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Blood products, human immunoglobulin and timing of immunization: Canadian Immunization Guide

For health professionals

Last partial content update: June 2026

This chapter has been updated based on the following statements from the National Advisory Committee on Immunization (NACI):

This information is captured in the table of updates.

Last complete chapter revision: December 2013

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General considerations

Blood products of human origin contain significant amounts of antibodies to infectious agents that are prevalent in the general population, such as measles virus and varicella zoster virus (VZV); these antibodies are present either because of natural infection or following vaccination. Therefore, administration of Ig preparations and certain blood products can interfere with the immune response to parenteral live virus vaccines if given concurrently with or shortly before or after the vaccine. The duration of the interference with the immune response to the vaccine is related to the amount of antibody in the Ig preparation or blood product. Exceptions include respiratory syncytial virus monoclonal antibody (RSVAb) and transfusion of washed red blood cells (which is infrequently used). These products do not interfere with live vaccines because RSVAb contains only antibody to respiratory syncytial virus and washed red blood cells contain a negligible amount of antibody.

There is minimal or no interference between blood products or Ig preparations, and the following vaccines:

These vaccines may be given concurrently with, or at any time before or after, an Ig preparation or blood product has been administered. If a parenteral vaccine and intramuscular Ig are given concurrently, administer the vaccine and Ig preparation at different anatomic injection sites, using separate needles and syringes.

Refer to vaccine specific chapters in Part 4 for additional information

Measles-mumps-rubella (MMR), measles-mumps-rubella-varicella (MMRV) and monovalent varicella vaccines

Guidelines for the interval between administration of Ig preparations or blood products and MMR, MMRV or monovalent varicella vaccines have been developed because of the potential for reduced effectiveness of the vaccine if Ig is administered with, or shortly before or after the vaccine; it should be noted that there are no additional safety concerns if Ig is inadvertently administered with, or shortly before or after the vaccine. For an optimum immune response to MMR, MMRV or monovalent varicella vaccine, the vaccine should be administered at least 14 days prior to administration of an Ig preparation or blood product, or the vaccine administration delayed until the antibodies in the Ig preparation or blood product have degraded (refer to Table 1). If the interval between the administration of any of these vaccines and subsequent administration of an Ig preparation or blood product is less than 14 days, or if these vaccines are administered before the antibody has degraded, repeat the vaccine dose after the recommended interval. The recommended interval between administration of Ig preparation or blood product and subsequent vaccination varies, depending on the Ig preparation or blood product (refer to Table 1). The recommended intervals between live parenteral vaccines should also be respected when repeating vaccine doses.

For measles post-exposure prophylaxis (PEP), Ig may be administered intramuscularly (IMIg) or intravenously (IVIg). IMIg is generally recommended for individuals weighing 30 kg or less, while IVIg is recommended for those weighing more than 30 kg, as IMIg may not provide sufficient antibody concentrations at higher body weights.

Since human Ig dosages for measles PEP are considered an off-label use and may differ from product monographs, refer to Table 1 for the required intervals for subsequent vaccination and to Part 4 Measles vaccines chapter, Post-exposure prophylaxis for additional guidance.

Individuals who are receiving continuous subcutaneous Ig therapy should not be immunized with MMR, MMRV or monovalent varicella vaccine (refer to footnote 1 in Table 1). For these individuals, measles PEP with Ig is not required if the last dose of IVIg (at least 400 mg/kg) was received within three weeks prior to measles exposure, or if SCIg (at least 200 mg/kg) was received for 2 consecutive weeks prior to measles exposure.

Individuals who have undergone cardiac surgery with cardiopulmonary bypass would have received packed red blood cells and platelets and may have received frozen plasma. They may have received subsequent blood products in the ICU after their surgery. They should delay receiving MMR, MMRV or monovalent varicella vaccine until 7 months after the date they were discharged from the ICU.

