ID: 9 mo/o infant was brought in after exposure to measles;
HPI: Pt came into contact with an adult family member with skin rash and cold like Sx 5/7 ago; the adult patient was later diagnosed as measles; anxious parents want to know what options if any are available to prevent measles in their child; currently the child is completely asymptomatic;
PMH: non-contributory
E/O: Looks well; VSSA;
Physical examination is completely normal.
A/P:
A healthy 9mo/o infant exposed to measles before receiving first MMR injection which was due to be done @ 12mo;
Immune globulin (IG) 0.5ml/kg IM (IGIM) once; continue with the vaccination as planned @ 12-15mo;
Discussion(1):
General rule (post exposure, non-immune): MMR vaccine within 72h; immune globulin (IG) if >72h but <6d; if non-immune and receive IG should still receive MMR, but not earlier than 6mo after IGIM, and 8mo after IGIV; IG should not be used for outbreak control;
Post exposure, non-immune, @ ↑risk of complications (infants, pregnant women, immunocompromised)
Infants ≤12mo: IGIM 0.5ml/kg once (infants 6-11mo may receive MMR, but IGIM preferable to MMR if household contact due to ↑transmission risk); should receive MMR as scheduled @12 mo with second booster prior to school entry;
Pregnant women: IGIV 400mg/kg once;
Immunocompromised: IGIV 400mg/kg once;
Reference:
1. http://www.uptodate.com/contents/prevention-and-treatment-of-measles?source=search_result&search=measles+prevention&selectedTitle=1%7E150
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