Pertussis pep
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Pertussis pep

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    Pertussis pep Pertussis pep Presentation Transcript

    • 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.
    • Postexposure Prophylaxis
      • 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