Postexposure management of infections transmitted by the airborne route
| Infection and disease status of source individual | Disease status of exposed individual | Postexposure prophylactic regimen | Initial and follow-up evaluation |
|---|---|---|---|
| Measles: Patient with active infection (4–5 days before onset of rash to 4 days after rash) | Nonimmune immune-competent contactsa | Live measles virus-containing vaccine (2 doses MMR, or MMRV if indicated [eg, patient not immune to varicella], at least 28 days or 3 months apart, respectively) SC within 3 days of exposure | Exclusion of exposed nonimmune individuals from work from day 5 to 21 after exposure, unless vaccine was given within 3 days of exposure Exclusion of symptomatic individuals immediately from work until ≥ 4 days after onset of rash |
| Nonimmune pregnant women, infants aged < 12 months, or immunocompromised contacts (regardless of immune status) | A single dose of immune globulin 0.5 mL/kg IM or 400 mg/kg IV within 6 days of exposure | ||
| Tuberculosis (TB): Patient with untreated pulmonary or laryngeal TB b | Close contacts with unprotected exposure, regardless of history of TB or vaccination with BCG vaccine | One of the following regimens for LTBI, if TB disease is ruled out: Isoniazid 5 mg/kg orally daily plus vitamin B6 25–50 mg orally daily for 9 months or isoniazid 900 mg orally once weekly plus vitamin B 25–50 mg orally daily 6 plus rifapentine 900 mg orally once weekly for 3 months | TB symptom screen and TST or IGRA at presentation and 8–12 weeks postexposure if initially negative for TB infection Chest radiography if TST or IGRA is positive at presentation or follow-up Baseline and monthly liver function tests while on treatment for LTBI No work or school restriction for ex-posed asymptomatic individuals with or without LTBI |
| Varicella and disseminated herpes zoster (HZ): Patient with active infection from 1–2 days before onset of rash for varicella or from onset of rash for HZ, until all lesions have crusted | Nonimmune immunocompetent contactsc Nonimmune pregnant women or immunocompromised contacts | Two doses of varicella vaccine SC 1 month apart, first dose within 5 days of exposure A single dose of VariZIG 125 units/10 kg IM/IV within 96 hours (up to 10 days postexposure) or immune globulin 400 mg/kg IV if VariZIG is not available | Exclusion of nonimmune exposed individuals from work from day 8 to 21 after last exposure (from day 8 to 28 if they received VariZIG) Exclusion of symptomatic individuals with varicella or disseminated HZ from work until all lesions are dry and crusted |
↵a An individual is considered immune if any of the following applies: documentation of vaccination with 2 doses of live measles virus-containing vaccine, with the first dose of the vaccine being administered ≥ 12 months of age and the second dose at least 28 days after the first one; laboratory evidence of immunity; laboratory confirmation of disease; or birth before 1957 (except healthcare providers, who require one of the other indicators for immunity).
↵b For patients with pulmonary TB that tests positive on acid-fast bacilli smear, the contagious period starts 3 months before the collection date of the first smear-positive sputum or onset of symptoms, whichever is earlier, and ends when the patient is in airborne isolation or the date of collection for the first consistently negative smear results. For patients with pulmonary TB that tests negative on acid-fast bacilli smear, the contagious period starts 1 month before onset of symptoms and ends when the patient is in airborne isolation.
↵c An individual is considered immune to varicella or HZ if any of the following applies: documentation of vaccination with 2 doses of varicella vaccine; diagnosis or verification of history of varicella disease or HZ by a healthcare provider; serologic evidence of either immunity or disease; or birth in the United States before 1980 (except in healthcare providers, immunocompromised individuals, and pregnant women, who require one of the other indicators for immunity).
BCG = bacillus Calmette-Guérin; IGRA = interferon-gamma release assay; IM = intramuscularly; IV = intravenously; LTBI = latent tuberculosis infection; MMR = measles, mumps, rubella; MMRV = measles, mumps, rubella, varicella; SC = subcutaneously; TST = tuberculin skin test; VariZIG = varicella zoster immunoglobulin