30-year-old HIV (+) homosexual male who participates as a volunteer in an AIDS patient support center. According to his medical history he received diphtheria toxoid (Td) 6 years ago, MMR vaccine in childhood and adolescence, and hepatitis B 3 years ago. He is currently asymptomatic with a CD4 count above 200 cls/microliter. Which vaccines should we recommend?
Vaccination recommendations for HIV+ adults include hepatitis B, influenza, MMR, pneumococcal, Td and Tdap, and for some adults, hepatitis A, or combined A and B, bacterial meningitis, HPV and meningococcal (Source [1]). Considering that the individual has received some vaccines, has a CD4 count >100 (if lower there would be a contraindication) and works in a center that helps AIDS patients (he is equated to "health personnel") answers 2, 4 and 5 are wrong. All four vaccines in option 1 are administrable. In a little more detail: Vaccine against tetanus and diphtheria: all persons should be vaccinated against these two diseases. Hepatitis B vaccine: hepatitis B and HIV viruses share the same routes of transmission, so it is common for HIV-infected patients to also be infected with hepatitis B virus. It is therefore important to know whether the HIV-infected person has markers of hepatitis B infection and to proceed with vaccination if he/she does not have them. Vaccination against hepatitis A: Hepatitis A in a person with hepatitis B, hepatitis C or other liver disease can be very serious. Since these infections are more frequent in HIV-infected patients, vaccination against hepatitis A is recommended. Vaccination against influenza: influenza in a patient with a lack of immune response is more serious and presents a greater risk of complications, so annual vaccination against this disease is indicated. If the patient's immune status is very deteriorated, the response to vaccination is diminished. In this case, it is essential to vaccinate all the people living with the HIV-infected person to prevent them from transmitting the disease. Pneumococcal vaccine: pneumococcal infections (especially pneumonia) are up to 10 times more frequent in HIV-infected persons than in HIV-uninfected adults, so vaccination is recommended, although in patients with counts below 200/mm3 the protective response is usually not sufficient. They should receive a second dose at 3-5 years of age. HIV-infected children should be vaccinated with pneumococcal conjugate vaccine with the corresponding number of doses according to age. Vaccination against Haemophilus Influenzae type b: this bacterium causes pneumonia and meningitis, especially in children. Although in HIV-infected adults it represents a small number of the causes of infection, vaccination is recommended. Vaccination against measles, rubella and mumps (MMR): all three diseases can become more serious in HIV-infected patients, especially measles, so all of them should be vaccinated, provided that immunosuppression is not severe (count less than 200/mm3).
Seasonal influenza, pneumococcal, tetravalent meningitis and hepatitis A.
Seasonal influenza, Td, pneumococcal and tetravalent meningitis.
Tetravalent meningitis, pneumococcal and seasonal flu.
Td, tetravalent meningitis, pneumococcal.
Triple viral, seasonal flu, pneumococcal.
All four vaccines in option 1 are administrable. In a little more detail: Vaccine against tetanus and diphtheria: all persons should be vaccinated against these two diseases. Hepatitis B vaccine: hepatitis B and HIV viruses share the same routes of transmission, so it is common for HIV-infected patients to also be infected with hepatitis B virus. It is therefore important to know whether the HIV-infected person has markers of hepatitis B infection and to proceed with vaccination if he/she does not have them. Vaccination against hepatitis A: Hepatitis A in a person with hepatitis B, hepatitis C or other liver disease can be very serious. Since these infections are more frequent in HIV-infected patients, vaccination against hepatitis A is recommended. Vaccination against influenza: influenza in a patient with a lack of immune response is more serious and presents a greater risk of complications, so annual vaccination against this disease is indicated. If the patient's immune status is very deteriorated, the response to vaccination is diminished. In this case, it is essential to vaccinate all the people living with the HIV-infected person to prevent them from transmitting the disease. Pneumococcal vaccine: pneumococcal infections (especially pneumonia) are up to 10 times more frequent in HIV-infected persons than in HIV-uninfected adults, so vaccination is recommended, although in patients with counts below 200/mm3 the protective response is usually not sufficient.
Considering that the individual has received some vaccines, has a CD4 count >100 (if lower there would be a contraindication) and works in a center that helps AIDS patients (he is equated to "health personnel") answers 2, 4 and 5 are wrong.
Considering that the individual has received some vaccines, has a CD4 count >100 (if lower there would be a contraindication) and works in a center that helps AIDS patients (he is equated to "health personnel") answers 2, 4 and 5 are wrong.
Considering that the individual has received some vaccines, has a CD4 count >100 (if lower there would be a contraindication) and works in a center that helps AIDS patients (he is equated to "health personnel") answers 2, 4 and 5 are wrong.