Table 133-1.

Immunizations for HIV-Infected Adults Who Are Traveling to the Tropics

Vaccine	Recommendation	Comments
Routine immunizations*
Tetanus–diphtheria	Boost every 10 yr
Pneumococcus	Use 23-valent polysaccharide vaccine; boost at 5 yr	Recommended by USPHS–IDSA
Influenza		Recommended by ACIP, USPHS–IDSA
		Year-round infection in the tropics
		Southern Hemisphere: April through
		September; repeat annually
Hepatitis B	3 doses of Recombivax HB or Engerix B
Measles†	Single dose of measles vaccine or MMR for susceptible persons who are not severely immunosuppressed; in the face of severe immunosuppression, consider immunoglobulin
Standard travel immunizations
Hepatitis A	Single dose 2 wk prior to travel; boost at 6–12 mo
Poliomyelitis	Single dose of enhanced inactivated vaccine	Oral (live) vaccine is contraindicated and discouraged in close contacts
Typhoid	Single dose of polysaccharide vaccine at least 2 wk prior to travel; boost at 2 yr Alternately, two doses (separated by at least 1 mo) of inactivated vaccine; boost at 3 yr	Side effects lessened with polysaccharide vaccine; live oral vaccine is contraindicated
Yellow fever†		Contraindicated by the ACIP; recommended for those with asymptomatic HIV infection by WHO; considered for those with asymptomatic HIV infection who cannot avoid potential exposure, by USPHS, IDSA
Special travel immunizations
Cholera	Two doses, at least 1 wk apart; boost at 6-mo intervals	Rarely indicated, given low risk of disease and limited effectiveness of vaccine; live vaccine contraindicated
Meningococcus	Single dose (A/C/Y/W-135)
Plague	Three doses (one each at 0, 1, and 3–6 mo), with boost at 1 or 2 yr
Rabies	See text	Avoid giving HDCV given intradermally, given potentially weaker response
Japanese encephalitis	Three doses, one each on days 0, 7, and 30; boost, based on antibody levels, at 1–3 yr

^*Routine primary series of immunization for diphtheria–tetanus, MMR, and polio is assumed.

^†Absolutely or relatively contraindicated in some circumstances.