one embodiment of the preparation of an immunoglobulin composition according to the invention is detailed below . a linear , competitive elisa assay has been developed for determining vaccinia antibody titre . this assay has 2 purposes : the elisa is relatively quick and involves relatively few reagents . like all blood banking elisa &# 39 ; s , the elisa can be performed on a single dilution with only one replicate . vaccinia inactivated antigen is bound to the surface of microtiter wells . samples suspected of containing the specific immunoglobulin g ( vaccinia antibodies ) such as serum , plasma , purified and concentrated immunoglobulins , calibration standards or controls are pipetted into the wells and incubated at 37 ° c . vaccinia antibodies , if present , bind to the immobilized antigen . unbound material is removed in a washing step . in a second step , a goat anti - human igg alkaline phosphatase conjugate is added into the wells and the elisa plate is incubated at 37 ° c . after incubation , unbound conjugate is removed by washing . the enzymatic activity of alkaline phosphatase is then measured by its reaction with p - nitrophenyl phosphate substrate . the measurement is done in an elisa reader at 405 nm . a direct relation exists between the observed optical density and the vaccinia antibody titer . blood collection should be performed according to the current practices . serum or plasma should be separated as soon as possible to avoid any haemolysis . specimens may be stored for 7 days at 2 - 8 ° c . before using . for longer storage , freeze specimens at − 20 ° c . or colder . avoid repeated freezing and thawing . specimens with observable particulates , or after samples have thawed , should be centrifuged prior testing . a day prior to the beginning of the elisa procedure , prepare a working solution , by adding the entire contents of a 50 ml wash concentrate bottle ( r1 ) to 450 ml of distilled water and mixing overnight at room temperature until complete dissolution . prepared wash solution may be stored at 2 - 8 ° c . for up to 1 month . prepare 500 ml for one plate of 12 strips . using suitable test tubes and a microtiter plate , dilute the samples and standard controls as follows : a . test samples : first , make an initial dilution of 1 : 100 ( 10 μl sample in 990 μl sample diluent r2 ). then , further dilute the samples to 1 : 300 ( 150 μl of the 1 : 100 dilution into 300 μl sample diluent r2 ) and 1 : 1200 ( 100 μl of the 1 : 300 dilution in 300 μl sample diluent r2 ). b . standard calibrator ( r3 ) should be diluted 1 : 700 , 1 : 1000 , 1 : 1500 , 1 : 3000 and 1 : 6000 in sample diluent r2 . use an initial dilution of 1 : 100 ( 10 μl calibrator in 990 μl diluent r2 ) and then dilute further to reach the above dilutions ( 50 μl in 300 μl , 50 μl in 450 μl , 50 μl in 700 μl , 50 μl in 1450 μl and 50 1μl in 2950 μl sample diluent r2 , respectively ). p 1 c . standard negative control ( r4 ) should be diluted 1 : 300 : 10 μl in 2 . 99 ml sample diluent r2 . d . positive control ( r9 ) should be diluted 1 : 500 : 10 μl of r9 in 4 . 99 ml sample diluent r2 . 1 . pipette 100 μl of pre - diluted samples , standard calibrator ( calibrator ), negative control ( negcont ) and positive control ( poscont ) into their respective microwells of the assay strips according to the scheme below . the standard calibrators should be added in duplicates . add 100 μl of sample diluent ( r2 ) into 2 wells to be used as blanks . 2 . cover the strips with the plastic cover , and incubate at 37 ° c . for 1 hour . 3 . during incubation , prepare the conjugate solution by diluting the concentrated 5 conjugate ( r6 ) 1 : 14 in the conjugate diluent ( r5 ). dilute the conjugate according to the number of strips in use : for one strip : 70 μl in 930 μl diluent ; for two strips : 140 μl in 1860 μl diluent ; for three strips : 215 μl in 2800 μl diluent . 4 . at the end of incubation , remove the adhesive film , and using an automated plate washer , empty all wells by aspiration and wash six times ( 200 μl / well ) with diluted wash solution . on completion of washes , ensure that all wash solution is removed . 5 . dispense into each well 100 μl of the conjugate solution . cover the strips ( see step 2 ), and incubate at 37 ° c . for 1 hour . 6 . at the end of the incubation , aspirate the content of the wells and wash as described in step 4 . 7 . quickly dispense into each well 100 μl of substrate solution . cover the strips with aluminum foil and incubate for 45 minutes at room temperature . 8 . stop reaction by adding 50 μl stop solution ( r8 ) to each well . 9 . carefully wipe the plate bottom . read the absorbance ( od ) of the wells at 405 nm using an elisa microplate reader within 15 minutes of stopping the reaction . 