Postexposure management of infections transmitted by the droplet route
| Infection and disease status of source individual | Disease status of exposed individual | Postexposure prophylactic regimen | Initial and follow-up evaluation |
|---|---|---|---|
| Group A streptococcus: Patient with invasive GAS infection (eg, streptococcal toxic shock syndrome, necrotizing fasciitis, meningitis, or pneumonia), from 7 days before symptom onset until 24 hours of effective antibiotic therapy | High-risk household contacts and close contacts | One of the following regimens should be considered within 24 hours, and up to 7 days, after the last exposure: Cephalexin 250–500 mg orally 2 to 4 times daily for 10 days or amoxicillin 500 mg orally 3 times daily for 10 days or clindamycin 300 mg orally 3 times daily for 10 days or azithromycin 500 mg orally daily for 3–5 days | No work or school restriction for exposed asymptomatic individuals |
| Influenza: Symptomatic patient with laboratory-confirmed seasonal influenza A, B, or H1N1 infection, from 1 day before onset of symptoms until 24 hours after resolution of fever | Close contacts at high risk of complications of influenza or who are in close contact with individuals at high risk of influenza complications | One of the following regimens should be given within 48 hours of last exposure: a Oseltamivir 75 mg orally once daily for 10 days, or during outbreaks for a minimum of 2 weeks and up to 1 week after identification of the last case or zanamavir 10 mg (2 inhalations) once daily for 10 days, or during outbreaks for at least 2 weeks and up to 1 week after identification of the last case b | No work or school restriction for asymptomatic exposed individuals Exclusion of symptomatic health-care provider with confirmed influenza from patient care until afebrile ≥ 24 hours without the use of antipyretics |
| Mumps: Patient with laboratory-confirmed mumps infection, from 7 days before onset of parotitis to 9 days after | Nonimmune close contacts | Nonea | No work or school restriction for asymptomatic exposed individuals, including healthcare providers, who are either fully vaccinated or received one dose of the MMR vaccine Exclusion of susceptible exposed individuals from work from day 12 after first unprotected exposure through day 25 after last exposure Exclusion of symptomatic individuals with mumps, including health care providers, from work for 9 days from onset of parotitis |
| Meningitis: Patient with invasive meningococcal infection (meningitis or bacteremia) from 7 days before onset of illness until 24 hours of effective antibiotic therapyc | Household and close contacts, regardless of vaccination status | One of the following regimens should be given as soon as possible, and up to 14 days after exposure: A single dose of ciprofloxacin 500 mg orally d or a single dose of ceftriaxone 250 mg IM or rifampin 600 mg orally twice daily for 2 days | No work or school restriction for asymptomatic exposed individuals, including healthcare providers |
| Pertussis: Symptomatic patient in the first 3 weeks of illness confirmed with culture, polymerase chain reaction testing, or serology based on patient’s age | Household and close contacts, regardless of vaccination status | One of the following regimens should be given as early as possible but no later than 3 weeks after onset of cough in the index case:a Azithromycin 500 mg orally on day 1 followed by 250 mg daily on days 2 through 5 or TMP-SMX 1 double-strength tablet (TMP 160 mg, SMX 800 mg) orally twice daily for 14 days | No work or school restriction for asymptomatic individuals, including healthcare providers Exclusion of symptomatic individuals from work until 5 days of effective antibiotic therapy or negative micro-biologic testing (if not treated) |
| Rubella: Patient with confirmed rubella, from 1 week before to 7 days after onset of rash | Nonimmune contacts | Nonea | Acute and convalescent serology in susceptible pregnant women who had unprotected exposure; if seroconversion occurs, counseling about risk of congenital rubella syndrome Exclusion of susceptible exposed individuals from work from day 5 after first exposure to day 23 after last exposure Exclusion of symptomatic individuals with rubella, including healthcare providers, from work immediately until 7 days after rash onset |
↵a Unvaccinated or incompletely vaccinated individuals should be vaccinated according to the adult vaccination schedule.
↵b Zanamavir is not recommended for patients with underlying airway disease because of the risk of bronchospasm and decline in pulmonary function.
↵c Penicillins are ineffective in the eradication of N meningitidis from the nasopharynx because of their inability to achieve high levels in nasopharyngeal secretions; therefore, they are not recommended for postexposure prophylaxis.
↵d A single oral dose of azithromycin 500 mg is an option in areas where fluoroquinolone-resistant strains of N meningiditis have been identified.
GAS = group A Streptococcus; IM = intramuscular; MMR = measles, mumps, and rubella; TMP-SMX = trimethoprim-sulfamethoxazole