# Situation: The public health nurse of a Rural Health Unit (RHU) holds a monthly immunization session at a Barangay Health Station (BHS) under the National Immunization Program (NIP). A 10-week-old boy born to a mother with human immunodeficiency virus (HIV) infection has been confirmed HIV-positive. He is clinically well on antiretroviral therapy. He received bacille Calmette-Guérin (BCG) and hepatitis B vaccines at birth and all his 6-week vaccines before his diagnosis. According to Department of Health (DOH) guidelines, which vaccines should he receive today?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629528  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: The public health nurse of a Rural Health Unit (RHU) holds a monthly immunization session at a Barangay Health Station (BHS) under the National Immunization Program (NIP).

A 10-week-old boy born to a mother with human immunodeficiency virus (HIV) infection has been confirmed HIV-positive. He is clinically well on antiretroviral therapy. He received bacille Calmette-Guérin (BCG) and hepatitis B vaccines at birth and all his 6-week vaccines before his diagnosis. According to Department of Health (DOH) guidelines, which vaccines should he receive today?

## 보기

1. Second pentavalent and pneumococcal doses, plus inactivated polio vaccine **✔ 정답**
2. Second doses of pentavalent, pneumococcal, and oral polio vaccines, plus inactivated polio vaccine
3. No vaccines today until his CD4 count shows that his immune status is stable
4. Second doses of pentavalent, pneumococcal, and oral polio vaccines as scheduled

**정답: 1**

## 해설

Inactivated vaccines are safe in HIV infection, so his second pentavalent and pneumococcal conjugate doses are given on schedule. Oral polio vaccine is a live vaccine and is contraindicated in people with HIV under DOH guidelines, so inactivated polio vaccine (IPV) is used in place of oral polio vaccine. Delaying all vaccines would leave a high-risk infant unprotected.

## 심화 해설

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.

## 임상 시나리오

Immunizing an Infant With HIV10-week visit under DOH guidelines
Inactivated vaccines are safe in HIV: give the second pentavalent and pneumococcal conjugate doses on schedule.

Oral polio vaccine is live and is contraindicated in HIV under DOH guidelines; give inactivated polio vaccine (IPV) instead.

Do not delay vaccines while waiting for a CD4 count in a clinically well infant.

CautionAdding IPV does not make OPV safe. Do not give OPV to a child with HIV.

## 핵심 개념

- **Live attenuated vaccine** — A vaccine with weakened living organisms that can multiply and may cause disease in immunocompromised people.
- **Inactivated vaccine** — A vaccine containing killed organisms or their parts, which cannot cause infection.
- **Oral polio vaccine (OPV)** — A live oral vaccine against polio, contraindicated in people with HIV under DOH guidelines.
- **Inactivated polio vaccine (IPV)** — An injected polio vaccine made from killed virus, used in place of OPV in HIV.
- **Antiretroviral therapy** — Combination drug treatment that suppresses HIV and preserves immune function.

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