1 . calculate the mean od value for all replicates and subtract the mean blank od reading from all the results . for the test to be valid the following conditions should be true : ( a ) the mean negative control reading should be lower than the reading of the 1 : 700 dilution of the standard calibrator ; ( b ) the mean negative control reading should be lower than the reading of the 1 : 500 dilution of the positive control . 2 . plot the net od values at 405 nm obtained for the dilutions of the standard calibrator ( on the y - axis ) against the concentrations of these dilutions in omiru / ml ( on the x - axis ), where : the 1 : 700 dilution corresponds to 2 . 1 omiru / ml ; the 1 : 1000 dilution corresponds to 1 . 5 omriu / ml ; the 1 : 1500 dilution corresponds to 1 . 0 omriu / ml ; the 1 : 3000 dilution corresponds to 0 . 5 omriu / ml ; and the 1 : 6000 dilution corresponds to 0 . 25 omriu / ml . the linear range should be 0 . 3 - 1 . 5 omriu / ml . 3 . determine the vaccinia antibody titer of the test samples by interpolation from the calibration curve , and multiplying that value by the dilution factor of the sample . 4 . determine the titer of the positive control ( r9 ) according to the above . the whole test procedure is valid only if the titer of r9 is between 400 and 600 omriu / ml . a vaccinia immunized subject may be classified in one of the four following categories : accordingly and alternatively , results can be interpreted employing the table below : a . in most cases , only one of the two dilutions will result in a value within the linear range ( 0 . 3 - 1 . 5 omriu / ml ). however , in case both dilutions will result in a value within the linear range , the sample should be considered a low responder . b . the classification of the vaccine response categories is tentative and is based on the israeli vaccination program . however , a population may react differently in other vaccination programs and / or with a different vaccine preparation . therefore , the final scheme of interpretation will be determined following the clinical study . 1 . centers for disease control and prevention . vaccina ( smallpox ) vaccine : recommendations of the advisory committee on immunization practices ( acip ), 2001 . mmwr recomm rep 2001 jun . 22 ; 50 ( rr - 10 ): 1 - 25 . 2 . frey s . e ., newman f . k ., yan l ., belshe r . b . ( 2003 ) response to smallpox vaccine in persons immunized in the distant past . jama 289 ( 24 ): 3295 - 3299 . 3 . henderson d . a . ( 1999 ) smallpox : clinical and epidemiologic features . emerg . infect . dis . 5 : 537 - 539 . 4 . henderson d . a . et . al . ( 1999 ) smallpox as a biological weapon . jama 281 ( 22 ): 2121 - 2137 . 6 . who recommendations for production and control of smallpox vaccine ( 2004 ). who expert committee on biological standardization 53 rd meeting , 17 - 21 feb . 2003 . final report . the elisa allows for a linear continuous quantification of anti vaccinia by generating a direct relationship between the observed optical density at 405 nm and the vaccinia antibodies concentration in plasma and serum . 1 ml of pooled plasma derived from 50 vaccinated donors is used as a positive standard and is assigned a value of 1000 arbitrary units (= 1000 omirunits ), as described below in example i . 2 ) validation of an anti - vaccinia antibody test kit was performed as follows : 1 . in house testing of accelerated stability , precision , sensitivity , specificity and recovery with negative , positive , standard and blood bank specimens . this was carried out with at least three production lots of the product ( diagnostic kit ). 2 . suitable blood banks were contracted to run field validation tests . production lot kits were supplied to those establishments and in - house training of test kit operation was provided . the blood bank was required to test sets of standard and pre - tested specimens ( both negative and positive ) in order to validate that the test kits are properly operated . 3 . upon satisfactory accomplishment of ( 2 ) above , each blood bank was required to test 150 randomly selected donor specimens . those specimens were tested in parallel with a reference test kit . if the test results from the diagnostic company test kit and the reference test were concordant , the kit was approved for routine testing of donor blood units . 