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COVID-19: POST-EXPOSURE PROPHYLAXIS WITH IVERMECTIN IN CONTACTS.

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COVID-19: POST-EXPOSURE PROPHYLAXIS WITH IVERMECTIN IN CONTACTS. At Homes, Places of Work, Nursing Homes, Prisons, and Others. SUMMARY Post-Exposure Prophylaxis (PEP) is aimed at preventing the development of infection and disease after exposure to an infectious agent. PEP is indicated by the WHO, PAHO, the United States HHS and other widely recognized organizations for HIV infection, as well as for other infectious diseases such as Hepatitis B and C, Tuberculosis and Scabies. In the case of COVID-19, PEP is indicated for Contacts of people with a diagnosis of SARS CoV-2 infection. The identification of the Contacts of the infected person is carried out mainly in his or her Place of Residence and Work. If applicable, it is also carried out in School, modes of Transportation as well as other places where the infected may have stayed. PEP is also recommended in the case of Contact with persons suspected of having COVID-19. The Place of Residence may be a place where many people live, such as Nursing Homes, Prisons, Long-Term Residential Centers, Hospitals, among others. In these places, it is often justifiable to carry out large-scale PEP, especially if there are several people already sick on site. Based on local experience and existing publications, a general PEP Scheme consisting of a dose of 0.2 mg per kilo of weight for 2 days is proposed. A third dose (3 days) is indicated in male Contacts between the ages of 45 and 70. And 4 doses is given for men older than 70, and in the person(s) who assume(n) the role of “Caregiver”. The inclusion of Acetylsalicylic Acid (ASA) or Aspirin in the PEP Scheme is recommended in for men over 45 years of age and in “Persons with Increased Risk” of developing severe illness. Recommended dose is 1 tablet of 100 mg after lunch for 6 to 10 days. Contacts should remain under observation in case they begin to show characteristic symptoms of COVID-19, in which case they should move to therapeutic doses of Ivermectin. Special care must be taken in elderly people who are bedridden or with reduced mobility, in whom health checks must be more frequent and comprehensive.
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COVID-19: POST-EXPOSURE PROPHYLAXIS WITH IVERMECTIN IN
CONTACTS. At Homes, Places of Work, Nursing Homes, Prisons, and Others.
Aguirre-Chang, Gustavo and Trujillo, Aurora. ResearchGate. July 30, 2020.
English translation by Madeline Oh
Doi: http://dx.doi.org/10.13140/RG.2.2.34561.48483/3
SUMMARY
Post-Exposure Prophylaxis (PEP) is aimed at preventing the development of infection and
disease after exposure to an infectious agent. PEP is indicated by the WHO, PAHO, the United
States HHS and other widely recognized organizations for HIV infection, as well as for other
infectious diseases such as Hepatitis B and C, Tuberculosis and Scabies.
In the case of COVID-19, PEP is indicated for Contacts of people with a diagnosis of SARS
CoV-2 infection.
The identification of the Contacts of the infected person is carried out mainly in his or her Place
of Residence and Work. If applicable, it is also carried out in School, modes of Transportation
as well as other places where the infected may have stayed. PEP is also recommended in the
case of Contact with persons suspected of having COVID-19.
The Place of Residence may be a place where many people live, such as Nursing Homes,
Prisons, Long-Term Residential Centers, Hospitals, among others. In these places, it is often
justifiable to carry out large-scale PEP, especially if there are several people already sick on
site.
Based on local experience and existing publications, a general PEP Scheme consisting of a
dose of 0.2 mg per kilo of weight for 2 days is proposed. A third dose (3 days) is indicated in
male Contacts between the ages of 45 and 70. And 4 doses is given for men older than 70,
and in the person(s) who assume(n) the role of “Caregiver”.
The inclusion of Acetylsalicylic Acid (ASA) or Aspirin in the PEP Scheme is recommended in
for men over 45 years of age and in Persons with Increased Risk of developing severe illness.
Recommended dose is 1 tablet of 100 mg after lunch for 6 to 10 days.
Contacts should remain under observation in case they begin to show characteristic symptoms
of COVID-19, in which case they should move to therapeutic doses of Ivermectin. Special care
must be taken in elderly people who are bedridden or with reduced mobility, in whom health
checks must be more frequent and comprehensive.
