Postexposure management of infections via contact, injury, and bite routes
| Infection and disease status of source individual | Disease status of exposed individual | Postexposure prophylactic regimen | Initial and follow-up evaluation |
|---|---|---|---|
| Hepatitis A virus (HAV) Confirmed HAV infection from the incubation period (15–50 days) until one week after onset of jaundice | Nonimmune, healthy close contacts between 12 months and 40 years of age | Two doses of inactivated HAV vaccine (1,440 ELISA units per 1 mL for Havrix or 1 mL (50 U) for Vaqta IM in the deltoid muscle 6–18 months apart or immune globulin (IG) 0.02 mL/kg IM, single dose, in the deltoid or gluteal muscle | Source patient: anti-HAV IgM if status is unknown Exclusion of individuals with HAV infection from patient care, patient environment, food handling, or daycare until 7 days after onset of jaundice No work or school restriction for asymptomatic exposed individuals |
| Nonimmune close contacts with immunocompromising condition, chronic liver disease, < 12 months old, adults > age 40, or severe allergy to HAV vaccine | IG 0.02 mL/kg IM, single dose, in deltoid or gluteal muscle within 2 weeks of exposure | ||
| Immune close contacts (previously infected or vaccinated at least 2 weeks prior to exposure) | Not recommended | ||
| Rabies: Bites or contact with suspected rabid animal Contact with patients infected with rabies from 2 weeks before onset of symptoms | Previously unvaccinated | HRIg 20 IU/kgb single dose and four doses of rabies vaccine (1 mL) IM on days 0, 3, 7, and 14 (5th dose on day 28 for immunocompromised only)c | No work or school restriction for asymptomatic exposed individuals |
| Previously vaccinateda | Two doses of rabies vaccine IM on days 0 and 3 | ||
| Scabies: Patient with untreated infestationd | Close and sexual contacts within the preceding month before onset of symptoms or confirmed diagnosis | Permethrin 5% cream (preferred regimen), apply from neck to toe and wash off after 8–14 hours; repeat in 1–2 weeks or crotamiton 10% cream, lotion, after a bath, apply from chin to toes; repeat in 24 hours or two doses of ivermectin 200 μg/kg orally 2 weeks apart | Exclusion of infested individuals until the end of treatment or, for infested individuals with crusted scabies, until skin scrapings are negative No work or school restriction for asymptomatic exposed individuals |
| Tetanus: Not applicable | Individuals with tetanus-prone injuries: Completed primary vaccination series (≥ 3 doses) Unknown vaccination history or incomplete primary vaccination series (< 3 doses) | Clean, minor wounds: a single booster of age-appropriate tetanus toxoid-containing vaccine IM (DTaP, Tdap, DT, Td, TT) if at least 10 years since last dose of vaccine Other wounds: a single booster of age-appropriate tetanus toxoid-containing vaccine IM (DTaP, Tdap, DT, Td, TT) if ≥ 5 years since last dose of vaccine Clean, minor wounds: age-appropriate tetanus toxoid-containing vaccine IM (DTaP, Tdap, DT, Td, TT) and complete vaccine series according to schedule Other wounds: age-appropriate tetanus toxoid-containing vaccine IM (DTaP, Tdap, DT, Td, TT) and complete vaccine series according to schedule plus a single dose of tetanus immune globulin (TIg) 250 U IM, or immune globulin IV if TIg is not available, at a different site with different syringes than the vaccine | No work or school restriction for asymptomatic exposed individuals |
↵a Individuals are considered vaccinated if they received a complete series of a cell-culture vaccine such as human diploid cell vaccine or purified chick-embryo cell vaccine, three 1-mL doses given intramuscularly in the deltoid area on days 0, 7, and 21 or 28.
↵b Full dose of HRIg should be infiltrated in and around the wound if anatomically feasible, with the rest administered into the deltoid muscle, lateral or anterior thigh, or the gluteal region in a separate syringe and site from the vaccine. If HRIg is not administered when active vaccination is begun, it can be administered until day 7.
↵c Day 0 is when the first dose of rabies vaccine was administered. Administer in the deltoid muscle; never administer in the gluteal muscle because of the low titer of neutralizing antibodies.
↵d Affected individuals should be instructed to wash clothing, linens, and towels used within the previous week in hot water and dry at high heat and to vacuum the entire house, furniture, and car interior.
DTaP = diphtheria, tetanus, acellular pertussis vaccine; DT = diphtheria-tetanus toxoids adsorbed; ELISA = enzyme-linked immunosorbent assay; HRIg = human rabies immune globulin; IM = intramuscularly; IV = intravenous; IU = international units; N/A = not applicable; Td = tetanus-diphtheria toxoids adsorbed; Tdap = tetanus toxoid, reduced diphtheria toxoid, acellular pertussis vaccine; TT = tetanus toxoid; U = unit