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Immunizations for People With HIV

Healthy Living With HIV www.patientedu.org/hiv


T People who have HIV have weakened immune systems. This makes them more susceptible than others to getting infections. Several vaccinations, or immunizations, are often recommended to HIV patients so that serious illnesses can be prevented.

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here are many reasons why people living with HIV should be immunized from other diseases and infections. Because of vaccina­ tions, some diseases, such as polio and diphthe­ ria, have become very rare in the United States. Until all other diseases and infections can be eliminated, it’s important to keep immunizing, even if there are only a few cases of disease throughout the U.S. If the protection given by vaccination is taken away, more and more people will be infected. The disease will also spread to others, undoing any progress that has been made over the years. If people were to stop getting immunizations, dis­ eases that are almost unknown today would likely come back. Before long, epidemics of diseases that are nearly under control may reappear. More children would get sick, and more would die. Vaccinations aren’t done just to protect ourselves or our children, but also for our grand­children and their grandchildren. Take, for example, smallpox. Children no longer have to get smallpox shots because the disease no longer exists. The disease was eradicated because of the development of a vaccine for it. As long as immunizations continue in years to come, many diseases for which people can receive vaccina­ tions may not infect, cripple, or kill them or their children. Vacci­ nations are one of the best ways to put an end to the serious effects of certain diseases.

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T People who have HIV have weakened immune systems. This makes them more susceptible than others to getting infections. Several vaccinations, or immunizations, are often recommended to HIV patients so that serious illnesses can be prevented.

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here are many reasons why people living with HIV should be immunized from other diseases and infections. Because of vaccina­ tions, some diseases, such as polio and diphthe­ ria, have become very rare in the United States. Until all other diseases and infections can be eliminated, it’s important to keep immunizing, even if there are only a few cases of disease throughout the U.S. If the protection given by vaccination is taken away, more and more people will be infected. The disease will also spread to others, undoing any progress that has been made over the years. If people were to stop getting immunizations, dis­ eases that are almost unknown today would likely come back. Before long, epidemics of diseases that are nearly under control may reappear. More children would get sick, and more would die. Vaccinations aren’t done just to protect ourselves or our children, but also for our grand­children and their grandchildren. Take, for example, smallpox. Children no longer have to get smallpox shots because the disease no longer exists. The disease was eradicated because of the development of a vaccine for it. As long as immunizations continue in years to come, many diseases for which people can receive vaccina­ tions may not infect, cripple, or kill them or their children. Vacci­ nations are one of the best ways to put an end to the serious effects of certain diseases.

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When Living With HIV, Get Immunizations Since HIV weakens the immune system, people living with the virus are more likely to get infec­ tions than others. The CDC and other profes­ sional groups have created recommendations for people living with HIV to receive several vac­ cinations, or immunizations, to prevent other serious illnesses that may develop because they are immunocompromised. Research has shown that immunizations are most effective in people who have CD4 cell counts higher than 200 cells/mm3. People with CD4 cell counts lower than 200 cells/mm3 may not respond to some vaccines. In some cases, they may require additional doses of vaccine to achieve their intended protective effect. Doctors and healthcare providers can determine whether or not vaccinations are effective by performing a blood test for antibodies to the virus.

Important Recommendations The CDC recommends that all HIV patients receive vaccines for the hepatitis B virus, influ­ enza (flu), measles, mumps and rubella (MMR), polysaccharide pneumococcal pneumonia, and tetanus and diphtheria. Other HIV patients, depending on their health, may also receive vaccines for the hepatitis A virus, both hepati­ tis A and B, the Haemophilus influenzae type B infection, and/or meningococcal disease.

Vaccinations Recommended For All HIV Patients Hepatitis B Virus (HBV) All people with HIV should receive the hepatitis B virus (HBV) vaccine unless there is evidence of immunity or active hepatitis. A series of 3 shots over the course of 6 months will be given. All 3 doses are needed for the most effective and longest lasting immunity. A blood test should be performed once the immunization series is done to check for HBV antibodies. If antibodies are present, patients become immune to the virus. Additional shots may be necessary if the anti­ body levels are too low.

Influenza (Flu) People with HIV should receive an annual influ­ enza vaccination, but only by way of injection because these are not live vaccines. The nasal spray vaccine should not be used because it has a weakened form of the live influenza virus. This can infect people with compro­ mised immune systems.

