Vaccinia immune globulin
|Drug class||Immune globulin|
|Main uses||Complications of smallpox vaccination, monkeypox|
|Side effects||Headache, dizziness, nausea|
|Typical dose||6000 units/kg|
Vaccinia immune globulin (VIG) is a medication used to treat severe complications of smallpox vaccination and monkeypox. With respect to complications, it is used for eczema vaccinatum, progressive vaccinia, severe generalized vaccinia, and vaccinia infections in those with certain skin conditions. It is given by gradual injection into a vein.
Common side effects include headache, dizziness, and nausea. Severe side effects may include allergic reactions, kidney problems, blood clotting, and transfusion-related acute lung injury. It is an immune globulin, specifically a gamma globulin, made from the blood of people immunized against smallpox.
Vaccinia immune globulin was approved for medical use in the United States in 2005. In the United States it is not commercially available though may be acquired from the Strategic National Stockpile. In Canada it is available from Public Health Agency of Canada.
Side effects from smallpox vaccine
For a small percentage of the population, the smallpox vaccine produces severe side effects. These include postvaccinial central nervous system disease, progressive vaccinia, eczema vaccinatum, accidental implantations, “generalized vaccinia,” and the common erythematous and/or urticarial rashes.
It may be used for:
- Eczema vaccinatum
- Progressive vaccinia
- Severe generalized vaccinia
- Vaccinia infections in individuals who have skin conditions such as burns, impetigo, or eczema
- Infections induced by vaccinia virus that include its accidental implantation in eyes (except in cases of isolated keratitis), mouth, or other areas where vaccinia infection would constitute a special hazard.
It is not effective for smallpox itself or for encephalitis post vaccination.
There; however, is no data on if it is effective.
It is generally given at a dose of 6000 units/kg.
In the late 1940s, Dr. Henry Kempe suggested that the solution to the complications of the smallpox vaccine was to provide antibodies in the form of gamma globulin.  Kempe noted that for some infants, the smallpox vaccine failed to "take." Kempe believed this failure might be due to the high levels of maternal antibodies to vaccinia in the infants' blood. It appeared to Kempe, that the presence of the antibodies blocked viral replication and therefore a transfusion of antibodies from people who were immune due to vaccination, would help those in whom vaccination had failed. 
Society and culture
VIG is made from the pooled blood of individuals who have been inoculated with the smallpox vaccine. The antibodies these individuals developed in response to the smallpox vaccine are removed and purified.
- Smallpox Vaccine: Contraindications, Administration, and Adverse Reactions
- CDC Smallpox Home
- Quick Guide to Preexposure Smallpox Vaccination
- "Vaccinia Immune Globulin IV Monograph for Professionals". Drugs.com. Retrieved 16 September 2021.
- Research, Center for Biologics Evaluation and (12 April 2019). "Vaccinia Immune Globulin Intravenous (Human)". FDA. Retrieved 16 September 2021.
- "CNJ-016, Vaccinia Immune Globulin Intravenous (Human), sterile solution". Retrieved 16 September 2021.
- Canada, Public Health Agency of (18 July 2007). "Canadian Immunization Guide: Part 5 - Passive Immunization". www.canada.ca. Retrieved 16 September 2021.
- J.Michael Lane, MD, MPH,aJoel Goldstein, MD, FAAPaAdverse events occurring after smallpox vaccination. Seminars in Pediatric Infectious Diseases. Volume 14, Issue 3, July 2003, Pages 189–195
- Frelinger JA, Garba ML. Responses to smallpox vaccine. N Engl J Med. 2002;347:689–90. DOI PubMed
- Moller-Larsen A, Haahr S. Humoral and cell-mediated immune responses in humans before and after revaccination with vaccinia virus. Infect Immun. 1978;19:34–9.PubMed • Cohen J. Smallpox vaccinations: how much protection remains? Science. 2001;294:985. DOI PubMed
- "CDC Smallpox | Investigational Vaccinia Immune Globulin (VIG) Information". Bt.cdc.gov. Retrieved 2013-06-16.
- CDC. Recommendations for using smallpox vaccine in the pre-event vaccination program: Supplemental recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR 2003; 52 (RR07); 1-16.
- Dana A. Shea, Frank gottron, Holly Harvey. Monkeypox Technical Background and Outbreak Implications for Bioterrorism Preparedness. Congressional Research Service, Report for Congress.
- "Treatment | Monkeypox | Poxvirus | CDC". www.cdc.gov. 18 July 2021. Retrieved 16 September 2021.
- "Vaccinia immune globulin definition - Medical Dictionary definitions of popular medical terms easily defined on MedTerms". Medterms.com. 2012-06-14. Retrieved 2013-06-16.
- "CDC Smallpox | Medical Management of Smallpox (Vaccinia) Vaccine Adverse Reactions (Info for Clinicians and Public Health Professionals)". Bt.cdc.gov. Retrieved 2013-06-16.
- Bray, M. Henry Kempe and the Birth of the Vaccinia Immune Globulin. Clinical Infectious Diseases. Volume 39. Issue 6. pp. 767-769.