HIV/AIDS Treatment and Care : Clinical protocols for the European ...

ImmunIzatIon of PeoPle lIvIng wIth hIv and PeoPle at RIsk of hIv InfectIon
o children younger than 1 travelling to high-risk areas should receive 0.02–0.06 ml/kg, depending
on length of stay, since hepatitis A vaccine is not approved for children younger
than 1;
o people exposed to HAV who have not previously received hepatitis A vaccine, who should
be given HNIg as soon as possible within two weeks of exposure;
o people in close contact with a person who has hepatitis A;
o staff and children at child care centres where a hepatitis A case has been diagnosed; and
o people in certain common-source exposure situations (for example, patrons of a food establishment
with an HAV-infected food handler where the risk of transmission is determined to
be high).
• People who received a dose of hepatitis A vaccine at least one month before an exposure do not
need HNIg.
3.2.2. Measles
3.2.2.1. Recommendations
• For immunocompromised people (including those with HIV infection), HNIg is indicated to
prevent measles following exposure.
• If immediate protection against measles is required for immunocompromised patients with contraindications
for measles vaccination, including infants younger than 1, passive immunization
with HNIg 0.5 ml/kg of body weight (maximum dose 15 ml) should be administered intramuscularly
as soon as possible after exposure.
• Exposed symptomatic HIV-infected patients should receive HNIg regardless of their previous
vaccination status, as measles vaccine may not be effective in such patients and the disease may
be severe.
• For immunocompromised people receiving HNIg for measles prophylaxis, measles vaccination
should be delayed for six months following HNIg administration.
3.3. Human rabies immunoglobulin (HRIg)
3.3.1. Recommendations
• Immunocompromised patients, including those with HIV infection, should receive HRIg for the
same indications and in the same doses as immunocompetent patients do.
• HRIg is indicated for Category III contact (single or multiple transdermal bites or scratches,
contamination of mucous membrane with saliva from licks), along with the first dose of the
rabies vaccine series.
• HRIg treatment is not necessary for people vaccinated against rabies who have demonstrated
neutralizing antibody titres of at least 0.5 IU/ml (two intramuscular doses of a cell-derived vaccine
separated by three days are sufficient for such cases).
• If post-exposure treatment must be given to an immunocompromised HIV-infected person,
HRIg is mandatory, along with the first dose of an intramuscular rabies vaccine series.
• In addition, the antibody responses should be monitored serologically. For further details, see
Annex 3.
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