Vaccination recommendations for HIV+ adults include hepatitis B, influenza, MMR, pneumococcal, Td and Tdap, and for some adults, hepatitis A, or combined A and B, bacterial meningitis, HPV and meningococcal (Source [1]). Considering that the individual has received some vaccines, has a CD4 count >100 (if lower there would be a contraindication) and works in a center that helps AIDS patients (he is equated to "health personnel") answers 2, 4 and 5 are wrong. All four vaccines in option 1 are administrable. In a little more detail: Vaccine against tetanus and diphtheria: all persons should be vaccinated against these two diseases. Hepatitis B vaccine: hepatitis B and HIV viruses share the same routes of transmission, so it is common for HIV-infected patients to also be infected with hepatitis B virus. It is therefore important to know whether the HIV-infected person has markers of hepatitis B infection and to proceed with vaccination if he/she does not have them. Vaccination against hepatitis A: Hepatitis A in a person with hepatitis B, hepatitis C or other liver disease can be very serious. Since these infections are more frequent in HIV-infected patients, vaccination against hepatitis A is recommended. Vaccination against influenza: influenza in a patient with a lack of immune response is more serious and presents a greater risk of complications, so annual vaccination against this disease is indicated. If the patient's immune status is very deteriorated, the response to vaccination is diminished. In this case, it is essential to vaccinate all the people living with the HIV-infected person to prevent them from transmitting the disease. Pneumococcal vaccine: pneumococcal infections (especially pneumonia) are up to 10 times more frequent in HIV-infected persons than in HIV-uninfected adults, so vaccination is recommended, although in patients with counts below 200/mm3 the protective response is usually not sufficient. They should receive a second dose at 3-5 years of age. HIV-infected children should be vaccinated with pneumococcal conjugate vaccine with the corresponding number of doses according to age. Vaccination against Haemophilus Influenzae type b: this bacterium causes pneumonia and meningitis, especially in children. Although in HIV-infected adults it represents a small number of the causes of infection, vaccination is recommended. Vaccination against measles, rubella and mumps (MMR): all three diseases can become more serious in HIV-infected patients, especially measles, so all of them should be vaccinated, provided that immunosuppression is not severe (count less than 200/mm3).

Vaccination recommendations for HIV+ adults include hepatitis B, influenza, MMR, pneumococcal, Td and Tdap, and for some adults, hepatitis A, or combined A and B, bacterial meningitis, HPV and meningococcal (Source [1]). Considering that the individual has received some vaccines, has a CD4 count >100 (if lower there would be a contraindication) and works in a center that helps AIDS patients (he is equated to "health personnel") [HIDDEN]. [HIDDEN]. In a little more detail: Vaccine against tetanus and diphtheria: all persons should be vaccinated against these two diseases. Hepatitis B vaccine: hepatitis B and HIV viruses share the same routes of transmission, so it is common for HIV-infected patients to also be infected with hepatitis B virus. It is therefore important to know whether the HIV-infected person has markers of hepatitis B infection and to proceed with vaccination if he/she does not have them. Vaccination against hepatitis A: Hepatitis A in a person with hepatitis B, hepatitis C or other liver disease can be very serious. Since these infections are more frequent in HIV-infected patients, vaccination against hepatitis A is recommended. Vaccination against influenza: influenza in a patient with a lack of immune response is more serious and presents a greater risk of complications, so annual vaccination against this disease is indicated. If the patient's immune status is very deteriorated, the response to vaccination is diminished. In this case, it is essential to vaccinate all the people living with the HIV-infected person to prevent them from transmitting the disease. Pneumococcal vaccine: pneumococcal infections (especially pneumonia) are up to 10 times more frequent in HIV-infected persons than in HIV-uninfected adults, so vaccination is recommended, although in patients with counts below 200/mm3 the protective response is usually not sufficient. They should receive a second dose at 3-5 years of age. HIV-infected children should be vaccinated with pneumococcal conjugate vaccine with the corresponding number of doses according to age. Vaccination against Haemophilus Influenzae type b: this bacterium causes pneumonia and meningitis, especially in children. Although in HIV-infected adults it represents a small number of the causes of infection, vaccination is recommended. Vaccination against measles, rubella and mumps (MMR): all three diseases can become more serious in HIV-infected patients, especially measles, so all of them should be vaccinated, provided that immunosuppression is not severe (count less than 200/mm3).

30-year-old HIV (+) homosexual male who participates as a volunteer in an AIDS patient support center. According to his medical history he received diphtheria toxoid (Td) 6 years ago, MMR vaccine in childhood and adolescence, and hepatitis B 3 years ago. He is currently asymptomatic with a CD4 count above 200 cls/microliter. Which vaccines should we recommend?

Seasonal influenza, pneumococcal, tetravalent meningitis and hepatitis A.

Seasonal influenza, Td, pneumococcal and tetravalent meningitis.

Tetravalent meningitis, pneumococcal and seasonal flu.

Td, tetravalent meningitis, pneumococcal.

Triple viral, seasonal flu, pneumococcal.

Vaccination coverage against hepatitis A and B viruses, Streptococcus pneumoniae, seasonal flu, and A(H1N1)2009 pandemic influenza in HIV-infected patients.

