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SMALLPOX VACCINATION WITH HIV INFECTION

SMALLPOX VACCINATION WITH HIV INFECTION. Vaccine response Impact on HIV replication Risk of progressive vaccinia Recs for other live virus vaccines Pediatrics/pregnancy. Smallpox Vaccination with HIV Infection. John G. Bartlett, M.D. Johns Hopkins University. IMMUNE RESPONSE.

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SMALLPOX VACCINATION WITH HIV INFECTION

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  1. SMALLPOX VACCINATION WITH HIV INFECTION Vaccine response Impact on HIV replication Risk of progressive vaccinia Recs for other live virus vaccines Pediatrics/pregnancy

  2. Smallpox Vaccination with HIV Infection John G. Bartlett, M.D. Johns Hopkins University

  3. IMMUNE RESPONSE

  4. IMPACT OF VACCINES ON HIV* Vaccines: influenza, Pneumovax, DT Increase in plasma HIV RNA• Time: 2-8 weeks• Titer: <1 log10 c/ml Effect of HAARTProtective *NEJM 1996;334:1222 Blood 1995;86:1082

  5. MEASLES PNEUMONIA POST MMR (MMWR 1996;45:603) 20-year-old college freshman 9/3/92: 2nd dose MMR 10/2/92: dyspnea—PCP—cured 7/3/93: dyspnea, infiltrates unresponsive to Rx 10/6/93: lung biopsy—measles* Rx: IVIG—stabilized 12/17/93: patient died—no autopsy *Moraten (vaccine) strain

  6. YELLOW FEVER VACCINE Receveur MC, et al. CID 2000;31:7

  7. RISKS OF SMALLPOX VACCINATION

  8. DISSEMINATED VACCINIA IN MILITARY RECRUIT WITH HIV*(19-year-old military recruit) 4/84 - TLC 1500/mm3 5/8 - Smallpox vaccination 5/25 - Crypt. meningitis + thrush + adenopathy; TLC-610 6/8 - New ulcer at vaccination sitedisseminiated pustular rash Bx: vaccinia seen & grown 12/85- Died, no autopsy Redfield R. NEJM 1987;316:673

  9. VACCINE RECOMMENDATIONS: HIV-INFECTED PERSONS BCG Contraindicated Measles Contraindicated (Peds only) Varicella Contraindicated Yellow fever Contraindicated CD4 >200 Polio Inactivated only Typhoid Typhim V1 or inactivated

  10. RECOMMENDATIONS FOR MMR*(MMWR 1996;45:603) Vaccine Passive (outbreaks or exposure): IG

  11. CDC: INTERIM SMALLPOX RESPONSE PLAN AND GUIDELINES DRAFT 2.0 – 11/21/01 Contraindication: conditions that cause immunodeficiency such as HIV Household members: consider housing until lesions healed Face-to-face contact with case: outweighs vaccine risk

  12. National / Selective vaccination Exclude HIV Concerns: 300,000 untested* Contacts: secondary* Ring vaccination Vaccinate all* Must engage HIV community * VIG / Cidofovir

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