When is pneumococcal vaccine indicated in the management of HIV infection in primary care?

Updated: Apr 09, 2019
  • Author: Jason F Okulicz, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Answer

All patients with CD4 count above 200 cells/µL should receive a dose of PCV13 (Prevnar 13), followed by a dose of PPV23 (Pneumovax) at least 8 weeks later. If previously vaccinated with PPV23, give PCV13 at least 1 year after PPV23. A second PPV23 dose is recommended 5 years after the first PPV23 dose.

Polio vaccine

Oral polio vaccine (OPV) is contraindicated. Inactivated polio vaccine (IPV) should be given only if indicated. Administer 3 doses over 6-12 months for primary immunization.

Tetanus toxoid

Indications are same as for patients without HIV infection. Dose is Td, 0.5 mL IM; Tdap, 0.5-0.75 mL IM as per package insert. Substitute 1-time dose of Tdap vaccine at time of next booster, then Td every 10 years. Precautions should be observed with pregnancy. Td may be administered during second or third trimester or defer Td during pregnancy and administer Tdap postpartum.


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