Several vaccines are recommended in HIV-infected patients due to an increased risk of vaccine-preventable infections, severe forms of the disease, or shared transmission routes. Few data are available regarding vaccination coverage and its determinants in this population. A cross-sectional study was performed in HIV-infected patients included in a hospital-based cohort in 2011. Vaccination coverage against hepatitis A virus (HAV), hepatitis B virus (HBV), seasonal and A(H1N1)2009 pandemic influenza, and invasive pneumococcal diseases (IPD) were recorded. Factors associated with vaccination were assessed by multivariate logistic regression. 2467 patients were included (median age: 47 years; male gender 71.5%; men having sex with men (MSM): 43.9%; CDC stage C: 24.3%; HBV and/or hepatitis C virus co-infection: 14.4%). Median duration of HIV infection was 10 years and 93.1% of patients received combination antiretroviral therapy. At baseline, the median CD4 count was 527 cells/mm(3) and HIV viral load was <50 copies/mL in 83.3% of cases. Vaccination coverage for HBV, HAV, seasonal influenza, A(H1N1)2009 pandemic influenza, and IPD were 61.9%, 47.4%, 30.9, 48.3%, and 64.6%, respectively. Factors independently associated with vaccination were a younger (HBV) or an older age (influenza), male gender (HBV, HAV), MSM (HBV), CD4 count >200/mm(3) and HIV-RNA <50 copies/mL (IPD, influenza), longer duration of HIV infection (IPD, influenza), and follow-up by an experienced physician (HBV, IPD). Vaccination coverage remained insufficient for all vaccine-preventable infections investigated in this study. Determinants for vaccination were largely not evidence-based, and efforts should be focused on improving physicians' knowledge about guidelines.

Booster policy for adults.

A little over 100 years ago the first vaccines were manufactured. Since this time of success no vaccines have been developed for the great scourges of our time i.e. Malaria, helminthic disease and HIV. The morbidity and mortality rates of pneumococcal infection, influenza, hepatitis B and lately diphtheria are high, while vaccination booster rates among adults are not of acceptable values. The following causes have been taken into consideration: (1) there is no acceptance of the necessity of vaccination (2) physicians themselves do not have sufficiently favourable attitudes towards vaccines to put a special emphasis on vaccination for their patients; (3) Quite often a period of 20-30 years will pass between the time of leaving school (at 18 years) and incidence of major illness (visit to a doctor), so that there is no medical counsel concerning prophylaxis for the adult population; (4) high-risk groups are clearly defined but few of them are properly advised and get proper medical attention. Suggested booster strategies are: (1) professional advisory service for population groups and special schooling for physicians; (2) development of a patient chip card containing information about vaccinations, booster intervals and person's history for every physician; and (3) development of new combined vaccines for adults such as influenza and pneumococcal vaccine alone or in combination with diphtheria and tetanus toxoid.

National Immunisation Program Schedule

The national coverage rate has increased over the last 10 years, as of 2019. National Immunisation Program Schedule Childhood vaccinations Birth Hepatitis B 2 weeks (Can be given from 6 weeks of age) Diphtheria Tetanus Pertussis (whooping cough) Hepatitis B Polio Haemophilus influenzae type b Pneumococcal Rotavirus ("First dose must be given by 14 weeks of age, and the second dose by 24 weeks of age") 4 months Diphtheria Tetanus Pertussis (whooping cough) Hepatitis B, polio Haemophilus influenzae type b Pneumococcal Rotavirus 6 months Diphtheria Tetanus Pertussis (whooping cough) Hepatitis B, polio Haemophilus influenzae type b 12 months Meningococcal ACWY Measles, mumps, rubella (MMR Vaccine) Pneumococcal 18 months Haemophilus influenzae type b Measles, mumps, rubella (MMR Vaccine) Varicella (chickenpox) Diphtheria Tetanus Pertussis (whooping cough) 4 years Diphtheria Tetanus Pertussis (whooping cough) Polio

Antibody response to influenza, tetanus and pneumococcal vaccines in HIV-seropositive individuals in relation to the number of CD4+ lymphocytes.

To establish when the formation of antibodies against T-lymphocyte-dependent and -independent antigens is impaired during HIV infection. Prospective study on antibody formation before and 30 days and 60 days after vaccination with tetravalent influenza vaccine, tetanus toxoid and pneumococcal vaccine; booster with influenza vaccine was administered 30 days after initial vaccination. Outpatient clinic of University Hospital Leiden. Fifty-one HIV-infected individuals and 10 healthy controls. In HIV-infected individuals with < 100 x 10(6)/l CD4+ lymphocytes almost no influenza antibodies were formed; CD4+ counts between 100 and 300 x 10(6)/l correlated with suboptimal antibody formation; CD4+ counts > or = 300 x 10(6)/l yielded more individuals with protective antibody titres. Thirty days after vaccination, protective antibody titres against the four influenza strains had been achieved in 24% of all HIV-infected individuals for A/Beijing (H3N2) (controls, 90%), 59% for A/Taiwan (H1N1) (controls, 80%), 18% for B/Beijing (controls, 30%) and 37% for B/Panama (controls 90%). Booster vaccination after 1 month did not increase antibody levels. Anti-tetanus toxin antibody formation, which is also T-lymphocyte-dependent, was correlated with the number of CD4+ lymphocytes. After pneumococcal vaccination (T-lymphocyte-independent), normal antibody formation was observed in HIV-infected individuals, including those with low CD4+ counts. Influenza vaccination should not be administered to HIV-infected individuals with CD4+ counts < 100 x 10(6)/l; pneumococcal vaccination can be offered to all HIV-infected individuals and a tetanus toxoid booster should be administered when indicated.

Universal Immunisation Programme

Universal Immunisation Programme (UIP) is a vaccination programme launched by the Government of India in 1985. It became a part of Child Survival and Safe Motherhood Programme in 1992 and is currently one of the key areas under National Rural Health Mission since 2005. The programme now consists of vaccination for 12 diseases- tuberculosis, diphtheria, pertussis (whooping cough), tetanus, poliomyelitis, measles, hepatitis B, diarrhoea, Japanese encephalitis, rubella, pneumonia (haemophilus influenzae type B) and Pneumococcal diseases (pneumococcal pneumonia and meningitis). Hepatitis B and Pneumococcal diseases were added to the UIP in 2007 and 2017 respectively. The cost of all the vaccines are borne by the state and the government spent in 2017 to purchase the vaccines to provide them for free.