Keywords: COVID-19, Prophylaxis, Post-Exposure, Ivermectin, Contacts.
TYPES OF PROPHYLAXIS
Prophylaxis is a measures applied or used to prevent an infection or disease from developing
(1,2). Prophylaxis is applied to people who do not have the infection but who are at risk of
contracting it and take drugs against the infectious agent to prevent infection and disease.
The condition to give Prophylaxis for an infection is that there is exposure to the infectious
agent. There are 2 types of Prophylaxis depending on whether the drug is to be taken before
or after exposure to the infectious agent, according to this there are:
A) POST-EXPOSURE PROPHYLAXIS (PEP).
B) PRE-EXPOSURE PROPHYLAXIS (PrEP).
COVID-19: Post-Exposure Prophylaxis with Ivermectin in Contacts. Aguirre Chang, G. y Trujillo F., A.
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In this document we will deal with PEP, in another document we will elaborate on the PrEP.
POST-EXPOSURE PROPHYLAXIS (PEP)
PEP is a secondary prevention measure aimed at avoiding the development of infection and
disease after exposure to an infectious agent (1,2). PEP consists of giving the specific drug
against the infectious agent as soon as possible after exposure to the infectious agent.
PEP has been indicated for several years by the WHO, PAHO, the US Department of Health
and Human Services (HHS) and other recognized organizations, for HIV infection (1,2,3), is its
most frequently used in medical practice. It is also indicated for other infectious diseases such
as Hepatitis B and C (3) and Tuberculosis (4).
In the case of diseases transmitted more frequently through the respiratory tract, such as
Tuberculosis (4), Prophylaxis is aimed mainly at Contacts of sick people.
PEP is also indicated when a person has been exposed to aerosols existing in a certain
environment and, when a person has had direct contact or was exposed to body fluids or
secretions from a person or people with the infection.
DEFINITION OF CONTACT OF COVID-19
In the case of COVID-19, the WHO defines a Contact (5,6) to:
A person who experienced any of the following type of contact with a person who had probable
or confirmed case during the time period from 2 days prior to onset of symptoms and 14 days
after:
1. Face-to-face contact with probable or confirmed case within 1 meter of distance and for at
least 15 minutes.
2. Direct physical contact with a probable or confirmed case.
3. Direct care of a patient with probable or confirmed COVID-19 disease without using
appropriate personal protective equipment
4. Other situations as indicated by local risk assessments.
The WHO also clarifies that for confirmed asymptomatic cases, contact period is measured
from 2 days prior to the date when sample was taken that led to confirmation, until14 days
after.
The WHO defines a Confirmed Case as a person who has a positive laboratory test for COVID-
19 (5,6). This definition includes those who are Asymptomatic.
The Peruvian Standard called “Outpatient Management of persons affected by COVID-19” (7),
defines a Direct Contact as a “Person who shares or shared the same environment with a
confirmed case of COVID-19 infection at a distance of less than 1.5 meters (including
workplace, classroom, home, nursing homes, prisons and others) ”.
In addition, the Standard called "Guidelines for the Surveillance, Prevention and Health Control
of workers at risk of exposure to COVID-19" (8), a guideline specific for workers, defines Close/
Direct Contact as a person who shares or shared the same environment with a confirmed case
of COVID-19 within a distance of less than 1 meter for at least 60 minutes without any
protection measures.
For practical purposes, persons who had been within 1.5 meters of a suspected COVID-19
case can also be considered in PEP.
SOCIAL DISTANCING, EXPOSURE AND CONTACT WITH PEOPLE
Social or Physical Distancing is a practice that consists of maintaining a safe distance that
separates people. It is understood that this is a necessary distance required to ensure that
there is no exposure and that it is the sufficient distance to avoid the transmission of disease.
COVID-19: Post-Exposure Prophylaxis with Ivermectin in Contacts. Aguirre Chang, G. y Trujillo F., A.
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The WHO indicates on its website (9) that social distancing be maintained at at least 1 meter
(3 feet).
For its part, the US CDC, on its website (10) indicates that a distance of at least 6 feet, which
is equivalent to 1.8 meters, must be maintained with respect to people who are not members
of your household, both in indoor and outdoor spaces.
