglobulin prophylaxis (IGP) of tick-borne encephalitis (TBE). Analysis of the publications (since 1959) on this problem has indicated that more than half of them, including all papers with negative opinions as to IGP, contain the results of studies whose design are unsuitable for the solution of the problem associated with the efficiency of medical interventions in the context of evidence-based medicine. Analysis of the results of cohort studies has established that the timely single administration of an immunoglobulin (IG) preparation against TBE in a dose of 0.05 ml/kg body weight ensures protection on average in 79% of cases. Increasing the single dose to 0.1 ml/kg, as re-administration of IG, provides no additional protective effect. The preventive efficacy of IG preparations against TBE varies under the influence of factors, such as the infectious virus dose inoculated from tick suckling, the age of a victim, the antiviral activity of preparations with a antihemagglutinin titer of 1:20 with high infectious virus doses and the absence of reliable rapid tools for its determination on tick suckling, it is necessary to use IG with a titer of at least 1:80 and, desirably, more active in children, for postexposure prophylaxis of TBE.