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10 - Immunizations

from Part II - General issues in the care of pediatric HIV patients

Published online by Cambridge University Press:  03 February 2010

By
Rachel Y. Moon
Edited by
Steven L. Zeichner  and
Jennifer S. Read
Rachel Y. Moon
Affiliation:
Department of General Pediatrics and Adolescent Medicine, Children's National Medical Center, Washington, DC
Steven L. Zeichner
Affiliation:
National Cancer Institute, Bethesda, Maryland
Jennifer S. Read
Affiliation:
National Cancer Institute, Bethesda, Maryland
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Summary

General principles for immunizations in HIV-exposed and HIV-infected patients

Routine pediatric immunizations should be given to all HIV-exposed infants and HIV-infected children according to the schedule recommended by the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics (AAP) [1]. Additional vaccines, such as the polyvalent pneumococcal vaccine, may be indicated because of the patient's immunocompromised state. Please note that the recommendations in this chapter are US recommendations; guidelines in other countries and localities may vary.

In the USA, HIV-exposed and -infected children should not receive live-virus or live-bacteria vaccines, with the exception of measles, mumps, rubella (MMR), and varicella vaccine. The inactivated polio vaccine (IPV) should be given instead of the live oral polio vaccine (OPV). Varicella vaccine should be considered in HIV-infected children who are in CDC clinical class N1 or A1 with adequate CD4 counts (see below) [2]. MMR should be given to all HIV-exposed and -infected children unless they are severely immunocompromised (see below) [3]. Although Bacille Calmette—Guerin (BCG) is not recommended for HIV-exposed and -infected children in the USA [4, 5], the World Health Organization recommends BCG in HIV-infected children in countries with high HIV prevalence [6, 7]. However, testing for HIV infection in asymptomatic children without risk factors for HIV is not indicated before administering live virus vaccines.

In general, children with symptomatic HIV infection tend to have poor immunologic responses to vaccines, with decreasing responses as the infection progresses.

Type
Chapter
Information
Textbook of Pediatric HIV Care , pp. 145 - 152
Publisher: Cambridge University Press
Print publication year: 2005

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References

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  • Immunizations
    • By Rachel Y. Moon, Department of General Pediatrics and Adolescent Medicine, Children's National Medical Center, Washington, DC
  • Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read, National Cancer Institute, Bethesda, Maryland
  • Book: Textbook of Pediatric HIV Care
  • Online publication: 03 February 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544798.013
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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Immunizations
    • By Rachel Y. Moon, Department of General Pediatrics and Adolescent Medicine, Children's National Medical Center, Washington, DC
  • Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read, National Cancer Institute, Bethesda, Maryland
  • Book: Textbook of Pediatric HIV Care
  • Online publication: 03 February 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544798.013
Available formats
×

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  • Immunizations
    • By Rachel Y. Moon, Department of General Pediatrics and Adolescent Medicine, Children's National Medical Center, Washington, DC
  • Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read, National Cancer Institute, Bethesda, Maryland
  • Book: Textbook of Pediatric HIV Care
  • Online publication: 03 February 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544798.013
Available formats
×