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Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents

Figure: Recommended Immunization Schedule for Adults and Adolescents with HIV Infection

Last Updated: September 13, 2017; Last Reviewed: September 13, 2017

Adapted from the Advisory Committee on Immunization Practices (ACIP) recommended immunization schedules for adults and adolescents. These immunization schedules are available at www.cdc.gov/vaccines/schedules/hcp/index.html. Detailed information on these and other vaccines can be found at www.cdc.gov/vaccines/hcp/acip-recs/index.html.

Figure 1. Recommended immunization schedule for adults and adolescents with HIV infection, United States, 2017
 Vaccine Age  CD4 Cell Count (cells/μl)
 13-18 years 19-26 years 27-59 years 60-64 years ≥65 years  <200  ≥200
Influenza1 1 dose annually  1 dose annually
Tdap/Td2  1 dose Tdap, then Td booster every 10 yrs  1 dose Tdap, then Td booster every 10 yrs
MMR3 2 doses if CD4 cell count ≥200
     Contraindicated 2 doses if born in 1957 or later
VAR4 2 doses if CD4 cell count ≥200  Contraindicated  2 doses
HZV5            Contraindicated  
HPV6 3 doses        3 doses through age 26 yrs
PCV137  1 dose  1 dose
PPSV237  2 doses  1 dose  Up to 3 doses depending on age
HepA8  2 or 3 doses depending on vaccine  2 or 3 doses depending on vaccine 
HepB9  3 doses  3 doses
MenACWY10   2 doses, then booster every 5 yrs  2 doses, then booster every 5 yrs
MenB10  2 or 3 doses depending on vaccine  2 or 3 doses depending on vaccine
HIB11  1 or 3 doses depending on indication  1 or 3 doses depending on indication

 

  Recommended for adults and adolescents with HIV infection   Recommended for adults and adolescents with HIV infection and other indications
  Contraindicated   No recommendation

 

Abbreviations used for vaccines
HepA hepatitis A vaccine IIV inactivated influenza vaccine RIV recombinant influenza vaccine
HepA-HepB hepatitis A and hepatitis B vaccine
MenACWY
serogroups A, C, W, and Y meningococcal vaccine
Td
tetanus and diptheria toxoids
HepB hepatitis B vaccine
MenB
serogroup B meningococcal vaccine
Tdap
tetanus toxoid, reduced diptheria toxoid, and acellular pertussis vaccine
HiB
Haemophilus influenzae type b vaccine
MMR
measles, mumps, and rubella vaccine (live)
   
HPV vaccine human papillomavirus vaccine
PCV13
13-valent pneumococcal conjugate vaccine
VAR
varicella vaccine (live)
HZV  herpes zoster vaccine (live)
PPSV23
23-valent pneumococcal polysaccharide vaccine
   

 

Report clinically significant postvaccination events to the Vaccine Adverse Event Reporting System (VAERS) at www.vaers.hhs.gov or by telephone, 800-822-7967.

All vaccines listed on this immunization schedule except herpes zoster and 23-valent pneumococcal polysaccharide vaccines are covered by the Vaccine Injury Compensation Program. Information on how to file a claim is available at www.hrsa.gov/vaccinecompensation or by telephone, 800-338-2382.

Footnotes. Recommended immunization schedule for adults and adolescents with HIV infection, United States, 2017

