Inactivated vaccines on schedule, IPV instead of OPV
This 10-week-old is HIV-positive but clinically well on antiretroviral therapy. Under Department of Health (DOH) guidelines, inactivated vaccines are safe in HIV infection, so his second pentavalent and pneumococcal conjugate doses are given on schedule today. Oral polio vaccine (OPV) is a live vaccine and is contraindicated in people with HIV under DOH guidelines, so inactivated polio vaccine (IPV) is used in its place. The correct choice is the second pentavalent and pneumococcal doses plus IPV, with no OPV.
Why live vaccines are a concern
Live attenuated vaccines contain weakened organisms that can multiply in the body. In a child with impaired immunity, a live vaccine strain may cause disease. Oral polio vaccine also carries a rare risk of vaccine-associated paralytic polio, which is higher in immunocompromised people. Inactivated vaccines contain no living organisms, so they cannot cause infection, although the immune response may sometimes be weaker in HIV infection.
Why delaying all vaccines is wrong
An infant with HIV is at higher risk of severe disease from vaccine-preventable infections, such as pneumococcal disease and pertussis. Waiting for a CD4 count before giving any vaccine would leave him unprotected without reducing any risk, because inactivated vaccines are safe regardless of CD4 count. Watch out! Do not let a diagnosis of HIV stop all immunization; the question is which specific vaccines are live and which are inactivated.
Why adding IPV does not make OPV safe
The option that gives the second doses of pentavalent, pneumococcal, and oral polio vaccines plus IPV may seem like extra protection. However, IPV does not make the live OPV safe, so OPV is still contraindicated. The option that gives all three second doses as scheduled ignores the HIV status completely.
| Vaccine due today | Type | Give to this infant? |
|---|
| Pentavalent, second dose | Inactivated | Yes, on schedule |
| Pneumococcal conjugate, second dose | Inactivated | Yes, on schedule |
| Oral polio vaccine, second dose | Live | No; contraindicated in HIV |
| Inactivated polio vaccine | Inactivated | Yes, in place of OPV |
Exam takeaway
In HIV infection, give inactivated vaccines on schedule and replace oral polio vaccine with inactivated polio vaccine. Key point! For any immunization item involving immunosuppression, first sort the vaccines into live and inactivated, then apply the rule for that condition.