Immunizations in HIV Flashcards
(129 cards)
1
Q
What does ACIP recommend for immunizing people with HIV?
A
Immunizing similarly to the general population, with key exceptions.
2
Q
Which live virus vaccines are contraindicated in people with HIV with CD4 <200 cells/mm3?
A
- Measles
- Mumps
- Rubella
- Varicella (VAR)
- Live attenuated typhoid Ty21a
- Yellow fever
3
Q
Which live virus vaccine is contraindicated for any CD4 counts?
A
Live attenuated influenza vaccine (LAIV)
4
Q
What vaccines have specific recommendations related to HIV status?
A
- COVID-19
- Hepatitis A (HAV)
- Hepatitis B (HBV)
- Meningococcus serogroup A, C, W, Y (MenACWY)
- Pneumococcal vaccines
- Human papillomavirus
5
Q
What defines advanced HIV?
A
CD4 count <200 cells/mm3, history of AIDS-defining illness without immune reconstitution, or clinical manifestations of symptomatic HIV.
6
Q
What should adults and children >5 years with HIV receive regarding COVID-19 vaccinations?
A
A dose of the updated COVID-19 vaccine regardless of their CD4 count or HIV viral load.
7
Q
True or False: Individuals with advanced or untreated HIV may receive one additional COVID-19 vaccine dose.
A
True
8
Q
What is the association between lower CD4 counts and COVID-19 outcomes in people with HIV?
A
Lower CD4 counts are associated with higher risk for ICU admission, invasive mechanical ventilation, or death.
9
Q
What is the recommended dosing schedule for the hepatitis A vaccine (HepA) for people with HIV?
A
A two-dose series (0 and 6–12 months for Havrix or 0 and 6–18 months for Vaqta).
10
Q
What should be administered for people with HIV traveling to countries with endemic HAV?
A
Immunoglobulin G (IgG) 0.1 mL/kg for travel <1 month; 0.2 mL/kg for travel ≥2 months.
11
Q
What is the preferred hepatitis B vaccine for people without chronic HBV infection?
A
Heplisav-B intramuscularly at 0 and 4 weeks.
12
Q
What is the vaccination schedule for prior non-responders to Hepatitis B vaccine?
A
Administer HepBCpG (Heplisav-B) IM at 0 and 4 weeks, with consideration for a third dose at 24 weeks.
13
Q
What should be done for people with HIV who have been exposed to HBV and were vaccinated previously?
A
No additional vaccine is needed if they have documented antibody response.
14
Q
What is the recommended HPV vaccine for people with HIV?
A
9-valent inactivated recombinant vaccine (Gardasil 9).
15
Q
At what age should the HPV vaccination series ideally be initiated for people with HIV?
A
At age 11 or 12 years.
16
Q
What is the recommendation regarding the influenza vaccine for people with HIV?
A
Administer age-appropriate inactivated influenza vaccine or recombinant influenza vaccine annually.
17
Q
What vaccine is contraindicated for people with HIV?
A
Live attenuated influenza vaccine (LAIV).
18
Q
What should be administered to pregnant people with HIV regarding influenza?
A
Inactivated influenza or recombinant vaccine at any time during pregnancy.
19
Q
What is the significance of the influenza vaccine formulations?
A
Vaccine formulations are updated yearly to reflect circulating strains.
20
Q
What is contraindicated for people with HIV?
A
LAIV administered via nasal spray
LAIV stands for Live Attenuated Influenza Vaccine.
21
Q
What type of influenza vaccines are recommended for people with HIV aged 65 years or older?
A
High-dose, recombinant, and adjuvanted influenza vaccines
These are recommended over standard-dose unadjuvanted inactivated vaccines.
22
Q
During which months do annual epidemics of seasonal influenza typically occur in the United States?
A
October to April
23
Q
What are the two surface antigens used to categorize Influenza A viruses?
A
- HA
- Neuraminidase (NA)
24
Q
What is antigenic drift?
A
Point mutations and recombination events within a subtype
25
True or False: People with HIV are at high risk of serious influenza-related complications.
True
26
What is the recommended vaccination strategy for people with HIV who have minimal AIDS-related symptoms and normal CD4 counts?
