Post Exposure Prophylaxis Flashcards
How long after mpox exposure can you use vaccination as PEP?
Are there any exceptions?
Mpox vaccine should be given within 4 days of exposure.
For those at high risk of severe disease (pregnant women, immunocompromised, children) this can be extended to 14 days
Prophylaxis for avian influenza exposure and special considerations for H7N9
75 mg oseltamivir OD for 10 days (up to 42 days if continuous exposure)
Double dosing 75 mg oseltamivir BD for 10 days
Why is HNIG contraindicated in patients with IgA deficiency?
Due to risk of possible anaphylaxis
Who is at risk of severe CP?
Pregnant (susceptible)
Neonates
Immunocompromised
Why is CP-PEP recommended for pregnant women?
Reduce severity of maternal disease
Theoretical reduction in the risk of fetal infection in the 1st 20W
In late pregnancy, PEP may reduce risk of neonatal infection
Who needs PEP after exposure to CP/SH?
Significant exposure during IP
At risk of severe CP
No Ab to VZV
In relation to CH/SH- what is considered significant exposure?
1) Type of VZV infection in index case:
CP, dis Shingles, IC with exposed SH, IS with localised SH on any part (viral shedding is greater)
2) Timing of exposure:
1 or more exposure during IP
Continuous exposure (HH/nursery/care worker)
3) Closeness and duration of contact (in addition to above):
Same room =/>15min
F2F contact (no time specified)
IS contacts on a large open ward (air-borne transmission reported)
How is CP transmitted?
and what is the secondary infection rate from HH contact?
Person-Person primarily by inhalation of aerosols generated from:
Vesicular fluid from CP/SH lesions
Infected RT secretions
——
70-90%
How is Shingles transmitted?
Primarily by direct contact with vesicle fluid in IC patient BUT maybe aerosolised from infected RT secretions in IS patients
What is the VZV IgG cut-off to give PEP in pregnant women, IS and neonates?
Pregnant women: <100IU/ml
IS: <150IU/ml
Neonates ( Group 2) : < 150IU/ml ( no test required for group 1)
What should you advise if a 2nd/subsequent exposure occurred:
1) within the 1st 7d of PEP?
2) 8 or more days after 1st exposure?
1) Extend the course until 14 days after the 1st day of second exposure.
2) A new course should be started.
What is the brand name of VZV-immunoglobulin available in the UK?
Who should get it?
What is the recommended dose?
When is should be given?
From where can you obtain this product?
Varitect CP (off-label, not licensed in the UK)- produced by Biotest as a solution for IV infusion.
Neonates group 1 (in addition to IV ACV
50IU/kg (2ml/kg) as a single dose (slow infusion)
ASAP- preferably within 96hr and NO longer than 10d post-exposure.
Through the UKHSA Rabies & Ig service (delivered within 5hr)
CP-PEP, Who should get Normal IVIG?
What is the recommended dose?
When it should be given?
1) Contacts who can not receive anti-virals
And
Neonate group 1 when there is a delay in getting Varitect CP
2) 0.2g/kg (4ml/kg for 5% solution)
3) Ideally within 10d
Preferably within 7d for neonates and IS
BUT can be given later if necessary
What are the steps need to be taken in case of inadvertent administration of the LAV for CP/SH to
1) Immunosuppressed pt
2) pregnant woman
1) Urgently asses the degree of Immunosuppression
PEP with ACV/VCV from d7 (if necessary)
OR
Observe + treat if developed CP
2) If received Zostavax:
Risk assessment and if required VZV IgG test > if negative > offer PEP within 7 days but up to 10d after vaccination (value of this need to be discussed with national experts)
If received Varilrix/Varivax:
Can be reassured, no reported FVS.
Report BOTH to the UK vaccine in Pregnancy surveillance programme
