The documents discuss post-exposure prophylaxis guidelines for measles and varicella. For measles exposure, susceptible contacts should receive the MMR vaccine or IG within 72 hours. Exposed contacts are isolated for 5-21 days or 5-28 days if immunocompromised. For varicella exposure, susceptible contacts receive vaccination within 3-5 days if immunocompetent or IG within 10 days if immunocompromised. Exposed contacts are isolated for 8-21 days or 8-28 days if immunocompromised. The documents also provide guidance on isolation periods, chemoprophylaxis, vaccination and hospital exposure management for both infections.

1. POST-EXPOSURE
PROPHYLAXIS
for Measles and Varicella

2. CASE 1
 9 months old, female
 3 days PTA, had onset of cough and low-
grade fever
 Admitted at 12am due to fast breathing
 In the morning, onset of maculopapular
rash initially noted on the face then
progressed to the trunk and extremities.
(+)bilateral purulent conjunctivitis
 No measles vaccination

3. MEASLES
MODE OF
TRANSMISSION
Direct contact with infectious droplets or by
airborne spread
Virus viable in the air or infected surfaces for
up to 2 hour
INCUBATION
PERIOD
8 to 12 days with a range of 7 to 21 days

4. ACTION PLAN?
 Isolate the patient

5. ISOLATION OF HOSPITALIZED PATIENT
Index Patient 4 days before appearance of the rash and
4 days after the appearance of the rash.

6. ACTION PLAN?
 Isolate the exposed contacts

7. ISOLATION OF HOSPITALIZED PATIENT
Exposed Contacts Immunocompetent: Day 5 after first
exposure until day 21 after last exposure.
Immunocompromised: Day 5 after first
exposure until day 28 after last exposure.

8. ACTION PLAN?
 Do contact tracing
EMERGENCY ROOM
Exposed Diagnosis History of
vaccination
Period of
isolation
Action
Dr.B. Well Yes N/A N/A
Patient 001
12mo/F
PCAP-C No 5-21 days Give first dose of MMR within
72h
Patient 002
3yo/M
PCAP-C Yes x 1 dose of
MMR
5-21 days Give second dose of MMR
within 72h
Patient 003
9yo/F
ALL on
chemotherapy
No 5-28 days Give IVIG 400mg/kg/dose
within 6 days from exposure
Patient 004
3mo/M
AGE with
moderate
dehydration
No N/A N/A

9. VACCINATION
 Time to administer
Administer within 72 hours of measles exposure to susceptible
individuals.
 Eligible patients for vaccination
Exposed individuals ≥6 months who have not been vaccinated or
have received only 1 dose of vaccine (the second measles
vaccine dose can be administered ≥28 days after the first measles
vaccine dose)

10. IMMUNOGLOBULIN
Time to administer
Administer either intramuscularly (IGIM) or intravenously (IGIV) within 6
days of exposure
Recommended dose:
IGIM: 0.50 ml/kg (the maximum dose by volume is 15 ml)
IGIV: 400 mg/kg
IG is not indicated for household or other close contacts who have received 1 dose of vaccine at 12 months
or older unless they are severely immunocompromised
IGIV is the recommended IG preparation for pregnant women without evidence of measles immunity and for
severely immunocompromised hosts.

11. Eligible patients for Immune Globulin
Regardless of immunologic or vaccination status:
 Severe primary immunodeficiency
 Received a bone marrow transplant, until at least 12 months after finishing all
immunosuppressive treatment, or longer in patients who develop graft-versus-host
disease
 On acute lymphoblastic leukemia treatment, within and until at least 6 months after
completion of immunosuppressive chemotherapy
 Received a solid organ transplant
 People with HIV infection or AIDS who have severe immunosuppression
 Younger than 12 months whose mothers received biologic response modifiers during
pregnancy
IMMUNOGLOBULIN

12. ACTION PLAN?
 Do contact tracing
EMERGENCY ROOM
Exposed Diagnosis History of
vaccination
Period of
isolation
Action
Dr.B. Well Yes N/A N/A
Patient 001
12mo/F
PCAP-C No 5-21 days Give first dose of MMR within
72h
Patient 002
3yo/M
PCAP-C Yes x 1 dose of
MMR
5-21 days Give second dose of MMR
within 72h
Patient 003
9yo/F
ALL on
chemotherapy
No 5-28 days Give IVIG 400mg/kg/dose
within 6 days from exposure
Patient 004
3mo/M
AGE with
moderate
dehydration
No N/A N/A

14. CASE 2
 12 year old, female
 Known case of nephrotic syndrome since 2018
 Fever for 2 days with several episodes of
vomiting.
 Moderately dehydrated on admission.
 1st hospital day: admitted in the emergency
room then transferred to regular ward after
24hrs
 2nd hospital day: noted development of pruritic
vesicular rash over the trunk  generalized
 Failed to disclose previous exposure to cousin
with varicella 2 wks ago
 No receipt of varicella vaccination

15. VARICELLA
MODE OF
TRANSMISSION
Direct contact, airborne droplets, or infected
respiratory tract secretions
Contact with vesicular zoster lesions
INCUBATION PERIOD 14 to 16 days (range: 10-21 days)
1-16 days of life in neonatal varicella
PERIOD OF
COMMUNICABILITY
1-2 days before the rash to crusting of
all lesions

16.  Index patient – isolate until all lesions are crusted
 Neonates born to mothers with varicella – until 21 days-28 days
of age
 if IGIV was administered
 Separate infant from mother to minimize risk of infection
 If the infant develops varicella, mother may care for the
infant
 If neonate is born with lesions (congenital varicella)
mother and newborn should be isolated and discharge
home if clinically stable
ISOLATION OF HOSPITALIZED PATIENT

