Immunization
HIV-infected children should be protected from vaccine-preventable diseases. Most vaccines recommended for routine use can be administered safely to HIV-exposed or HIV-infected children. All inactivated vaccines can be administered safely to persons with altered immunocompetence whether the vaccine is a killed whole organism or a recombinant, subunit, toxoid, polysaccharide, or polysaccharide protein -conjugate vaccine. If inactivated vaccines are indicated for persons with altered immunocompetence, the usual doses and schedules are recommended. However, the effectiveness of such
vaccinations might be suboptimal. Persons with severe cell-mediated immune deficiency should not receive live attenuated vaccines. However, children with HIV infection are at higher risk than immunocompetent children for complications of varicella,
herpes zoster, and
measles. On the basis of limited safety, immunogenicity, and efficacy data among HIV-infected children, varicella and measles-
mumps-
rubella vaccines can be considered for HIV-infected children who are not severely immunosuppressed (i.e., those with age-specific CD4 cell percentages of >15%). Oral
polio, and intranasal influenza vaccine are contraindicated in HIV-infected patients.
Immunization status should be reviewed at every visit and response to vaccination (antibody response) evaluated when indicated.
There is no safety or efficacy data related to the administration of rotavirus vaccine to infants who are potentially immunocompromised, including those who are HIV-infected. However, two considerations support vaccination of HIV-exposed or -infected infants: first, the HIV diagnosis may not be established in infants born to HIV-infected mothers before the age of the first rotavirus vaccine dose; and second, vaccine strains of rotavirus are considerably attenuated.
Ideally live vaccines are avoided in immunosuppressed children. Also, there is insufficient evidence on the efficacy of BCG in HIV infected individuals. Complications arising from
BCG vaccine in form of local lymphadenitis, ulcers are similar in HIV and non HIV children. Only a handful of cases of disseminated BCG disease in HIV infected children and adults have been reported till date. Latest WHO recommendations state that BCG should not be administered to infants known to be HIV-infected in view of possibility of BCGiosis. In practice, this has made little difference in
TB-endemic settings where HIV co-infection is most common, since the majority of infants are not known to be HIV-infected at birth and this is when the majority of the world’s children receive BCG vaccine.