Table 5.

Postexposure management of HCP to infections transmitted by contact route.

Pathogen/infection	Disease status of source patient	Disease status of exposed HCP	PEP regimen	Initial assessment and follow up of exposed HCP	Primary prevention	Adverse effects of PEP regimen
HAV	Patients with acute HAV infection confirmed serologically (presence of serum anti-HAV IgM antibodies), from the incubation period (15–50 days) until 7 days after onset of jaundice	Nonimmune HCP reporting close contact with index patients if an epidemiologic investigation indicates HAV transmission has occurred between patients and HCP	Two doses of hepatitis A vaccine 6–18 months apart (1440 EL.U in 1 mL for HAVRIX and 1 mL (50 U for VAQTA vaccine) IM in the deltoid muscle OR A single dose of Ig 0.02 mL/kg IM in the deltoid or gluteal musclea	No need for work restriction or modification for asymptomatic exposed HCP Infected exposed HCP should be excluded from patient care, patient environment, or food handling until 7 days after onset of jaundice	Patients with hepatitis A infection require standard precautions HCP should be vaccinated with two doses of hepatitis A vaccine, 6–12 months apart, if at high risk of future exposure or when the vaccine is indicated (e.g. travelers to endemic areas, injection drug users, MSM, patients with chronic liver disease)	Hepatitis A vaccine: fever, injection-site reactions, rash, and headache IG: injection-site reactions, muscle rigidity and cramps at injection site, body aching, and gastrointestinal symptoms
HSV 1,2	Patients with active lesions	HCP who have unprotected contact with skin lesions or with virus-containing secretions, such as saliva, vaginal secretions, or amniotic fluidb	None	No need for work restriction or modification of asymptomatic exposed HCP Symptomatic exposed HCP should be evaluated by occupational health to determine if they can continue providing patient carec	Patients with mucocutaneous, disseminated, severe extensive HSV infection or neonates with HSV infection require contact precaution until all lesions are dry and crusted Standard precautions for patients with other types of HSV infection
Scabies	Patients with untreated infestation	HCP in close contact with infested patients	Permethrin 5% cream (apply from neck to toe, wash off after 8–14 hours, repeat in 1–2 weeks) OR Crotamiton 10% cream or lotion (after a bath, apply from chin to toes; repeat in 24 hours) OR Sulfur 5%–10% ointment (apply for 3 consecutive days) OR Lindane 1% lotion (apply from neck down, wash off after 8–12 hours; do not repeat; do not apply immediately after a bath or shower) OR Ivermectin 200 µg/kg orally two doses 2 weeks apart	No need for work restriction or modification of asymptomatic exposed HCP Symptomatic HCP should be excluded from work until treated and deemed to be free of infestation by occupational health	Patients with scabies require contact isolation until 24 hours after effective treatment Rooms used by patients infested with scabies should be vacuumed and cleaned thoroughly; patients’ bedding, linens, and towels should be washed in hot water and dried at high heat cycle, or dry cleaned	Permethrin 5% and crotamiton 10% cream, lotion: skin irritation Sulfur 5%–-10% ointment: dryness, malodor, and staining fabrics; safe in pregnancy Lindane 1% lotion: skin irritation and dryness, aplastic anemia, and neurotoxicity such as seizures Lindane is contraindicated in patients with extensive dermatitis, pregnant and lactating women Ivermectin: pruritus, tachycardia, dizziness, edema, arthralgia, nausea, diarrhea, increased liver function tests. Ivermectin should be avoided in pregnant and lactating women
Pediculosis (lice)	Patients with untreated infestation	HCP in contact with the skin or clothing of infested patients	None	No need for work restriction or modification of asymptomatic exposed HCP Symptomatic exposed HCP should be excluded from work until treated and assessed to be free of immature and adult lice by occupational health	Patients with pediculosis require contact isolation until 24 hours after effective treatment Rooms used by patients infested with pediculosis should be vacuumed and cleaned thoroughly; patients’ bedding, linens, and towels should be washed in hot water and dried at high heat cycle, or dry cleaned

^aIg should be used as PEP for nonimmune exposed HCP who are >40 years of age, or who are deemed immunocompromised, have chronic liver disease, or have severe allergic reaction to hepatitis A vaccine.

^bExposed areas of skin that have abrasions, minor cuts, or other lesions are the most commonly affected sites in exposed HCP.

^cThe decision will depend on the extent, location, and severity of HSV infection in the HCP and the risk of serious disease in the patients taken care of by the HCP (e.g. immunocompromised, severely malnourished, patients with severe burns or eczema, and neonates). For example, HCP with HSV infections of the fingers or hands should be excluded from work until all lesions are crusted.

Abbreviations: HAV = Hepatitis A virus; HCP = Healthcare personnel; HSV = Herpes simplex virus; Ig = Immunoglobulin; IgM = Immunoglobulin M; IM = Intramuscular; MSM = Men who have sex with men; PEP = Postexposure prophylaxis.

Information from refrences [1,4,5,83-86,88,89].