Infant mortality

Vaccinations The Centers for Disease Control and Prevention (CDC) defines infants as those 1 month of age to 1 year of age. For these infants, the CDC recommends the following vaccinations: Hepatitis B (HepB), Rotavirus (RV), Haemophilus Influenzae type B (HIB), Pneumococcal Conjugate (PCV13), Inactivated Poliovirus (IPV < 18 yrs), Influenza, Varicella, Measles, Mumps, Rubella (MMR), and Diphtheria, tetanus, acellular pertussis (DTapP < 7yrs). Each of these vaccinations are given at particular age ranges depending on the vaccination and are required to be done in a series of 1 to 3 doses over time depending on the vaccination.

Factors associated with poor adherence to vaccination against hepatitis viruses, streptococcus pneumoniae and seasonal influenza in HIV-infected adults.

Vaccination against various pathogens is recommended for HIV positive adults. There are not sufficient data either on vaccination coverage of HIV positive adults or the risk factors associated with poor adherence to routine vaccination. During the period 2004-2014 vaccination coverage of a group of HIV infected adults against hepatitis A virus (HAV), hepatitis B virus (HBV), seasonal influenza virus and pneumococcal disease was recorded. Vaccination coverage was separated into two chronological periods, before and after 2010, as 2010 marks the start of the economic crisis in Greece. 1210 patients were included in our study. Vaccine coverage throughout the study for hepatitis B, hepatitis A, seasonal influenza and pneumococcal infection was 73.6%, 70.4%, 39% and 79%, respectively. The complete lack of insurance coverage was an independent factor of non-compliance in all proposed vaccines (vaccination against pneumococcal disease: OR: 0.82 95%CI: 0.49-1.35, vaccination against HBV: OR: 0.82, 95% CI: 0.45-1.49, vaccination against HAV OR: 0.54, 95%CI: 0.34-0.87, vaccination against influenza: OR: 1.27, 95% CI: 0.76-2.10). In addition, low educational level was associated with poor compliance to vaccination against pneumococcal disease, hepatitis A, hepatitis B, and influenza. Finally, the recommendation for vaccination after the onset of the economic crisis (2010) led to poor compliance to vaccination against HBV, HAV and pneumococcal disease, but not against influenza. In our study, vaccination coverage for vaccine-preventable diseases was found to be insufficient for HIV positive adults in Northern Greece. Also, low educational level, lack of insurance coverage and economic distress have contributed to poor vaccine compliance, leading to poor protection of the HIV positive population and decreased immune coverage in the community.

Mission Indradhanush

It aims to immunise all children under the age of 2 years, as well as all pregnant women, against seven vaccine preventable diseases(like 7 colors of a rainbow/indradhanush). The diseases being targeted are diphtheria, whooping cough, tetanus, poliomyelitis, tuberculosis, measles, meningitis and Hepatitis B. In addition to these, vaccines for Japanese encephalitis and Haemophilus influenzae type B are also being provided in selected states. In 2016, four new additions have been made namely Rubella, Japanese Encephalitis, Injectable Polio Vaccine Bivalent and Rotavirus. In 2017, Pneumonia was added to the Mission by incorporating Pneumococcal conjugate vaccine under Universal Immunisation Programme. Intensified Mission Indradhanush

HIV and pregnancy

Immunizations All pregnant women should receive the inactivated influenza vaccine and the TdaP vaccine, which covers tetanus, diphtheria, and pertussis (whooping cough) during the first trimester, regardless of their HIV status. If a pregnant woman tests positive for HIV, she should also be administered the pneumococcal vaccine, meningococcal vaccine, and Hepatitis A vaccine and Hepatitis B vaccine following a conversation with her provider. Vaccination is important to prevent serious infectious complications associated with the aforementioned diseases, which patients with HIV are at higher risk of contracting. Pregnant women should notably not receive live vaccines, including the Human papilloma virus (HPV) vaccine, measles mumps and rubella (MMR) vaccine, live influenza vaccine, and varicella (Chicken pox) vaccine regardless of their HIV statuses, as these vaccines can potentially harm the fetus.

Causes of Pediatric Meningitis in Botswana: Results From a 16-Year National Meningitis Audit.

Central nervous system infections are an important cause of childhood morbidity and mortality in high HIV-prevalence settings of Africa. We evaluated the epidemiology of pediatric meningitis in Botswana during the rollout of antiretroviral therapy, pneumococcal conjugate vaccine and Haemophilus influenzae type B (HiB) vaccine. We performed a cross-sectional study of children (<15 years old) evaluated for meningitis by cerebrospinal fluid (CSF) examination from 2000 to 2015, with complete national records for 2013-2014. Clinical and laboratory characteristics of microbiologically confirmed and culture-negative meningitis were described and incidence of Streptococcus pneumoniae, H. influenzae and cryptococcal meningitis was estimated for 2013-2014. A total of 6796 unique cases were identified. Median age was 1 year [interquartile range 0-3]; 10.4% (435/4186) of children with available HIV-related records were known HIV-infected. Overall, 30.4% (2067/6796) had abnormal CSF findings (positive microbiologic testing or CSF pleocytosis). Ten percent (651/6796) had a confirmed microbiologic diagnosis; including 26.9% (175/651) Cryptococcus, 18.9% (123/651) S. pneumoniae, 20.3% (132/651) H. influenzae and 1.1% (7/651) Mycobacterium tuberculosis. During 2013-2014, national cryptococcal meningitis incidence was 1.3 cases per 100,000 person-years (95% confidence interval, 0.8-2.1) and pneumococcal meningitis incidence 0.7 per 100,000 person-years (95% confidence interval, 0.3-1.3), with no HiB meningitis diagnosed. Following HiB vaccination, a marked decline in microbiologically confirmed cases of H. influenzae meningitis occurred. Cryptococcal meningitis remains the most common confirmed etiology, demonstrating gaps in prevention-of-mother-to-child transmission and early HIV diagnosis. The high proportion of abnormal CSF samples with no microbiologic diagnosis highlights limitation in available diagnostics.