Receive inactivated influenza vaccine (IIV) to develop adequate antibody responses
27
What is the effectiveness of trivalent IIV for prevention of confirmed influenza illness in people with HIV?
75%
## Footnote
Based on a randomized placebo-controlled trial in South Africa.
28
What is the recommended timing for influenza vaccination?
Before onset of influenza activity in the community
29
What should health care providers aim for when offering influenza vaccination?
By the end of October if possible
30
What is the MMR vaccine contraindicated for?
People with HIV with CD4 count <200 cells/mm3
31
What is the recommended vaccination schedule for the MMR vaccine for those with CD4 count ≥200 cells/mm3?
Two doses at least 1 month apart
32
What should be done for measles exposure of nonimmune individuals with CD4 count <200 cells/mm3?
Administer immunoglobulin (IG) within 6 days of exposure
33
What is the mortality rate of measles in people with advanced HIV?
As high as 40%
34
What is the incidence of measles cases in the European region in 2022?
Greater than 30,000 cases
35
What should be done if there is no serologic evidence of immunity after two doses of MMR vaccine?
Consider repeating the two-dose MMR vaccine series
36
What is the recommended vaccination for adolescents and adults with HIV who have not been previously vaccinated against meningococcal disease?
Two doses of quadrivalent meningococcal conjugate vaccine (MenACWY) at least 8 weeks apart
37
What is the recommendation for repeat vaccination against meningococcal disease for people with HIV who have been vaccinated previously?
Repeat vaccination every 5 years
38
What is the most common cause of bacterial meningitis among children and young adults in the United States?
Meningococcal meningitis
39
What is the increased risk of meningococcal disease in people with HIV?
Five- to 24-fold increased risk
40
What should be administered within 72 hours of measles exposure for nonimmune individuals with CD4 count ≥200 cells/mm3?
MMR vaccine
41
What are the available vaccines for meningococcal disease?
* MenACWY
* MenB
* MenABCWY
42
What is the recommended MenB vaccination strategy for adolescents and young adults with HIV?
Offer MenB vaccination with shared decision-making
43
What is the primary vaccine recommended for people with HIV to prevent meningococcal disease?
MenACWY
44
What vaccination should individuals with component deficiency or using a complement inhibitor receive?
MenB vaccination
## Footnote
Eculizumab and ravulizumab are examples of complement inhibitors.
45
What are the two available MenB vaccines?
* MenB-4C (Bexsero; two-dose series at 0 and 1 month)
* MenB-FHbp (Trumenba; three-dose series at 0, 1–2, and 6 months for people with HIV)
46
What components does MenB-4C consist of?
* Three recombinant proteins
* Outer membrane vesicles containing outer membrane protein porin A
47
Are MenB vaccines interchangeable?
No, the same product must be used for all doses in the series.
48
What should be done if a person previously vaccinated with MenB is identified as being at increased risk during an outbreak?
A single booster dose of the same vaccine is recommended ≥1 year after the primary series completion.
49
True or False: Urban outbreaks of meningococcal meningitis have been reported among men who have sex with men in the U.S.
True
50
What is recommended for pregnant and lactating people with HIV regarding MenACWY vaccine?
They should receive MenACWY vaccine if indicated (AIII).
51
What is the recommendation regarding MenB vaccination during pregnancy?
It should be deferred unless the pregnant person is at increased risk and benefits outweigh potential risks (CIII).
52
What is the live nonreplicating smallpox and mpox vaccine available?
JYNNEOS (Bavarian Nordic)
53
Who should receive mpox vaccination with JYNNEOS?
* All people with HIV
* Pregnant or breastfeeding individuals with potential mpox exposure
* Any other people with HIV who request vaccination
54
What is the vaccination schedule for JYNNEOS?
Two doses (0.5 mL subcutaneous or 0.1 mL intradermal) 4 weeks apart (AII).
55
What is the recommendation for unvaccinated people with HIV who experience known exposure to mpox?
Administer a complete series of JYNNEOS as soon as possible, ideally within 4 to 14 days after exposure (BII).
56
What are the available pneumococcal vaccines?
