Table 9.

Summary of How Immunization Recommendations for HIV-Infected Children Differ From Standard Immunization Schedule

VACCINESPECIFIC RECOMMENDATIONS FOR HIV-INFECTED CHILDRENRATIONALE FOR SPECIALIZED RECOMMENDATION IN HIV-INFECTED CHILDREN
PCV13Administer to 6- to 18-year-olds who have not received itElevated risk of pneumococcal infections
PPSV23Administer 2-dose series beginning at age 2 yearsElevated risk of pneumococcal infections
HibAdminister one dose of Hib vaccine to children ≥5 years if incomplete Hib vaccine historyElevated risk of infections due to encapsulated bacteria
MCVPrimary series should be 2 doses at least 8 weeks apartLower response rate to single dose of MCV
HBVRoutine assessment of seroprotection (anti-HBsAb ≥10 mIU/mL) 1-2 months after completion of seriesLower response rate to vaccine series
InfluenzaUse trivalent injectable vaccine instead of live-attenuated intranasal vaccinePotential for live vaccines to cause illness in immunocompromised host
VaricellaDo not administer if severely immunocompromised or severe symptomsPotential for live vaccines to cause illness in immunocompromised host
MMR-VDo not use (MMR-V has higher varicella vaccine dose than monovalent varicella vaccine)Potential for live vaccines to cause illness in immunocompromised host
MMRDo not administer if severely immunocompromised; Repeat MMR immunization (once receiving effective ART) if MMR doses given before effective ART establishedPotential for live vaccines to cause illness in immunocompromised host; Lower probability and less durability of MMR vaccine response before ART
  • ART=antiretroviral therapy; HBsAb=hepatitis B surface antibody; HBV=hepatitis B virus; Hib=Haemophilus influenzae type b; HIV=human immunodeficiency virus; MCV=meningococcal conjugate vaccine; MMR=measles-mumps-rubella; MMR-V=measles-mumps-rubella-varicella; PCV13=13-valent pneumococcal conjugate vaccine; PPSV23=23-valent pneumococcal polysaccharide vaccine.