InternalMed_Harrison

immunization with the 23-valent pneumococcal polysaccharide vaccine is one of the generally recommended prophylactic measures for patients with HIV infection. This is likely most effective if given while the CD4+ T cell count is >200/μL and, if given to patients with lower CD4+ T cell counts, should be repeated once the count has been above 200 for 6 months. Although clear guidelines do not exist, it also makes sense to repeat immunization every 5 years. The incidence of bacterial pneumonia is cut in half when patients quit smoking.

InternalMed_Harrison

Because of the increased risk of infections due to Streptococcus pneumoniae and other bacterial pathogens that cause pneumonia after influenza, the conjugate pneumococcal vaccine (Prevnar 13) followed by the 23-valent polysaccharide vaccine (Pneumovax) as well as influenza vaccine should be administered. The estimated rates of response to influenza vaccine are >80% among persons with asymptomatic HIV infection and <50% among those with AIDS. In general, live attenuated vaccines are contraindicated for persons with immune dysfunction. Because measles (rubeola) can be a severe or lethal infection in HIV-positive patients, these patients should receive the measles vaccine (or the combination MMR vaccine) unless the CD4+ T cell count is <200/μL. Between 18% and 58% of symptomatic HIV-infected vaccinees develop adequate measles antibody titers, and 50–100% of asymptomatic HIV-infected persons seroconvert.

Vaccine Information Statement

Requirements for distribution A VIS must be given prior to vaccination in the United States when a patient is being vaccinated for diphtheria, tetanus, pertussis, measles, mumps, rubella, polio, hepatitis A, hepatitis B, Haemophilus influenzae type b (Hib), influenza, pneumococcal conjugate, meningococcal, rotavirus, human papillomavirus (HPV), or varicella (chickenpox) according to the National Childhood Vaccine Injury Act (NCVIA). The VIS must be given to the person receiving the vaccine or to their parent/legal representative prior to each dose of the vaccine. The "legal representative" is defined as the person who can consent to the vaccination under the laws of the state in which the vaccine is being given. The CDC has also developed VISs for vaccines not covered by the NCVIA, which are recommended for use with these vaccines, and required if the vaccines are purchased under CDC contract under the "duty to warn" clause.

InternalMed_Harrison

Recommended as Standard of Care for Primary and Secondary Prophylaxis Prior bout of PCP Close contact with case of active pulmonary TB Drug resistant Same with high probability of exposure to drug-resistant TB Trimethoprim/sulfamethoxazole (TMP/SMX), 1 DS tablet qd PO TMP/SMX, 1 SS tablet qd PO Aerosolized pentamidine, 300 mg via Respirgard II nebulizer every month TMP/SMX, 1 SS PO daily Human Immunodeficiency Virus Disease: AIDS and Related Disorders All patients, preferably before CD4+ T cell count ≤200/μL Hepatitis B vaccine: 3 doses Hepatitis A vaccine: 2 doses (13) 0.5 mL IM × 1 followed in 8 weeks or more by pneumococcal polysaccharide vaccine (23) if CD4+ T cell count >200/μL Oseltamivir 75 mg PO qd Streptococcus pneumoniae Reimmunize patients initially immunized at a CD4+ T cell count <100/μL whose CD4+ T cell count then increases to >200/μL Human papillomavirus All patients 13–26 years of age HPV vaccine; 3 doses

Pediatrics_Nelson

Routine immunizations are recommended to prevent vaccine-preventable infections but may result in suboptimal immune responses. In addition to heptavalent pneumococcal conjugate vaccine, 23-valent pneumococcal polysaccharide vaccine is recommended for HIV-infected children at 2 years of age and adolescents and adults with CD4 counts at or above 200/mm3. Because of the risk of fatal measles in children with AIDS, children without severe immunosuppression should receive their first dose of MMR at 12 months of age and may receive the booster as soon as 4 weeks later. Varicella zoster virus (VZV) vaccine should be given only to asymptomatic, nonimmunosuppressed children beginning at 12 months of age as two doses of vaccine at least 3 months apart. Inactivated split influenza virus vaccine should be administered annually to all HIV-infected children at or after 6 months of age. HIV-infected children exposed to varicella or measles should receive varicella zoster immune globulin or

Vaccination in Brazil

Routine vaccinations Vaccination coverage includes: For children BCG vaccine, Intradermal, at birth Hepatitis B vaccine, at birth, 1 and 6 months Pentavalent vaccine, DTP (whole cell pertussis component), HB, and Hib, administered at 2, 4, and 6 months, with a booster (DTP) at 15 months and 4 years. Polio vaccine (inactivated), at 2 and 4 months Polio vaccine (oral), at 6 and 15 months Rotavirus vaccine (monovalent oral human rotavirus vaccine) at 2 and 4 months Pneumococcal vaccine 10-valent conjugate vaccine d at 2, 4, 6, and 10 months Yellow fever vaccine at 9 months and booster every 10 years MMR vaccine at 12 months and 4 years Meningococcal vaccine at 3, 5, and 15 months Influenza vaccine, annually MMRV vaccine, after 1 year of age Hepatitis A vaccine, at 0 and 6 to 12 months For adults:

The Green Book (immunisation guidance, UK)

Part two: diseases, vaccinations and vaccines Diseases and their vaccines are listed in alphabetical order and include all vaccines recommended in the routine immunisation programme for all children in the UK. Vaccine requirements for travellers and for contacts of people with infectious disease are included. The 2006 edition incorporated the then new vaccines for meningococcal group C and pneumococcal infections, included the cessation of the school's BCG programme and the introduction of the Hib-MenC booster at 12 months of age. Diseases included: Anthrax Cholera Diphtheria Haemophilus influenzae type b (Hib) Hepatitis A Hepatitis B Influenza Japanese encephalitis Measles Meningococcal Mumps Pertussis Pneumococcal Polio Rabies Rubella Smallpox and vaccinia Tetanus Tick-borne encephalitis Tuberculosis Typhoid Varicella Yellow fever

Pneumococcal conjugate vaccine

Evidence supporting addition to routine vaccination schedules After introduction of the pneumococcal conjugate vaccine in 2000, several studies described a decrease in invasive pneumococcal disease in the United States. One year after its introduction, a group of investigators found a 69% drop in the rate of invasive disease in those of less than two years of age. By 2004, all-cause pneumonia admission rates had declined by 39% (95% CI 22–52) and rates of hospitalizations for pneumococcal meningitis decreased by 66% (95% CI 56.3-73.5) in children younger than 2. Rates of invasive pneumococcal disease among adults have also declined since the introduction of the vaccine. Vaccination in low-income countries

Incidence and risk factors for invasive pneumococcal disease in HIV-positive individuals in the era of highly active antiretroviral therapy.