* PCV15 (Vaxneuvance, Merck)
* PCV20 (Prevnar 20, Pfizer)
* PPSV23 (Pneumovax, Merck)
57
What is the recommendation for people with HIV without a history of pneumococcal vaccination?
Administer either PCV20 or PCV15 (AII).
58
What should be done if PCV15 is used?
Administer a dose of PPSV23 at least 8 weeks later (AII).
59
What is recommended for people with HIV who received PCV13 and were 65 years or older when they received PPSV23?
They do not require further doses of PPSV23.
60
What RSV vaccine is recommended for all people with HIV older than 75 years?
A single respiratory syncytial virus (RSV) vaccine (Abrysvo, Arexvy, or mRESVIA) is recommended (CIII).
61
What is the efficacy of RSVPreF3 (Arexvy) against RSV-related lower respiratory tract disease?
83% efficacy compared to placebo.
62
What are the contraindications for administering live replicating vaccinia vaccines?
Contraindicated in pregnant, breastfeeding, or immunocompromised individuals, including those with HIV (AII).
63
What is the recommendation for Tdap vaccination for individuals with HIV?
Administer Tdap once if not vaccinated at age 11 or older, then Td or Tdap every 10 years thereafter (AII).
64
When should pregnant people with HIV receive Tdap vaccination?
One dose of Tdap during each pregnancy, preferably between 27 weeks and 36 weeks gestation (AIII).
65
What vaccine should a person with HIV receive if they have not been vaccinated at age 11 or older?
Acellular pertussis vaccine (Tdap) once
## Footnote
Followed by tetanus and diphtheria toxoids vaccine (Td) or Tdap every 10 years thereafter.
66
When should pregnant people with HIV receive the Tdap vaccine?
During each pregnancy, preferably between 27 weeks and 36 weeks gestation
## Footnote
This is recommended to protect both the mother and the baby.
67
What should adolescents and adults with HIV who have not received the primary vaccination series for tetanus, diphtheria, or pertussis do?
Administer one dose of Tdap followed by one dose of Td or Tdap at least 4 weeks later, and another dose 6 to 12 months after the last dose
## Footnote
Tdap can be substituted for any Td dose and is preferred as the first dose.
68
How does CD4 count affect antibody response to tetanus and diphtheria vaccination?
Antibody response varies; it is attenuated in individuals with advanced HIV and low CD4 counts
## Footnote
For CD4 count >300 cells/mm3, response to tetanus is similar to the general population, but diphtheria response remains diminished.
69
What are the two Tdap vaccines available for individuals aged ≥10 years in the United States?
Adacel and Boostrix
## Footnote
Both are inactivated vaccines considered safe at any CD4 count.
70
What is the vaccination schedule for adults not previously vaccinated for tetanus, diphtheria, and pertussis?
Receive a single dose of Tdap, followed by a Td or Tdap booster every 10 years
## Footnote
This schedule is the same for individuals with HIV and those without.
71
What is the live attenuated varicella vaccine available?
Varivax (Merck)
## Footnote
This vaccine is used to prevent primary varicella infection.
72
What conditions indicate presumed immunity to varicella for people with HIV?
Receipt of two doses of varicella vaccine, diagnosis of varicella or herpes zoster, or laboratory evidence of immunity
## Footnote
This includes confirmed disease history.
73
What is the recommendation for varicella vaccination for people with HIV and CD4 count ≥200 cells/mm3?
Administer two doses of varicella vaccine 4 to 8 weeks apart
## Footnote
This is applicable for those who are varicella nonimmune.
74
Is VAR contraindicated for people with HIV with CD4 count <200 cells/mm3?
Yes
## Footnote
This is due to the increased risk of vaccine-related complications.
75
What vaccine is recommended for people with HIV aged ≥18 years to prevent herpes zoster?
Recombinant adjuvanted zoster vaccine (RZV), Shingrix
## Footnote
Administer two doses at 0 and 2 to 6 months.
76
When should RZV vaccination be considered for people with HIV?
Consider delaying until the patient is virologically suppressed on ART or until the CD4 count is ≥200 cells/mm3
## Footnote
This ensures a robust vaccine response.
