Table 2.

Screening, immunization and prophylaxis recommendations for infectious diseases in hospitalized persons who inject drugs.^*

Hepatitis A  ● Screening for preexisting immunity: Hepatitis A IgG  ● Immunization: Two-dose vaccine. Interval between doses depends on vaccine preparation.

Hepatitis B  ● Screening: surface antigen, core IgG and surface antibody  ● Immunization: If all of the above are negative, immunize with two- or three-dose vaccine series.**

Hepatitis C  ● Screening: Hepatitis C antibody with reflex to RNA. For persons with known antibody positivity, screen with Hepatitis C RNA.

Tetanus  ● Immunization:   ○ Adults without documented prior receipt of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine should receive one dose of Tdap.   ○ Adults with prior documented Tdap should receive a tetanus and diphtheria toxoids (Td) booster vaccine if ten years have elapsed since their last documented tetanus and diphtheria vaccine.

Pneumococcus  ● Immunization: One-time dose of 23-valent pneumococcal polysaccharide vaccine (PPSV23) for patients with chronic heart, lung or liver disease, alcohol use disorder, or cigarette smoking, as well as certain other chronic medical conditions, asplenia or immunocompromising conditions.

HIV  ● Pre-exposure prophylaxis (PrEP) can be offered to patients at risk of HIV acquisition from injecting drugs or sex.  ● Post-exposure prophylaxis (PEP) can be offered to persons with high-risk exposure and as a bridge to PrEP79

^*Special situations exist for the immunization of pregnant women or those with incomplete or unknown vaccination or other special populations. Consult recommendations from the American Committee on Immunization Practices for full details.

^**The two-dose, novel adjuvant Hepatitis B vaccine is given across a four-week interval and, thus, a full vaccination series may be possible during a hospitalization for patients who remain hospitalized for the full duration of infective endocarditis therapy.