CONDITION FOR MAINTENANCE OF CONTACT
To maintain the condition of being a Contact, a person must not present with symptoms.
Contacts must remain under observation with periodic health checks to see if they begin to
present characteristic symptoms of COVID-19. When they do, they are no longer considered
a Contact, become Suspect or Probable case of COVID-19, and will have to start early
treatment for the disease. It should be also be taken into account that during the incubation
period people do not exhibit symptoms. Therefore it is posible that a "Contact" had actually
already been infected, but is still in the incubation period. Taking this consideration into
account, it should be noted that those who begin to present with symptoms prior to 4 days after
a close contact with a person with COVID-19 had already infected.
PEOPLE FOR WHOM PEP IS INDICATED.
The first indication of PEP is directed primarily at Contacts. Thus, when identifying a person
sick with COVID-19, after prescribing individual treatments, their Contacts should be identified.
We also recommend PEP for Contact of people suspected of COVID-19, i.e. people with
symptoms suggestive of COVID-19 but do not have confirmation of diagnosis.
The identification of the Contacts of the infected person is carried out mainly in their homes or
place of residence and workplace, And if applicable, it is also carried out in their schools,
transportations that they had used and other places where they stayed.
The place of residence can be a place where many people live, such as Nursing Homes,
Prisons, Long-Term Care Centers, Hospitals, among others.
There is also special situation of exposure where contact with infectious secretions from a
confirmed case of COVID-19 can occur. This can occur for especially healthcare professionals.
We must mention that, by Regulation of the Ministry of Health of Peru (12), the Prophylactic
Treatment for COVID-19 was approved on April 14, 2020. This Standard puts
chemoprophylaxis into consideration for following cases:
a. Health workers who have directly participated in the care of suspected or confirmed
cases of COVID-19.
b. Household contacts of confirmed COVID-19 cases.
c. Other groups that, due to the nature of their residence or activity, are considered high-
risk populations.
This Standard indicates that chemoprophylaxis is a complementary measure and does not
replace the preventive measures already in place such as social distancing, quarantine, hand
hygiene, respiratory hygiene and use of personal protective equipment.
The prophylaxis approved for this Norm was with Hydroxychloroquine, and which was later the
Norm wa annulled (13).
Table 1 shows list of persons for whom PEP is indicated for a disease transmitted mainly by
the respiratory tract, such as COVID-19.
Following paragraphs describe each of these groups of people for whom PEP is indicated in
the case of COVID-19:
COVID-19: Post-Exposure Prophylaxis with Ivermectin in Contacts. Aguirre Chang, G. y Trujillo F., A.
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Table 1
PERSONS FOR WHOM POST-EXPOSURE PROPHYLAXIS (PEP) IS INDICATED
IN COVID-19
1. CONTACTS OF A CONFIRMED OR PROBABLE CASE OF INFECTION.
2. CONTACTS OF PERSONS SUSPECTED OF HAVING THE INFECTION.
3. CONTACTS IN PLACES WHERE MANY PEOPLE LIVE (Nursing Home, Prisons
among Others).
4. HEALTH PERSONNEL WHO DID NOT USE PPE OR DID NOT APPLY ITS
PROTOCOL DURING THE EVALUATION OF A CONFIRMED OR PROBABLE
CASE OF INFECTION.
5. HIGH PROBABILITY OF BEING A CONTACT AFTER BEING EXPOSED TO AN
ENVIRONMENTS WITH A VERY LIKELY PRESENCE OF AEROSOLS AND / OR
CONTAMINATED SURFACES OR OBJECTS (PLACES WITH HIGH PEOPLE
TRAFFIC).
6. PERSON WHO HAD A DIRECT CONTACT WITH INFECTIOUS SECRETIONS
FROM A CONFIRMED OR PROBABLE CASE.
1. CONTACTS OF A CONFIRMED OR PROBABLE CASE OF INFECTION.
After confirming the diagnosis of COVID-19, and giving instructions to the ill patient, one
must proceed to identify all of his or her Contacts in the following locations:
1) Place of Residence: family’s home or residence where the ill patient lives. They can
be designated as family, or residential contacts.