3 ) equivalence with the serum neutralization method the golden standard for measuring biological activity ( viral inactivation ) of anti - viral antibodies is the viral neutralization assay . neutralization of a virus is defined as the loss of infectivity through reaction of the virus with a specific antibody . the loss of infectivity is brought about by interference of the bound antibody with any one of the steps leading to the release of the viral genome into the host cells . in this assay , a constant predetermined dose of virus ( 400 - 600 opfu / ml ) is allowed to react with various dilutions of the neutralizing sample ( plasma or intravenous immunoglobulin ) and then inoculated into cell culture . the plaque reduction neutralization titer 50 % ( prnt 50 ) is a specific and sensitive test that quantifies the sample dilution that gives 50 % reduction in plaques relative to the virus control well . it is based on the fact that vaccinia virus produces cytopathic effects ( cpe ), which can be observed as plaques in bs - c - 1 cell culture . this cpe is neutralized by the presence of specific antibodies . in this assay , a given viral load is mixed with a dilution series of plasma or serum samples for a given time , after which the dilution series is then plated on the virus &# 39 ; s host tissue culture cell line . after 48 - 72 hours the number of viral plaques is counted . the geometric average of the plaque number is calculated from the dilution series , as is the viral count of the control plasma without the specific antibodies . virus counts without the control result in a number that is called neutralization inhibition 50 — the plasma or serum dilution that gives a 50 % reduction in the viral titer . the assay is very cumbersome , takes at least 4 working days and is not adapted to high throughput samples . it involves a fully equipped virological lab with the capabilities of continuous culturing of viruses and cell culture in a highly classified control environment . thus , the equipment , the environment and the technical skill are far above what can be found in conventional blood banking . 1 . 1 1 , 2 , 5 , 10 and 20 ml pipettes , sterile , for cell culture 1 . 4 37 ° c . water - jacketed incubator with 5 % co 2 ( omrix # 00 - 020323 - 02 ) 1 . 8 filter 0 . 8 / 0 . 2 μm , 32 mm diameter , supor ( gelman , product # 4658 ) 2 . 1 growth medium : mem — earle &# 39 ; s , without l - glutamine ( minimum essential medium eagle , biological industries beit haemek , cat . # 01 - 025 - 1 ) 2 . 2 foetal calf serum ( fcs ) ( biological industries beit haemek , cat . # 04 - 121 - 1 ) 2 . 3 l - glutamine in saline , 20 millimoles ( biological industries beit haemek , cat . # 03 - 020 - 1 ) 2 . 4 penicillin ( 10000 u / ml )- streptomycin ( 10 mg / ml ) amphotericin b ( 25 μg / ml ) solution ( biological industries beit haemek , cat . # 03 - 033 - 1 ) 2 . 5 sodium bicarbonate 7 . 5 % solution ( biological industries beit haemek , cat . # 03 - 040 - 1 ) 2 . 6 nonessential amino acids solution ( biological industries beit haemek , cat . # 01 - 340 - 1 ) 2 . 7 sodium pyruvate solution 100 mm , ( biological industries beit haemek , cat . # 03 - 042 - 1 ) 2 . 8 trypsin edta solution ( 0 . 25 % trypsin ) ( biological industries beit haemek , cat . # 03 - 050 - 1 ) 2 . 14 growth medium : mem ( earle &# 39 ; s ) 2 ×, without l - glutamine ( minimum essential medium eagle , biological industries beit haemek , cat . # 01 - 025 - 9 ) bs - c - 1 cells : ( atcc — ccl - 26 ) continuous cell line of cercopithecus aethiops ( monkey , african green ) kidney epithelial , atcc lot # 1182351 . the cells are maintained according to sop # 08030105 . vaccinia ( ihd strain ): ( atcc vr - 156 ): vaccinia belongs to the poxvirus family , orthopoxvirus genus . virions enveloped ; slightly pleomorphic ; ovoid , or brick - shaped ; 140 - 260 nm in diameter ; 220 - 450 nm long . composed of an external coat containing lipid and tubular or globular protein structures enclosing one or two lateral bodies and a core , which contains the genome . virions contain one molecule of linear double stranded dna the medium is made up with mem with the addition of 2 mm l - glutamine , 1 mm sodium pyruvate , 0 . 1 mm nonessential amino acids , 1 . 5 g / l sodium bicarbonate , 1 % penicillin - streptomycin - amphotericin b solution , and 2 % fcs . work under sterile conditions . add to 230 ml of mem , 2 . 5 ml l - glutamine , 2 . 5 ml sodium pyruvate , 2 . 5 ml nonessential amino acids , 5 ml sodium bicarbonate , 2 . 5 ml penicillin - streptomycin - amphotericin b solution and 5 ml fcs respectively . filter through a 250 ml 0 . 2 □ m cellulose acetate filter system . the medium is stable for one month at 2 - 8 ° c . if not contaminated . before addition of medium to the cells , bring the medium to 37 ° c . using a water bath . the medium is made up with mem 2 × with the addition of 4 mm l - glutamine , 1 % penicillin - streptomycin - amphotericin b solution , and 4 % fcs . work under sterile conditions . add to 230 ml of mem 2 ×, 5 ml l - glutamine , 2 . 5 ml penicillin - streptomycin - amphotericin b solution and 10 ml fcs respectively . filter through a 250 ml 0 . 2 □ m cellulose acetate filter system . the medium is stable for one month at 2 - 8 ° c . if not contaminated . before addition of medium to the cells , add 2 . 