Public Health England (PHE) has issued updated guidelines on the use of post-exposure prophylaxis (PEP) for measles in high-risk groups. The guidance summarises the evidence on PEP and provides advice on assessing the need for PEP for immunosuppressed individuals, pregnant women and infants.
Changes from the previous guidelines include a new section on inadvertent vaccination with MMR in immunosuppressed individuals.
The document advises that pregnant women do not require PEP if they are inadvertently given MMR vaccine but require follow-up. PHE says the data collected since 1981 are “reassuring with regards to maternal and infant outcomes, when MMR is given in pregnancy or shortly prior to pregnancy”.
Based on the review of evidence, PHE has determined that a prophylactic dose of immunoglobulin is unlikely to offer additional benefit to those who have detectable measles antibody using standard assays, as their antibody levels are probably significantly higher than those achieved after a prophylactic dose of immunoglobulin.
People with severe defects of cell mediated immunity who are on regular IV immunoglobulin (IVIG) replacement therapy do not require additional IVIG if the most recent dose was administered less than three weeks before exposure, the guidelines state. It says such individuals would be under the management of specialists in immunology and their need for replacement immunoglobulin therapy will have already been assessed.
The guidelines also include update to doses of human normal immunoglobulins following changes to vial sizes and new logistics for ordering and issuing immunoglobulins from the Rabies and Immunoglobulins service at PHE Colindale.
The full guidelines are available here.