Special Populations
10
HIV-Infected Adults, Adolescents, and Children (Table 2)
Inactivated Vaccines
54. HIV-infected patients should be vaccinated according to the CDC
annual schedule for the following inactivated vaccines: IIV (SR-H),
PCV13 in patients <2 years (SR-M), H influenzae type b conjugate
vaccine (Hib) (SR-H), diphtheria toxoid, tetanus toxoid, acellular
pertussis vaccine (DTaP) (SR-M), tetanus toxoid, reduced diphtheria
toxoid, and reduced acellular pertussis vaccine (Tdap) (SR-VL),
tetanus toxoid, reduced diphtheria toxoid vaccine (Td) (SR-L),
hepatitis B vaccine (HepB) (SR-M), hepatitis A vaccine (HepA) (SR-
M), inactivated poliovirus vaccine (IPV) (SR-M), and quadrivalent
human papillomavirus vaccine (HPV4)* in females and males 11-26
years of age (SR-VL) with additions noted below.
55. PCV13 should be administered to HIV-infected patients ≥2 years
old as in recommendations 27a-c (Table 2; SR-L to M).
56. PPSV23 should be administered to HIV-infected children ≥2 years
of age who have received indicated doses of PCV (SR-M), to HIV-
infected adults with CD4 T-lymphocyte counts of ≥200 cells/mm
3
(SR-M), and to HIV-infected adults with CD4 T-lymphocyte counts
of <200 cells/mm
3
(WR-L). PPSV23 should be given ≥8 weeks
after the indicated dose(s) of PCV13 and a second dose of PPSV23
should be given 5 years later (SR-L).
57. HIV-infected children who are >59 months of age and have not
previously received Hib should receive 1 dose of Hib (SR-L). Hib is
NOT recommended for HIV-infected adults (WR-L).
58. HIV-infected children age 11-18 years should receive a 2-dose
primary series of MCV4 two months apart (SR-M). A single booster
dose (third dose) should be given at age 16 years if the primary
series was given at age 11 or 12 years, and at age 16-18 years if
the primary series was given at age 13-15 years (SR-L). If MCV4 is
administered to HIV-infected children 2-10 years of age because
of risk factors for meningococcal disease, a 2-dose primary series
of MCV4 should be administered with a 2-month interval between
doses and a booster dose 5 years later (SR-VL).
59. HIV-infected patients should receive HepB series (SR-M), with
consideration of high-dose HepB (40 μg/dose) for adults (WR-M)
and adolescents* (WR-L). One to two months after completion, they
should be tested for anti-HBs (antibodies to hepatitis B surface
antigen) (SR-L). If a postvaccination anti-HBs concentration of ≥10
mIU/mL is not attained, a second 3-dose series of HepB (SR-L)
should be administered (alternative: 1 dose of HepB after which
anti-HBs is tested*) using standard-dose (SR-M) or high-dose
HepB (40 μg/dose)* (WR-L) for children and high-dose HepB for
adolescents* and adults (SR-L).