77
Is RZV recommended during pregnancy?
No
## Footnote
Vaccination is not recommended during pregnancy due to safety concerns.
78
Should RZV be given during an acute episode of herpes zoster?
No
## Footnote
Administration during an acute episode is contraindicated.
79
What is the vaccination recommendation for people with HIV regarding COVID-19?
People with HIV should receive a complete COVID-19 vaccine series regardless of their CD4 count or HIV viral load or their pregnancy or breastfeeding status.
## Footnote
Current recommendations can be found on CDC.gov.
80
What is the preferred vaccination for HAV nonimmune individuals?
Two-dose series of either Havrix or Vaqta.
## Footnote
Havrix: 1.0 mL IM (0, 6–12 months); Vaqta: 1.0 mL IM (0, 6–18 months).
81
What should be done if total antibody response to HAV vaccination is negative after 4 weeks?
Revaccinate, preferably after the CD4 count is ≥200 cells/mm3.
## Footnote
This is a recommendation for individuals who are susceptible.
82
What is the preferred vaccination for HBV nonimmune individuals?
Heplisav-B IM at 0 and 4 weeks.
## Footnote
Alternative options include Engerix-B or Recombivax HB.
83
What is the definition of vaccine nonresponder for HBV?
If anti-HBs <10 mIU/mL after complete series.
## Footnote
This indicates a lack of adequate immune response.
84
What should be administered to exposed individuals who have not received a vaccine for HBV?
Administer or complete the HepB vaccine series and a dose of HBIG.
## Footnote
This should be done as soon as possible after exposure.
85
What is the vaccination schedule for the recombinant 9-valent HPV vaccine?
0.5 mL IM three-dose series (0, 1–2, and 6 months).
## Footnote
Vaccination is not recommended during pregnancy.
86
What is the annual recommendation for influenza vaccination?
One dose of age-appropriate IIV or RIV annually.
## Footnote
LAIV is contraindicated.
87
What type of vaccine is contraindicated if CD4 count is <200 cells/mm3?
MMR vaccine.
## Footnote
This highlights the risk for immunocompromised individuals.
88
What is the recommended post-exposure prophylaxis for measles?
Administer MMR vaccine within 72 hours of exposure or IG within 6 days.
## Footnote
MMR vaccine and IG should not be administered simultaneously.
89
What is the vaccination recommendation for individuals with no prior polyvalent meningococcal vaccine?
MenACWY vaccine (Menveo or MenQuadfi) two-dose series (0.5 mL IM) at least 8 weeks apart.
## Footnote
Pregnant and lactating people with HIV should receive MenACWY if indicated.
90
What is the vaccination recommendation for individuals with increased risk for MenB?
Administer either MenB vaccine: two-dose series of Bexsero or three-dose series of Trumenba.
## Footnote
MenB vaccines are not interchangeable.
91
What is the vaccination recommendation for mpox exposure?
Administer two-dose series of JYNNEOS (0.5 mL SQ or 0.1 mL ID) given 28 days apart.
## Footnote
Live-replicating vaccinia vaccines are contraindicated for people with HIV.
92
What is the pneumococcal vaccination recommendation for those with no prior pneumococcal vaccine?
Administer either PCV20 or PCV15 followed by PPSV23 after at least 8 weeks.
## Footnote
ACIP recommended PCV21 as an option for adults aged ≥19 years.
93
What should be done if a patient previously received only PPSV23?
Administer either PCV20 or PCV15 at least 1 year after last PPSV23 dose.
## Footnote
No follow-up with another dose of PPSV23 is necessary.
94
What is the recommendation for adults aged ≥65 years who received PPSV23?
No further doses of PPSV23 are required.
## Footnote
Shared decision-making is recommended regarding administration of PCV20.
95
What is the CD4 count threshold for optimizing vaccine efficacy?
>200 cells/mm3
96
What is recommended for individuals who have previously received only PPSV23?
Administer either PCV20 or PCV15 at least 1 year after last PPSV23 dose
97
What is the recommended dose of PCV20?
0.5 mL IM x 1
98
What is the recommended dose of PCV15?