Table 1: Guidelines for the interval between administration of immunoglobulin (Ig) preparations or blood products and measles-mumps-rubella (MMR), measles-mumps-rubella-varicella (MMRV) or monovalent varicella vaccine to maximize immunization effectiveness
Immunoglobulin or blood product Dose, route Interval between receipt of Ig or blood product and subsequent administration of MMR, MMRV or monovalent varicella vaccine (months)
Standard immunoglobulin (human)Table 1 - Footnote 1
Immunoglobulin (Ig) 0.02 - 0.06 mL/kg, IM 3
0.25 mL/kg, IM 5
0.50 mL/kg, IM 6
Intravenous immunoglobulin (IVIg) 400 mg/kg, IV 8
1,000 mg/kg, IV 10
2,000 mg/kg, IV 11
Blood transfusion products
Plasma and platelet products 10 mL/kg, IV 7
Whole blood 10 mL/kg, IV 6
Packed red blood cells 10 mL/kg, IV 5
Reconstituted red blood cells 10 mL/kg, IV 3
Washed red blood cellsTable 1 - Footnote 2 10 mL/kg, IV 0
Specific immunoglobulin (human)
Cytomegalovirus immunoglobulin (CMVIg) 150 mg/kg, IV 6
Hepatitis B immunoglobulin (HBIg) 0.06 mL/kg, IM 3
Rabies immunoglobulin (RabIg) 20 IU/kg, IM 4
Rh immunoglobulin (RhIg) 300 mcg, IM 3Table 1 - Footnote 3
Tetanus immunoglobulin (TIg) 250 units, IM 3
Varicella immunoglobulin (VarIg) 125 IU/10 kg, IM 5
Specific immunoglobulin (humanized monoclonal antibody)
Respiratory syncytial virus monoclonal antibody (RSVAb): palivizumab 15 mg/kg/4 weeks, IM 0
Respiratory syncytial virus monoclonal antibody (RSVAb): nirsevimab 50 mg/0.5 mL if weight is less than 5 kg, IM 0
100mg/1 mL if weight is greater than or equal to 5 kg, IM
200 mg (2 x 100 mg/1 mL), IM
Respiratory syncytial virus monoclonal antibody (RSVAb): clesrovimab 105 mg/0.7 mL, IM 0
210 mg (2 x 105 mg/0.7 mL), IM

Rh immunoglobulin (RhIg)

A risk-benefit assessment is needed for post-partum women and post-partum individuals who have received RhIg and require MMR or monovalent varicella vaccine. The risk of lowered vaccine efficacy due to potential interference from the RhIg needs to be weighed against the need for protection against the vaccine preventable disease. To optimize response to vaccine, rubella-, measles- or varicella-susceptible women and individuals who receive RhIg in the peri-partum period should generally wait 3 months before being vaccinated with MMR or varicella vaccine.

However, if there is a risk of: exposure to rubella, measles, or varicella; recurrent pregnancy in the 3 months post-partum period; or a risk that vaccines may not be received later, either MMR or monovalent varicella vaccine or both may be given prior to discharge. In this context, serologic testing for antibodies to the vaccine antigens should be done 3 months after vaccination and non-immune women and individuals should be revaccinated. In the event that a post-partum woman and post-partum individual receives either MMR or varicella vaccine or both vaccines in the 14 days prior to receiving RhIg, serologic testing for MMR or varicella should be done 3 months later and revaccinated if non-immune.

Yellow fever vaccine

The background antibody level for yellow fever is low in North America; therefore, an Ig or blood product produced from blood donated in Canada or the United States is unlikely to interfere with vaccination with yellow fever vaccine.

Chapter revision process

This chapter was updated to incorporate guidance from the National Advisory Committee on Immunization (NACI) statements on Updated guidance to protect infants and children from respiratory syncytial virus (RSV) disease: Use of monoclonal antibodies (nirsevimab and clesrovimab) and the RSVpreF vaccine, published April 10, 2026, and Updated recommendations on measles post-exposure prophylaxis, published June 4, 2025.

Acknowledgements

Recent updates were prepared by N Mohamed and M Haavaldsrud and reviewed by E Abrams, W Siu, O Baclic and C Jensen.

NACI gratefully acknowledges the contribution of: C Tremblay.

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2026-06-16