14 Jun 2016
People living with HIVLive vaccinations are contraindicated in individuals with immunosuppression due to human immunodeficiency virus (HIV) infection
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 ; for any YF vaccine recipient, serious adverse events following YF vaccination are most likely to occur immediately and up to 23 days post vaccination .
The antibody response in those living with HIV may be reduced and revaccination should be considered after 10 years for those at continuing risk .
- British HIV Association (BHIVA) Guidelines on the use of vaccine in HIV-positive adults 2015
- BHIVA Guidance on vaccination of HIV infected children in Europe 2012
- Children’s HIV Association (CHIVA) Immunization of HIV-infected children
- Public Health England, Contraindications and special considerations Ch.6. Immunisation against infectious disease, April 2013
- Public Health England. Yellow fever Ch 35 Immunisation against infectious disease, April 2014
- British HIV Association, BHIVA guidelines on the use of vaccines in HIV-positive adults 2015, November 2015
Guidelines on clinical procedures
- Medical letter of exemption
- International Certificate of Vaccination or Prophylaxis (ICVP)
- Record keeping and consent