4 % sodium bicarbonate and bring the medium to 37 ° c . using a water bath . to a beaker with 60 ml etoh , transfer 20 g tragacanth . stir the tragacanth until reaching a homogeneous suspension ( 15 min ). wait until decantation and discard the supernatant repeat the stirring 3 times . dry the tragacanth cake using a folded filter and then by placing into a 37 ° c . incubator for 3 h . pass through a gauze pad . store at rt . dissolve 8 g clean tragacanth in 1000 ml purified water for 2 hrs at 70 ° c . bring final volume to 1000 ml with purified water , then autoclave at 120 ° c . for 30 min . the tragacanth solution should be aliquoted to 50 ml vials under sterile condition . store for up to two years at 2 - 8 ° c . prepare 5 % phenol by adding 50 ml phenol to 950 ml purified water . prepare a 3 % fuchsin solution by dissolving 3 g of fuchsin in 100 ml etoh . mix well between the 100 ml fuchsin and the 1 l phenol solutions . store at rt for up to 2 years . protect from light with aluminum foil . the duration of a neutralization assay is 5 days , and is made up of the following stages : day 1 : seeding bs - c - 1 cells , that were grown as described in sop # 08030105 , onto a 6 - well plate ( section 9 . 1 ). day 5 : cell staining and determination of prnt 50 ( section 9 . 3 ) seed bs - c - 1 cells ( passage 4 - 40 ) on a 6 - well plate at a concentration of 4 × 10 5 cell / well ( according to sop # 08030105 ). the cells should reach confluence on the next day for the virus neutralization assay ( day 2 ). 5 . 2 . 1 . 1 prepare a pool of vaccinia virus in growth medium , meme 2 % fcs , to a final concentration between 800 - 1200 pfu / ml . 5 . 2 . 1 . 2 prepare serial dilutions of sample in growth medium , meme 2 % fcs , in the range of 1 / 40 - 1 / 40960 . plasma and serum samples should be inactivated at 56 ° c . for 30 min . 5 . 2 . 1 . 3 mix each ivig dilution with an equal volume of the vaccinia pool , thus obtaining a final dilution of 1 / 80 - 1 / 81920 for ivig and a final concentration of 400 - 600 pfu / ml for vaccinia virus pool ( e . g 500 μl of 1 / 40 - diluted ivig with 500 μl of 800 - 1200 pfu / ml vaccinia virus gives a final ivig dilution of 1 / 80 and 400 - 600 pfu / ml vaccinia ). ivig ( for ivig assay ): mix omrigam 5 % batch # f 18132 ( manufactured from an american source plasma ) at a dilution of 1 / 40 with an equal volume of the vaccinia virus pool , thus obtaining a final dilution of 1 / 80 for omrigam 5 % and a final concentration of 400 - 600 pfu / ml for the vaccinia virus pool . plasma ( for plasma assay ): mix a negative plasma lot # 3562515 ( 18201 ) at a dilution of 1 / 40 with an equal volume of the vaccinia virus pool , thus obtaining a final dilution of 1 / 80 for plasma and a final concentration of 400 - 600 pfu / ml for the vaccinia virus pool . serum ( for serum assay ): mix a negative serum at a dilution of 1 / 40 with an equal volume of the vaccinia virus pool , thus obtaining a final dilution of 1 / 80 for serum and a final concentration of 400 - 600 pfu / ml for the vaccinia virus pool . mix a positive sample ( h0402 1 ) at a dilution of 1 / 40 with an equal volume of the vaccinia virus pool , thus obtaining a final dilution of 1 / 80 for the positive sample and a final concentration of 400 - 600 pfu / ml for the vaccinia virus pool . roll all ivig mixtures and controls for 90 min at 37 ° c . 5 . 2 . 3 virus inoculation ( day 2 ) 5 . 2 . 3 . 1 after 90 min incubation , observe the bs - c - 1 cell monolayers ( that were prepared on day 1 ) which must be healthy and confluent . 5 . 2 . 3 . 2 discard the medium from each well . 5 . 2 . 3 . 3 carefully add 0 . 2 ml sample mixtures and controls to the wells and gently rock the plate to achieve an even distribution of the inoculums . 5 . 2 . 3 . 4 allow the non - neutralized vaccinia virus to adsorb for 60 min at 37 ° c . in the co 2 incubator . 5 . 2 . 3 . 5 combine between the growth medium ( mem × 2 4 % fcs ) and the tragacanth solution ( 1 : 1 ), and add 2 . 4 % sodium bicarbonate . 5 . 2 . 3 . 6 add 3 ml of the tragacanth - medium , to each well . 5 . 2 . 3 . 7 incubate the plate in a 37 ° c . incubator for 72 hrs . 5 . 3 cell staining and determination of prnt 50 ( day 5 ) 5 . 3 . 1 examine the plate by a microscope for observation of lysed cells . 5 . 3 . 2 the staining process should no longer be sterile . it should be carried out in a chemical hood . 5 . 3 . 3 empty the wells by tapping . 5 . 3 . 4 add 500 μl etoh to each well . wait 2 minutes . take the solution out of the wells by tapping . 5 . 3 . 5 add 500 μl fuchsin staining solution ( section 8 . 4 ) to each well . wait 2 minutes . take the solution out of the wells by tapping . 5 . 3 . 