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MANAGEMENT OF HIV INFECTION IN CHILDREN k) General considerations for immunisation In general, vaccines may be less effective in HIV infected children due to their impaired immune response. Even after appropriate vaccination, the child may still be susceptible to vaccine preventable diseases and should therefore be given appropriate preventive therapy after exposure to these diseases where available. Immunisation with live vaccines carries a risk of causing disease in the immunocompromised host in addition. Recommendations for immunisation in HIV infected infants and children must take into account available data on the safety, immunogenicity and effectiveness of each vaccine in this special group of children. A recent 92, Level 9 review provides a relevant and detailed discussion of these issues. Recommendation for routine childhood immunisation All infants born to HIV infected mothers should receive routine childhood immunisation at the usual recommended age. (Grade B) The following precautions are recommended for live-attenuated vaccines: • BCG should not be given in symptomatic HIV infected infants or children (WHO Stage 2, 3, 4) as they are at higher risk of developing disseminated disease. (Grade B) • OPV should be replaced by injectable Inactivated Polio Vaccine (IPV). (Grade C) • MMR should be given as per schedule except to those who have severe immunosuppression (CD4 < 15%) (Grade C) Refer to Appendix 4 on age-related immunological criteria Additional vaccines: Pneumococcal polysaccharide vaccine - a single dose should be given to HIV infected child over 2 years of age. (Grade C) (Refer to Appendix 7) Where available all HIV infected children below 5 years of age should receive pneumococcal conjugate vaccine. (Grade B) (Refer to Appendix 7) Varicella vaccine should be offered to an HIV infected child >12 months of age without history of varicella in WHO Clinical Stage 1, 2 or 3 and with CD4 >15%. Two doses of varicella vaccine at a minimum interval of 3 months should be given. (Grade C) 15
2.7 CLINICAL AND LABORATORY MONITORING OF THE PERINATALLY EXPOSED INFANT Clinical, immunological and virological monitoring is done to monitor the well-being of the infant, determine the HIV infection status and, for those who are infected, to determine the timing of initiation of ART and response to therapy. Clinical monitoring should include: • Monitoring of physical growth • Monitoring of developmental milestones • Early detection of opportunistic infections • Review of immunization • Monitoring for adverse effects of drug therapy MANAGEMENT OF HIV INFECTION IN CHILDREN Table 2: IMMUNISATION SCHEDULE FOR HIV INFECTED INFANTS AND CHILDREN Vaccine Asymptomatic Symptomatic Comment BCG Recommended Omit* Hepatitis B Recommended Recommended DTP Recommended Recommended Hib Recommended Recommended OPV Omit Omit Replace with IPV IPV Recommended Recommended MMR Recommended Recommended* Varicella Recommended Recommended* Pneumococcal Recommended Polysaccharide Vaccine (PPV) Recommended Use in children age > 2 years Pneumococcal Consider Consider Conjugate vaccine is more Conjugate immunogenic than Vaccine (PCV) polysaccharide vaccine. However, they are currently expensive *Omit if severely symptomatic (WHO Stage 4) or severe immunosuppression (CD4 < 15%) 16
Page 2 and 3: This Guideline is intended a guide
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Page 8 and 9: REVIEW COMMITTEE The draft guidelin
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MANAGEMENT OF HIV INFECTION IN CHIL
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71 Appendix 2 WHO CLINICAL STAGING
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Appendix 6 MANAGEMENT OF HIV INFECT
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Appendix 7 MANAGEMENT OF HIV INFECT
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3.30 MB - Academy of Medicine of Malaysia

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