II. Precautions
- Do not give Live Vaccines (e.g. oral polio, Varicella Vaccine, Flumist) if CD4 Count <200
- Defer non-urgent Vaccinations until after Antiretroviral therapy initiated to boost immune response
III. Preparations: Live Vaccines
- Avoid Live Vaccines in HIV when CD4 Count <200
- Specific Live Vaccines to avoid
- Herpes Zoster Vaccine (recombinant Herpes Zoster Vaccine is not contraindicated)
- Varicella Vaccine
- Rotavirus Vaccine
- Oral Polio Vaccine
- Live Attenuated Influenza Vaccine (e.g. Flumist)
- Measles Mumps Rubella Vaccine (MMR Vaccine)
IV. Preparations: Indicated Non-Live Vaccines
- Consider delayed Vaccination until CD4 Count>200 and after Antiretroviral therapy initiated
-
Pneumococcal Vaccine
- Prevnar 13 followed by Pneumovax at least 8 weeks later
- Give after diagnosis and then every 6 years
- Immunogenicity is better if higher CD4 Count >200
- Conjugated H Influenza type b capsular Vaccine
- Highly immunogenic in HIV without advanced disease
- Influenza Vaccine yearly (inactivated form)
- Hepatitis A Vaccine (all of those susceptible)
- Hepatitis B Vaccine (if HBsAg negative)
- Routine Tetanus Vaccine (Tdap or Td)
- Human Papilloma Virus Vaccine (Gardasil, consider for those up to age 45 years old)
- Meningococcal Vaccine (all patients with HIV)
- Consider Hib Vaccine
- Recombinant Herpes Zoster Vaccine (Shingrix, for those over age 50 years)