Vaccination of HIV infected children (UK schedule, 2018)

Abbreviation list
DTaP/IPV/Hib – diphtheria/tetanus/acellular pertussis/inactivated polio vaccine/ Haemophilus
influenzae type b

DTaP/IPV or dTaP/IPV - diphtheria/tetanus/acellular pertussis/inactivated polio vaccine

“D” - vaccines containing the higher dose of diphtheria toxoid (contain not less than 30IU)

“d” - vaccines containing the lower dose of diphtheria toxoid (contain approximately 2IU)

PCV13 – 13-valent pneumococcal conjugate vaccine

Hib/MenC - Haemophilus influenzae type b and Neisseria meningitidis capsular group C

conjugate vaccine

MenC - meningococcal capsular group C conjugate vaccine

4CMenB – multicomponent meningococcal capsular group B protein vaccine

LAIV – live attenuate influenza vaccine

MMR – measles, mumps, rubella vaccine

HPV – human papilloma virus vaccine

MenACWY – quadrivalent meningococcal capsular groups A, C, W and Y conjugate vaccine

Hep A&B – combined hepatitis A and hepatitis B vaccine

BCG - Bacillus Calmette–Guérin vaccine

QIV – quadrivalent inactivated influenza vaccine

Table 1. Routine childhood immunisations (2018)

Age Diseases protected against Vaccine given Trade name Usual site

Eight weeks old Diphtheria, tetanus, pertussis, DTaP/IPV/Hib/HepB Infanrix hexa Thigh
polio, Haemophilus influenzae
type b (Hib) and hepatitis B

Meningococcal group B (MenB) MenB Bexsero Left thigh

Rotavirus gastroenteritis Rotavirus Rotarix By mouth

Pneumococcal (13 serotypes) PCV Prevenar 13 Thigh

Twelve weeks old Diphtheria, tetanus, pertussis, DTaP/IPV/Hib/HepB Infanrix hexa Thigh
polio, Hib and hepatitis B

Rotavirus Rotavirus Rotarix By mouth

Sixteen weeks Diphtheria, tetanus, pertussis, DTaP/IPV/Hib/HepB Infanrix hexa Thigh
old polio, Hib and hepatitis B

Men B MenB Bexsero Left thigh

Pneumococcal (13 serotypes) PCV Prevenar 13 Thigh

Six months and Influenza QIV Thigh
older ≥6 months – 2
years

LAIV
≥2 years old Fluenz Tetra Both
Consult annual DoH nostrils
guidance

One year old Hib and MenC Hib/MenC Menitorix Upper

(on or after the arm/thigh
child’s first Pneumococcal PCV Prevenar 13 Upper
birthday) arm/thigh
Measles, mumps & rubella MMR* MMR Upper
VaxPRO or arm/thigh
Priorix
Chicken pox VZV* (2nd dose Varivax Upper
given ≥2m) arm/thigh

Men B MenB Bexsero Left thigh

3 years 4 months Diphtheria, tetanus, pertussis DTaP/IPV Infanrix IPV Upper arm
old or soon after and polio or Repevax
Measles, mumps and rubella MMR Upper arm
 MMR* (check first VaxPRO or
dose given) Priorix

12 – 13 years old Cervical cancer caused by HPV x 3 doses Gardasil Upper arm
(females & human papillomavirus (HPV) (0, 1, 6 months)
males) types 16 &18; genital warts
caused by types 6 & 11
14 years old Tetanus, diphtheria and polio dTaP/IPV (check Revaxis Upper arm
(school year 9) MMR
Meningococcal groups status) Nimenrix or Upper arm
A, C, W, Y disease MenACWY Menveo

Hepatitis A and B Hep A and B, Twinrix or Upper arm

booster dose or Ambirix
primary course (if
previously
unimmunised)

