Compound
Anti-tick immunoglobulin contains an immunologically active protein fraction, which is isolated from donor serum or plasma. It contains antibodies specific to the tick-borne encephalitis . To obtain protein, plasma is used, which is obtained from the blood of healthy donors who have been tested for the absence of antibodies to the hepatitis C and HIV . Glycine (aminoacetic acid) is used as a stabilizer. preservatives or antibiotics in the composition of the drug.
Contraindications to taking the drug
Immunoglobulin, as a compound of protein fractions, has a high degree of allergenicity, because The human body perceives any proteins as foreign.
Its injections are prohibited:
- with a confirmed allergy to any donor blood components;
- when diagnosing general protein intolerance.
In severe situations, the only contraindication is a high probability of anaphylactic shock.
If there is none, then the possible harm from the use of immunoglobulin is extinguished by antihistamines.
Allergic diseases characterized by hypersensitivity to foreign proteins:
- bronchial asthma;
- chronic urticaria (urticarial vasculitis), recurrent;
- violation of amino acid metabolism (phenylketonuria, PKU);
- atopic dermatitis (eczema);
- various types of food protein intolerance.
People prone to allergic reactions should consult an allergist before starting treatment. Antihistamines are prescribed in a course: they are injected on the day of taking anti-tick Ig and for the next 8–10 days.
Autoimmune diseases in which immunoglobulin after an encephalitis tick bite should be used with caution:
- blood diseases - neutropenia, thrombocytopenic purpura, hemolytic anemia;
- endocrine disorders – type I diabetes mellitus;
- changes in joints and connective tissue - rheumatoid arthritis, multiple sclerosis, systemic lupus erythematosus, scleroderma, etc.;
- kidney damage - glomerulonephritis, glomerulopathy, failure.
Treatment of patients with these pathologies is carried out in parallel with the main therapeutic course with the permission of the appropriate specialist: hematologist, rheumatologist, nephrologist, etc.
Contraindications
You cannot give an Immunoglobulin injection against ticks if the following diseases and conditions occur:
- manifestation of serious allergic reactions to administered blood products;
- allergic diseases ( asthma , atopic dermatitis) ;
- a history of severe allergic reactions to certain allergens (in this case, administration of the drug while taking antihistamines is allowed);
- systemic diseases, the origin of which is associated with immunopathological mechanisms (the drug can be administered only against the background of appropriate treatment).
Vaccination after a tick bite
If a tick is attached, it must be removed with all precautions. It needs to be put in a jar and taken to the hospital on the very first day for examination. If his infection is confirmed, there is still no absolute guarantee that the person is also infected.
There is no need to take a blood test after the bite, nothing will show up. Encephalitis can be detected in the blood using PCR only two weeks after a tick attack. It is in these cases that the patient is given an injection of immunoglobulin. Then, based on the incubation period, which lasts one month, one can judge whether a person is infected. If alarming external manifestations appear, urgent medical attention will be required. If an erased form of FE is detected, injections are given over the next five days, until the serious condition is eliminated. It is manifested by a high body temperature that cannot be reduced by medications.
The meningeal form involves the use of immunoglobulin once every 10 hours for 5 days. Injections are canceled as soon as symptoms and brain function improve.
The focal form of encephalitis is characterized by various neurological symptoms. The drug is also administered once a day, so that the break is at least 9–10 hours. When the patient's condition is stabilized, they are canceled. Positive changes should become obvious within a week after the injections.
It is important to distinguish between tick vaccination and the administration of immunoglobulin after a bite. These are completely different things. Even the smallest age of a child is not an obstacle to using immunoglobulin intramuscularly. Even infants are not an exception. The only thing that should be taken into account is that the child does not receive treatment with calcium gluconate at the same time. The absence of contraindications is also important. There is a ban only on TBE vaccinations for children under 12 years of age.
Children are given immunoglobulin for tick bites only after examination by a doctor. This is due to the fact that there is no specific pediatric dosage of the drug; it must be determined by the doctor himself. It is necessary to weigh the child and multiply his weight by the standard dosage.
Immunoglobulin is injected exclusively intramuscularly, into the upper part of the buttock or into the thigh, its outer part. This use is not practiced intravenously. The dose of immunoglobulin for a tick bite is calculated depending on the person’s weight and depends on the purpose of administration:
- Prevention - once and again after a month.
- If the tick has already bitten, then the vaccination is done once.
- Treatment of abortive, febrile forms of TBE – X ml/kg. Then in the same amount over the next 4 days until the patient’s condition normalizes.
- For the meningeal form, the same dosage is given every 11 hours and for at least 5 days until the intensity of symptoms decreases.
