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Immunization of children infected with HIV: a public health perspective
1Office of AIDS Surveillance, New York Department of Health, NY 10013.
Insights
Routine childhood immunizations are recommended for most children with HIV. Specific vaccine recommendations, like substituting inactivated poliovirus vaccine (IPV) for oral poliovirus vaccine (OPV), are advised for at-risk children.
Area of Science:
- Pediatrics
- Immunology
- Infectious Diseases
Background:
- Many children in the U.S. are infected with HIV, often linked to parental intravenous drug use.
- Medical consensus supports routine childhood immunizations for asymptomatic HIV-infected children.
- Specific considerations are necessary for children with known HIV or family history of immunodeficiency.
Purpose of the Study:
- To outline recommended immunization schedules for children at risk of or infected with HIV.
- To address the role of HIV antibody testing in routine childhood immunization decisions.
- To evaluate the safety and efficacy of specific vaccines in HIV-infected children.
Main Methods:
- Review of current medical opinions and guidelines regarding childhood immunizations in HIV-infected populations.
- Analysis of the reliability of HIV antibody testing in young children due to maternal antibodies.
- Assessment of adverse effects and potential efficacy of oral poliovirus vaccine (OPV) and measles vaccine in HIV-infected individuals.
Main Results:
- Routine immunizations are generally recommended for well-appearing children with HIV.
- Inactivated poliovirus vaccine (IPV) is recommended over OPV for antibody-positive children or those with family HIV.
- Measles vaccine should be administered at 15 months, or earlier during outbreaks, irrespective of immunodeficiency symptoms.
Conclusions:
- Routine HIV antibody testing before immunization is not indicated due to test unreliability in young children.
- Immunization with OPV and MMR vaccines has not shown adverse effects in HIV-infected individuals and may be beneficial.
- Adherence to modified immunization schedules ensures protection for HIV-exposed and infected children.
Abstract:
The vast majority of HIV infected children in the United States are from inner city families where one or both parents have used intravenous drugs. The bulk of medical opinion indicates that in most cases these children, when they appear well, should receive their routine childhood immunizations. For children who are known to be antibody positive, or where it is known that a family member has HIV related immunodeficiency, IPV should be substituted for OPV. Measles vaccine should be given at 15 months when the child is manifesting no overt symptoms of immunodeficiency. In outbreak periods and in endemic areas measles vaccine should be given regardless of symptomatology. HIV antibody testing prior to the routine immunization of children at risk is not indicated for two reasons. First, the test is not a reliable indication of infection in the child, as passive maternal antibody may persist up to 15 months of age and cannot at this time be distinguished from the child's own antibody. Second, immunization with OPV and MMR have not yet been noted to cause adverse effects in HIV infected individuals and may be efficacious at least in the younger child who may be early in the course of disease and maintain some T and B cell function.