6 count the number of plaques . virus control should result in 80 - 120 pfu / well . negative control should result in a uniform and intact monolayer . plasma , serum and ivig negative controls should give ≧ 80 % plaques of the virus control . positive control should give a ≦ 50 % plaques compared to the plasma , serum or ivig negative control . the prnt 50 ( expressed in μg / ml ) for each sample is the igg concentration at which there is 50 % neutralization of vaccinia virus as determined by the non - linear relationship ( dose - response curve ) between the log of the igg concentration ( initial igg concentration divided by the dilution ) and the percentage of plaque neutralization relative to the control sample ( taken as 100 %). virology methods manual , brian w j mahy and hillar o kangro . a pilot study was conducted with the israel defense forces ( idf ), which served as a model for the vaccination and screening of plasma donors . upon a full analysis of the data , the statistical power was generated from which the exception and the exclusion criteria of the plasma donation , apart from the general blood banking , were finally formulated . the vaccination of the idf subjects was conducted in accordance with the cdc guidelines ( see the website beginning with www and followed by : bt . cdc . gov / agent / smallpox / response - plan / index . asp # guideb ). additional criteria that may arise from the full analysis of the pilot study were implemented in the vaccination protocol . plasma screening was performed using the same standards as in the pilot study , with a few changes that were derived from the full statistical analysis of the data . the final cutoff for high titre ( ht ) hyper immune donation was used after the full assessment of the titer variability and the estimation of the percentage of the population that would contribute to the ht hyper immune plasma . an example of donor variability is seen in fig1 . this ht hyper immune population was kept between 10 - 15 % of all subjects who showed either sero - conversion or clinical signs that the immunization was successful . plasma collection was conducted according to the fda guidelines and the local blood banks &# 39 ; standard operation . selected subjects was repeatedly taken advantage of , for example by using a plasmapheresis or plasma donation technique ( see for example u . s . pat . no . 6 , 692 , 739 , whose contents are incorporated herein by reference ). subjects without any clinical signs were excluded from plasma donation . these subjects were revaccinated . clinical signs are as follows : a normal primary vaccination appears as a papule after 3 - 4 days , and rapidly progresses to a vesicle with the surrounding erythema by the 5th - 6th day . the vesicle center becomes depressed and progresses to a well - formed pustule by the 8th - 9th day . by the twelfth day , or soon thereafter , the pustule crusts over , forming a brown scab , which progresses from the center of the pustule to the periphery . after 2 . 5 to 3 weeks , the scab detaches and a well - formed scar remains . rarely , in some previously unvaccinated individuals , seemingly appropriate vaccination techniques may not result in any reaction . one should assume that the individual is not immune and repeat attempts should be made to achieve a primary take . at least three attempts should be made , switching skin sites after a second unsuccessful attempt . systemic symptoms : systemic symptoms are expected and usually occur about a week after vaccination . these include : soreness at the vaccination site intense erythema ringing the vaccination site malaise lymphadenopathy ( local ) myalgia , headache , chills , nausea , fatigue fever the occurrence of these normal reactions varies considerably from study to study . the following table lists the symptoms covered by the studies and provides an indication of the range : the plasma donation should take place when the scab from the vaccine separates from the skin , or 21 days post - vaccination , whichever is later . all plasma samples were qualified according to the fda guidelines for plasma safety . all qualified donations were screened for high vaccinia titer . only plasma donation with predetermined minimal vaccinia titers will be pooled for fractionation of ht hyper immune vig . receipt of plasma donation and release for fractionation was according to preset acceptance criteria . these criteria include only using plasma units with vaccinia antibodies titers above 1800 omirunits / ml . a . re - suspension of 10 - 12 kg of paste ii ( equivalent to 2 . 5 - 3 . 