- In the focal form, the same dosage is injected 5–6 days every 8–10 hours. The amount of solution is calculated by the doctor based on the patient’s condition. This form of the disease requires the largest amount of medicine.
Before use, the drug must be warmed at room temperature for at least 2 hours. The liquid must be taken into the syringe very carefully, avoiding the formation of foam. The ampoule should not be stored open. When there are suspicions that the packaging has been damaged, it is better to refuse to use it. Injections are carried out only by a nurse in a medical facility. This is important to prevent such a dangerous complication as anaphylactic shock. For the same reason, observation after the injection is required for 0.5-1 hours.
Instructions for Anti-tick Immunoglobulin (Method and dosage)
Intramuscular administration of the drug is provided. The drug cannot be administered intravenously. The instructions for Immunoglobulin against tick-borne encephalitis also require keeping the solution for two hours at a temperature of 18 to 22 degrees Celsius. In the process of opening the ampoule and administering the product, you must strictly adhere to the requirements of antiseptics and asepsis. To prevent foam from appearing, the product must be drawn into a syringe with a needle that has a wide clearance.
Do not store the solution in an ampoule that has been opened. Do not use the drug if the labeling or integrity has been damaged.
For the purpose of prevention, it is administered to a person who has been bitten by a tick. First of all, the drug is administered to people who have not received vaccination against tick-borne encephalitis, as well as to those who have not received the full course of vaccination. It is necessary to administer the drug as soon as possible after the time when the infection supposedly occurred, but no later than 4 days later
It is also possible to administer the medication before expected contact with the tick-borne encephalitis virus. The protective effect disappears after 24-48 hours, the protection lasts for four weeks. If necessary, Antiencephalitis Immunoglobulin can be reintroduced after four weeks. For prevention, it is practiced to administer the medicine once at the rate of 0.1 ml per 1 kg of person’s weight.
After a tick bite, treatment should be administered as soon as possible after the symptoms of the disease appear. For erased and abortive forms of tick-borne encephalitis, 0.1 ml of the drug per 1 kg of weight is administered every day for 3-5 days. At least 21 ml of Immunoglobulin should be administered per course of treatment.
Patients with the meningeal form of the disease are given the drug every day, 0.1 ml per 1 kg of weight every 10-12 hours for at least 5 days, until the general condition improves. With this form of infection, the total dose of medication should be at least 70 ml.
In the focal form of tick-borne encephalitis, 0.1 ml per 1 kg of weight is administered every day every 8-12 hours. Treatment lasts at least 5-6 days until the person’s condition stabilizes. The course of treatment should include a total dose of 80–130 ml of the drug. If the course of the disease is very severe, you can increase the dose to 0.15 ml per 1 kg of weight
Prevention of tick-borne encephalitis: can we rely on immunoglobulin?
In summer, the risk of catching a tick is present everywhere: in the forest and in the city park. How effective are immunoglobulin injections? How does it affect the immune system? What determines whether a person gets encephalitis or not if he is bitten by an infected tick? We asked these questions to Professor, Doctor of Medical Sciences Irina Izvekova.
— Irina Yakovlevna, what is the difference between vaccination and immunoglobulin?
- The difference is fundamental. Vaccination, to one degree or another, replicates the formation of natural immunity. The vaccine contains components of the cell wall of the pathogen, in this case a virus. There are structural proteins in the body that are very important. Protein E is one of the structural proteins of the cell membrane; it is this protein that is used as the basis for all anti-tick vaccines. But the virus genome was removed from the vaccine, and protein E, which produces antibodies, was left. This is close to a certain extent to the natural version of the formation of immunity.
Immunoglobulin has nothing to do with active immune formation at all; this is called replacement therapy. Immunoglobulin contains a certain amount of antibodies. To create it, donor cells (usually vaccinated soldiers or people who have had tick-borne encephalitis) are used.
Antibodies are infused into people who have been bitten in the belief that the virus may have reached them. And if a person does not have immunity, then the immunoglobulin [virus] will bind him.
— Is the administration of immunoglobulin always required for a tick bite and is this a reliable prevention of tick-borne encephalitis?
“We almost never determine the criteria for who immunologically needs it. The fact is that doctors use immunoglobulins very widely in practice. This is one of the priority therapies for many diseases. With regard to such express prevention against tick bites, there is no clear understanding of who needs it. The virus in a tick will not necessarily end up in a person, and statistically there is a very high probability of not getting sick.
But the administration of immunoglobulin does not guarantee protection against encephalitis. These are just attempts to prevent the disease. If there is an option to get vaccinated and build up your immunity, since these are the antibodies that last for a long time, then you need to choose it. And artificial immunity from immunoglobulin disappears after a month. It costs more than vaccination. Patients often think that if they give immunoglobulin, this means that they will not get sick. Nothing like this.