2) Places of Work or Labor: the definition of Contact as established by the WHO and
specifically by the National Standard must be met. In this regard, the Peruvian Standard
for workers (9) specifically defines a Contact as the person who shares or shared the
same environment of a confirmed case within a distance of less than 1 meter for at least
60 minutes without any protection measure.
3) Schools or Education Centers: this applies to cases where students and teachers
attend face-to-face classes.
4) Means of transportation: could be Contacts in from plane, train, boat, buses, etc.
5) Others: depending on the case, there may be other places where the patient stayed,
for example, a Restaurant, a Financial Institution, a Health Office or another place.
These Contacts must also be identified.
2. CONTACTS OF PERSONS SUSPECTED OF HAVING THE INFECTION.
It can be a circumstantial contact with a person or persons suspected of having COVID-19,
either in a Hospital, Healthcare center, in public transport, in the Terminal, bus stop, etc.
In these cases, depending on the situation, PEP can be justified.
There are professions or activities that make exposure and contact with suspicious persons
more frequent, these are:
- Personnel from the Admitting Department, Medical Records and Lobby Areas of
Hospitals and Healthcare Centers: if during their work the personnel are exposed to a
suspected case of COVID-19 without using complete or adequate Personal Protective
Equipment (PPE).
- Personnel from the Army, Police Forces or Fire Department who have been
exposed without wearing complete or adequate PPE: if during their patrol work, or
COVID-19: Post-Exposure Prophylaxis with Ivermectin in Contacts. Aguirre Chang, G. y Trujillo F., A.
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during any intervention, rescue or aid work, the personnel in question had been exposed
to a person or persons suspected of COVID-19.
- People who serve customers in Markets, Fairs, etc: in cities with established
community transmission. These are places with a high number of people with suspected
cases of COVID-19.
3. CONTACTS IN PLACES WHERE MANY PEOPLE LIVE.
When investigating Contacts of an Infected person, their place of residence or home may
be a place where many residents live, such as Nursing Homes, Prisons, Hospitals,
Neuropsychiatric Institutions, among others. Evaluation should be carried out to see if social
distancing between residents is fulfilled in these place as well as to see if rooms, bathrooms,
dining rooms, kitchen, common areas and other environments are shared.
In these places, it is often justified to carry out PEP on a large scale, especially if there are
3 or more confirmed or probable cases in the same place of residence. This is because it is
estimated that there are more asymptomatic or presymptomatic cases in the incubation
period, from whom new infections can arise every day.
In these cases, PEP should be made available as much as possible to all the people who
enter these places of residence.
We will mention the following specific places where many people can reside:
1) Prisons: places of confinement (jails, penitentiaries, prisons, correctional facilities) are
centers that share diverse services and are usually overcrowded. This facilitates the
transmission of the disease. Apart from the detainees, Contacts include personnel in
charge of monitoring and providing the residents with the different services.
2) Nursing Homes, Long-Term Care Centers, Neuropsychiatric Institutions: due to
advanced age and reduced mobility, this is a population group at high risk of developing
severe or critical illness and of dying. Apart from the hospitalized patients, healthcare
personnel and those in charge of providing different services in these places are also
Contacts.
3) Hospitals: outbreaks can occur in some hospitalization areas. This become especially
important when there is inadequate isolation and / or sufficient separation between
hospital beds.
4. HEALTH PERSONNEL WHO DID NOT USE PPE OR DID NOT APPLY ITS PROTOCOL
DURING THE EVALUATION OF A CONFIRMED OR PROBABLE CASE OF INFECTION.
In this regard, the Peruvian Norms (7, 8) include in their definition of Contacts healthcare
personnel who have not used PPE and who have not applied the protocol to put on, take off
and / or dispose of PPE during the evaluation of a case confirmed COVID-19.
It can also be a partial, incomplete or insufficient use of PPE, of poor quality or in a
deteriorated or inappropriate state.
5. HIGH PROBABILITY OF BEING A CONTACT AFTER EXPOSURE TO AN
ENVIRONMENT WITH A VERY LIKELY PRESENCE OF AEROSOLS AND / OR
CONTAMINATED SURFACES OR OBJECTS (PLACES WITH HIGH TRAFFIC OF
PEOPLE COMING FROM A PLACE WITH COMMUNITY TRANSMISSION).
