Source / episode info
- **Episode:**252
- **Title:**Divine Intervention Episode 252 – Post Exposure Prophylaxis and The NBMEs.
- **Published:**2020-08-01
- Source:Episode page
One-liner
Episode 252 is a comprehensive review of post-exposure prophylaxis for multiple pathogens (HBV, HIV, VZV, Rabies, TB, Tetanus), emphasizing specific vaccine/immunoglobulin protocols, contraindications (e.g., live vaccines in immunocompromised patients), and critical timing guidelines required for board success.
High-yield summary
- Tetanus PEP: If unsure of vaccination history or >10 years since last dose, administer Tdap vaccine + Tetanus Immune Globulin (TIG). If <5 years, no action is needed regardless of wound severity.
- HBV Neonate Care: A newborn exposed to a mother with HBsAg positive status requires both the Hepatitis B vaccine and Hepatitis B immune globulin (HBIg), administered in separate arms.
- TB Screening: For high-risk individuals (e.g., immunocompromised, recent travel) or those with TST > 5 mm, perform an IGRA; if positive, initiate latent TB regimen (INH + Pyridoxine/Vitamin B6).
- Rabies PEP: Requires both Rabies Immune Globulin (RIG) and the vaccine. RIG should be infiltrated directly around the wound site to neutralize local toxin.
- Live Vaccines Contraindications: Live attenuated vaccines (e.g., Varicella, MMR) are contraindicated in immunocompromised patients (e.g., HIV with CD4 < 200 cells/mm³), who must instead receive immune globulins or alternative therapies.
Learning objectives
- Differentiate the appropriate post-exposure prophylaxis regimens for HBV, HIV, VZV, and Rabies based on exposure risk and patient immune status.
- Apply critical thinking regarding vaccine administration guidelines (e.g., separate sites for HBIg/vaccine; infiltration site for RIG).
- Recognize contraindications to live vaccines in immunocompromised patients and know the appropriate substitute immunoglobulins.
- Master the timing rules for Tetanus prophylaxis based on vaccination history (<5 years vs. >10 years or unknown).
- Understand the principles of TB screening (TST vs. IGRA) and the initiation of LTBI treatment with INH/Pyridoxine.
Board exam buzzwords