0.5 mL IM x 1
99
Is follow-up with another dose of PPSV23 necessary after administering PCV15 or PCV20?
No
100
What is the recommended RSV vaccine dosage for individuals aged ≥75 years?
One dose 0.5 mL IM of RSV vaccine (Arexvy, Abrysvo, or mRESVIA)
101
What is the recommendation for individuals aged 60–74 years with a comorbid condition increasing RSV disease risk?
One dose 0.5 mL IM of RSV vaccine (Arexvy, Abrysvo, or mRESVIA)
102
What is the recommendation for pregnant people between 32–36 weeks’ gestation regarding RSV vaccine?
One dose 0.5 mL IM of RSV vaccine (Abrysvo)
103
When is the RSV season in the continental United States?
Typically September–January
104
What is the recommended timing for RSV vaccination before delivery?
At least 14 days prior to delivery
105
What is the vaccination recommendation for those not previously vaccinated for Tetanus, Diphtheria, and Pertussis?
One dose 0.5 mL IM Tdap, followed by Td or Tdap at least 4 weeks later
106
What is the recommended Tdap booster schedule after the initial dose?
Td or Tdap every 10 years
107
When should Tdap be administered during pregnancy?
Preferably in gestational weeks 27–36
108
What is the varicella vaccine recommendation for individuals with CD4 count ≥200 cells/mm3?
Two-dose (0.5 mL SQ) series of VAR 4–8 weeks apart
109
What is the contraindication for Varivax?
CD4 count <200 cells/mm3
110
What are the criteria for evidence of immunity to varicella?
Documented receipt of two doses of Varivax or MMRV; diagnosis of varicella or zoster; laboratory evidence of immunity or disease
111
What is the recommended vaccination for individuals aged ≥18 years regarding Zoster?
Two-dose (0.5 mL IM) series of RZV (Shingrix) 2–6 months apart
112
When should RZV vaccination be delayed?
Until patient is virologically suppressed on ART or after immune reconstitution
113
What is the recommendation for cholera vaccination for travelers?
Not routinely recommended for most travelers
114
What is the cholera vaccination recommendation for individuals aged 18–64 years with CD4 count >200 cells/mm3?
Lyophilized CVD 103-HgR (Vaxchora) single oral dose at least 10 days prior to potential exposure
115
What is the recommended vaccination for typhoid for those at risk?
One dose 0.5 mL (25 mcg) IM Vi capsular polysaccharide vaccine at least 1 week before exposure
116
What is the recommendation for yellow fever vaccination for individuals aged ≤59 years?
One dose of YF vaccine if asymptomatic with CD4 count >500 cells/mm3
117
What is contraindicated for yellow fever vaccination?
CD4 count <200 cells/mm3
118
What is the recommended vaccination schedule for polio for those at higher risk?
Three doses IPV 0.5 ml IM at 0 and 1–2 months, with third dose given 6–12 months after second dose
119
What is the vaccination recommendation for COVID-19 in relation to HIV?
For current COVID-19 vaccination recommendations, please visit the CDC’s COVID-19 Vaccines website
120
What is the recommended vaccination schedule for Hepatitis A?
Two to three doses (varies by formulation)
121
What is the recommended vaccination schedule for Hepatitis B?
Two to three doses (varies by formulation and indication)
122
What is the HPV vaccination recommendation for ages 18–26 years?
Three doses
123
What is the vaccination recommendation for Influenza?
One dose annually
124
What is the recommendation for MMR vaccination for those born after 1956?
Two doses if no history of vaccination or positive antibody titer
125
What is the recommended schedule for Meningococcal A,C,W,Y Conjugate (MenACWY)?
Two doses, then booster every 5 years
126
What is the vaccination recommendation for Mpox (MVA-BN, Attenuated)?
Two doses
127
What is the recommendation for Mpox (ACAM2000, Live-Replicating)?
Contraindicated
128
What is the vaccination recommendation for Pneumococcal Conjugate (PCV15, PCV20)?
One dose
129
What is the recommendation for Pneumococcal Polysaccharide (PPSV23)?
One dose (if conjugate vaccine was PCV-15)
