Post-Exposure Prophylaxis Among Healthcare Workers

Recommendations

Immunization of Healthcare Personnel

For healthcare personnel, immunization against certain diseases is recommended to prevent infections, protect patients, and ensure a safe healthcare environment. Specific recommendations are tailored to the individual's role, exposure risk, and vaccination history.

●      Hepatitis B: for all healthcare personnel due to the risk of exposure to blood and body fluids.

●      Influenza: Annual vaccination is crucial especially in settings with vulnerable populations.

●      Measles, Mumps, and Rubella (MMR): For HCP without documented or presumptive evidence of immunity.

●      Varicella (Chickenpox): For HCP without documented or other evidence of immunity.

●      Meningococcal Disease: For those at increased risk of exposure.

●      Other Vaccines: According to individual occupational and clinical risk assessment (Strong Recommendation)

Human Immunodeficiency Virus (HIV) Post Exposure Prophylaxis (PEP) is recommended following a high-risk occupational exposure (sharps or mucosal splash) (Strong Recommendation)

We advise against HIV PEP where there is no or negligible risk of HIV transmission (e.g: Through intact skin that comes in contact with HIV infected or other body fluids (Strong Recommendation)

Post-exposure prophylaxis offered as early as possible, to individuals with suspected or known exposure to HIV, ideally within 24 hours but not later than 72 hours. (Strong Recommendation)

An HIV PEP regimen with two ARV drugs is effective, but three drugs are preferred (Conditional Recommendation)

A 28-day prescription of antiretroviral drugs should be provided for HIV post-exposure prophylaxis (Strong Recommendation)

For HCP with written documentation of a complete hepatitis B vaccination series and a documented anti-HBs level of ≥10 mIU/mL, no HBV post-exposure prophylaxis is necessary, regardless of the source patient's HBsAg status (Strong Recommendation)

For vaccinated HCP with written documentation of a complete hepatitis B vaccination series but without previous anti-HBs testing, the HCP should be tested for anti-HBs and the source patient should be tested for HBsAg within 24 hrs after exposure (Strong Recommendation)

If anti-HBs is <10 mIU/mL and the source patient is HBsAg-positive or has unknown HBsAg status, the HCP should receive one dose of HBIG and be revaccinated as soon as possible. HepB vaccine may be administered simultaneously with HBIG but at a different anatomical site (Strong Recommendation)

If anti-HBs is <10 mIU/mL and the source patient is HBsAg-negative, the HCP should receive one additional HepB vaccine dose followed by repeat anti-HBs testing 1–2 months later. If anti-HBs remains <10 mIU/mL, the HCP should complete a second vaccine series and undergo repeat anti-HBs testing 1–2 months after the final dose (Strong Recommendation)

If the source patient is HBsAg-negative, the HCP should complete the HepB vaccine series according to the recommended schedule (Strong Recommendation)

For HCP with anti-HBs <10 mIU/mL after two complete hepatitis B vaccine series, if the source patient is HBsAg-positive or has unknown HBsAg status, the HCP should receive two doses of HBIG, with the first dose administered as soon as possible after exposure and the second dose 1 month later. HepB vaccine is not indicated (Strong Recommendation)

Give hepatitis B vaccination within 7 days and ideally within 48 hours of exposure as it is highly effective in preventing HBV infection after exposure (Strong Recommendation)

If HBIG is required, it should ideally be given within 48 hours of exposure, but not later than one week after exposure (Strong Recommendation)

Prompt administration of PEP is essential for optimal effectiveness. Ideally, both the vaccine and HBIG should be given within 48 hours of exposure (Strong Recommendation)

Post-vaccination testing anti hepatitis B surface (anti-HBs) should be performed to confirm immunity in those who received the vaccine (Strong Recommendation)

Individuals who do not develop adequate anti-HBs levels after the primary vaccine series should be evaluated and may require a second vaccine series (Strong Recommendation)

Hepatitis C virus (HCV) antibody or HCV ribonucleic acid (RNA) test should be carried out on the recipient at six weeks, 12 weeks and six months after the exposure incident (Strong Recommendation)

Tetanus Immunoglobulin (TIG) is recommended as post-exposure prophylaxis for those with tetanus prone wounds based on a risk assessment for who meet the following criteria:

·       Not adequately vaccinated or immunization status not known

·       Are immunocompromised, even if fully immunized.

If both TIG plus a vaccine are to be given, administer at separate sites (Strong Recommendation)

For healthcare personnel (HCP) exposed to diphtheria, regardless of vaccination status, the recommendation is to administer PEP, exclude them from work, and obtain both nasal and pharyngeal swabs for diphtheria culture. If cultures are negative, they can return to work while completing antibiotic therapy. (Strong Recommendation)

For HCP with presumptive evidence of measles immunity, PEP and work restrictions are not necessary after exposure to measles. Presumptive evidence of immunity includes documented vaccination with two doses of Measles, mumps and rubella (MMR) vaccine, laboratory evidence of immunity, or laboratory confirmation of past measles infection. (Strong Recommendation)

For asymptomatic HCP with presumptive evidence of mumps immunity exposed to mumps, work restrictions are not necessary, but daily monitoring for symptoms is recommended. Specifically, this monitoring should occur from the 10^th day after their first exposure through the 25^th day after their last exposure. (Strong Recommendation)

For asymptomatic healthcare personnel with presumptive evidence of rubella immunity exposed to rubella, work restrictions are not necessary. Instead, daily monitoring for signs and symptoms of rubella should be implemented from the 7^th day after the first exposure through the 23^rd day after the last exposure. (Strong Recommendation)

for HCP regarding Neisseria meningitidis exposures, administer antimicrobial prophylaxis regardless of vaccination status after exposure, exclude those with invasive disease from work until 24 hours after proper antimicrobial therapy, and no work restrictions for those with nasopharyngeal carriage. (Strong Recommendation)

For asymptomatic HCP exposed to pertussis, or who are likely to interact with people at increased risk for severe pertussis, PEP with antibiotics is recommended, or if not receiving PEP, they should be restricted from contact with vulnerable patients for 21 days after exposure. (Strong Recommendation)

The recommendations for HCP with rabies virus exposure involve administering PEP (Strong Recommendation)

Work restrictions are not necessary for asymptomatic HCP. However, HCP with suspected or confirmed rabies should be excluded from work, in consultation with public health authorities. (Strong Recommendation)

For asymptomatic HCP with documented immunity to varicella, post-exposure prophylaxis and work restrictions are not necessary after exposure to varicella or herpes zoster (Strong Recommendation)

These individuals should ensure they are up-to-date with their varicella vaccinations, receiving a second dose if only one dose has been documented, within 3-5 days of exposure if 4 weeks have passed since the first dose (Strong Recommendation)

Implement daily monitoring for signs and symptoms of varicella from the 8th day after the first exposure through the 21st day after the last exposure (Strong Recommendation)

For asymptomatic healthcare personnel exposed to varicella or herpes zoster, without evidence of immunity, PEP and work exclusion should be from the 8th day after the first exposure through the 21st day after the last exposure. (Strong Recommendation)

For HCP with varicella (chickenpox), exclude from work until all lesions have dried and crusted, or, for those with non-vesicular lesions, until no new lesions appear within a 24-hour period (Strong Recommendation)

Do not routinely exclude healthcare personnel only on the basis of their pregnancy or intent to be pregnant from the care of patients with infections that have potential to harm the fetus (e.g., Cytomegalovirus (CMV), Human Immunodeficiency Virus (HIV), viral hepatitis, herpes simplex, parvovirus, rubella, varicella); Any work restriction should be based on the specific occupational exposure risk (Strong Recommendation)