Match each of the following high-risk infectious exposure scenarios with the most appropriate immediate management or post-exposure prophylaxis (PEP) step.
- A 28-year-old resident physician sustains a deep needlestick injury after drawing blood from a patient with chronic hepatitis B and negative HIV serology. The physician's anti-HBs titer was 45 mIU/mL after their vaccination series five years ago.No post-exposure prophylaxis or baseline serologic testing is required; provide standard wound care.
- A 32-year-old pregnant woman at 12 weeks gestation reports that her 5-year-old nephew, whom she babysits daily, developed a 'slapped cheek' rash yesterday. Her own childhood infection history is unknown.Perform serologic testing for specific IgG and IgM antibodies to assess maternal infection status.
- A 45-year-old camper awakens in his tent to find a bat flying around. He captures the bat but notices two small puncture marks on his lower leg. He has never received any specialized pre-exposure vaccinations.Administer human rabies immune globulin (HRIG) and initiate the active vaccine series.
- A 21-year-old college student presents to student health requesting antibiotics. He shares an apartment with a classmate who was admitted to the ICU yesterday with a purpuric rash and bacterial meningitis.Prescribe a prophylactic course of oral ciprofloxacin, oral rifampin, or a single dose of intramuscular ceftriaxone.
- A 55-year-old renal transplant recipient on maintenance immunosuppression is visited by a grandchild who develops vesicular lesions later that evening. The patient has never had chickenpox or the varicella vaccine.Administer varicella-zoster immune globulin (VZIG) as soon as possible, ideally within 10 days of exposure.
Answer
The resident physician requires no PEP. The pregnant woman requires Parvovirus B19 serology. The camper requires HRIG and rabies vaccine. The college roommate requires meningococcal chemoprophylaxis (ciprofloxacin, rifampin, or ceftriaxone). The transplant recipient requires VZIG.
Each correct match directly pairs the specific exposure risk with the host's current immune status to determine the exact protocol recommended by the CDC.
Step-by-Step Solution
Key Concept
Post-exposure prophylaxis and immediate management of high-yield infectious diseases