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Immunizations

for Health Care Providers

Immunizations

Key Points

  • All HIV-infected patients should be offered hepatitis B, pneumococcus, and inactivated influenza vaccination as recommended.
  • Other vaccines may be indicated for some HIV-infected patients (see Immunization Schedule).
  • Live virus vaccines should not be administered to HIV-infected patients, with the possible exception of MMR and varicella immunizations.

Background

  • Immunization is a cost-effective, low-risk intervention to prevent morbidity and mortality in HIV-infected patients.
  • The current recommendations regarding immunization of HIV-infected individuals are available at aidsinfo.nih.govLink will take you outside the VA website.; the most recent schedule is shown on the next page.
  • All HIV-infected individuals should be offered 23-valent pneumococcus and hepatitis B vaccination (if not already immune to HBV); vaccination with the inactivated trivalent influenza vaccine should be offered annually during influenza season.
  • Other vaccines should be offered based on specific risk factors; see next page.
  • Live virus vaccines generally should not be administered to HIV-infected patients; however, administration of MMR, varicella, and zoster vaccines may be appropriate for some patients.

Veterans with HIV*

Influenza vaccination: 60%

Pneumococcus vaccination: 68%

Hepatitis B vaccination: 40%

*Veterans in the VA HIV Clinical Case Registry in care in 2007 who received the indicated immunizations

Table 1. Immunization Schedule for HIV-Infected Adults
Vaccine ↓Indication →HIV infection, CD4 T-lymphocyte count
* Covered by the Vaccine Injury Compensation Program

1 HPV vaccination is FDA approved for males aged 9-26, routine administration has not yet been recommended by ACIP.

2 Administer only if specific risk factors for meningococcus.

Figure For all persons in this category who meet the age requirements and who lack evidence of immunity (eg, lack documentation of vaccination or have no evidence of prior infection)
Figure Recommended if some other risk factor is present (eg, on the basis of medical, occupational, lifestyle, or other indication)

Adapted from the Advisory Committee on Immunization Practices (ACIP) Adult Immunization Schedule. For detailed information on immunizations against influenza, pneumococcal disease, hepatitis B, human papillomavirus, varicella, and hepatitis A, refer to the Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents. For information on immunizations against tetanus, diphtheria, pertussis, measles, mumps, rubella, and meningococcal disease, refer to recommendations of the ACIPLink will take you outside the VA website..
<200 cells/µL≥200 cells/µL
Tetanus, diphtheria, pertussis (Td/Tdap)*Substitute one-time dose of Tdap for Td booster; then boost with Td every 10 years
Human papillomavirus1*3 doses for females through age 26 years
Varicella*Contraindicated2 doses
ZosterContraindicatedNo recommendation
Measles, mumps, rubella*Contraindicated1 or 2 doses
Influenza (inactivated)*1 dose TIV annually
Pneumococcal (polysaccharide)1 dose; one-time revaccination recommended after 5 years (or at age >65 years)
Hepatitis A*2 doses
Hepatitis B*3 doses
Meningoccoccal2*1 or more doses

Print table

References

  • Centers for Disease Control and Prevention. Recommended adult immunization schedule -- United States, 2010. MMWR Mortal Wkly Rep. 2010 Jan 15;59(1):1-4.
  • Centers for Disease Control and Prevention. FDA licensure of quadrivalent human papillomavirus vaccine (HPV4, Gardasil) for use in males and guidance from the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2010 May 28;59(20):630-2.