接触者の感染予防 アメリカの場合 （自分用メモ）

Hepatitis B virus

• Unvaccinated - A single dose of hepatitis B immune globulin, 0.06 mL per kg IM within 24 hours of exposure, followed by hepatitis B vaccine series.
• Previously vaccinated with documented inadequate response - A single dose of hepatitis B immune globulin, 0.06 mL per kg IM within 24 hours of exposure, followed by hepatitis B vaccine booster.
• Previously vaccinated, nonresponder - A single dose of hepatitis B immune globulin, 0.06 mL per kg IM within 24 hours of exposure, followed by hepatitis B vaccine series or Hepatitis B immune globulin, 0.06 mL per kg IM twice within 24 hours of exposure, for individuals who did not respond to two vaccine series.
• Previously vaccinated with adequate response - None.

Hepatitis C virus

• Hepatitis C seronegative - None available.

Hepatitis A virus

• Unvaccinated - A single dose of hepatitis A vaccine within two weeks of exposure.
• Unvaccinated, immunocompromised, chronic liver disease, younger than 12 months, or severe allergy to vaccine - A single dose of immune globulin (0.02 mL per kg IM) within two weeks of exposure.

Varicella zoster virus

• Nonimmune (i.e., no history of varicella and negative serology) who has not received two doses of vaccine - Healthy persons: varicella vaccine within five days of exposure. Pregnant women, neonates, or immunocompromised persons: varicella zoster immune globulin (125 units per 10 kg IM) as soon as possible (up to 10 days postexposure), or immune globulin (400 mg per kg IV) if varicella zoster immune globulin is unavailable.

Influenza

• High-risk group - Unvaccinated persons: influenza vaccine

Rabies

• Previously unvaccinated - Rabies vaccine should be given as early as possible on days 0, 3, 7, and 14 postexposure, in addition to human rabies immune globulin (20 units per kg in a single dose) on day 0.  Rabies immune globulin should be infiltrated around the wounds first if anatomically feasible, with the rest administered IM into the gluteal region.  If the person is immunocompromised, a fifth dose of rabies vaccine should be given on day 28.
• Previously vaccinated - Rabies vaccine only on days 0 and 3 with documentation of protective neutralizing antibodies (> 0.5 IU per mL); otherwise give vaccine on days 0, 3, 7, 14, and 28 postexposure.

Invasive group A streptococcal infection

• High-risk household contacts - A single dose of penicillin G benzathine (600,000 units IM in patients weighing < 60 lb [27 kg] or 1,200,000 units IM in patients weighing = 60 lb) plus Rifampin (10 mg per kg twice daily orally, divided into two doses; maximum daily dosage: 600 mg) twice daily for four days, or Clindamycin (20 mg per kg orally; maximum daily dosage: 900 mg) three times daily for 10 days, or Azithromycin (Zithromax; 12 mg per kg orally; maximum daily dosage: 500 mg) daily for five days.

Invasive meningococcal infection

• Any close contact regardless of vaccination status - Ciprofloxacin (Cipro; a single dose of 500 mg orally), or Azithromycin (a single dose of 500 mg orally), or Ceftriaxone (Rocephin; a single dose of 250 mg IM), or Rifampin (600 mg orally, twice daily for two days). Begin antimicrobial chemoprophylaxis as early as possible, but no more than 14 days after exposure.

Pertussis

• All household and other close contacts regardless of vaccination status - Azithromycin (500 mg orally) on day 1, then 250 mg daily for four days, or Clarithromycin (Biaxin; 500 mg orally) twice daily for10 days, or Erythromycin (500 mg orally) four times daily for 14 days, or Trimethoprim/sulfamethoxazole (160/800 mg orally) twice daily for seven to 14 days.

Tetanus

• Any person with an uncertain or incomplete history of completing a three-dose primary series of tetanus toxoid – containing vaccine, or if the most recent dose was given ≥ 10 years ago (for minor and clean wounds) or ≥ five years ago (for puncture wounds or wounds contaminated with dirt) - Tetanus toxoid–containing vaccine (Td, Tdap, TT); add a single dose of tetanus immune globulin (250 units IM), except after minor and clean wounds, if it is unclear that the three-dose primary vaccination series has been completed.

• Td = tetanus and diphtheria toxoids;
• Tdap = tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine;
• TT = tetanus toxoid.

• Adults 65 years and older should receive Td, not Tdap. Adults or adolescents who have uncertain or incomplete primary vaccination histories should complete the primary series of three doses for tetanus, diphtheria, and acellular pertussis. Tetanus toxoid and tetanus immune globulin should be administered at separate sites with separate syringes. Antimicrobial prophylaxis against tetanus is not advised.

Tuberculosis

• Every person at risk regardless of previous bacille Calmette-Guérin immunization or tuberculosis history - Tuberculin skin test or interferon-gamma release assay should be performed at baseline and at eight to 12 weeks after exposure. If tuberculin skin test ≥ 5 mm or interferon assay is positive, for nine months treat with isoniazid plus vitamin B_6.

Measles

Nonimmune contacts - Pregnant women or immunocompromised persons: a single dose of immune globulin (0.25 mL per kg). Others: measles vaccine within three days of exposure.

(Bader et al. Am Fam Physician. 2013 Jul 1;88(1):25-32.)