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When Living With HIV, Get Immunizations Since HIV weakens the immune system, people living with the virus are more likely to get infec­ tions than others. The CDC and other profes­ sional groups have created recommendations for people living with HIV to receive several vac­ cinations, or immunizations, to prevent other serious illnesses that may develop because they are immunocompromised. Research has shown that immunizations are most effective in people who have CD4 cell counts higher than 200 cells/mm3. People with CD4 cell counts lower than 200 cells/mm3 may not respond to some vaccines. In some cases, they may require additional doses of vaccine to achieve their intended protective effect. Doctors and healthcare providers can determine whether or not vaccinations are effective by performing a blood test for antibodies to the virus.

Important Recommendations The CDC recommends that all HIV patients receive vaccines for the hepatitis B virus, influ­ enza (flu), measles, mumps and rubella (MMR), polysaccharide pneumococcal pneumonia, and tetanus and diphtheria. Other HIV patients, depending on their health, may also receive vaccines for the hepatitis A virus, both hepati­ tis A and B, the Haemophilus influenzae type B infection, and/or meningococcal disease.

Vaccinations Recommended For All HIV Patients Hepatitis B Virus (HBV) All people with HIV should receive the hepatitis B virus (HBV) vaccine unless there is evidence of immunity or active hepatitis. A series of 3 shots over the course of 6 months will be given. All 3 doses are needed for the most effective and longest lasting immunity. A blood test should be performed once the immunization series is done to check for HBV antibodies. If antibodies are present, patients become immune to the virus. Additional shots may be necessary if the anti­ body levels are too low.

Influenza (Flu) People with HIV should receive an annual influ­ enza vaccination, but only by way of injection because these are not live vaccines. The nasal spray vaccine should not be used because it has a weakened form of the live influenza virus. This can infect people with compro­ mised immune systems.

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Measles, Mumps, and Rubella (MMR) The only live vaccine recommended for HIVinfected people is the measles, mumps, and rubella (MMR) vaccine. HIV-positive adults with CD4 counts lower than 200 cells/mm3, a history of an illness that is considered the first sign of the onset of AIDS, or clinical symptoms of HIV should not receive the vaccine because the risk of developing MMR outweighs the ben­ efits. Each component of the MMR vaccine can be given separately. People may need 1 or 2 shots, depending on how many antibodies are produced after immunization.

Polysaccharide Pneumococcal (Pneumonia) The polysaccharide pneumococcal vaccine should be given soon after people with HIV are diagnosed unless they’ve been vaccinated within the last 5 years. The vaccine protects against 23 of the most common types of pneumococcal bacteria that cause pneumonia. If CD4 counts are lower than 200 cells/mm3 when the vaccine is given, the vaccine may be less effective. That’s because these people have weakened immune systems and may not be able to produce enough antibodies. In such cases, the vaccination will need to be repeated when CD4 counts are more than 200 cells/mm3. People typically receive 1 or 2 shots every 5 years.

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Tetanus and Diphtheria Toxoid (Td) Vaccination for tetanus and diphtheria toxoid (Td) is recommended in all people with HIV to prevent tetanus (lockjaw) and diphtheria (a contagious infection of the throat). This vaccine should be given to everyone with HIV regardless of whether or not they’re immunocompromised. Patients receive 1 shot every 10 years. See Table 1 on pages 8-9 for a summary of vac­ cinations that are recommended for all people living with HIV.

Vaccinations Recommended For Specific HIV Patients Hepatitis A Virus (HAV) The hepatitis A virus (HAV) vaccine should be given to HIV-infected people who are healthcare workers, men who have sex with men, injection drug users, hemophiliacs, living with chronic liver disease (including chronic hepatitis B or C), or traveling to regions of the world where hepatitis is prevalent. Patients receive 2 shots over 12 to 18 months.

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Measles, Mumps, and Rubella (MMR) The only live vaccine recommended for HIVinfected people is the measles, mumps, and rubella (MMR) vaccine. HIV-positive adults with CD4 counts lower than 200 cells/mm3, a history of an illness that is considered the first sign of the onset of AIDS, or clinical symptoms of HIV should not receive the vaccine because the risk of developing MMR outweighs the ben­ efits. Each component of the MMR vaccine can be given separately. People may need 1 or 2 shots, depending on how many antibodies are produced after immunization.