There are situations in which a person goes to a place with a high community transmission
rate, where there is a large number of people in transit from a city, district, or a gathering.
COVID-19: Post-Exposure Prophylaxis with Ivermectin in Contacts. Aguirre Chang, G. y Trujillo F., A.
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After going to these places there is a high probability of exposure to aerosols and / or
contaminated surfaces or objects, generating a significant risk of acquiring the infection.
Going to these places indicates a high probability of being a Contact, since some people
suspected of suffering from COVID-19 are present in these places, many of whom may be
without symptoms, or have only very mild symptoms. Markets, fairs, galleries, shopping
centers, airports, interstate terminals, waiting rooms, auditoriums, churches, gyms,
amusement parks, buses and other places are all considered such places where social
distancing between people is difficult, and where there is a high number of people suspected
of having COVID-19.
6. PERSON WHO HAD A DIRECT CONTACT WITH INFECTIOUS SECRETIONS FROM A
CONFIRMED OR PROBABLE CASE OF INFECTION.
There is a special situation of exposure with infectious secretions from a confirmed case of
COVID-19. This occurs more in health professionals. The current Peruvian Standard (8)
includes in the definition of Contacts people who had direct contact with infectious secretions
from a confirmed case of COVID-19.
In all these cases, PEP should be given shortly after exposure, it is indicated to be given
within 48 hours (2 days) of exposure, the earlier the better.
BACKGROUND TO THE USE OF IVERMECTIN AS PROPHYLAXIS
Several studies since the late 90s report the use of Ivermectin as Prophylaxis for cases of
Scabies. Among them, a study carried out in Brazil recommended dosing of 0.3 mg per
kilogram of weight every 7 days in prisons (14). Another study carried out in the Netherlands
reports its use at a dose of 0.2 mg. per kilogram of weight given once prophylactically to adults
of an average 24 years of age. These people, who came mainly from Ethiopia and Eritrea,
were asylum seekers, Ivermectin was administered to these people as part of a scabies
prevention and treatment program (15). Another study showed that administration of a massive
dose of 2 doses of 0.2 mg per kilogram of weight of ivermectin, one week apart, was effective
in controlling scabies and impetigo (16).
DOSE FOR PEP WITH IVERMECTIN.
In the case of COVID-19, PEP is indicated in order not to become infected with the SARS-
CoV-2 virus. If they already had the infection, they would be receiving Therapeutic Treatment,
not a Prophylactic one.
For Prophylaxis we are recommending the standard dose of 0.2 mg per kilogram of weight
(0.091 mg per pound of weight).
Ivermectin has been used for decades, has high levels of safety, and has been shown to have
mostly minor side effects, most frequent ones being a abdominal discomfort, semi-liquid stool,
diarrhea, nausea, dizziness, anorexia, blurred and / or yellowish vision and urticaria. In the few
cases where these side effects do occur, they are mild and temporary.
CLINICAL STUDIES ON PEP IN COVID-19
To date, there have been some studies on PEP in COVID-19, in which Hydroxychloroquine
has been used (17,18,19,20).
The website Clinicaltrials.gov is a database of clinical studies, and as of August 22, 2020 there
was only one study on PPE for COVID-19 with Ivermectin that is being developed in Egypt.
This study is called “Prophylactic Ivermectin in COVID-19 Contacts” (21) and is described as
COVID-19: Post-Exposure Prophylaxis with Ivermectin in Contacts. Aguirre Chang, G. y Trujillo F., A.
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a randomized, Interventional study. The Protocol they established is two separate doses of
Ivermectin in 72 hours: after the 1st dose, the second dose is given on the third day.
For our part, we have reported our experience of Prophylaxis for COVID-19 with Ivermectin in
adult contacts (22), the results of which are described later.
In addition, two Prophylaxis studies have been carried out, but are not in Contacts, i.e. they
are not Post-Exposure studies. One of these studies has been developed in Argentina (23),
has already been completed and is in the stages of final document preparation. In this study,
topical Ivermectin at a dose of 1 drop on the tongue every 6 hours together with application of
intranasal spray of Carrageenan, a polysaccharide derived from red algae, to the nasal mucosa
was used. In the communications of results (24), this regimen was found to be very favorable
as none (0%) of those who received Prophylaxis became infected after 21 days of follow-up,
while in the control group 11.4% developed COVID-19. This is a highly significant result (p
0.0001). The other Prophylaxis study is being developed in Singapore (25) and as of July 29 it
is still in the enrollment stage.
