Table 9.

Summary of How Immunization Recommendations for HIV-Infected Children Differ From Standard Immunization Schedule

VACCINE	SPECIFIC RECOMMENDATIONS FOR HIV-INFECTED CHILDREN	RATIONALE FOR SPECIALIZED RECOMMENDATION IN HIV-INFECTED CHILDREN
PCV13	Administer to 6- to 18-year-olds who have not received it	Elevated risk of pneumococcal infections
PPSV23	Administer 2-dose series beginning at age 2 years	Elevated risk of pneumococcal infections
Hib	Administer one dose of Hib vaccine to children ≥5 years if incomplete Hib vaccine history	Elevated risk of infections due to encapsulated bacteria
MCV	Primary series should be 2 doses at least 8 weeks apart	Lower response rate to single dose of MCV
HBV	Routine assessment of seroprotection (anti-HBsAb ≥10 mIU/mL) 1-2 months after completion of series	Lower response rate to vaccine series
Influenza	Use trivalent injectable vaccine instead of live-attenuated intranasal vaccine	Potential for live vaccines to cause illness in immunocompromised host
Varicella	Do not administer if severely immunocompromised or severe symptoms	Potential for live vaccines to cause illness in immunocompromised host
MMR-V	Do not use (MMR-V has higher varicella vaccine dose than monovalent varicella vaccine)	Potential for live vaccines to cause illness in immunocompromised host
MMR	Do not administer if severely immunocompromised; Repeat MMR immunization (once receiving effective ART) if MMR doses given before effective ART established	Potential for live vaccines to cause illness in immunocompromised host; Lower probability and less durability of MMR vaccine response before ART

ART=antiretroviral therapy; HBsAb=hepatitis B surface antibody; HBV=hepatitis B virus; Hib=Haemophilus influenzae type b; HIV=human immunodeficiency virus; MCV=meningococcal conjugate vaccine; MMR=measles-mumps-rubella; MMR-V=measles-mumps-rubella-varicella; PCV13=13-valent pneumococcal conjugate vaccine; PPSV23=23-valent pneumococcal polysaccharide vaccine.