Polysaccharide Pneumococcal (Pneumonia) The polysaccharide pneumococcal vaccine should be given soon after people with HIV are diagnosed unless they’ve been vaccinated within the last 5 years. The vaccine protects against 23 of the most common types of pneumococcal bacteria that cause pneumonia. If CD4 counts are lower than 200 cells/mm3 when the vaccine is given, the vaccine may be less effective. That’s because these people have weakened immune systems and may not be able to produce enough antibodies. In such cases, the vaccination will need to be repeated when CD4 counts are more than 200 cells/mm3. People typically receive 1 or 2 shots every 5 years.

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Tetanus and Diphtheria Toxoid (Td) Vaccination for tetanus and diphtheria toxoid (Td) is recommended in all people with HIV to prevent tetanus (lockjaw) and diphtheria (a contagious infection of the throat). This vaccine should be given to everyone with HIV regardless of whether or not they’re immunocompromised. Patients receive 1 shot every 10 years. See Table 1 on pages 8-9 for a summary of vac­ cinations that are recommended for all people living with HIV.

Vaccinations Recommended For Specific HIV Patients Hepatitis A Virus (HAV) The hepatitis A virus (HAV) vaccine should be given to HIV-infected people who are healthcare workers, men who have sex with men, injection drug users, hemophiliacs, living with chronic liver disease (including chronic hepatitis B or C), or traveling to regions of the world where hepatitis is prevalent. Patients receive 2 shots over 12 to 18 months.

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Table 1

Summarizing Recommended Vaccines for All HIV-Positive Adults Comments and Warnings

Associated Disease

Dosage

Hepatitis B

3 shots over a 6-month period

Recommended unless there is evidence of immunity or active hepatitis. Blood test to check for HBV antibody levels should be done after completion of immunization series. Additional shots may be necessary if antibody levels are too low.

Flu

1 shot

Must be given every year. Only injectable flu vaccine should be given to those who are HIV positive. The nasal spray vaccine should not be used in this population.

Pneumonia

1 or 2 shots

Should be given soon after HIV diagnosis, unless vaccinated within the previous 5 years. If CD4 count is <200 cells/mm3 when the vaccine is given, immunization should be repeated when CD4 count is >200 cells/mm3. Repeat one time after 5 years.

Tetanus and Diphtheria Toxoid (Td)

1. Lockjaw 2. Diphtheria

1 shot

Repeat every 10 years.

Tetanus, Diphtheria, and Pertussis (Tdap)

1. Lockjaw 2. Diphtheria 3. Pertussis

1 shot

Recommended for adults 64 years of age or younger and should be given in place of next Td booster. Can be given as soon as 2 years after last Td for persons in close contact with babies under 12 months and healthcare workers.

Immunization Name

Hepatitis B virus (HBV)

Influenza

Polysaccharide pneumococcal

Source: AIDSInfo.nih.gov (http://aidsinfo.nih.gov/ContentFiles/Recommended_Immunizations_FS_en.pdf).

Hepatitis A/Hepatitis B Combined Vaccine

Meningococcal

People with HIV should get the hepatitis A/hepa­ titis B combination vaccine if they need both HAV and HBV immunization. Patients receive 3 shots over a 1-year period, and the vaccine lasts about 4 years.

The meningococcal vaccine helps prevent bacterial meningitis caused by Neisseria meningitides. It’s recommended for HIVinfected people who are college students, military recruits, or traveling to develop­ ing countries. Patients get 1 shot during their lifetime.

Haemophilus Influenzae Type B The Haemophilus influenzae type B vaccine helps prevent bacterial meningitis caused by H. influenza type B. HIV-positive adults and their doctors should talk about whether or not this immunization is needed. Patients get 1 shot during their lifetime.

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Table 1

Summarizing Recommended Vaccines for All HIV-Positive Adults Comments and Warnings

Associated Disease

Dosage

Hepatitis B

3 shots over a 6-month period

Recommended unless there is evidence of immunity or active hepatitis. Blood test to check for HBV antibody levels should be done after completion of immunization series. Additional shots may be necessary if antibody levels are too low.

Flu

1 shot

Must be given every year. Only injectable flu vaccine should be given to those who are HIV positive. The nasal spray vaccine should not be used in this population.

Pneumonia

1 or 2 shots

Should be given soon after HIV diagnosis, unless vaccinated within the previous 5 years. If CD4 count is <200 cells/mm3 when the vaccine is given, immunization should be repeated when CD4 count is >200 cells/mm3. Repeat one time after 5 years.

Tetanus and Diphtheria Toxoid (Td)

1. Lockjaw 2. Diphtheria

1 shot

Repeat every 10 years.