GREATER SEVERITY AND MORTALITY FROM COVID-19 IN MALE AND OLDER ADULTS
According to the death statistics published by the Peruvian Ministry of Health in the COVID-19
Situation Room (26), mortality is significantly higher in men and even higher after 45 years of
age. Mortality rate increases as age increases. Taking this fact into consideration, the
Prophylaxis Scheme had been established in the study (22) as follows: for men over 45 years
of age a second dose of the drug would be administered because this group is at a higher risk
of developing the disease with greater severity, and with critical illness and death.
PEP EXPERIENCE WITH IVERMECTIN IN ADULTS AND THE ELDERLY
From our experience (22) we found that, after giving Ivermectin dose of 0.2 mg per kilogram of
weight to 33 adults and the elderly who met the criteria of being Contacts of a confirmed case
of COVID-19, the following results were observed: in the 21-day follow-up period, none
developed symptoms of the disease.
It was not appropriate to carry out a molecular PCR test at 21 days since it has been described
that after 12 days the PCR starts to become negative (27,28). Therefore at 21 days it is not a
useful test to make the diagnosis of infection.
After completion this PEP study (22) when we extended the follow-up period of this group of
Contacts, it was observed that between days 25 and 32 from the initial date of the Ivermectin
dose, 4 people became infected. All 4 were male, older than 70 years, with reduced mobility
and with comorbidities. All 4 progressively developed severe disease, and had to be
hospitalized and admitted to the intensive care unit. With 7 being the total number of men over
70 years of age in the study carried out (22), 4 represents 57%, which is a high percentage.
This indicate that special care should be taken for men over 70 years of age.
DOSE FOR PEP WITH IVERMECTIN IN CONTACTS
Based on local experience and existing publications, a general PPE scheme is proposed
consisting of a daily dose of 0.2 mg. per kilo of weight for 2 days.
A third dose (3 days) is indicated in male contacts between 45 and 70 years of age, that is, in
this age group, 1 daily dose of 0.2 mg per kilo is indicated for 3 days. And 4 doses are indicated
in 4 consecutive days in men older than 70 years, this being the population group with the
highest risk of developing severe or critical illness and of dying, which can be corroborated in
the published death statistics (26).
COVID-19: Post-Exposure Prophylaxis with Ivermectin in Contacts. Aguirre Chang, G. y Trujillo F., A.
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Similarly, we indicate taking 0.2 mg per kilo for 4 days in a row to the person(s) who assume
the role of "Caregiver", this due to the high risk of infection, by entering contact with the patient
for several days in a row. If on the 4th day of taking Ivermectin the patient you are caring for
still has respiratory symptoms, it is recommended to extend the prophylaxis with Ivermectin to
more days, until no symptoms are present.
Table 2 shows the recommended doses for PEP with Ivermectin in Contacts.
INCLUSION OF ASA IN PROPHYLAXIS FOR “PEOPLE AT INCREASED RISK” OF
DEVELOPING SEVERE ILLNESS AND OF MORTALITY
Several studies indicate that in COVID-19 a state of thrombophilia associated with endotheliitis
and cell damage produced by the virus is generated (29,30). This in turn generates platelet
hyperactivity and release of highly thrombogenic microvesicles or extracellular microparticles
(31,32), thus giving an importance to Antiplatelet agents within the Therapeutic Plan.
In addition, according to the published statistics of deaths from COVID-19 (26), mortality is
significantly higher in men. This increases with age, and the most significant differences are
seen from 55 years of age. There are several publications which indicate that with increasing
age there is platelet dysfunction with hyperactivity, a situation which causes significant
problems (33,34,35).