Invasive pneumococcal diseases (IPDs) remain a significant cause of morbidity and mortality in human immunodeficiency virus (HIV)-positive individuals despite the widespread use of highly active antiretroviral therapy (HAART) and availability of pneumococcal vaccines. The aim of this study was to measure temporal trends in incidence and risk factors for IPD (defined as culture of Streptococcus pneumoniae from blood, cerebrospinal fluid or both) in a cohort of HIV-positive patients attending an ambulatory HIV care centre in Dublin, Ireland over a 10-year period 2006-2015. Incidence of IPD was determined as events per 100,000 person-years' follow-up. Poisson regression was used to assess linear trend in incidence over time. A nested case-control study (four controls per case) was undertaken to assess risk factors for IPD. Forty-seven episodes of IPD were identified in 42 HIV-positive individuals (median [IQR] age 38 years [33-43], 69% male, 86% injecting drug users (IDUs), median CD4 T-cell count 213 cells/mm<sup3</sup) over 16,008 person-years' follow-up (overall incidence rate 293/100,000 person-years). Three patients had two episodes and one patient had three episodes of IPD during the study period. The overall case fatality rate was 15% (95% confidence interval [CI] 4-24%). The incidence of IPD per 100,000 person-years decreased from 728 (95% CI, 455-1002), to 242 (95% CI, 120-365) to 82 (95% CI, 40-154) in calendar periods 2006-2008, 2009-2012 and 2013-2015, respectively (p < 0.01 for linear trend). Older age (p = 0.02), male gender (p = 0.05), detectable HIV viral load (p < 0.01) and non-receipt of pneumococcal vaccine (p = 0.03) were associated with IPD while IDU as risk of acquisition of HIV was of borderline significance (p = 0.06). HIV-positive individuals remain at greater risk of IPD compared to the general population. Pneumococcal vaccine should be seen as a priority to ensure optimal protection for HIV-positive patients.

An audit of pneumococcal and hepatitis vaccination in an outpatient HIV clinic.

HIV-positive adults are at risk of vaccine preventable infections including Streptococcus pneumoniae, hepatitis A virus (HAV) and hepatitis B virus (HBV). Uptake of immunisations in HIV patients is suboptimal despite evidence of efficacy. An audit was made of the vaccination records in 200 adult HIV-positive regular clinic attendees, with a CD4+ count >200 cells μL(-1). Medical records or laboratory data revealed that 10% had been vaccinated against S. pneumoniae; 74% were immune or immunised against HAV; 40% had evidence of natural infection with HBV and 84% of nonimmune patients had been vaccinated. Strategies to improve vaccine uptake are required.

WHO Model List of Essential Medicines

Sera, immunoglobulins and monoclonal antibodies Anti-rabies virus monoclonal antibodies Antivenom immunoglobulin Diphtheria antitoxin Equine rabies immunoglobulin Vaccines Recommendations for all BCG vaccine Diphtheria vaccine Haemophilus influenzae type b vaccine Hepatitis B vaccine Human papilloma virus (HPV) vaccine Measles vaccine Pertussis vaccine Pneumococcal vaccine Poliomyelitis vaccine Rotavirus vaccine Rubella vaccine Tetanus vaccine Recommendations for certain regions Japanese encephalitis vaccine Tick-borne encephalitis vaccine Yellow fever vaccine Recommendations for some high-risk populations Cholera vaccine Dengue vaccine Hepatitis A vaccine Meningococcal meningitis vaccine Rabies vaccine Typhoid vaccine Recommendations for immunization programmes with certain characteristics Influenza vaccine (seasonal) Mumps vaccine Varicella vaccine

[Which are the vaccines that human immunodeficiency virus infected patients must receive?].

Patients with aids are at increased risk of opportunistic and non opportunistic infections. It is now known that the incidence can be reduced by prophylactic measures and/or the use of vaccines. HIV infection produces an elevated frequency of severe pneumococcal disease with a rate of bacteriemia caused by Streptococcus pneumoniae 150-300 fold greater than rates reported in non-HIV infected people. For this reason, pneumococcal vaccine should be administered as early as possible in the course of the infection. Besides, the antibody response may be significantly higher for asymptomatic persons. Acute hepatitis caused by hepatitis B virus is milder than in non HIV infected patients but chronic disease is more frequent. The prognosis is worse and there is higher risk for infecting another persons. Hepatitis B vaccine is indicated for all the patients with HIV and negative serology for hepatitis B virus. Influenza vaccine is of limited effectiveness due to the high variability of the virus. Besides, influenza incidence is low among approximately young adults, HIV related immunodeficiency increased influenza risk only minimally, the vaccine is administered yearly and HIV-replication can increase in temporal association with vaccination. For all these reasons, fewer hospitalizations and deaths are prevented making it a far less cost-effective prevention strategy than pneumococcal vaccination. The risk of Haemophilus influenzae infections is elevated, but the vaccine is not routinely recommended because the more frequent serotype in HIV infected patients is b. For these subjects, passive immunization with immunoglobulin may also be necessary to provide protection. In conclusion, pneumococcal and hepatitis B vaccination is a reasonable prevention strategy for HIV infected patients at all stages of immunodeficiency. Influenza and H. influenzae vaccination are not recommended and alternative prevention strategies may be done.

