3.30 MB - Academy of Medicine of Malaysia

MANAGEMENT OF HIV INFECTION IN CHILDREN
There are minimal data on the protective efficacy of MMR vaccine in HIV
infected individuals. Experience in African countries has noted a reduction
in measles incidence in regions with high HIV prevalence by maintaining
92,Level 9
high immunisation rates and periodic supplementary campaigns.
d) Hepatitis B
Hepatitis B vaccine is a recombinant vaccine. No significant adverse events
were noted in cohort studies of infants receiving primary immunisation from
93,Level 6;94,Level 6
birth.
Studies on the immunogenicity of hepatitis B vaccine have demonstrated poorer
response rate in HIV infected infants and children with only 25-50% developing
95,Level 6;96,Level 6;97,Level 6;98,Level 6
protective antibodies after primary immunisation.
Booster doses or higher doses have not been found to be immunogenic.
99,Level 6;98,Level 6 There are no studies of the protective efficacy of hepatitis B
vaccine in HIV infected children.
e) Haemophilus influenzae type B (Hib)
Hib is a conjugated polysaccharide vaccine. The vaccine is safe and
immunogenic in HIV infected infants and children (although the immunogenic
response is less than that seen in normal children. 99,Level 4; 100,Level 6; 101,Level 6 Two
recent studies from South Africa suggest that Hib vaccine is effective in
protecting from invasive Hib disease although the level of protection is lower
102,Level 6;103, Level 6
than that seen in uninfected children (43.9-54.7% vs 83-90.8%).
f) Diphtheria, Tetanus, Pertussis (DTP)
DTP vaccine is safe and immunogenic in HIV infected infants and children.
82 ,Level 6;69,Level 6; 104,Level 6; 105,Level 6 However, GMTs achieved were lower than those in
non-infected infants. There is no rigorous study on the protective efficacy of
DTP vaccine in HIV infected children.
g) Pneumococcal vaccine
Children infected with HIV have a markedly increased risk of pneumococcal
infection - from 2.8 to 12.6 times the rate compared with those who are not
.106, Level 8;107,Level 6;108,Level 6; 109,Level 7
HIV infected.
Both pneumococcal polysaccharide (PPV) and pneumococcal conjugate
110, Level 4; 111, Level 4 ;112,
vaccines (PCV) are safe in HIV infected infants and children.
Level 6 Approximately 65-100% of HIV infected children developed protective
antibody after vaccination with PCV but GMTs achieved were lower than
113, Level 6; 112, Level 6; 111, Level 4
those in uninfected children.
The response to the polysaccharide vaccine is generally poorer than to the
conjugate vaccine. 111, Level 6; 115, Level 6 A large RCT from South Africa showed PCV
provided 65% protection against invasive pneumococcal disease among
116, Level 2
HIV infected infants.
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