PERTUSSIS SUMMARY OF PEP POST EXPOSURE PROPHYLAXIS (PEP)
Post-exposure chemoprophylaxis (PEP)
People with the highest priority for PEP include:
1) close contacts in household, childcare, and healthcare settings;
2) close contacts at high risk for severe disease and adverse outcomes;
3) close contacts who may transmit disease to persons at high risk for severe disease;
4) and close contacts in group settings where close interactions occur (e.g., after-school care groups, playgroups, groups of close friends, teammates, etc.).
Post-exposure chemoprophylaxis (PEP) INDICATIONS
CDC and AAP recommend PEP for all close contacts (of confirmed cases) , regardless of age or immunization status.
Starting PEP ≥3 weeks after exposure to an infectious case is probably of no benefit to the contact.
Administration of postexposure prophylaxis to asymptomatic household contacts within 21 days of onset of cough in the index patient ,can prevent symptomatic infection.
PEP recommended for all household close contacts of confirmed cases
Coughing (symptomatic) household members of a pertussis patient should be treated as if they have pertussis.
Low Threshold for PEP in exposure settings that include infants aged <12 months or women in the third trimester of pregnancy
Tx is the same for Symptomatic Pertussis & PEP
Azithromycin. Adults: 500 mg on day 1, followed by 250 mg per day on days 2--5.
Clarithromycin . Adults: 500 mg po bid for 7 days.
Erythromycin . Erythromycin estolate 500 mg po qid x 14 days
Alternate agent (TMP--SMZ). Bactrim DS 1tab po bid x 14 days
Close contact definition
Those who have had direct contact with respiratory, oral or nasal secretions from a symptomatic case (catarrhal or paroxysmal stages), e.g., a cough or sneeze in the face, sharing food/eating utensils, kissing
Performing a medical examination of the nose and throat ( without mask / gloves )
Sharing a confined space in close proximity for a prolonged period of time (≥1 hour) with a symptomatic case.
High risk ( for severe pertussis disease ) Contact Definition
Contacts at high risk for severe pertussis disease and adverse outcomes include:
1 ) Contacts who may transmit pertussis to a high risk person (healthcare or childcare workers)
2 ) Pregnant or recently post-partum women
3 ) Infants <6 months of age, especially premies
4 ) Unimmunized infants and children
5 ) Persons with neuromuscular disease
6 ) Persons who have severe underlying disease such as chronic lung disease or cystic fibrosis or immunocompromised