#IDBoardPearls #IDtwitter
Post-exposure prophylaxis. As with all things, timing maters 😷
1️⃣ HAV:
Indications - close contacts, child care & school contacts, food handlers
⏲ 2 weeks - 💉
👉🏼 + Ig if > 60 YO or immunocompromised
⏲ 28 days - 💉
👉🏼 + Ig if chronic liver disease
Post-exposure prophylaxis. As with all things, timing maters 😷
1️⃣ HAV:
Indications - close contacts, child care & school contacts, food handlers
⏲ 2 weeks - 💉
👉🏼 + Ig if > 60 YO or immunocompromised
⏲ 28 days - 💉
👉🏼 + Ig if chronic liver disease
or Hep B/C infection
⏲ 8 weeks - 💉 if there are > 1 close contacts in 🏠
2️⃣ HBV:
Indications - percutaneous or mucosal exposure, sex or needling sharing contact, victim of sexual assault
⏲- within 24 hrs, up to 7 days
📌Unvaccinated 🧍🏻♀️+ source HBsAg + ➡️ 💉 + Ig
⏲ 8 weeks - 💉 if there are > 1 close contacts in 🏠
2️⃣ HBV:
Indications - percutaneous or mucosal exposure, sex or needling sharing contact, victim of sexual assault
⏲- within 24 hrs, up to 7 days
📌Unvaccinated 🧍🏻♀️+ source HBsAg + ➡️ 💉 + Ig
📌Vaccinated 🧍🏻♀️+ source HBsAg + ➡️ booster 💉
📌Unvaccinated 🧍🏻♀️+ source HBsAg - (or unknown) ➡️ 💉 series
📌Vaccinated 🧍🏻♀️+ HBsAg - (or unknown) ➡️ no treatment
3️⃣ VZV:
Indications - face to face contact or in a room for > 15 min with the following:
📌exposure to chickenpox or
📌Unvaccinated 🧍🏻♀️+ source HBsAg - (or unknown) ➡️ 💉 series
📌Vaccinated 🧍🏻♀️+ HBsAg - (or unknown) ➡️ no treatment
3️⃣ VZV:
Indications - face to face contact or in a room for > 15 min with the following:
📌exposure to chickenpox or
disseminated zoster (48 hr prior to onset of rash)
📌 exposure to exposed lesions in immunocompetent hosts
📌 exposure to localized zoster (day of rash onset until lesions crust) in immunosuppressed hosts
⏲ - 10 days
👉🏼 Give VZIG
4️⃣ Tetanus:
Indication - wounds with delayed
📌 exposure to exposed lesions in immunocompetent hosts
📌 exposure to localized zoster (day of rash onset until lesions crust) in immunosuppressed hosts
⏲ - 10 days
👉🏼 Give VZIG
4️⃣ Tetanus:
Indication - wounds with delayed
surgical intervention, significant tissue injury, contact with soil/foreign bodies
⏲ - during injury
📌< 3 does of Td or unknown 💉hx ➡️ Ig + Td/Tdap (if < 1 YO at home)
📌 > or = 3 doses of Td ➡️ Td/Tdap (if < 1 YO at home) IF last 💉 was > or = 5 yrs ago
5️⃣ MMR:
Indications-
⏲ - during injury
📌< 3 does of Td or unknown 💉hx ➡️ Ig + Td/Tdap (if < 1 YO at home)
📌 > or = 3 doses of Td ➡️ Td/Tdap (if < 1 YO at home) IF last 💉 was > or = 5 yrs ago
5️⃣ MMR:
Indications-
non-immune contacts of measles
⏲ - 3 days for 💉 or within 6 days for Ig
‼️vaccine is 🚫 for mumps & rubella outbreaks. Ab don’t develop quickly enough to 🛡
📌Ig used only when 💉 is contraindicated, measles ab -, immunosuppressed, 🤰🏻, or 👶🏻
6️⃣ Meningococcal:
Indications -
⏲ - 3 days for 💉 or within 6 days for Ig
‼️vaccine is 🚫 for mumps & rubella outbreaks. Ab don’t develop quickly enough to 🛡
📌Ig used only when 💉 is contraindicated, measles ab -, immunosuppressed, 🤰🏻, or 👶🏻
6️⃣ Meningococcal:
Indications -
🏠 & 😘 contacts, exposure w/ CPR
⏲ - 24 hrs
👉🏼 cipro x 1 + MenAcwy or Hib/MenC if previous 💉 > 1 yr
7️⃣ HIV:
Indications - sexual or needle sharing exposure, occupational exposure w/ HIV + source
⏲ - ASAP
👉🏼 TDF/FTC + RAL or DTG
‼️4th gen 🧪at baseline, 6 wks, 12 wks, & 4 mo
⏲ - 24 hrs
👉🏼 cipro x 1 + MenAcwy or Hib/MenC if previous 💉 > 1 yr
7️⃣ HIV:
Indications - sexual or needle sharing exposure, occupational exposure w/ HIV + source
⏲ - ASAP
👉🏼 TDF/FTC + RAL or DTG
‼️4th gen 🧪at baseline, 6 wks, 12 wks, & 4 mo
Other important considerations…
8️⃣ Rabies:
Indications - exposure to rabid 🐕🦇🦊🦨🦝
⏲ - given despite length of delay
Ig + 💉 to area of bite
‼️IF 💉 has been given > 7 days prior, Ig not indicated
See this amazing 🧵by @WuidQ
👇🏼
8️⃣ Rabies:
Indications - exposure to rabid 🐕🦇🦊🦨🦝
⏲ - given despite length of delay
Ig + 💉 to area of bite
‼️IF 💉 has been given > 7 days prior, Ig not indicated
See this amazing 🧵by @WuidQ
👇🏼
https://twitter.com/WuidQ/status/1082655372857565184
And last but not least…
9️⃣ Herpes B:
Indications - exposure via mucosal secretions, bites, or skin tear to macaques 🐒
⏲ - within 5 days
👉🏼 give acyclovir/valaciclovir for 14 days
See this 🧵 by @MayoClinicINFD for more info!
👇🏼
9️⃣ Herpes B:
Indications - exposure via mucosal secretions, bites, or skin tear to macaques 🐒
⏲ - within 5 days
👉🏼 give acyclovir/valaciclovir for 14 days
See this 🧵 by @MayoClinicINFD for more info!
👇🏼
https://twitter.com/mayoclinicinfd/status/1312354062495608833
Ok… 1 more! 😅
🔟 Pertussis:
Indication - contact (face to face within 3 ft) with a person with pertussis
⏲ - within 21 days
👉🏼 give 5 days of azithro or 7 days of clarithro
🔟 Pertussis:
Indication - contact (face to face within 3 ft) with a person with pertussis
⏲ - within 21 days
👉🏼 give 5 days of azithro or 7 days of clarithro
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