During a large community outbreak of measles last year, infection preventionists at Children’s Minnesota Hospital in Minneapolis worked with the state health department to deliver post-exposure prophylaxis (PEP) to 138 (80%) of 173 people who were defined as PEP-eligible.
“PEP can be given to people who are exposed and susceptible — so this is those who don’t have immunity,” said Julie LeBlanc, MPH, CIC, healthcare epidemiologist at Children’s Minnesota, at the 2018 Association for Professionals in Infection Control and Epidemiology conference in Minneapolis.
“The unfortunate part is that the window of time to give that PEP is really limited. So when you have a confirmed case, the clock is ticking and you need to really promptly assess for exposures, identify who needs PEP, and then it’s go time.”
During the outbreak, PEP or MMR vaccine was administered to asymptomatic susceptible people exposed to a confirmed measles case in the hospital or community according to the following risk categories and guidelines1.
• Infant less than 6 months old
- Less than 72 hours: Give intramuscular immune globulin (IGIM2) 0.5 mL/kg3
- 72 hours through day 6: Give IGIM2
• Infant age 6 through 11 months
- Less than 72 hours: Give IGIM2 or MMR vaccine
- 72 hours through day 6: Give IGIM2
• Susceptible pregnant woman
- Less than 72 hours: Give intravenous immune globulin (IGIV2): 400 mg/kg
- 72 hours through day 6: Give IGIV2
• Severely immunocompromised
- Less than 72 hours: Give IGIV2
- More than 72 hours: Give IGIV2
• Close contact over 1 year old
- Less than 72 hours: Give MMR vaccine if no contraindications.
- 72 hours through day 6: Give IGIM2 if less than 66 lbs. IGIV2 may be considered in susceptible close contacts 66 pounds or more. However, priority for IGIV should be given to susceptible pregnant women and severely immunocompromised contacts, as IGIV is expensive and difficult to administer.
- Minnesota Department of Health. Measles Post-Exposure Prophylaxis (PEP) for Non-Symptomatic Susceptible Contacts: https://bit.ly/2u7o4WY.