Notes:
1. All infants should follow the UK primary childhood immunization schedule. The primary immunization should
NOT be delayed.
2. Children should not receive BCG.
3. If HAART is indicated for the older children with absent or non-protective antibody levels – vaccination should
be delayed until ~ 6 months of VL<50 and CD4>15%.
4. MMR*, VZV* or LAIV*should be postponed if there is severe immunosuppression (see Table 2 below).
Also, avoid live vaccines if there is a severely immunocompromised household member, however consider
the vaccination as soon as immune reconstitution is achieved on HAART. QIV should be given in place of LAIV.
5. VZV and MMR can be given either on the same day, or at a four week interval (2014, PHE recommendations).
6. VZV vaccine should be offered for VZV seronegative children over 1 year of age. 2 doses at least 2 months apart.
7. Flu. Live attenuated influenza vaccine (LAIV) should be given annually to children 2 years of age
and older. If there is a severely immunocompromised household member, administer an injected QIV vaccine
instead.
8. HBV course is included for babies as part of the routine NHS childhood vaccination programme from September
2018. Combined HAV/HBV vaccine should be considered in children over 1 year if previously unimmunized. All
children should receive as adolescents a booster dose or full vaccination course (combined Hep A&B) if
previously unimmunized. Consider giving earlier if at particular risk.
9. 2 doses of PCV13 should be offered to all age groups if previously unimmunized. The use of PPV is
controversial in this context and not included in this guideline.
10. Men B is included for babies as part of the routine NHS childhood vaccination programme from September 1
2015. The vaccine could also be considered for all ages if previously unimmunized (see table 1 for recommended
dosing schedule, “incomplete or uncertain immunization status guidance”).
11. HPV. Quadrivalent vaccine (Gardasil), 3 doses, should be offered to both females and males.

Further information on immunisation can be found:

- “Guidance on vaccination of HIV-infected children in Europe”. Paediatric European Network for
Treatment of AIDS (PENTA) Vaccines Group. HIV Med. 2012.
- Immunisation against infectious diseases GOV.UK, The Green Book. Routine Childhood Immunisations,
Autumn 2018.
Table 2. Indicators of severe immunosupression (CDC, 1994)
Age CD4 count CD4%
<12 months < 750 < 15%
1 – 5 years < 500 < 15%
≥ 6 years < 200 < 15%

Table 3. Consider serology (can be performed at time of annual reviews) and if seronegative,
immunise accordingly, see the “incomplete or uncertain immunisation guidelines” 2018

When? Which?
Baseline serology, if uncertain/incomplete Diphtheria, tetanus, MenC, Hib, PCV, VZV, HepA/B, MMR
immunisation (eg, new arrival) If seronegative, immunise accordingly
~ 16 – 18 months PCV, Hib, MenC, VZV, HepB
(at least 4 -6 weeks after primary booster immunisation) If seronegative, give booster immunisation accordingly
3 – 5 years old Measles, rubella, tetanus, diphtheria
(at least 4-6 weeks after pre-school boosters) If seronegative, give booster immunisation accordingly
13 – 18 years old Hep A&B, measles, rubella, Men C, tetanus, diphtheria
(at least 4-6 weeks after boosters) If seronegative, give booster immunisation accordingly
Pre-primary HBV vaccination HepBsAg, HepBsAb, HepBcAb (if any serology positive discuss with
Network hub re: further investigation/management)
HepBsAb (ideally >100 IU/L. If <10 IU/L after primary course, repeat
6-8 weeks post 3rd dose HBV primary course and repeat serology at 6-8 weeks. If continued failure of
adequate serological response see BHIVA adult immunisation guideline
and discuss with Network hub. If >10 but <100 IU/L after primary course,
offer one booster vaccine and recheck serology after 6-8 weeks)

Notes.
1. If boosters are given, check serology at least 4 -6 weeks following immunisation.
2. If children are not on HAART, they are unlikely to make optimal responses. Repeat serology is not recommended
3. Repeat serology when on HAART for 6 – 12 months and re-immunise accordingly.
4. Check VZV and MMR serology following completion of the immunization and if no evidence of seroconversion
after 2 doses - arrange the 3rd dose. If still seronegative after the 3rd dose of MMR or VZV vaccines, no
further booster immunisation is recommended.
5. For PCV serology, serotype specific antibodies against pneumococcal serotypes included in the PCV13 should be
requested
6. Serology results may be taken into account but it should be noted that correlates of protection are not well
established in the paediatric HIV infected population.