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2–2 | Clinical Manual for Management of the HIV-Infected Adult/2006
Immunizations for HIV-Infected Patients
Traveling to Developing Countries
Routine vaccinations should be reviewed and updated
before travel. All patients traveling to other countries
should be evaluated for both routine and destinationspecific
immunizations and prophylaxes. Killed and
recombinant vaccines (eg, diphtheria-tetanus, rabies,
hepatitis A, hepatitis B, Japanese encephalitis) should
be used for HIV-infected persons just as they would be
used for HIV-uninfected persons anticipating travel. For
further information, see the Centers for Disease Control
and Prevention (CDC) Web page at http://www.cdc.
gov/travel/. Recommendations specific to HIV-infected
travelers are located in “The Immunocompromised
Traveler” under the section called “Special Needs
Travelers.” Select the “Traveler’s Health” option for
regional travel documents and information on outbreaks.
Decisions about immunization for the HIV-infected
traveler should take into consideration the traveler’s
current CD4 count, history of an AIDS-defining illness,
and clinical manifestations of symptomatic HIV. In the
CDC recommendations, asymptomatic HIV-infected
persons with CD4 counts of 200-500 cells/µL are
considered to have limited immune deficits, whereas
patients with CD4 counts >500 cells/µL are considered
to have no immunologic compromise. For patients
taking antiretroviral therapy, current CD4 counts rather
than nadir counts should be used in deciding about
immunizations.
The following should be noted about specific
vaccinations:
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Inactivated (killed) enhanced potency-polio and
typhoid vaccines should be given instead of the live,
attenuated forms. In adults aged >18 years, vaccinate
8 weeks before travel to allow time for the initial 2
doses of polio vaccine.
Measles or measles-mumps-rubella (MMR; omit
if patient has evidence of immunity) should not be
given to severely immunocompromised patients.
Instead, immune globulin should be given to
measles-susceptible, severely immunocompromised
persons traveling to measles-endemic countries.
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Yellow fever vaccine is a live-virus vaccine with
uncertain safety and efficacy for HIV-infected
persons and should be avoided if possible. Travelers
with asymptomatic HIV infection and relatively
high CD4 counts who cannot avoid potential
exposure to yellow fever should be offered the choice
of vaccination. If travel to a zone with yellow fever
is necessary and vaccination is not administered,
patients should be advised about the risk of yellow
fever, instructed about avoiding the bites of vector
mosquitoes, and provided with a vaccination waiver
letter.
The influenza season in the southern hemisphere
is April through September, but in the
tropics influenza is a year-round infection.
Immunocompromised patients should be protected
according to influenza risk at the destination. HIVinfected
patients should not be given live intranasal
influenza vaccine.