What is the recommended post-exposure prophylaxis (PEP) for individuals exposed to COVID-19 (Coronavirus disease 2019)?

Post-Exposure Prophylaxis Recommendations for COVID-19 Exposure

Primary Recommendation

For individuals with high-risk exposure to COVID-19, post-exposure prophylaxis with anti-SARS-CoV-2 monoclonal antibodies is recommended, particularly for those who are not vaccinated, vaccine non-responders, or not expected to respond to vaccines. 1

Risk Assessment and Eligibility

Post-exposure prophylaxis should be targeted to:

• High-risk individuals including:

  • Patients with hematological malignancies
  • Immunocompromised patients
  • Unvaccinated individuals
  • Vaccine non-responders
  • Elderly patients with comorbidities

• Exposure criteria:

  • Close contact with confirmed COVID-19 case
  • Suspicious exposure to environments positive for SARS-CoV-2

Definition of Close Contact 1

• Individuals who have had face-to-face contact with COVID-19 patients
• Caregivers and household members of COVID-19 patients
• Healthcare workers with direct patient contact without appropriate PPE
• Passengers who shared transportation with COVID-19 patients
• Other circumstances determined by professional investigation

Prophylactic Options

First-Line Option:

• Anti-SARS-CoV-2 monoclonal antibodies 1, 2
  • Administer as soon as possible after exposure
  • Highest level of recommendation (AIIt) for high-risk patients

Alternative Options (if monoclonal antibodies unavailable):

• High-titer convalescent plasma (within 72 hours of exposure) 1, 2
• Antiviral medications may be considered in specific situations 2, 3

Monitoring Protocol for Exposed Individuals

All exposed individuals, regardless of whether they receive PEP, should:

1. Observe strict 14-day health observation period starting from last contact with infected person or environment 1
2. Monitor for symptoms (fever, respiratory symptoms, diarrhea)
3. Seek immediate medical attention if symptoms develop 1
4. Wear appropriate masks (N95 preferred, surgical mask as alternative) 1
5. Avoid public transportation if seeking medical care; use private vehicle with windows open for ventilation 1
6. Maintain distance from others (at least 1 meter) 1

Special Considerations

For Healthcare Workers:

• Wear appropriate PPE including N95 respirator, gown, gloves, and eye protection when caring for COVID-19 patients 1
• Minimize exposure by reducing number of staff in contact with patients 1
• Follow proper infection control protocols for equipment and room handling 1

For Hematological Malignancy Patients:

• Pre-exposure prophylaxis with long-acting anti-SARS-CoV-2 monoclonal antibodies is recommended for non-immunized patients 1, 2
• Full vaccination program should still be completed even if previously infected with SARS-CoV-2 1, 2

Common Pitfalls and Caveats

1. Delayed administration: PEP effectiveness decreases with time after exposure. Administer as soon as possible after exposure.

2. Overreliance on PEP: PEP should complement, not replace, other preventive measures such as vaccination, masking, and social distancing.

3. Inappropriate risk assessment: Not all exposures warrant PEP. Focus on high-risk individuals with significant exposures.

4. Inadequate follow-up: Even with PEP, exposed individuals must complete the full 14-day observation period.

5. Drug interactions: Consider potential interactions between monoclonal antibodies and other medications the patient may be taking.

6. False sense of security: Remind patients that PEP is not 100% effective and they should continue monitoring for symptoms.

The evidence supporting post-exposure prophylaxis for COVID-19 is still evolving, with most recommendations based on expert consensus and extrapolation from experience with other infectious diseases 4, 5. However, given the potential benefits in preventing infection in high-risk individuals, monoclonal antibody PEP represents an important strategy in the comprehensive approach to COVID-19 prevention.