— There is an opinion that administering immunoglobulin later than 12 hours after the bite is useless.
This is true? - Not certainly in that way. Indeed, there should be a certain time interval during which immunoglobulin can be administered, but 12 hours is too limited a period of time. In fact, it is believed that the maximum is three days.
It is best to administer on the first day; on the second day, part of the virus has already entered the cells; on the third, you can only make an attempt to catch something. But, as a rule, this is already ineffective. At the same time, no one can guarantee the effect of immunoglobulin due to many circumstances. At a minimum, a person may have his own initial baseline antibody titer, because we all live in this region and therefore could have been infected. Therefore, it may turn out that the administration of immunoglobulin is not necessary.
— Do residents of endemic areas have developed immunity to tick-borne encephalitis? Or is this a myth?
— There really is such a percentage of the population. If you were born in this zone, walked through the forest, perhaps drank goat's milk, with which you could get the virus, then there is a high chance that you have already become infected without noticing, and your body has developed immunity to the tick-borne encephalitis virus.
You can encourage people to check their own protective titers. However, there is not necessarily a strict correlation between the presence of the virus in a tick and human infection.
There is also an interesting nuance: if the human body itself has begun to produce antibodies, then the introduction of immunoglobulin will only slow down this process.
— What factors determine whether a person gets encephalitis or not? Does it matter what part of the body the virus is injected into?
— There are many theories. For example, it is believed that if a tick bites the head, the disease will be more severe. There is no evidence of this, because the pathogen penetrates where the vessels are close. After a bite, the virus quickly enters the bloodstream. In other words, no matter where the tick bites, encephalitis can develop in any case.
And, of course, everything depends on the individual immunity factors of the bitten person. If a person always develops antibodies well, that is, the body is healthy, then there is a high probability that he will cope on his own. If you look at the statistics of what happens to a person after a bite, then in 90% nothing happens.
Firstly, most ticks are not infected, and secondly, there may be a small viral load. During the season, ticks bite many more people than go to clinics. During the season, about 20 thousand people who are bitten are registered in our region, in the Kemerovo Territory and the Urals up to 40 thousand - and these are only those who know that they have been bitten.
But about two hundred people get sick. The infection can occur in the form of mild meningitis or in the form of severe encephalitis. But even if it is only meningitis, it leaves behind a post-encephalitis syndrome, after which a person feels unhealthy for a long time.
— People only hear about tick-borne encephalitis. However, ticks also carry other diseases, such as borreliosis.
— Today they talk not only about encephalitis and borreliosis. Ticks carry at least six types of infections. We have been talking about borreliosis for a very long time, and moreover, infection of ticks with Borrelia is higher than with the encephalitis virus. This is a long-term disease. It can be treated quite well with antibiotics if the diagnosis is made correctly and quickly.
— Do I need to see a doctor if a tick has just crawled across a person?
— Any crawling is considered a factor of a possible bite. The female and male bite differently. The female bites deeply due to the structure of her jaw apparatus, remains at the site of the bite for quite a long time, maybe several days, and the male attaches himself for about an hour. And since a tick bite is painless, the presence of a male may mean that the bite has already been committed.
— Is the tick population changing? What trends can be traced?
— Every spring they check how many virus-forming (infected) ticks there are in a specific area. Explore city parks, cemeteries and suburban areas. In the Akademgorodok area there is always a high percentage of infected ticks - about 5%. The percentage varies from three to five. This is monitored and recorded, but there is no clear trend relationship.
Some say that the population is increasing, but if you look at the statistics over many years, you will find that it does not fluctuate very much. The characteristics of the ticks themselves change, and more active ones appear. For example, in Academgorodok a type of tick has appeared that is carried not by rodents, but by birds. This means the distribution area is increasing.
— Do ticks develop resistance to the drugs used to treat areas?
— Those repellents that are used now are tested on ticks. And so far, starting from “DETA” and ending with the newest ones, everyone is working. They cause paralysis in ticks.
— Is it possible to make a forecast regarding the development of mites?
— German virologists studied the metamorphoses of ticks over hundreds of thousands of years and showed a photograph of a female tick, whose age was determined by gas chromatography. This is around the time when dinosaurs were on the planet.
Now there are no dinosaurs, but the tick looks exactly the same. And if we return to the question of what will happen to it, then, most likely, humanity will no longer exist, but the tick will remain.
Interaction
Human immunoglobulin against tick-borne encephalitis can be used simultaneously with other drugs, but the drug must be administered separately and not mixed with other medications.
It is permissible to carry out active immunization using live viral vaccines only three months after the last administration of Immunoglobulin.
An interval of at least 4 weeks should be maintained between the administration of the drug and subsequent vaccination against tick-borne encephalitis.