0 kg of immunoglobulin ). b . manufacturing of bulk 10 % solvent detergent treated and 20 nanometer filters immunoglobulin . the ht hyper immune vig may be characterized according to the usp monograph for intramuscular immunoglobulin . stability studies of the ht hyper immune vig final containers should also be carried out . the following is a product characterization of one example of an immunoglobulin composition ( ht - vig ) according to the invention . ht - vig is a sterile solution containing 10 % protein ( 100 mg in 1 ml solution of which at least 95 % is human normal immunoglobulin g ), 10 % maltose , and water for injections . ht - vig undergoes viral removal / inactivation technology ; composed of 3 viral inactivation steps : the cohn - cold ethanol fractionation has been validated as a primary virus inactivation step . ht - vig undergoes a second virus inactivation step by the solvent detergent method using tnbp / triton x - 100 and a third inactivation step by nanofiltration at ph 4 and makes ht - vig a very safe immunoglobulin . ht - vig is a clear or slightly opalescent , almost odourless , colourless to pale yellow liquid for intravenous or intramuscular administration . the sterile filling of the product is carried out in glass , siliconized vials of 10 ml with 4 - 5 ml fill volume or in a pre - filled 4 - 5 ml syringe . vials / syringes should be stored at a temperature between 2 - 8 ° c ., protected from light parameters limits characters clear or slightly opalescent and colorless or pale yellow solution . ouchterlony gives a positive reaction with human protein anti - sera and a negative reaction with animal protein anti - sera . igg by cellulose acetate ≧ 95 % electrophoresis igg content 85 mg / ml - 110 mg / ml vaccinia antibody titer 40 , 000 / ou / ml anti - hepatitis a & gt ; 100 iu / ml anti - hbsag & gt ; 0 . 5 iu / g igg total protein 8 . 3 %- 1 . 1 % ( w / v ) distribution of molecular monomer and dimer ≧ 90 . 00 % size ( hplc ) polymers and aggregates ≦ 3 . 00 % anticomplementary activity ≦ 1 ch 50 / mg igg * prekallicrein activity * ≦ 35 iu / ml * anti - a & amp ; anti b the 1 : 64 dilutions do not show haemagglutinins agglutination * tri - n butyl phosphate ( gc ) ≦ 5 . 0 μg / ml ( ppm )* triton x - 100 ( hplc ) ≦ 5 . 0 μg / ml ( ppm )* iga content ≦ 0 . 36 mg / ml igm content ≦ 0 . 24 mg / ml (≦ 10 mg / dl ) ph 5 . 1 - 6 . 0 osmolality ≧ 240 mosmol / kg h 2 o sodium ( flame photometer ) & lt ; 20 mmol / l maltose 90 - 110 g / l pyrogens ( 10 ml / kg rabbit ) non pyrogenic sterility ( steritest ) sterile ag hbs negative ab hiv negative ab hcv negative hcv - rna ( pcr ) in plasma negative pool data collection is a straightforward process and can follow the local data banking standard operating procedures ( sop ) already in place at each center . the subjects &# 39 ; questionnaires for the vaccination and the evaluation of the screening program , was formulated . the blood collection , storage and shipment instruction were written and supervised according to sop . all attachments to the vaccination screening and plasma collection protocols were formatted in an electronic copy as well as a hard copy to allow for analysis and surveillance by the quality assurance team . data was entered into a pc - based database system ( e . g . paradox ) to enable on - line querying and production of up to date reports . all statistical analysis was performed using a statistical software package for the pc ( e . g . sas ). standard parametric tests were run to compare symptomatic and antibody responses . primary analysis included safety , serological and clinical data . the parameters for response to the vaccine included data of clinical skin reactions , normal reactions , adverse effects , severe adverse effects and anti - vaccinia titers . those subjects having titers that are above the threshold chosen as eligible for collection and assigned for hyper immune , were included in the preliminary analysis , but they were also analyzed separately in a sub - analysis to see if they correlate to any of the parameters collected in the vaccination questionnaire . viral removal / inactivation technologies are well known . for example , one such technology is disclosed in u . s . pat . no . 6 , 468 , 733 , whose contents are incorporated herein by reference . the ht - vig product may include viral removal steps according to these technologies , such as nano - filtration and solvent detergent treatment , which exhibit high margins of viral inactivation of all known viruses , including parvo - viruses . the solvent - detergent was removed through a specific solvent detergent removal resin that has the capability of binding hydrophobic substances and molecular sieving of large molecules . the column outflow yields an immunoglobulin solution that has a very low dimer and polymer content , allowing a high throughput through nanofiltration . this results in a liquid immunoglobulin preparation that is devoid of active viruses , while featuring a very high yield . furthermore , the above process can be performed at a low ph thus allowing in addition the inactivation of viruses that are