Post-exposure prophylaxis

Post-exposure prophylaxis

• Human Normal Immunoglobulin (HNIG) or hepatitis A vaccine may be used depending on the clinical situation
  • HNIG is typically reserved for those who cannot receive the vaccine or where rapid protection is required (e.g. immunosuppressed individuals)
  • In most cases, hepatitis A vaccine is preferred for post-exposure prophylaxis

• HBsAg positive source
  • If the person exposed is a known responder (anti-HBs ≥10 mIU/mL following full vaccination), a booster dose should be given
    booster dose should be given
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  • If they are a non-responder (anti-HBs <10 mIU/mL 1–2 months after completing the full course), they should receive hepatitis B immunoglobulin (HBIG) and a booster vaccine
    hepatitis B immunoglobulin (HBIG) and a booster vaccine
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• Unknown source
  • For known responders, a booster dose may be considered depending on the risk assessment
  • For non-responders, HBIG and a booster vaccine should be given
  • Individuals undergoing a primary course of vaccination should complete an accelerated schedule and may be offered HBIG if the risk of exposure is considered high

• There is no effective post-exposure prophylaxis for hepatitis C
  no effective post-exposure prophylaxis for hepatitis C
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• Initial testing should include baseline HCV serology and HCV RNA (PCR)
• Repeat HCV RNA at 6 and 12 weeks post-exposure, and HCV antibody at 3 and 6 months
• If seroconversion occurs, early referral to hepatology for consideration of direct-acting antiviral therapy is advised

• The risk of HIV transmission depends on the nature of the exposure (e.g. needlestick, type of sexual contact, human bite) and the viral load
  The viral load determines the risk of HIV transmission following a needle stick injury
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  Importance: 44
  of the source individual
• Low-risk incidents such as human bites
  Post-exposure prophylaxis for HIV is not recommended following human bites
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  Importance: 72
  generally do not require post-exposure prophylaxis (PEP), unless blood is present or other risk factors apply
• First-line PEP regimen is oral antiretroviral therapy: tenofovir disoproxil/emtricitabine (Truvada®) + raltegravir
  tenofovir disoproxil/emtricitabine (Truvada®) + raltegravir
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  • PEP should be started as soon as possible (ideally within 1–2 hours, and no later than 72 hours post-exposure)
  • Treatment course lasts 4 weeks
    Post-exposure prophylaxis for HIV: oral antiretroviral therapy for 4 weeks
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    Importance: 81
• HIV serological testing is required at 12 weeks after completing PEP
• PEP reduces the risk of HIV transmission by approximately 80%

• Varicella zoster immunoglobulin (VZIG) should be given to IgG-negative pregnant women or immunosuppressed individuals after significant exposure
  • If VZIG is unavailable or >10 days post-exposure, oral aciclovir may be considered (based on risk assessment)

Estimates of transmission risk for single needlestick injury