VACCINATION in HIV

All recommended childhood immunizations should be administered to HIV-exposed infants. In a child with HIV infection, all inactivated vaccines can be administered safely.

Live attenuated vaccines are contraindicated in severely immunocompromised infants and children with HIV infection (CD4 <15% in children up to 5 years, and CD4 count <200 cells/mm3 in children aged >5 years).

HIV-exposed infants and children should be immunized according to the routine national immunization schedule with a few exceptions detailed below.

Specific points to be kept in mind:

BCG -HIV-exposed infants should be given BCG at birth.
- If BCG has not been given at birth or for neonates with HIV infection confirmed by early virological testing, BCG vaccination should be delayed until ART has been started and the infant confirmed to be immunologically stable (CD4 >25%).
- For Children who are receiving ART, and have not received BCG earlier, it may be given once they are clinically well and “Immunologically stable” (CD4% >25% for children aged <5 years or CD4 count ≥200 cells/ mm3 if aged >5 years).
HEPATITIS B -It is desirable to check for seroconversion and give boosters as required especially for hepatitis B. A 4-dose, double-quantity schedule for hepatitis B has been recommended in view of poor seroconversion with routine immunization.
ROTAVIRUS VACCINE, though a live vaccine, is recommended for use in HIV-exposed infants. It should not be given in children with known severe immunodeficiency.
MEASLES – Children who are not Immunologically Stable, should not receive measles virus-containing vaccine.
- A supplemental dose of measles containing vaccine may be considered in HIV-exposed infants or soon after diagnosis of HIV infection in children older than 6 months who are not receiving ART till they are revaccinated at the 9 months plus as per UIP
- An additional dose of measles containing vaccine should be administered to HIV-infected children receiving ART following immune reconstitution (CD4 count 20%–25%).
PNEUMOCOCCAL CONJUGATE VACCINE (PCV13) is given at 2, 4 and 6 months, with booster at 12–15 months. Pneumococcal polysaccharide vaccine (PPSV23) should be administered at least 8 weeks after the last dose of PCV to children with HIV infection aged 2 years or older.
INACTIVE JAPANESE ENCEPHALITIS (JE) vaccine is safe for use in children with HIV infection. A reduced immune response may be seen in HIV-infected children. Live attenuated JE vaccine is to be avoided in children with HIV.

Desirable vaccines not currently available through the national schedule include the following:

Inactivated Hepatitis A vaccine (two doses 6 months apart between 12–23 months)
Inactivated Influenza vaccine (starting at 6 months of age: two doses 1 month apart; 9 years and above: single dose; annual booster with single dose)
Varicella vaccine: Administer the first dose at age 15–18 months and the second dose at age 4–6 years. Since this is a live attenuated vaccine, it is given only to asymptomatic children who are not severely immunocompromised.
HIB – A single dose of Hib is indicated in unimmunized children >5 years of age (those who have not completed the primary series and the 15-month booster of Hib earlier).
Meningococcal conjugate vaccine (MenACWY) should be administered two doses at least 8 weeks apart between 9–23 months of age, and a booster 2–5 years after the primary series.
FOR ADOLOSCENTS -The three-dose series of human papillomavirus vaccine; tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine; and meningococcal conjugate vaccine all are indicated in HIV-infected adolescents.