sensitive to low ph . the storage of the liquid product may be at room temperature for at least two years in pre - filled , ready to use syringes . for longer storage times , the product may be stable for up to 3 years at 2 - 8 ° c . three studies concerning israeli and u . s . plasma donation samples have been conducted : plasma for fractionation and manufacturing of hyper immune vaccinia immunoglobulin is usually collected from voluntarily revaccinated donors . to commence this investigation , the variability of anti vaccinia immunoglobulin in the plasma donations and percentage of plasma units suitable for pooling was studied . the collection of suitable plasma donations from revaccinated subjects is based on clinical manifestation of the vaccine . on the other hand the hyper immune plasma collection is based primarily on the plasma titers . the correlation between these two methods was assessed . manufacturing of hyper immunoglobulins carries inherent risks of achieving low yields that might drastically reduce the economic viability of certain manufacturing technology . the highly sensitive elisa assay can detect residual titers of anti - vaccinia igg in regular plasma pools . it can also detect this immunoglobulin g in intravenous immunoglobulin batches . the theoretical yield of the vig production process was calculated . the results indicated that the method of the invention is suitable for the production of high titer vig . screening of anti vaccinia titers in plasma units donated by revaccinated subjects background : plasma donations for the production of vaccinia - rich intravenous immunoglobulin were collected from revaccinated donors during the israeli emergency program , in which selected military and health services personnel were vaccinated against smallpox . since donor selection was based exclusively on clinical manifestation signs and not on sero - conversion immunoglobulin titers , an assessment was needed to evaluate the titers in plasma manufacturing pools . methods : 37 plasma donations were selected randomly out of 24 , 000 subjects who were inoculated intradermally 30 days previously with 20 μl of the elstree vaccinia virus ( mean titer , 10 7 pfu per milliliter ). the plasma units were monitored for the titers of anti - vaccinia immunoglobulin using an elisa assay . 3 ml of each of the plasma donations were mixed with the other samples and the pool served as a positive standard . the pooled plasma positive standard was then assigned 1000 arbitrary units ( 1000 omriunits / ml ). 20 - 40 omriunits will neutralize vaccinia virus by 50 % in a neutralization assay of the kind described above ( the prnt50 assay ). the pooled vaccinia plasma positive standard may be obtained on request from omrix biopharmaceuticals , ltd ., tel aviv , israel . results : the results are summarized in fig1 . it was found that the variability in the donated plasma units ranged between 26 units and 6530 omriunits . the calculated average was 971 . 8 omriunits , the standard deviation was 1349 while the median was only 542 omriunits . the results of the calculated average coincides with the average of the experimentally mix plasma units , indicating that the mixture of different plasma units does not differ from the calculated one . this indicates that the elisa does not suffer form inhibitory reactions often occurring when plasma donations are mixed . conclusion : only about 10 % of the population had titers that are significantly higher than the average of the plasma donation collected from revaccinated subjects . it is apparent that if only plasma donations that have titers higher than 1800 omriunits / ml are collected ( very high titer plasma donations ), the pooled hyper immune plasma titer would be at least 5 times higher than the regular rich pooled vaccinia immunoglobulin . it is therefore obvious that screening of plasma donation of all revaccinated population is required to identify very high titre individuals having a very high titre of the specific antibodies . it was found that the very high titre individuals stably maintain a very high titre of specific antibodies . fig2 and 3 show the titers of two high titre individuals of about 3000 omriunits / ml . this titre was maintained even 3 months after revaccination and following almost 20 plasma donations . correlation between clinical responses and sero - conversion of smallpox vaccination of revaccinated adults background : the production of vaccinia immune globulin ( vig ) relies on the collection of plasma from recently vaccinated adult subjects . recent reports indicated that the clinical response of naive subjects exceeded 95 %, while reports from the early 1960s showed that the clinical response in revaccinated children is much lower . a clinical experiment was designed to evaluate the response