2025 – PAGE 344 – VACCINES, IMMUNIZATIONS AND CONTRAINDICATIONS
(DOUBLE TAKE) MEASLES POST-EXPOSURE PROPHYLAXIS: The table below describes prophylaxis for people who are exposed to measles and who are not pregnant or immunocompromised.
| Age | Exposed <3 days ago | Exposed 4-6 days | Exposed >6 days |
| < 6 months old | IGIM | IGIM | No PEP indicated because it’s too late to prevent the onset of the disease |
| 6-11 months old | MMR | IGIM | |
| > 12 months old | MMR #1 if never received.
MMR #2 if it’s been at least 28 days since MMR #1. No PEP needed if already received 2 MMR doses. |
Too late for PEP.
MMR #1 after home quarantine for 21 days if never received. MMR #2 may be given to >4 years old if it’s been at least 28 days since MMR #1. |
- PEARLS: DO NOT GIVE MMR for at least 6 months after giving IGIM, DO NOT GIVE MMR and IGIM at the same time.
- PEARL: For severely immunocompromised patients, give IVIG (or IGIM if <12 months old) if it’s been <6 days since exposure, regardless of immunity to measles.
- PEARL: For pregnant patients with unknown immunity or only 1 MMR vaccine, draw stat measles titers to determine immunity. If immune, PEP is not indicated. If non-immune (IgG negative or 0 doses MMR), give IVIG if it’s within 6 days of exposure.
- PEARL: If a child gets the MMR vaccine within 72 hours of exposure, let them go back to daycare or school.
- MNEMONIC: Mom’s antibodies can linger and “fight” the MMR vaccine until about 6 months, which is why we give IGIM as post-exposure prophylaxis to those under 6 months of age.
- TREATMENT: The treatment for measles is supportive.
- TETANUS & TETANUS BOOSTER
DTaP and DT are for kids under 7. DTaP is used for the routine vaccinations at 2 months, 4 months, 6 months, 15 months, and 5 years. Tdap is then given as a routine booster around 11–12 years of age to continue protecting against tetanus and pertussis. The Tdap booster is given even if the child recently received a booster for a possible exposure. After that, the Tdap booster is given every 10 years. For a possible exposure, kids under the age of 7 get DT, kids between 7 and 10 get Td, and kids 11 and older get Tdap. Replace DTaP with DT, and replace Tdap with Td, for any child who cannot get the pertussis component of the vaccine (e.g., allergic).
- CLEAN WOUND: If the last shot was < 10 years ago, there’s no need for a booster. If it was > 10 years ago, they are due for a booster anyways, so go ahead and give it!
- DIRTY WOUND: If the last shot was > 5 years ago, give a booster. If the wound is dirty and the immunization status is unknown or incomplete, give IMMUNOGLOBULIN + BOOSTER.
- MNEMONIC: Do the D’s and T’s confuse you? Just remember that the D’s get smaller with age. DTaP and DT are for kids < 7 years old. Tdap is for everyone else.