Surveillance of Vaccination Coverage Among Adult Populations -United States, 2018.

Adults are at risk for illness, hospitalization, disability and, in some cases, death from vaccine-preventable diseases, particularly influenza and pneumococcal disease. CDC recommends vaccinations for adults on the basis of age, health conditions, prior vaccinations, and other considerations. Updated vaccination recommendations from CDC are published annually in the U.S. Adult Immunization Schedule. Despite longstanding recommendations for use of many vaccines, vaccination coverage among U.S. adults remains low. August 2017-June 2018 (for influenza vaccination) and January-December 2018 (for pneumococcal, herpes zoster, tetanus and diphtheria [Td]/tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis [Tdap], hepatitis A, hepatitis B, and human papillomavirus [HPV] vaccination). The National Health Interview Survey (NHIS) is a continuous, cross-sectional national household survey of the noninstitutionalized U.S. civilian population. In-person interviews are conducted throughout the year in a probability sample of households, and NHIS data are compiled and released annually. NHIS's objective is to monitor the health of the U.S. population and provide estimates of health indicators, health care use and access, and health-related behaviors. Adult receipt of influenza, pneumococcal, herpes zoster, Td/Tdap, hepatitis A, hepatitis B, and at least 1 dose of HPV vaccines was assessed. Estimates were derived for a new composite adult vaccination quality measure and by selected demographic and access-to-care characteristics (e.g., age, race/ethnicity, indication for vaccination, travel history [travel to countries where hepatitis infections are endemic], health insurance status, contacts with physicians, nativity, and citizenship). Trends in adult vaccination were assessed during 2010-2018. Coverage for the adult age-appropriate composite measure was low in all age groups. Racial and ethnic differences in coverage persisted for all vaccinations, with lower coverage for most vaccinations among non-White compared with non-Hispanic White adults. Linear trend tests indicated coverage increased from 2010 to 2018 for most vaccines in this report. Few adults aged ≥19 years had received all age-appropriate vaccines, including influenza vaccination, regardless of whether inclusion of Tdap (13.5%) or inclusion of any tetanus toxoid-containing vaccine (20.2%) receipt was measured. Coverage among adults for influenza vaccination during the 2017-18 season (46.1%) was similar to the estimate for the 2016-17 season (45.4%), and coverage for pneumococcal (adults aged ≥65 years [69.0%]), herpes zoster (adults aged ≥50 years and aged ≥60 years [24.1% and 34.5%, respectively]), tetanus (adults aged ≥19 years [62.9%]), Tdap (adults aged ≥19 years [31.2%]), hepatitis A (adults aged ≥19 years [11.9%]), and HPV (females aged 19-26 years [52.8%]) vaccination in 2018 were similar to the estimates for 2017. Hepatitis B vaccination coverage among adults aged ≥19 years and health care personnel (HCP) aged ≥19 years increased 4.2 and 6.7 percentage points to 30.0% and 67.2%, respectively, from 2017. HPV vaccination coverage among males aged 19-26 years increased 5.2 percentage points to 26.3% from the 2017 estimate. Overall, HPV vaccination coverage among females aged 19-26 years did not increase, but coverage among Hispanic females aged 19-26 years increased 10.8 percentage points to 49.6% from the 2017 estimate. Coverage for the following vaccines was lower among adults without health insurance compared with those with health insurance: influenza vaccine (among adults aged ≥19 years, 19-49 years, and 50-64 years), pneumococcal vaccine (among adults aged 19-64 years at increased risk), Td vaccine (among all age groups), Tdap vaccine (among adults aged ≥19 years and 19-64 years), hepatitis A vaccine (among adults aged ≥19 years overall and among travelers aged ≥19 years), hepatitis B vaccine (among adults aged ≥19 years and 19-49 years and among travelers aged ≥19 years), herpes zoster vaccine (among adults aged ≥60 years), and HPV vaccine (among males and females aged 19-26 years). Adults who reported having a usual place for health care generally reported receipt of recommended vaccinations more often than those who did not have such a place, regardless of whether they had health insurance. Vaccination coverage was higher among adults reporting ≥1 physician contact during the preceding year compared with those who had not visited a physician during the preceding year, regardless of whether they had health insurance. Even among adults who had health insurance and ≥10 physician contacts during the preceding year, depending on the vaccine, 20.1%-87.5% reported not having received vaccinations that were recommended either for all persons or for those with specific indications. Overall, vaccination coverage among U.S.-born adults was significantly higher than that of foreign-born adults, including influenza vaccination (aged ≥19 years), pneumococcal vaccination (all ages), tetanus vaccination (all ages), Tdap vaccination (all ages), hepatitis B vaccination (aged ≥19 years and 19-49 years and travelers aged ≥19 years), herpes zoster vaccination (all ages), and HPV vaccination among females aged 19-26 years. Vaccination coverage also varied by citizenship status and years living in the United States. NHIS data indicate that many adults remain unprotected against vaccine-preventable diseases. Coverage for the adult age-appropriate composite measures was low in all age groups. Individual adult vaccination coverage remained low as well, but modest gains occurred in vaccination coverage for hepatitis B (among adults aged ≥19 years and HCP aged ≥19 years), and HPV (among males aged 19-26 years and Hispanic females aged 19-26 years). Coverage for other vaccines and groups with Advisory Committee on Immunization Practices vaccination indications did not improve from 2017. Although HPV vaccination coverage among males aged 19-26 years and Hispanic females aged 19-26 years increased, approximately 50% of females aged 19-26 years and 70% of males aged 19-26 years remained unvaccinated. Racial/ethnic vaccination differences persisted for routinely recommended adult vaccines. Having health insurance coverage, having a usual place for health care, and having ≥1 physician contacts during the preceding 12 months were associated with higher vaccination coverage; however, these factors alone were not associated with optimal adult vaccination coverage, and findings indicate missed opportunities to vaccinate remained. Substantial improvement in adult vaccination uptake is needed to reduce the burden of vaccine-preventable diseases. Following the Standards for Adult Immunization Practice (https://www.cdc.gov/vaccines/hcp/adults/for-practice/standards/index.html), all providers should routinely assess adults' vaccination status at every clinical encounter, strongly recommend appropriate vaccines, either offer needed vaccines or refer their patients to another provider who can administer the needed vaccines, and document vaccinations received by their patients in an immunization information system.

