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To Vaccinate or Not to Vaccinate

By Marcya G. Owens

November 2000

Last winter my infectious disease doctor told me to ask my primary care doctor for flu, pneumococcal, and tetanus vaccine shots. Due to some mix-ups in their office, I was unable to get the shots that season. As a result, I decided to wait the spring and summer out and get all vaccines in the early fall season, just before flu season really began. I was not fortunate enough though to have the luxury of waiting, because in August of this year I contracted pneumococcal pneumonia. This was most unpleasant and definitely at an untimely moment, since we had just moved into the office and I was preparing for the Women's HIV Healing Retreat.

Truthfully, I never felt that I would get pneumococcal bacteria. My viral load was around 700 and my CD4 (T Cell) count was above 500. Although I have many friends with better lab results, I never figured that I could get sick with those labs. This made me wonder, "Would I have saved myself from this untimely and inconvenient illness if I had only received those vaccine shots?"

Which vaccines are unsafe for individuals with HIV infection?

Live virus or live bacteria vaccines, with the exception of measles-mumps-rubella (MMR), should never be given to individuals with HIV infection. Although MMR is a live vaccine, it is considered safe for individuals with HIV. All other live vaccines are considered harmful to individuals with HIV, including BCG, oral polio vaccine, oral typhoid vaccine (ty21a), varicella-zoster vaccine, and yellow fever vaccine. If polio vaccination is recommended for someone with HIV or one of their family members, then the enhanced-potency inactivated polio vaccine (eIPV) should be used.

What vaccines are commonly recommended for individuals with HIV?

The pneumococcal polysaccharide vaccine is considered standard care for individuals with HIV. The influenza vaccine (flu shot) should be considered to prevent clinical syndromes that may mimic more serious opportunistic infections. Although the data is conflicting, there is some evidence that the flu shot may cause a rise in viral load. The best way around this factor is to get the flu shot right after having blood drawn for your viral load; this should give you plenty of time before your next viral load for the flu shot effects to wear off. (The flu vaccine takes up to four weeks to become fully active.)

Additionally, individuals with HIV should be screened for hepatitis B and offered a vaccine if applicable. The hepatitis A vaccine can be given safely to HIV-infected individuals who are at risk -- primarily those with negative anti-HAVIgG who are traveling to an endemic area, sexually active gay men, injection drug users, or those exposed to a community outbreak.

Why should HIV-infected individuals get vaccinated?

According to the U.S. Naval Medical Center in San Diego, the flu vaccine is extremely effective in HIV-1-infected individuals. In a study with 102 individuals, 49% of the placebo (a substance containing no medical benefit -- usually a "sugar pill") recipients and 29% of the vaccine recipients reported respiratory symptoms. The researchers confirmed flu infection in 10 recipients of the placebo group and no cases among the vaccine group.

In the United States there are 100 million flu cases each year, causing approximately 40,000 deaths and nearly $30 billion in health care costs. The flu comes from the influenza virus, which invades the respiratory tract and can trigger a number of very unpleasant symptoms such as muscle aches, chills, cough, fever, sore throat, appetite loss, headache and runny nose.

More serious conditions such as bacterial pneumonia can develop in addition to the flu. Pneumonia is when there is an acute infection within your lungs causing inflammation. This is caused by viruses, bacteria or other microorganisms, and sometimes physical and chemical irritations.

How do vaccines work?

Vaccines which are weakened or inactivated forms of disease-causing agents that stimulate the production of memory cells, a type of immune cell. This exposure to the weakened germ creates memory cells that are able to recognize the germ if it returns. When the memory cells come in contact with the germ again, they summon the immune system battle team to war against the unwelcome germ before it has a chance to spread.

When should you get vaccinated?

The flu shot is administered annually. Flu season covers the months between November and April. Health care providers recommend that you get your flu shot sooner rather than later, especially as it takes four weeks for the vaccine to become fully effective. From September to December is the best time to get your flu shot, but it's never too late. The pneumococcal vaccine only needs to be given every five years. The tetanus booster should be given every ten years. The hepatitis A and B, and measles vaccines only need to be given once.

