ADULT IMMUNIZATIONS – ANSWERS
Case #3:
You
are seeing a 35 year-old HIV+ patient in the ACS clinic
Which of the following IS NOT contraindicated?
The answer is B, the Hepatitis A vaccine, which is
recombinant. The others are all live
vaccines.
Discuss the risks
and benefits of immunizing an immunocompromised person, side effects and
contraindications.
In general, known HIV
infected persons should not receive live-virus or live-bacteria vaccines.
It is important that HIV+ patients be given pneumococcal
vaccine, influenza vaccine every fall, and Hepatitis B vaccine in patients with
high-risk behavior and negative for Hep B Ab.
All patients should be screened for hepatitis C as well, and if positive
should be immunized against Hep B if nonimmune, and Hep A if indicated. Tetanus-Diptheria toxoid is safe in
immunocompromised persons, and can be given when warranted.
MMR vaccine should NOT
be administered to severely immunocompromised persons. MMR
should routinely be administered at 15 months of age to HIV-infected
children. It should also be considered
for all symptomatic HIV-infected
persons who would otherwise be eligible for the measles vaccine, since a
measles infection could be severe.
Oral Polio Vaccine should
not be used to immunize immunocompromised patients, their household contacts,
or nursing personnel in close contact with these patients. Inactivated polio vaccine delivered
subcutaneously is the preferred vaccine if warranted in the patient, or to
household contacts. The oral polio vaccine is essentially not in use at all in
the US, and has been replaced with the IPV (inactivated polio vaccine) given IM
or SQ. Polio vaccine is not recommended
for anyone over the age of 18. Adults
living in the US who have never received or completed the primary series of
immunizations need not be vaccinated unless they are planning travel to an area
where exposure to wild-type virus is likely.
Previously vaccinated adults can receive one booster if traveling to an
endemic polio area.