Implementation of EACS vaccination recommendations among people living with HIV.

With modern combination antiretroviral Treatment (cART) a normal life expectancy among people living with HIV (PLWH) has become reality if started early enough prior to the onset of more pronounced immunodeficiency. Therefore, prevention measures against other infectious diseases among this vulnerable group have gained increased attention. Indeed, the EACS guidelines recommend vaccinations against HAV, HBV, HPV, Influenza, Neisseria meningitidis, Streptococcus pneumoniae and VZV in HIV-infected adults. All PLWH under cART attending our ID outpatient clinic between April to June 2018, were assessed during consultation for vaccination status regarding pneumococcus, Hepatitis A and B, influenza, varicella, meningococcus and HPV using a pre-defined questionnaire, vaccination certificates and medical records. In addition, the cohort database was screened for Hepatitis A and B serology and HIV surrogate markers. A total of 305 PLWH (82.3% male, 17.7% female) was included, median age was 48 years (IQR 47-51). Median CD4 + T cell count was 543 (IQR 304-770), and for 297 (97.4%) PLWH CD4 + T cell count was ≥ 200/ul. The viral load was undetectable (< 40 copies/ml) in 289 (94.8%) cases. Highest vaccination rates were observed for HAV (87.4%), Streptococcus pneumoniae (77.4%) and Influenza (76.5%). 64.3% PLWH got vaccinated against HBV, whereas VZV vaccination only played a minor role, in the context of the high rate of cleared infections (99.0%). Lowest vaccination rates were detected for HPV (0%) and Neisseria meningitidis (3.0%). Our data suggest that vaccination rates among PLWH are higher compared to the general German population. Implementation of EACS guidelines into daily routine though is not fully executed and the need for improving vaccination rates has to be emphasized. Centrally organized vaccination registers as well as electronic medical records could be helpful tools to detect a lack of vaccination coverage and send digital vaccination reminders particularly among risk groups.

Pneumococcal vaccine

Pneumococcal vaccines are vaccines against the bacterium Streptococcus pneumoniae. Their use can prevent some cases of pneumonia, meningitis, and sepsis. There are two types of pneumococcal vaccines: conjugate vaccines and polysaccharide vaccines. They are given by injection either into a muscle or just under the skin. The World Health Organization (WHO) recommends the use of the conjugate vaccine in the routine immunizations given to children. This includes those with HIV/AIDS. The recommended three or four doses are between 71 and 93% effective at preventing severe pneumococcal disease. The polysaccharide vaccines, while effective in healthy adults, are not effective in children less than two years old or those with poor immune function. These vaccines are generally safe. With the conjugate vaccine about 10% of babies develop redness at the site of injection, fever, or change in sleep. Severe allergies are very rare.

Invasive pneumococcal disease in a cohort of HIV-infected adults: incidence and risk factors, 1990-2003.

To investigate the association between the introduction of HAART and invasive pneumococcal disease (IPD) in HIV-infected patients. Incidence of IPD was determined from 1990 to 2003 in a cohort of HIV-infected individuals and a nested case-control study assessed risk factors of IPD. There were 72 cases over 19,020 person-years of follow-up (overall IPD rate, 379/100,000 person-years). In the calendar periods 1990-1995, 1995-1998, and 1998-2003, the IPD incidence per 100,000 person-years was 279 [95% confidence interval (CI), 150-519], 377 (95% CI, 227-625) and 410 (95% CI, 308-545), respectively (P = 0.516). CD4 cell count < 200 cells/microl [odds ratio (OR), 3.0; 95% CI, 1.2-7.6), HIV RNA > 50,000 copies/ml (OR, 2.8; 95% CI, 1.2-6.5), hepatitis C (OR, 4.9; 95% CI, 1.7-14.9), serum albumin (OR, 0.1; 95% CI, 0.04-0.5), injection drug use in women (OR, 3.8; 95% CI, 1.6-8.8), and education beyond high school (OR, 0.2; 95% CI, 0.05-0.8) were significantly associated with IPD in multivariate analysis. No treatment factor, including HAART (OR, 0.7; 95% CI, 0.3-1.5) and pneumococcal vaccination (OR, 0.9; 95% CI, 0.5-1.6), was associated with IPD. IPD incidence did not change significantly during the widespread dissemination of HAART in this cohort. IPD risk was associated with several sociodemographic and clinical factors.

Vaccine Damage Payment

The vaccination must have been for one of the following diseases: diphtheria tetanus pertussis (whooping cough) poliomyelitis measles mumps rubella (German measles) tuberculosis (TB) haemophilus influenzae type B (HIB) meningococcal group C (meningitis C) pneumococcal infection human papillomavirus pandemic influenza A (H1N1) 2009 (swine flu) - up to 31 August 2010 smallpox - up to 1 August 1971 Coronavirus (COVID-19) The vaccination must also have been administered before the claimant's 18th birthday, unless the vaccination was administered during an outbreak of disease in the United Kingdom or the Isle of Man, or if it was a vaccine for poliomyelitis, rubella, Meningococcal Group C, human papillomavirus, pandemic influenza A (H1N1) 2009 (swine flu) or COVID-19. The vaccination must have been administered in the United Kingdom or the Isle of Man, or as part of Armed Forces medical treatment.

Community-Acquired Pneumococcal Pneumonia in Virologically Suppressed HIV-Infected Adult Patients: A Matched Case-Control Study.

