Aug 31, 2013
can u kindly list vaccines indicated for hiv poz? can one take yellow fever and herpes zoster vaccine if cd4 count is more than 200? otherwise how a hiv poz can visit south america or africa without yellow fever vaccine? what other vaccines for local diseases like west nile? thanx
Response from Dr. Young
Hello and thanks for posting your important question.
Vaccinations can prevent many serious infections and are generally safe for people living with HIV. It's important to be mindful that while most vaccines are "inactivated" (meaning no live component), so vaccines contain live attenuated (crippled) virus. Most live vaccines are not recommended for people with significant immune system problems.
In terms of recommended vaccinations, all people living with HIV should have pneumococcal ("pneumonia") vaccine, annual influenza ("flu"), tetanus/pertussus (DTaP), and if appropriate, hepatitis A and hepatitis B vaccinations. Meningococcus ("meningitis") vaccination is recommended for people with high risk of exposure, including sexually active gay men in certain US cities.
Certain live attenuated viral vaccinations could be considered in special situations, but usually only for people whose CD4 counts are above 200. This includes yellow fever vaccination- YF vaccine should only be administered if you're CD4 count is above 200 and you're traveling to a high-risk country who requires the vaccination for entry. For people with CD4 counts below 200, a medical waiver stating a medical contraindication should be provided. Many countries in African and South America do not require YF vaccination, so check with each countries consulate or the the US Centers for Disease Control's country-by-country listing for additional details of recommended travel medicines/vaccinations.
As for herpes zoster vaccination- the live attenuated vaccine is currently not recommended for people living with HIV, though increasing clinical trials data strongly suggests that the vaccine is safe for people with higher CD4 counts. I suspect that we'll eventually see a recommendation for vaccination for positives.
There is no vaccine for West Nile Virus- speaking to the importance of prevention of mosquito bites in regions with this (and other) mosquito-borne infections.
I hope that's helpful, BY
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