Pediatric emergency medicine trisk 2095 2095
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care facility. Schoolroom exposure of an isolated case and routine play
contacts do not require ISG. However, a second case within a class is an
indication for immunoprophylaxis of the rest of the class. Serologic testing of
close contacts is not recommended, as it adds to unnecessary cost and
potential treatment delay. Importantly, current guidelines recommend
preexposure prophylaxis via routine HAV immunization for all children.
Recently, studies have shown that immunizing patients postexposure with the
hepatitis A vaccine is as effective as providing immune globulin.
Hepatitis B
Prophylactic treatment to prevent infection after exposure to HBV should be
considered in individuals who do not have documented immunity from the
HBV vaccine in the following ED situations: (i) Sexual exposure to the HBV
surface antigen–positive patient, (ii) inadvertent percutaneous or permucosal
exposure to HBV surface antigen–positive blood, (iii) household exposure of
an infant younger than 12 months to a primary caregiver who has acute HBV.
Before treatment in the first two situations, testing for susceptibility is
recommended if it does not delay treatment beyond 14 days postexposure.
Breast-feeding of an infant by an HBV surface antigen–positive mother poses
no additional risk if the infant has received HBV and HB immunoglobulin.
Testing for anti-HBV core Ab is the most efficient prescreening procedure.
HBV is 100-fold more infectious than HIV. Do not dismiss a positive antiHBsAg (surface antigen) as postvaccination response if risk factors present as
it can be a marker of chronic infection. All HBsAg- and HBcAb-positive
patients merit confirmatory HBV DNA confirmation. All susceptible persons
should receive a single dose of hepatitis B immunoglobulin (0.06 mL/kg)
intramuscularly and hepatitis B vaccine in recommended doses.
MISCELLANEOUS ABDOMINAL EMERGENCIES
Gastroesophageal Reflux Disease
GER and gastroesophageal reflux disease (GERD) are among the more
common abdominal complaints seen in the pediatric emergency department.
The NASPGHAN defines GER as the physiologic passage of gastric contents
into the esophagus, and GERD as reflux associated with troublesome
symptoms or complications. GER is reported in two-thirds of otherwise
healthy infants and complications from GERD account for a significant
