BC Centre in HIV/AIDS Primary Care Guidelines

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2.1 Immunizations

CategoryVaccineDescriptionRecommended forFormulationsScheduleDosage per vaccineRoute of administration
Recommended Vaccines Hepatitis A Vaccine Formalin inactivated Monovalent with an aluminium hydroxide or influenza virosome adjuvant all HAV-susceptible (anti-HAV Ab) individuals Vaqta®, Havrix®, Avaxim®, EpaxalBerna® 0, 1, 6 months (different from standard schedule of 0, and 6 – 12 months) Standard adult dose (formulation dependent) IM
Hepatitis B Vaccine Monovalent recombinant DNA vaccine all susceptible (HBsAg and anti-HBs less than 10 IU) individuals; and those anti-HBc+ with HBsAg and anti-HBs and undetectable HBV DNA Recombivax® (10 µg/mL), Recombivax® Adult Dialysis Formulation (40 µg/mL) or Engerix Adult® (20 µg/mL) 0, 1, and 6 months Adults age ≥20:
Recombivax®: 4 mL, Recombivax® Adult Dialysis Formulation: 1 mL, Engerix Adult®: 2 mL
IM
Pneumococcal Vaccine 23-valent pneumococcal polysaccharide vaccine (Pneu-P-23) and pneumococcal conjugate vaccine (Pneu-C-13) all individuals, regardless of CD4 cell count

Pneu-P-23,

Pneu-C-13

  • If not previously vaccinated: Initial dose of Pneu-C-13, then Pneu-P-23 at ≥8 weeks
  • If Pneu-P-23 previously received: Pneu-C-13 at ≥1 year after Pneu-P-23
  • If re-immunization with Pneu-P-23 needed: ≥8 weeks after Pneu-C-13 and ≥5 years after initial Pneu-P-23
0.5 mL (standard adult IM dose) IM
Influenza Vaccine Inactivated split-virus vaccine all individuals including pregnant women, regardless of CD4 cell count or HIV pVL Fluviral ® and Vaxigrip® (change annually; see BC Immunization Manual) Single yearly injection 0.5 mL (standard dose) IM
Td/TdaP Tetanus, diphtheria and acellular pertussis all individuals, regardless of CD4 cell count Td®, Adacel®. Routine boosting: Substitute one-time dose of TdaP for Td booster, then boost with Td every 10 years ideally when CD4>200/µL; if woman is pregnant then use Td. Td®: 0.5 mL (standard dose), Adacel®: 0.5 mL (standard dose) IM
Vaccines to consider MMR Vaccine live, attenuated measles, mumps, and rubella virus vaccine susceptible adolescents and adults without evidence of immunity and with CD4 ≥200 cells/µL and CD4 ≥15% M-M-R® II Two-dose series administered 3 months apart 0.5 mL (standard dose) subcutaneous injection
Varicella vaccine single antigen, live, attenuated non-pregnant adults with no evidence of immunity, no clinical evidence of being immunocompromized, CD4 >200 cells/µL and CD4 fraction >15%. Contraindicated if CD4 <200 cells/µL or CD4 fraction <15%. Varilrix®, Varivax® III 2 doses at least 4 weeks apart if not previously vaccinated, or the second dose if they have received only one dose 0.5 mL (standard adult dose) subcutaneous injection
Herpes Zoster Vaccine Herpes Zoster Vaccine
  • use to prevent shingles is not routinely recommended
  • contraindicated when CD4<200/µL
Zostavax II®   0.65 mL (single vial content) subcutaneous injection
HPV4 vaccine Human papillomavirus vaccine HIV+ girls and women and HIV+ boys and men aged 9–26 years, regardless of CD4 count, to prevent infection caused by HPV types 6, 11, 16 and 18 and related diseases Gardasil® (HPV4) 3-dose series  0.5 mL IM

Other screening and health maintenance interventions may be indicated depending on the age and gender of the patient. See also: The Canadian Guide to Clinical Preventive Health Care

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