Essential Vaccinations for HIV-Positive Adults and Adolescents

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1 Essential Vaccinations for HIV-Positive Adults and Adolescents Janak A. Patel, MD Professor & Director, Pediatric Infectious Diseases Director, Maternal-Child Program University of Texas Medical Branch Galveston, Texas

2 Source of Information British HIV Association Guidelines for immunization of HIV-infected adults 2008 HIV Medicine 9: , Infectious Disease Society of America clinical practice guideline for vaccination of the immunocompromised host CID 58:e44-100, 2014

3 Vaccination Policy Issues Unlike pediatric vaccines, access to vaccination for adults through public sector or private insurance is difficult in both resource-rich and resource-poor countries. Many of the newer vaccines are very expensive and usually no specific funding is provided for purchasing vaccines in most HIV care programs. No specific immunization guidelines have been developed (eg. by WHO) that are unique to the developing, tropical countries where the types and frequency of pathogen exposure may be different then the developed, temperate countries. Additional research for vaccine efficacy and funding for routine vaccine access for HIV-infected adults are needed for the developing world.

4 Basic Considerations for Vaccination of HIV-Infected Persons Immunologic status of the individual Prevalence of high risk infections in the community Past history of vaccination or natural disease

5 2013 IDSA Guidelines

6 Hepatitis A & B: Inactivated Vaccine Vaccine/ disease Hepatitis B virus (HBV) Combined Hep B and Hep A vaccine Hepatitis A Dosage High dose: 40 µg; three shots at 0,1-2, 6 months Three shots as above Two shots at 0, 6 months Recommendations Receive unless past history of hepatitis B or immunity is present 1-2 months after the series is completed, get a blood test for anti-hbs antibody to check for immunity. If it's too low (<10 miu/ml), repeat another 3-dose series As above

7 Pneumococcus: Inactivated Vaccines Vaccine/ disease Pneumococcalprotein conjugate (pneumonia) PCV-13 Pneumococcalpolysaccharide PPSV-23 Dosage Recommendations One shot For all adolescents and adults if not fully vaccinated previously as children One shot- >8 wks after above PCV 13 Repeat in five years. For adults who have previously received PPSV23, PCV13 should be administered after an interval > 1 year

8 Influenza: Inactivated and Live Vaccines Vaccine Dosage Recommendations Inactivatedtrivalent or quadrivalent one shot Repeat every year by mid-november for best protection Livequadrivalent Intranasal Consider in healthy HIV-infected adolescents (<17 yrs age) on ART for >16 wks and CD% >15, and HIV viral load <16,000

9 Meningococcus: Inactivated Vaccine Vaccine/ disease Meningococcus - conjugate (A,C,Y,W135) Dosage 2 shots, 2 months apart Recommendations For adolescents only; up to age 18 yrs Not recommended for adults Give booster in 5 yrs if previous two shots were at age <10 yrs

10 Tetanus, Diphtheria,Pertussis: Inactivated Vaccines Vaccine/ disease Tetanus and diphtheria OR Tetanus, diphtheria and pertussis Dosage one shot Recommendations Repeat every 10 years Give it earlier with injury

11 Human Papilloma Virus: Inactivated Vaccine Vaccine/ disease Quadrivalent (6, 11, 16, 18) Dosage 3- doses at 0, 1-2, 6 months Recommendations Quadrivalent is preferred over bivalent because of better coverage for genital warts (types 6, 11) or Bivalent (16, 18) Same as above* * European Union (Dec 2013) and many other countries have approved a twodose series for girls only (age 9-14 yrs)

12 Varicella: Live Vaccine Vaccine/ disease Varicella Or Varicella combined with MMR (MMR-V) Dosage 2 shots, >3 months apart Recommendations For non-immune persons >14 yrs age only if CD4 count >200 MMR-V should not be used

13 Measles, Mumps, Rubella: Live Vaccine Vaccine/ disease Measles, mumps, and rubella (MMR) Dosage one or two shots Recommendations For those without prior immunity Individual components not available in USA Give only if CD4 cell count > 200

14 Contraindicated vaccines regardless of CD4 counts BCG Zoster

15 Thank You

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