Tetanus, Diphtheria, and Pertussis (Tdap)

1. Lockjaw 2. Diphtheria 3. Pertussis

1 shot

Recommended for adults 64 years of age or younger and should be given in place of next Td booster. Can be given as soon as 2 years after last Td for persons in close contact with babies under 12 months and healthcare workers.

Immunization Name

Hepatitis B virus (HBV)

Influenza

Polysaccharide pneumococcal

Source: AIDSInfo.nih.gov (http://aidsinfo.nih.gov/ContentFiles/Recommended_Immunizations_FS_en.pdf).

Hepatitis A/Hepatitis B Combined Vaccine

Meningococcal

People with HIV should get the hepatitis A/hepa­ titis B combination vaccine if they need both HAV and HBV immunization. Patients receive 3 shots over a 1-year period, and the vaccine lasts about 4 years.

The meningococcal vaccine helps prevent bacterial meningitis caused by Neisseria meningitides. It’s recommended for HIVinfected people who are college students, military recruits, or traveling to develop­ ing countries. Patients get 1 shot during their lifetime.

Haemophilus Influenzae Type B The Haemophilus influenzae type B vaccine helps prevent bacterial meningitis caused by H. influenza type B. HIV-positive adults and their doctors should talk about whether or not this immunization is needed. Patients get 1 shot during their lifetime.

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Vaccinations Not Recommended For HIV Patients

See Table 2 for a summary of vaccinations that are recommended for some specific populations of people living with HIV.

Table 2

Three vaccines—anthrax, smallpox, and vari­ cella-zoster (shingles)—are not recommended for people living with HIV. Viral vaccines con­ tain a live virus and should only be given in people with HIV if the possible health benefits clearly outweigh the risks. This is because live

Summarizing Recommended Vaccines for Some HIV-Positive Adults Comments and Warnings

Associated Disease

Dosage

Hepatitis A

2 shots over a 1or 1.5-year period

1. Hepatitis A 2. Hepatitis B

3 shots over a 6-month period or 4 shots over a 1-year period

Can be used in those who require both HAV and HBV immunization.

Bacterial meningitis

1 shot

HIV-positive adults and their healthcare providers should discuss whether Haemophilus influenzae immunization is needed.

Human papillomavirus (HPV)

Human papillomavirus

3 shots over 6 months

Recommended for females ages 9-26. Not recommended to be given during pregnancy.

Measles, Mumps, and Rubella (MMR)

1. Measles 2. Mumps 3. Rubella (German Measles)

1 or 2 shots

People born before 1957 do not need to receive this vaccine. HIV positive adults with CD4 counts <200 cells/mm3, a history of AIDS-defining illness, or clinical symptoms of HIV should not get the MMR vaccine. Each component can be given separately if needed to achieve adequate antibody levels.

Meningococcal

Bacterial meningitis

1 or 2 shots

Recommended for college students, military recruits, people who do not have a spleen, and people traveling to certain parts of the world. Repeat after 5 years if still at risk for infection.

Varicella

Chickenpox

2 shots over 4-8 weeks

People born before 1980 do not need to receive this vaccine. Recom­mended unless there is evidence of immunity or CD4 count is 200 cells/mm3 or below. Not recommended to be given during pregnancy.

Immunization Name

Hepatitis A virus (HAV)

Hepatitis A/Hepatitis B combined vaccine (Twinrix) Haemophilus influenzae type B

Recommended for healthcare workers, men who have sex with men, injection drug users, people with chronic liver disease (including chronic hepatitis B or C), hemophiliacs, and people traveling to certain parts of the world.

Source: AIDSInfo.nih.gov (http://aidsinfo.nih.gov/ContentFiles/Recommended_Immunizations_FS_en.pdf).

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Vaccinations Not Recommended For HIV Patients

See Table 2 for a summary of vaccinations that are recommended for some specific populations of people living with HIV.

Table 2

Three vaccines—anthrax, smallpox, and vari­ cella-zoster (shingles)—are not recommended for people living with HIV. Viral vaccines con­ tain a live virus and should only be given in people with HIV if the possible health benefits clearly outweigh the risks. This is because live

Summarizing Recommended Vaccines for Some HIV-Positive Adults Comments and Warnings

Associated Disease

Dosage

Hepatitis A

2 shots over a 1or 1.5-year period

1. Hepatitis A 2. Hepatitis B

3 shots over a 6-month period or 4 shots over a 1-year period

Can be used in those who require both HAV and HBV immunization.