percentage and to assess the correlation between the revaccinated subjects &# 39 ; clinical response and the increase in anti - vaccinia titers . method : in this randomized , single - blind , prospective study , 157 adults who had been previously immunized , were inoculated intradermally with 20 μl of the elstree vaccinia virus ( mean titer , 10 7 pfu per milliliter ), using a hypodermic needle , and the site was covered with a semi permeable dressing . subjects were monitored for vesicle formation on days 3 - 4 and days 7 - 9 ( a clinical response of the success of vaccination ) and for adverse events for 30 days after immunization . serum samples were taken on day 0 ( before the vaccination ), day 14 , and day 30 ( plasma donation ). the serum titers were tested using the linear , quantitative elisa . results : success rates differed only slightly between the clinical responders and sero - conversion . clinical responders were 62 . 87 %— very similar to the subjects who demonstrated sero - conversion ( 62 . 42 %). serum titers in all the responding subjects were reduced by an average of 30 % between the 14th and 30th days after the re - vaccination . in addition to the formation of pustules , common adverse events consistent with the presence of an acute viral illness including the formation of satellite lesions , regional lymphadenopathy , fever , headache , nausea , muscle aches , fatigue , and chills appeared only in a small percentage of the subjects . the correlation between the sero - converted subjects ( results of day 14 vs . day 0 ) and the clinical formation of pustules appearance on days 7 - 9 was 87 . 74 %— very close to the correlation percentage found between the sero - converted subjects that have pustules on days 3 - 4 and / or days 7 - 9 ( 88 . 44 ). serum titers at day 0 were very variable , and become even more variable as titers increased after 14 days . this variability appeared also at 30 days after the vaccination . only 10 - 15 percent of the subjects had high titers that would be suitable for hyper immune vaccinia immunoglobulin production . conclusions : when 20 μl of elstree vaccine strain at a titer of 10 7 pfu is given to revaccinated adult subjects , 62 . 87 responded clinically , similar to the 62 . 42 sero - conversion rates . there is a very high correlation between the two methods ( about 88 %). anti - vaccinia titers reach a peak at 14 days after vaccination and decline by about 30 % at 30 days . the titers of the revaccinated subjects was shown to be highly variable at 30 days after the vaccination and only 10 - 15 % of the revaccinated subjects had titers above 1000 arbitrary units which comply with the production of hyper - immune vaccine globulins . these data suggest that a screening test for the hyper - immune subject should be mandatory . preliminary studies indicate that the titers of immunoglobulin g of revaccinated volunteers are very variable , thus vig products that are produced from such pooled plasma result in relatively low titers . the studies indicate that it is feasible to utilize the fast screening elisa method in which the high titer anti vaccinia plasma samples can be singled out . pooling high titer plasma units that account for 10 - 15 % of the donor population for the production of a 10 % intravenous immunoglobulin and concentrating the pool would result in production of ht - vig .
a method for preparing a concentrated , immunoglobulin composition for treating subjects vaccinated against or infected with a pathogenic microorganism , comprising : selecting a population of individuals previously vaccinated against one or more antigens associated with the pathogenic microorganism ; determining the level of specific antibodies immunoreactive with the pathogenic microorganism in a blood or blood component of the individuals to identify very high titre individuals having a very high titre of the specific antibodies ; combining blood or blood components comprising immunoglobulins from the very high titre individuals ; and purifying and / or concentrating the product of step , thereby obtaining a concentrated immunoglobulin composition . also disclosed is a concentrated immunoglobulin composition comprising specific antibodies immunoreactive with a pathogenic microorganism , characterized in that the titre of specific antibodies of the composition is at least 5 times higher than the average titre of specific antibodies of a population of individuals previously vaccinated against one or more antigens associated with the pathogenic microorganism . the composition has a relatively high protein concentration and a low percentage of protein aggregates , and is therefore suitable for both iv and im administration . in a preferred embodiment , the pathogenic microorganism is smallpox virus or vaccinia virus .