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Human Immunodeficiency Virus and Opportunistic Infections
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Post-exposure prophylaxis should be given to individuals who have been at a higher risk (>1:1000) or moderate risk (1:1000–1:10,000) as soon as possible after exposure. The BHIVA PEP guideline has a good overview of the risks per particular exposure. Overall, if the prevalence in the area is low, the risk of transmission—(the risk that the source is positive, which varies per area) × (risk per exposure)—will automatically also be low.
Sexual abuse
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Prescription of a 28-day course of often costly postexposure prophylaxis, bearing a strong side effect profile, should be carefully considered. The decision to proceed with HIV postexposure prophylaxis (PEP) should be made in consultation with a pediatric specialist in infectious disease.35 An additional useful resource is the PEPline (888/448–4911; http://nccc.ucsf.edu/clinician-consultation/pep-post-exposure-prophylaxis/).
Influenza
Published in James M. Rippe, Lifestyle Medicine, 2019
Antiviral medicines taken daily during a period of exposure are 79%–90% effective at preventing influenza. Chemoprophylaxis should be started within 48 h of exposure to be effective. Indiscriminate use of prophylaxis is not recommended as it can promote antiviral resistance, but can be considered if there is an outbreak in a long-term care facility or on a case-by-case basis after exposure in a person at high risk of complications from influenza vaccine. The recommended dose of oseltamivir for chemoprophylaxis against influenza in adults is 75 mg orally once a day. The recommended dose of zanamivir for prophylaxis of influenza (types A and B) in adults in a household setting is two inhalations (5 mg per inhalation) orally once daily. The recommended duration of post exposure prophylaxis is generally 10 days after a household exposure or seven days following exposure in other situations. The dose should be given at approximately the same time each day.27
Notifications of suspected rabies exposure increased in Finland: 26 years of one health surveillance, 1995–2020
Published in Infectious Diseases, 2023
Ruska Rimhanen-Finne, Jukka Ollgren, Tuija Gadd, Tiina Nokireki
Person-to-person transmission of rabies is very rare but has been documented in cases of organ and tissue transplantation [20]. In theory, transmission can occur when infectious saliva or tears get into an open wound or a mucous membrane. In 2007, exposure of hospital staff to a rabies patients’ saliva was explored in Finland [21]. Exposure of persons could not be excluded, and they were given vaccine prophylaxis. One hospital worker had suspected salivary-mucous membrane and blood exposure while cannulating the patient and was given immunoglobulin and vaccine prophylaxis. Post-exposure prophylaxis is recommended to health workers who examine a person with suspected or diagnosed rabies infection incurred via a needlestick or incision or if the saliva of a person with rabies comes into contact with the worker’s mucosa, broken skin or rash.
Neutralizing anti-spike monoclonal antibodies for COVID-19 in vulnerable populations: lessons learned and future directions
Published in Expert Opinion on Biological Therapy, 2023
In addition to treatment of mild-to-moderate COVID-19, bamlanivimab and etesevimab combination was also authorized as postexposure prophylaxis. Post-exposure prophylaxis was recommended to high-risk patients who are not vaccinated or are unable to mount an effective immune response to the vaccine and they have been exposed to COVID-19 [18]. This EUA was based on a clinical trial that compared bamlanivimab alone with placebo in exposed but PCR-negative patients [12]. In this study, 966 exposed persons were randomized to receive post-exposure prophylaxis with bamlanivimab alone or placebo. The primary end point of symptomatic COVID-19 within 8 weeks of randomization was significantly lower among patients who received bamlanivimab (8.5%) compared to placebo (15.2%), with relative risk reduction of 57% (Table 2). There were five COVID-19 deaths in the study, and all received placebo [12].
Mpox: epidemiology, clinical manifestations and recent developments in treatment and prevention
Published in Expert Review of Anti-infective Therapy, 2023
Nikil Selvaraj, Shreya Shyam, Puvin Dhurairaj, Kaviarasan Thiruselvan, Akil Thiruselvan, Yochana Kancherla, Pritika Kandamaran
People who have had high-risk exposures to case-patients during their infectious phase are advised to get the PEP vaccine. Additionally, it is suggested on a case-by-case basis for people who have been exposed to situations posing a medium risk. In general, postexposure prophylaxis is not advised for low- or uncertain-risk exposures. Public health professionals advise delivering vaccinations as soon as feasible within four days of exposure to prevent or attenuate illness in nations where immunization has been implemented as PEP [5]. Given the potential possibility that it might still decrease infection even if it occurs near the end of the incubation period, immunization as PEP has been utilized in the US and UK up to 14 days post-exposure. The CDC currently advises vaccination as pre-exposure prophylaxis (PrEP) for laboratory personnel who conduct OPXV testing, including MPXV, personnel who handle OPXV cultures or animals infected with OPXV, and specific members of public health response teams who may need vaccination for preparedness reasons [5]. In Montreal, Canada, the extension of the vaccine as PrEP to cover homosexual, bisexual, and other men who have sex with men (MSM) is a result of newly available epidemiologic information identifying populations that may be at increased risk of exposure in the context of the current outbreaks [28].