Immunizations
Recommended Immunizations for Non-Pregnant Human Immunodeficiency Virus (HIV)-Infected Adults
Table 1 Recommended Immunizations for Non-Pregnant HIV-Infected Adults
| Vaccine |
Indications |
Schedule |
| Tetanus, Diphtheria, and Pertussis (Tdap),* and |
For patients who have not received the primary series |
Administer 1 dose of Tdap, followed by a dose of Td at 1 month and a second dose of Td 6–12 months later |
| Tetanus-Diphtheria (Td)* |
For patients who have already received the primary series |
Administer 1 dose of Tdap booster every 10 years |
| Influenza |
For all patients |
Administer 1 annual dose. Do not use FluMist because it contains live virus. |
| Pneumococcal polysaccharide |
For all patients |
Administer 1 dose followed by one revaccination after 5 to 6 years (or more) have elapsed since initial vaccination |
| Hepatitis A* |
For patients at increased risk for hepatitis A |
Administer 2 doses (0 and 6–12 months) |
| Hepatitis B* |
For patients without serologic evidence of prior hepatitis B virus (HBV) infection or who have not previously received the complete series of HBV vaccination |
Strongly encourage the vaccine series—3 doses (0, 1 to 2, and 6 months) |
| Measles, Mumps, Rubella (MMR)* |
For all asymptomatic HIV-infected patients who do not have evidence of severe immunosuppression and who are seronegative for antibody to MMR |
Administer 1 dose |
| For patients with severe immunosuppression (<200 cells/mm3) |
Do not administer vaccine |
| Human Papillomavirus (HPV) |
For women between the ages of 9 and 26 years |
Administer 3 doses (at 0, 2, and 6 months) |
| Varicella* |
For persons who are susceptible |
Consider administering 2 doses (at 0 and 4–8 weeks) |
For other vaccines, see Centers for Disease Control and Prevention (CDC) recommendations. Available at: >http://www.cdc.gov/vaccines/
*Covered by the Vaccine Injury Compensation Program
Refer to the original guideline document for more information on the recommended vaccines.
Recommended Immunizations for Pregnant HIV-Infected Adults
Routine pregnancy testing of women of childbearing age before administering a live-virus vaccine is not recommended (Centers for Disease Control and Prevention [CDC], 1998).
Clinicians should avoid administering immunizations late in the third trimester to avoid the theoretical possibility of the vaccines causing increased viral load levels at the time of delivery.
Because of the importance of protecting women of childbearing age against rubella, clinicians should adopt the following practices in any immunization program:
- Ask women if they are or could be pregnant or intend to become pregnant within the next 4 weeks
- Explain the potential risk of vaccination to the fetus to women who state that they are not pregnant
- Counsel women who are vaccinated to avoid pregnancy during the 4 weeks after Measles, Mumps, Rubella (MMR) vaccination (CDC, 1998; "Control and prevention of rubella," 2001; CDC, "Revised ACIP recommendation," 2001).
- Do not vaccinate women who state that they are pregnant; administer rubella vaccine immediately after delivery in rubella-susceptible HIV-infected women with CD4 counts >200 cells/mm3
- Test pregnant women for rubella immunity at the first antepartum visit
Clinicians should counsel pregnant women who are inadvertently vaccinated or who become pregnant within 4 weeks after MMR or varicella vaccination about the theoretical risk to the fetus; however, exposure to MMR or varicella vaccines during pregnancy generally is not a reason to terminate a pregnancy (CDC, 1998; "Prevention of varicella," 1996).
Table 2 Recommended Immunizations for Pregnant HIV-Infected Adults
| Vaccine |
Indications |
Recommendations |
| Tetanus |
For women who have not received Td vaccination in last 10 years but have been previously immunized |
Administer Td booster |
| For women who have never been immunized or have only been partially immunized |
Administer the complete primary series, including Tdap (see Table 1 above) |
| For women for whom the vaccine is indicated but who do not receive the complete 3-dose series during pregnancy |
Follow up after delivery to ensure that the series is completed |
| Influenza |
For all pregnant women |
Administer vaccine during influenza season, regardless of stage of pregnancy |
| Hepatitis A |
For pregnant women at increased risk for hepatitis A* |
Offer hepatitis A vaccine series |
| Hepatitis B |
For all pregnant women who are hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), and hepatitis B core antibody (HBcAb) immunoglobulin G (IgG) negative |
Administer hepatitis B vaccine |
For pregnant women who are HBsAg-positive |
Ensure that 1) the infant receives HBIG and that the hepatitis B vaccine series is initiated within 12 hours after birth, and 2) the recommended hepatitis B vaccine series is completed in the infant |
| Pneumococcal polysaccharide |
For pregnant women who have not received the vaccine within the last 6 years |
Administer vaccine |
| Measles, Mumps, Rubella (MMR) |
For pregnant women or women intending to become pregnant in the next 4 weeks |
Do not administer vaccine |
| For pregnant women who are rubella-susceptible |
Administer vaccine immediately after delivery |
| For household contacts of pregnant women |
Administer vaccine when indicated |
| Varicella |
For all pregnant women |
Do not administer vaccine |
| For household contacts of pregnant women |
Administer vaccine when indicated |
| For women who are exposed to varicella at any point during pregnancy with no history of previous varicella |
Perform antibody testing for previous varicella exposure. If exposure is negative, administer varicella zoster immune globulin (VZIG) |
(CDC, 1998; CDC, "Control and prevention of rubella," 2001; CDC, "Revised ACIP recommendation," 2001; CDC, 1996; Shields et al., 2001; "Diphtheria, tetanus, and pertussis," 1991; Bridges et al., 2001; Neuzil et al., 1998; "Hepatitis B virus," 1991)
*Persons with chronic liver disease (e.g. hepatitis B or C); travelers to countries with high endemicity of infection; persons who live in a community experiencing an outbreak of hepatitis A virus (HAV) infection; illicit drug users, particularly injection drug users; persons who have clotting-factor disorders; persons at occupational risk for infection.
Notes
Influenza: It has been shown that women in the second and third trimesters of pregnancy are at an increased risk for hospitalization from influenza.
Hepatitis A and B: No known risk exists for the fetus from passive immunization of pregnant women with immune globulin preparations.
MMR: Persons who receive MMR vaccine do not transmit the vaccine viruses to contacts (CDC, 1998).
Varicella: Transmission of varicella vaccine virus to contacts is rare (CDC, 1996).
Concurrent Administration of Antimicrobial Agents and Vaccines
Clinicians should discontinue antiviral drugs active against herpesviruses ≥24 hours before administration of varicella vaccine.
Vaccines and Allergens
Before administering the influenza vaccine, clinicians should ask patients whether they are able to eat eggs without adverse effects. Clinicians should not administer the influenza vaccine to patients who have a history of anaphylactic or anaphylactic-like allergy to eggs.
Clinicians should use extreme caution when administering vaccines that contain gelatin to persons who have a history of anaphylactic reaction to gelatin or gelatin-containing products.
