14 Jun 2016

People living with HIV

Live vaccinations are contraindicated in individuals with immunosuppression due to human immunodeficiency virus (HIV) infection People living with HIV

Live vaccinations (such as the yellow fever vaccination) are contraindicated in individuals with immunosuppression due to human immunodeficiency virus (HIV) infection [1, 2].

Yellow fever (YF) vaccine should be avoided where possible for those living with HIV. However, when travel to YF risk areas is unavoidable, YF vaccine can be considered for asymptomatic travellers if they have a stable (at least 3 months) CD4 count greater than 200 cells/µl (> 15% in children) and a suppressed viral load. Specialist advice should be sought in these cases. See TravelHealth Pro HIV and AIDS factsheet.

  • Patients should be counselled about the benefits and risks of vaccination in relation to the risk of exposure, emphasising that a high CD4 cell count and a suppressed viral load on antiretroviral therapy (ART) are likely to maximise safety and efficacy of vaccination.

  • If certificate requirements only, rather than true exposure risk are the only reasons to vaccinate, a Medical letter of Exemption can be considered (which may be taken into account by a receiving country).

  • Ideally, vaccine recipients should be monitored closely for post vaccine adverse events [3]; for any YF vaccine recipient, serious adverse events following YF vaccination are most likely to occur immediately and up to 23 days post vaccination [2].

The antibody response in those living with HIV may be reduced and revaccination should be considered after 10 years for those at continuing risk [3]. 

Resources

Infants under 9 months of age

The risk of yellow fever vaccine-associated encephalitis is higher in infants under nine months of age Read more

Febrile illness

General vaccine guidance from Public Health England states that minor illnesses without fever or systemic upset are not valid reasons to postpone immu Read more

Pre-conception, pregnant women and breastfeeding

Each situation should be evaluated on a case by case basis, a comprehensive risk assessment should be performed, and women should be encouraged to mak Read more

Individuals aged 60 years and older

Age alone is not considered a contraindication to YF vaccination, and vaccination can be given to those aged 60 years and older following risk assessm Read more

Off-site administration

Off-site administration policy for designated Yellow Fever Vaccination Centres (YFVCs) in England, Wales and Northern Ireland Read more
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