17. ACTION PLAN?
 Contact tracing
EMERGENCY ROOM
Exposed Diagnosis History of
vaccination
Action Period of
isolation
Patient 001
18/F
Non-Hodgkin’s
lymphoma,
PCAP-C
No Give oral Acyclovir
(20mg/kg/dose) QID for 7 days
*begin 7-10 days after exposure
8-21 days
Patient 002
4yo/M
Kawasaki disease
Received IVIG at
the ER
No Give varicella vaccine 11 month
after IVIG
8-28 days
1B WARD
Patient 003
10/M
CKD on high dose
steroids >2wks
No Give IVIG 400mkdose within 10
days
8-28 days
Patient 004
2/F
AGN No Give varicella vaccine within
3-5 days
8-21 days

18.  Exposed individual without immunity* - Day 8 until 21 days after exposure
 Evidence of immunity*
 Receipt of 2 varicella vaccine doses
 Laboratory evidence of immunity or laboratory confirmation of prior
wild-type disease
 Diagnosis of varicella or zoster by a health care provider
 Verification of history of varicella or zoster by health care provider
ISOLATION OF HOSPITALIZED PATIENT

19. Immune Globulin (IGIV)
 Eligible patients for Immune Globulin
 Congenital or acquired T-lymphocyte immunodeficiency
 Children receiving immunosuppressive therapy >2 mg/kg/day of systemic
prednisone (or its equivalent) for >14 days
 All children with HIV infection regardless of CD4+ T-lymphocyte percentage
 All hematopoietic stem cell transplant patients regardless of pre-transplant
immunity status
IGIV should be withheld for at least 2 weeks after receipt of varicella vaccine
VACCINATION
PASSIVE IMMUNOPROPHYLAXIS:

20. Immune Globulin (IGIV)
 Administer as soon as possible within 10 days to susceptible
immunocompromised children who are exposed with no history
of varicella or vaccination and/or unknown or negative serologic
test results is recommended
 Recommended dose: 400 mg/kg IV
Exposed individual given IGIV – Day 8 until 28 days after
exposure
VACCINATION
PASSIVE IMMUNOPROPHYLAXIS:

21.  Varicella vaccine
 Administer within 3 to 5 days after varicella or herpes zoster exposure for
healthy individual without evidence of immunity (12 months or older) as soon as
possible
 Recommended dose: 0.5 mL subcutaneously
 A second vaccine dose should be administered minimum of 28 days interval
after the first dose
 Withheld for 3-11 months, if patient has recently received IGIV, whole blood or
plasma transfusions
POST-EXPOSURE VACCINATION

22.  For mildly immunocompromised individuals without evidence of
immunity or for immunocompetent patients for whom varicella
prevention is desired who have been exposed to varicella or herpes
zoster
Recommended Dose:
 Oral Acyclovir (20mg/kg/dose) QID for 7 days (maximum daily dose of 3200 mg)
 Oral Valacyclovir (if > 20mg/kg/dose) TID for 7 days
 To begin 7 to 10 days after exposure
CHEMOPROPHYLAXIS

23. ACTION PLAN?
 Contact tracing
EMERGENCY ROOM
Exposed Diagnosis History of
vaccination
Action Period of
isolation
Patient 001
18/F
Non-Hodgkin’s
lymphoma,
PCAP-C
No Give oral Acyclovir
(20mg/kg/dose) QID for 7 days
*begin 7-10 days after exposure
8-21 days
Patient 002
4yo/M
Kawasaki disease
Received IVIG at
the ER
No Give varicella vaccine 11 month
after IVIG
8-28 days
1B WARD
Patient 003
10/M
CKD on high dose
steroids >2wks
No Give IVIG 400mkdose within 10
days
8-28 days
Patient 004
2/F
AGN No Give varicella vaccine within 3-
5 days
8-21 days

24. ACTION PLAN?
 Contact tracing
EMERGENCY ROOM
Exposed Diagnosis History of
vaccination
Action Period of
isolation
Dr. A.A. Well Yes x 2 doses - N/A
Nurse A.B. Well Yes x 1 dose Give 2nd dose within 3-5 days N/A

25.  Healthcare professionals, patients and visitors who have been
exposed and who lack evidence of immunity to varicella should
be identified
 Varicella immunization is recommended for people without
evidence of immunity, provided there are no contraindications to
vaccine use
 If vaccine cannot be administered and VariZIG/IVIG is not
indicated, preemptive oral acyclovir or valacyclovir can be
considered.
HOSPITAL EXPOSURE TO VARICELLA

26.  All exposed patients without evidence of immunity should be discharged as
soon as possible
 Healthcare professionals who have received only 1 dose of vaccine and who
are exposed to VZV should receive the 2nd dose with a single-antigen varicella
vaccine, preferably within 3-5 days of exposure, provided 4 weeks have
elapsed after the 1st dose
 Immunized healthcare professionals who develop breakthrough infection
should be considered infectious until vesicular lesions have crusted, or if they
had maculopapular lesions, until no new lesions appear within a 24-hour period
HOSPITAL EXPOSURE TO VARICELLA

27. ACTION PLAN?
 Contact tracing
EMERGENCY ROOM
Exposed Diagnosis History of
vaccination
Action Period of
isolation
Dr. A.A. Well Yes x 2 doses - N/A
Nurse A.B. Well Yes x 1 dose Give 2nd dose within 3-5 days N/A

28. Good morning and
stay safe!