  1. Influenza vaccination
    Administer age-appropriate inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV) to adults and adolescents annually. Administer IIV or RIV to pregnant women. For adults and adolescents with a history of hives-only egg allergy, administer IIV or RIV. Those with a history of egg allergy other than hives (e.g., angioedema or respiratory distress) may receive IIV or RIV in a medical setting under supervision of a health care provider who can recognize and manage severe allergic conditions. A list of currently available influenza vaccines is available at www.cdc.gov/flu/protect/vaccine/vaccines.htm.
  2. Tetanus, diphtheria, and pertussis vaccination
    Administer 1 dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) to adults and adolescents who were not previously vaccinated with Tdap, followed by a tetanus and diphtheria toxoids (Td) booster every 10 years. Administer 1 dose of Tdap to women during each pregnancy, preferably in the early part of gestational weeks 27–36. Information on the use of Tdap or Td as tetanus prophylaxis in wound management is available at www.cdc.gov/mmwr/preview/mmwrhtml/rr5517a1.htm.
  3. Measles, mumps, and rubella vaccination
    Administer a 2-dose series of measles, mumps, and rubella vaccine (MMR) at least 1 month apart to adults and adolescents with a CD4 cell count ≥200 cells/μL who do not have evidence of immunity to measles, mumps, and rubella (born before 1957, documentation of receipt of MMR, or laboratory evidence of immunity or disease). Pregnant women with a CD4 cell count ≥200 cells/μL who do not have immunity to rubella should receive a 2-dose series of MMR at least 1 month apart after pregnancy. Adults and adolescents with a CD4 cell count <200 cells/μL should not receive MMR.
  4. Varicella vaccination
    Administer a 2-dose series of varicella vaccine (VAR) 3 months apart to adults and adolescents with a CD4 cell count ≥200 cells/μL who do not have evidence of immunity to varicella (documented receipt of 2 doses of VAR, born in the United States before 1980, diagnosis of varicella or zoster by a healthcare provider, or laboratory evidence of immunity). Those with a CD4 cell count <200 cells/μL should not receive VAR.
  5. Herpes zoster vaccination
    There is no recommendation for herpes zoster vaccine (HZV) for adults and adolescents with a CD4 cell count ≥200 cells/μL. Those with a CD4 cell count <200 cells/μL should not receive HZV.
  6. Human papillomavirus vaccination
    Administer a 3-dose series of human papillomavirus (HPV) vaccine at 0, 1–2, and 6 months to adults and adolescents through age 26 years. Pregnant women are not recommended to receive HPV vaccine.
  7. Pneumococcal vaccination
    Administer 1 dose of 13-valent pneumococcal conjugate vaccine (PCV13) followed by 1 dose of 23-valent pneumococcal polysaccharide vaccine (PPSV23) at least 2 months later. Administer a second dose of PPSV23 at least 5 years after the first dose of PPSV23. If the most recent dose of PPSV23 was administered before age 65 years, at age 65 years or older, administer another dose of PPSV23 at least 5 years after the last dose of PPSV23.
  8. Hepatitis A vaccination
    Administer a 2-dose series of single antigen hepatitis A vaccine (HepA) at 0 and 6–12 months or 0 and 6–18 months, depending on the vaccine, or a 3-dose series of combined hepatitis A and hepatitis B vaccine (HepA-HepB) at 0, 1, and 6 months to adults and adolescents who may not have a specific risk but wants protection against hepatitis A infection. Administer a HepA-containing vaccine series to adults and adolescents at risk which includes chronic liver disease, receive clotting factor concentrates, men who have sex with men, inject illicit drugs, and travel in countries with endemic hepatitis A.
  9. Hepatitis B vaccination
    Administer a 3-dose series of single-antigen hepatitis B vaccine (HepB) or combined hepatitis A and hepatitis B vaccine (HepA-HepB) at 0, 1, and 6 months.
  10. Meningococcal vaccination
    Administer a 2-dose primary series of serogroup A, C, W, and Y meningococcal vaccine (MenACWY) at least 2 months apart, and revaccinate every 5 years. Serogroup B meningococcal vaccine (MenB) is not routinely recommended. Young adults and adolescents age 16 through 23 years (preferred age range is 16 through 18 years) may receive MenB (a 2-dose series of MenB-4C at least 1 month apart or a 3-dose series of MenB-FHbp at 0, 1–2, and 6 months) based on individual clinical decision.
  11. Haemophilus influenzae type b vaccination
    Adults and adolescents with HIV infection are not routinely recommended to receive Haemophilus influenzae type b vaccine (Hib). Administer Hib to those with asplenia, hematopoeitic stem cell transplant, and other indications.

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