Taking the aforementioned into account, the inclusion of ASA in the PEP Scheme should be
recommed in men over 45 years of age and in "People at Increased Risk" of developing severe
illness and of mortality from COVID-19 (36). These are people with one or more of the following
diagnoses or conditions: 1) Type 2 Diabetes and Pre-Diabetes; 2) Angina pectoris, Heart
Failure and other coronary artery diseases; 3) Controlled Arterial Hypertension (to indicate
ASA, Hypertension must be controlled, since it should not generate episodes of elevated
pressure that could cause bleeding); 4) Obesity (BMI> 30); 5) Cancer; 6) Chronic Renal
Insufficiency; 7) Emphysema and Chronic Bronchitis; 8) Immunosuppressed people (due to
organ or bone marrow transplantation, as well as those who are on a prolonged use of
corticosteroids or immunosuppressants); 9) Smoking (smokers).
The recommended dose is 1 tablet of 100 mg after lunch for 6 to 10 days.
In the event that the person who is going to take ASA has or has a history of symptoms
associated with an increase in gastric acid (gastritis, heartburn) or gastroesophageal reflux (a
burning sensation in the middle between the chest and the abdomen, from regurgitation of
acidic fluid), the indication of ASA will necessarily be accompanied by one of the following
gastric protection measures:
- Sodium Bicarbonate: 1 sachet of Andrews Salt or a similar product, or 1/2 teaspoon (3
gr.) Of Powdered Sodium Bicarbonate, in 1 glass with water; take it at 11 am and 10 pm
for 5 days, then only at 10 pm for the other days you take AAS and up to 10 days.
- Famotidine: 40 mg every 12 hours, or Ranitidine: 300 mg. daily, or 150 mg. every 12
hours during the days you take AAS.
MONITORING AND CONTROL OF CONTACTS WITH PEP
In general, Contacts should remain under close observation with frequent health checks every
12 to 24 hours in order to see if they begin to presentwith characteristic symptoms of COVID-
19. If so, they must go to therapeutic doses of Ivermectin, and this must be started early to
treat the illness.
Special care must be taken in elderly people who are prone or with reduced mobility. In them,
it is important to have prior controls of their oxygen saturation, temperature, heart and
COVID-19: Post-Exposure Prophylaxis with Ivermectin in Contacts. Aguirre Chang, G. y Trujillo F., A.
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respiratory rate, to have their baseline values and to be able to identify variations in these
values early.
They require more frequent and careful observation and monitoring. Due to age, they usually
do not develop a fever, and if they do, it may not be high and may go unnoticed. Because of
their reduced mobility, dyspnea is not evident and can only be detected when there is advanced
involvement of the lungs. In older adults it is recommended to monitor temperature (infrared
thermometers are not recommended for this), heart rate and oxygen saturation (with pulse
oximeter), appetite, presence of semi-liquid stools, night sweats and any symptoms that
indicate acute condition of the illness.
Table 2
EQUIVALENT PROPHYLACTIC DOSES FOR DIFFERENT PACKAGING TYPES OF
IVERMECTIN
Table describes the doses and equivalences for the different packaging types of Ivermectin
presentations: 0.6% dropper bottles, 1% bottles and 6 mg tablets.
OTHER POST-EXPOSURE PREVENTION MEASURES
We are aware that Handwashing is a very important preventive measure post-exposure in a
situation where the infection can be contracted from the virus. Similarly, we promote post-
exposure gargling, mouthwash and nasal rinses where there is a risk that the virus may have
entered through the nose or throat.
COVID-19: Post-Exposure Prophylaxis with Ivermectin in Contacts. Aguirre Chang, G. y Trujillo F., A.
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It is also recommended that Contacts follow a diet devoid of pro-inflammatory foods such as
foods rich in Arginine and Histamine, which include walnuts of all kinds, hazelnuts, pecans,
almonds, peanuts, pistachios, chestnuts; orange, tangerine, grapefruit, grape, coconut,
elderberry, blackberry, blueberry, cashew or marañon, cocoa, cocoa chocolate; sesame seeds,
oats, rice (especially whole wheat), wheat, whole wheat bread, barley, peas or green peas;
garlic, rutabaga or kohlrabi, cucumber, cabbage, spinach; mayonnaise, chili, curry,
monosodium glutamate; sausages, cold cuts, canned fish or meat (food preserves), alcohol;
and also coffee, sodas and energy drinks with caffeine.
In older adults, especially men, it is also recommended that they take Vitamin D, A, C and Zinc.
REFERENCES
1. OPS. VIH/SIDA. Profilaxis Posterior a la Exposición (PEP). Disponible en:
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