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HIV + received live H1N1 Flumist vaccine in error
Jan 11, 2010

Hi Dr. Frascino,

My husband on 1/9/10 received the H1N1 live vaccine in error at the VA. We called his Infectious Disease doctor who basically said all we could do is watch and wait and indicated that if he develops severe flu like symptoms that he would likely prescribe Tamiflu right away. So far so good. (And FYI his viral load is undetectable and his T-cells are 212 at last count after being under 200 for a few years.) After much googling, I came to the conclusion that although it appears a double blind clinical trial was done in which Hiv positive persons received the flumist that there are no research on the effectiveness of it in those with HIV. That being said, would it be advisable for him to get the injectable vaccine at some point as well? Thank you in advance and for all that you do!

Response from Dr. Frascino

Hi,

No, I would not recommend revaccinating with the killed injectable H1N1 vaccine. The FluMist live vaccine is a risk for those with suppressed or deficient immune systems; however, there is no reason to believe it would not provide effective immunity. Hopefully that's all it will provide and not actually a case of full-blown flu! I agree with the infectious disease doctor's advice and plan.

Dr. Bob

H1N1 nasal mist Oct 16, 2009

Hello Dr. Bob,

I would hope everything is well with you and would appreciate once again if you could help me with a concern.

I will be able to get the H1N1 nasal spray at work in the next few days and was wondering if someone with HIV and a T-cell count of 600 and undetectable viral load could take the H1N1 flu mist.

I just spoke to my ID doctor and he told me that I could and that the guidelines will be changing in regards to HIV positive people taking the flu mist.

It's not that I don't trust him, but it's always nice to get your much appreciated opinion.

Response from Dr. Frascino

Hi,

The nasal vaccine (FluMist) is made from an attenuated live virus. This means the virus has been weakened and tamed in the laboratory so it cannot cause illness. (The measles and chickenpox vaccines are also made from live attenuated viruses.) The attenuated virus can multiply only in the cooler temperatures of the nasal passages and cannot survive in the higher temperatures of the respiratory tract (lungs). When the vaccine is sprayed into the nose, it multiplies on the mucous membranes in the nose and throat, triggering the body's immune response without causing illness. FluMist is not approved or recommended for people with HIV or asthma, pregnancy women or those with significant underlying medical conditions, like heart disease or diabetes.

The injectable vaccine is made from a killed influenza virus that is highly purified and broken into tiny pieces. It cannot recombine in the body to produce a viable virus or cause illness (flu). However, it can still stimulate the immune system to evoke a protective immune response. For now, HIV-positive folks should get the injectable (killed) vaccine. To date there have been no changes made to the published guidelines for recommended use of these vaccines. HIVers should get only the injectable (killed) vaccine and continue to avoid live attenuated vaccines, including the nasal mist (FluMist) vaccines.

We'll keep you posted here on this site on any future revisions to the guidelines.

Dr. Bob


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