| |
Main Article
The Centers
for Disease Control and Prevention (CDC)
has recognized primary prevention through
vaccines asone of the most important public
health advances of the twentieth century.1 Vaccines
have modified the common causes of death.
One of the most notable achievements of
immunizations was the eradication of smallpox.
In the late eighteenth century, Edward
Jenner noted that dairy workers who contracted
cowpox never acquired smallpox. Jenner
vaccinated a boy with cowpox and then,
six weeks later, with smallpox.The boy
never acquired smallpox. Jenner published
his findings in 1798, and this form of
vaccination quickly gained popularity.
Further refinement of the smallpox vaccine
and implementation of its use worldwide
resulted in the last case of natural smallpox
occurring in 1977.2
Although the protection that immunizations
provide is important for all patients,
it is particularly critical in patients
with immuno-compromising illnesses, such
as HIV/AIDS. In the care of HIV-infected
patients, immunizations are an opportunity
to prevent serious and potentially life
threatening diseases.
In recommending immunizations to HIV-infected
patients, it is important to remember
the following general principles. First,
humoral and cellular responses to antigensare
inversely correlated with the patient’s
CD4 count. Because of this, single-dose
vaccines should be given as soon as the
patient’s HIV status is identified.
In cases in which the patient’s
HIV status is identified late in the course
of the disease, and immunocompromise is
already present (CD4 count is less than
200 cells/uL), consideration should be
given to treating the patient with highly
active antiretroviral therapy (HAART).
In the eventthat the patient will be treated
with HAART, it may be prudent to delay
the administration of one-time immunizations
until after immune reconstitution has
occurred. Secondly, in general, for HIV-infected
people, live virus vaccines are usually
contraindicated, and inactivated vaccines
are not. Finally, it is important for
the clinician to avoid checking patients’ viral
load for one month after the administration
of immunizations because they may cause
a transient rise inthese viral load numbers.3,4
The immunization schedule for HIV-infected
persons, in all age groups, differs from
those who are not infected with HIV. Because
New Jersey is a high prevalence state,
ranking fifth in the country in reported
adult and adolescent AIDS cases, third
in the country in reported pediatric AIDS
cases, and having 32,885 persons living
with HIV/AIDS disease, many New Jersey
physicians treat HIV-infected patients.5
Pediatric immunizations are a vital part
of preventing the serious sequelae of
many childhood infectious diseases. Since
HIV-infected children are immunocompromised,
it is important for the physicians caring
for these children to provide them with
appropriate immunizations according to
the schedule recommended by the CDC’s
Advisory Committee on Immunization Practices
(ACIP).6 This paper provides
recommendations on immunizations and alternatives
for primary infectious disease prevention
for children and adolescents infected
with HIV. |
|
