Post-exposure prophylaxis

Question 1

Which common viruses can be targeted by PEP?

Answer 1

HIV
HAV
HBV
Rabies
VZV
Influenza

Question 2

Which common bacteria can be targeted by PEP?

Answer 2

N. meningitidis
Anthrax
Plague
Pertussis
Tetanus

Question 3

What is the incubation period of HAV?

Answer 3

14-28d

Question 4

What is the transmission mode of HAV?

Answer 4

Fecal-oral

Question 5

What is the R0 of HAV?

Answer 5

3.6

Question 6

What are preventative measures for HAV?

Answer 6

Good sanitation
Food appropriately heated
Avoid food and water in endemic areas
Vaccination

Question 7

Give examples of HAV contacts

Answer 7

Household
Day-care
Workplace of food handlers
Sexual
Illicit drug use

Question 8

What are the attack rates of HAV in household contacts?

Answer 8

15-30%
Higher among children

Question 9

What is patron risk of HAV if a food handler is infected?

Answer 9

Generally low
Risk is higher when food handler has diarrhoea

Question 10

When can HAV PEP NOT be given?

Answer 10

Once secondary cases start to appear -> 2w period of PEP exceeded (incubation)
HCWs (standard IPC)

Question 11

What are the options for HAV PEP?

Answer 11

Single dose vaccine
HAV Ig

Question 12

Who can receive HAV vaccine?

Answer 12

12m-40y
Immunocompetent

Question 13

Who should receive HAV Ig?

Answer 13

<12m
>40y
Immunosuppressed
Chronic liver disease
0.02ml/kg

Question 14

What is the incubation period of HBV?

Answer 14

1-4m

Question 15

What is the transmission mode of HBV?

Answer 15

Blood > body fluids

Question 16

What is HBV transmission risk if source is HBsAg and HBeAg positive?

Answer 16

37-62%

Question 17

What is HBV transmission risk if source is HBsAg positive and HBeAg negative?

Answer 17

23-37%

Question 18

Which contacts should receive HBV PEP?

Answer 18

HCWs
IVDU
Unprotected sex
Neonates

Question 19

Discuss HBV PEP

Answer 19

1. Wound management (irrigate copiously)
2. HBsAb <10 or never vaccinated
   - HBV vaccine + HBIG
   Within 24h (up to 7d for sexual)

Question 20

What percentage of HBV vertical transmission happens intrapartum?

Answer 20

99&

Question 21

What percentage of perinatally acquired HBV results in chronic HBV of the child?

Answer 21

90%

Question 22

How should you manage a mother with HBV?

Answer 22

Start TDF in 3rd trimester to drop VL

Question 23

How do you provide HBV PEP for a neonate to prevent vertical transmission?

Answer 23

HBV vaccine and HBIG at birth
Vaccine schedule 0/4/8
Monitor longterm for seroconversion

Question 24

What is the incubation period of VZV?

Answer 24

14-16d

Question 25

What is the transmission mode of VZV?

Answer 25

Droplet Direct contact with vesicle fluid

Question 26

For how long is a VZV patient infectious?

Answer 26

1-2d pre rash until all lesions cruster

Question 27

What is the secondary household attack rate of VZV?

Answer 27

>90%

Question 28

Which VZV contacts should receive PEP?

Answer 28

Exposed, susceptible adults and children 5min - 1h exposure face to face contact Close contact with rash

Question 29

Discuss the varicella vaccine

Answer 29

Immunocompetent (live, attenuated vaccine) Within 3-5d

Question 30

Discuss the varicella immunoglobulin (VariZIG)

Answer 30

Within 10d Immunosuppressed Pregnant women Neonates

Question 31

When is influenza PEP indicated?

Answer 31

H5N1 avian flu contacts Immunosuppressed

Question 32

Discuss influenza PEP

Answer 32

Oseltamivir 75mg dy 7-10d

Question 33

What is the incubation period of n. meningitidis?

Answer 33

2-10d (usually d4)

Question 34

What is the transmission mode of n. meningitidis?

Answer 34

Respiratory droplet Nasopharyngeal colonisation

Question 35

Which groups should receive n. meningitidis vaccine due to high risk?

Answer 35

Asplenia Complement deficiency Travellers to endemic areas Military recruits Microbiologists Large crows/gatherings Dormitories

Question 35

What are the PEP options for n.meningitidis?

Answer 35

1. Rifampin 2. Ciprofloxacin 3. Ceftriaxone

Question 36

Which n. meningitis contacts require PEP?

Answer 36

Prolonged contact >8h while <1m away Direct contact with secretions

Question 37

Discuss the rifampin dose for meningitis PEP in children >1m

Answer 37

10mg/kg/12h x 2d

Question 37

Discuss the rifampin dose for PEP in children <1m

Answer 37

5mg/kg/12h x 2d

Question 38

Discuss the ciprofloxacin dose for meningitis PEP in adults

Answer 38

500mg single dose

Question 39

Discuss the rifampin dose for meningitis PEP in adults

Answer 39

600mg/12h x 2d

Question 40

Discuss the CTX dose for menigitis PEP in children <15y

Answer 40

125mg IM single dose

Question 41

Discuss the CTX dose for menigitis PEP in adults

Answer 41

250mg IM single dose

Question 42

What is the incubation period of tetanus?

Answer 42

2-38d

Question 43

What is the mode of transmission of tetanus?

Answer 43

Direct inoculation of spores into tissue

Question 44

What tetanus vaccine options are there?

Answer 44

DTap Tdap Td

Question 45

When is DTap given in the SA EPI?

Answer 45

6w 10w 14w 18m

Question 46

When is Td given in the SA EPI?

Answer 46

6y 12y

Question 47

What PEP should a clean and minor wound with <3 previous doses of tetanus toxoid receive?

Answer 47

Vaccine

Question 48

What PEP should a clean and minor wound with >3 previous doses of tetanus toxoid receive?

Answer 48

Vaccine if last dose >10y ago

Question 49

What PEP should a NON clean and minor wound with <3 previous doses of tetanus toxoid receive?

Answer 49

Vaccine Ig

Question 50

What PEP should a NON clean and minor wound with >3 previous doses of tetanus toxoid receive?

Answer 50

Vaccine if last dose >5y ago No Ig