Post-Exposure Prophylaxis (PEP)
Non-Immunized and Partially Immunized Patients
Patients who are not immunized or who only received partial immunization (e.g., 1 dose of the MMR vaccine) may benefit from PEP; vaccination or Immunoglobulin (IG) injection may be effective up to 72 hours and 6 days, respectively, after exposure. Available data suggest an efficacy of up to 90% for PEP vaccination and 100% for IG. Immunoglobulin is particularly useful in patients for whom vaccination is either contraindicated or carries an increased risk of complications, including infants younger than 12 months, immunocompromised persons and pregnant individuals. The Advisory Committee on Immunization Practices (ACIP) recommends that IG be given by intramuscular injection (IGIM) at a dose of 0.5 mL/kg of body weight (with a maximum dose of 15 mL, ie, a maximum body weight of 30 kg) or intravenously (IGIV) at a dose of 400 mg/kg of body weight, depending on the clinical situation.
Because the passive immunity conferred by IG is…
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Non-Immunized and Partially Immunized Patients
Patients who are not immunized or who only received partial immunization (e.g., 1 dose of the MMR vaccine) may benefit from PEP; vaccination or Immunoglobulin (IG) injection may be effective up to 72 hours and 6 days, respectively, after exposure. Available data suggest an efficacy of up to 90% for PEP vaccination and 100% for IG. Immunoglobulin is particularly useful in patients for whom vaccination is either contraindicated or carries an increased risk of complications, including infants younger than 12 months, immunocompromised persons and pregnant individuals. The Advisory Committee on Immunization Practices (ACIP) recommends that IG be given by intramuscular injection (IGIM) at a dose of 0.5 mL/kg of body weight (with a maximum dose of 15 mL, ie, a maximum body weight of 30 kg) or intravenously (IGIV) at a dose of 400 mg/kg of body weight, depending on the clinical situation.
Because the passive immunity conferred by IG is temporary, it should be followed up by MMR vaccination after at least 6 months (for IGIM) or 8 months (for IGIV). Recommendations for PEP endorsed by the American Academy of Pediatrics (AAP) are shown in Table 3-2 (for all except pregnant and immunocompromised patients) and Table 3-3 (for pregnant and immunocompromised patients).
References
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