Bacterial meningitis

1 shot

HIV-positive adults and their healthcare providers should discuss whether Haemophilus influenzae immunization is needed.

Human papillomavirus (HPV)

Human papillomavirus

3 shots over 6 months

Recommended for females ages 9-26. Not recommended to be given during pregnancy.

Measles, Mumps, and Rubella (MMR)

1. Measles 2. Mumps 3. Rubella (German Measles)

1 or 2 shots

People born before 1957 do not need to receive this vaccine. HIV positive adults with CD4 counts <200 cells/mm3, a history of AIDS-defining illness, or clinical symptoms of HIV should not get the MMR vaccine. Each component can be given separately if needed to achieve adequate antibody levels.

Meningococcal

Bacterial meningitis

1 or 2 shots

Recommended for college students, military recruits, people who do not have a spleen, and people traveling to certain parts of the world. Repeat after 5 years if still at risk for infection.

Varicella

Chickenpox

2 shots over 4-8 weeks

People born before 1980 do not need to receive this vaccine. Recom­mended unless there is evidence of immunity or CD4 count is 200 cells/mm3 or below. Not recommended to be given during pregnancy.

Immunization Name

Hepatitis A virus (HAV)

Hepatitis A/Hepatitis B combined vaccine (Twinrix) Haemophilus influenzae type B

Recommended for healthcare workers, men who have sex with men, injection drug users, people with chronic liver disease (including chronic hepatitis B or C), hemophiliacs, and people traveling to certain parts of the world.

Source: AIDSInfo.nih.gov (http://aidsinfo.nih.gov/ContentFiles/Recommended_Immunizations_FS_en.pdf).

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viral vaccines can sometimes infect the person receiving it. In some instances, it may infect people who come into close contact with a recently vaccinated person. While this is not common, it occurs most often in people with weakened immune systems. See Table 3 for a summary of vaccinations that are not recommended for people living with HIV.

Summarizing Vaccines Not Recommended for HIV-Positive Adults

Learn More If you still have questions, the following resources offer more information about immunizations and HIV:

TheBody.com www.thebody.com/ content/art6124.html

Table 3

Immunization Name

Anthrax

Smallpox

Shingles

Associated Disease

Anthrax

Smallpox

Shingles

Comments and Warnings

The currently available smallpox vaccine is a live viral vaccine. Some live vaccines are not recommended for people with HIV. Although the currently licensed anthrax vaccine is not a live vaccine, the Advisory Committee on Immunization Practices does not recommend routine anthrax vaccination.

* Immunization for adults 60 years of age and older. Source: AIDSInfo.nih.gov (http://aidsinfo.nih.gov/ContentFiles/Recommended_Immunizations_FS_en.pdf).

Centers for Disease Control and Prevention www.cdc.gov/vaccines/

AIDSInfo http://aidsinfo.nih. gov/ContentFiles/ Recommended_ Immunizations_FS_en.pdf

National Foundation for Infectious Diseases http://www.nfid.org/

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viral vaccines can sometimes infect the person receiving it. In some instances, it may infect people who come into close contact with a recently vaccinated person. While this is not common, it occurs most often in people with weakened immune systems. See Table 3 for a summary of vaccinations that are not recommended for people living with HIV.

Summarizing Vaccines Not Recommended for HIV-Positive Adults

Learn More If you still have questions, the following resources offer more information about immunizations and HIV:

TheBody.com www.thebody.com/ content/art6124.html

Table 3

Immunization Name

Anthrax

Smallpox

Shingles

Associated Disease

Anthrax

Smallpox

Shingles

Comments and Warnings

The currently available smallpox vaccine is a live viral vaccine. Some live vaccines are not recommended for people with HIV. Although the currently licensed anthrax vaccine is not a live vaccine, the Advisory Committee on Immunization Practices does not recommend routine anthrax vaccination.

* Immunization for adults 60 years of age and older. Source: AIDSInfo.nih.gov (http://aidsinfo.nih.gov/ContentFiles/Recommended_Immunizations_FS_en.pdf).

Centers for Disease Control and Prevention www.cdc.gov/vaccines/

AIDSInfo http://aidsinfo.nih. gov/ContentFiles/ Recommended_ Immunizations_FS_en.pdf

National Foundation for Infectious Diseases http://www.nfid.org/

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Immunizations for People With HIV