Do you think about immunizations when caring for HIV-positive individuals? This World Hepatitis Day (July 28), we are raising awareness on the importance of hepatitis immunizations for people infected with HIV.
Immunocompromised people, including those with HIV, are more susceptible to a number of vaccine-preventable diseases, including hepatitis A and B. There is the potential for serious illness and even death in the under-immunization of HIV-infected individuals. This is why every effort should be made to ensure adequate protection of this population through immunization.
As HIV progresses, the immune system weakens and the effectiveness of immunization decreases while the risk associated with administering live vaccines increases. For this reason, special considerations apply when immunizing people diagnosed with with HIV.
Immunization with inactivated vaccines
There are no contraindications to the use of inactivated vaccines in HIV-positive individuals. However, immunocompromised individuals may not mount an optimal immune response to vaccines. For this reason, specific vaccine formulations and / or specific immunization schedules may be recommended. For example, when providing the hepatitis B vaccine to people diagnosed with HIV, a double dose for age is indicated. Furthermore, an additional dose of hepatitis A vaccine is indicated for all susceptible HIV-positive persons.
In addition to the hepatitis A and B vaccines, the following vaccines should be offered:
- All routine inactivated vaccines
- Hib vaccine
- Pneumococcal vaccine
- Influenza vaccine
More information on these vaccines can be found in the BCCDC Immunization Manual Section VII – Biological Products.
Immunization with live vaccines
Special considerations apply when vaccinating immunocompromised individuals with live vaccines. This is because live vaccines can cause serious adverse events in some immunocompromised individuals as a result of the uncontrollable replication of the virus or bacterium. However, in some situations, live vaccines (for example, MMR, varicella, oral cholera, and yellow fever) may be given to individuals diagnosed with HIV.
Live vaccines can be given if the HIV-infected individual’s immune system is not significantly compromised and the risk of disease outweighs the risk of vaccination. The decision to immunize an immunocompromised individual with a live vaccine can only be made following an expert consultation. The expert must be the physician most knowledgeable about the client’s current health status, their immunosuppressive disease and the vaccine. A written referral form for vaccination must be completed.
For more information about the immunization of immunocompromised persons, see the BCCDC Immunization Manual Section III – Immunization of Special Populations.
Next time you are caring for an individual who has been diagnosed with HIV, think immunizations!