The study aimed to investigate whether the clinical presentations and outcomes (length of stay, ICU admission, and 30-day mortality) of pneumococcal pneumonia in virologically suppressed patients who were HIV-infected on ART with a CD4+ T-cell count > 350 cells/mm<sup3</sup are comparable to those seen in patients with HIV, using a case-control design. A case-control study was carried out in Hospital Clinic, Barcelona, Spain (2001-2016). Control patients were matched by age (±10 years), sex, comorbidities, and pneumonia diagnosis in the same calendar period. Clinical presentation and outcomes of pneumococcal pneumonia in patients who were and were not infected with HIV were compared. Pneumococcal pneumonia was studied in 50 cases (HIV infection) and 100 control patients (non-HIV infection). Compared with the control patients, case patients had higher rates of influenza (14% vs 2%, P = .007) and pneumococcal vaccination (10% vs 1%, P = .016). The group of cases also presented a higher rate of coinfection with hepatitis B virus (6% vs 0%, P = .036). Both groups presented similar ICU admission (18% vs 27%, P = .22), need for mechanical ventilation (12% vs 8%; P = .43), length of stay (7 days vs 7 days, P = .76), and 0% of 30-day mortality. No evidence was found of a more severe presentation or a worse clinical outcome in cases than in control patients. Pneumococcal pneumonia episodes requiring hospitalization in virologically suppressed patients with HIV with > 350 CD4+ T-cell count/mm<sup3</sup were neither more severe nor had worse prognosis compared with uninfected patients. These results support the fact that such patients do not need treatment, admission, or care sites different to the general population. ClinicalTrials.gov; No. 2009/5451; URL: www.clinicaltrials.gov.

WHO Model List of Essential Medicines for Children

Immunologicals Diagnostic agents Tuberculin, purified protein derivative (PPD) Sera and immunoglobulins Antivenom immunoglobulin Diphtheria antitoxin Vaccines BCG vaccine Diphtheria vaccine Haemophilus influenzae type b vaccine Hepatitis B vaccine HPV vaccine Measles vaccine Pertussis vaccine Pneumococcal vaccine Poliomyelitis vaccine Rotavirus vaccine Rubella vaccine Tetanus vaccine Japanese encephalitis vaccine Yellow fever vaccine Tick-borne encephalitis vaccine Cholera vaccine Dengue vaccine Hepatitis A vaccine Meningococcal meningitis vaccine Rabies vaccine Typhoid vaccine Influenza vaccine Mumps vaccine Varicella vaccine Muscle relaxants (peripherally-acting) and cholinesterase inhibitors Neostigmine Suxamethonium Vecuronium Pyridostigmine Ophthalmological preparations Anti-infective agents Aciclovir Azithromycin Erythromycin Gentamicin Natamycin Ofloxacin Tetracycline Anti-inflammatory agents Prednisolone

Medical exclusion of immigrants

Vaccinations The vaccination requirement includes the following vaccinations: Mumps, Measles, Rubella, Tetanus, diphtheria, Meningococcal disease, Pneumococcal disease, Haemophilus influenzae type B, Rotavirus, Varicella, Influenza, Hepatitis A and B, Pertussis, and Polio. These requirements are established by the Advisory Committee on Immunization Practices (ACIP). Examination The examination “consists of a physical examination, an evaluation (skin test/chest x-ray examination) for tuberculosis, and blood test for syphilis”. All immigrants are required to have this examination conducted by a panel physician overseas before they come to America. Foreign nationals pay for their own exam but the cost is covered by the US government for refugees. I-693, the Report of Medical Examination and Vaccination Record, is used to report the medical examination to officials. There is no filing fee for the I-693 form.

Immunization histories given by adult caregivers accompanying children 3-36 months to the emergency department: are their histories valid for the Haemophilus influenzae B and pneumococcal vaccines?

To obtain immunization histories from adult caregivers accompanying children to the emergency department (ED), to determine the accuracy of the caregiver's report for the Haemophilus influenzae B (Hib)and 7-valent pneumococcal vaccine (PCV7). This was a prospective, observational study of children age 3 to 36 months presenting to the Albert Einstein Medical Center ED during the period of November 1, 2004, through January 31, 2005. Caregivers were asked to complete a questionnaire about their child's immunization status and if the child's vaccinations were up-to-date. Immunization records were obtained from the child's most recent primary care physician (PCP) to determine whether the caregiver's report was correct for PCV7 and Hib. Children were considered delayed if they were more than 30 days past due date for one or both vaccines according to the PCP records. Of 205 PCP offices contacted, we were able to obtain 173 immunization records for our analysis. Examination of vaccine records showed that 109 (63.0%) of the 173 children were up-to-date on both immunizations. When the child's caregiver was asked if shots were up-to-date, 159 (91.9%) of 173 said that all shots were given, and only 14 (8.1%) of 173 reported being behind schedule. Of the adults reporting the child up to date, 105 (66.0%) of the 159 children were confirmed to be up-to-date. Thus, 34.0% of caregivers were incorrect in stating that their child's immunization status was up-to-date for both these vaccines. Caregiver report was determined to be inaccurate for Hib and PCV7. Despite 91.5% of caregivers stating that shots were up-to-date, only 66.0% were correct that their child was up-to-date with these 2 vaccines. The ED physician should use caution in making clinical decisions based on the history given by a caregiver regarding their child's immunization status.

Managing vaccines: defining the remit of primary care and specialist HIV clinics in the delivery of immunization to individuals with HIV infection.

The British HIV Association (BHIVA) has published guidelines for immunization of HIV-infected adults. A chart review of 200 HIV-infected patients diagnosed was conducted to determine shortcomings in previous practice and determine which vaccines should routinely be given in specialist HIV clinics and which might be able to be delegated to primary care clinics. Data were collected on administration of three categories of vaccinations: (1) vaccines used in all individuals with chronic disease (pneumococcal, influenza, swine flu H1N1); (2) targeted vaccinations used in non-immune individuals with HIV who are at risk of exposure (hepatitis A and hepatitis B); (3) routine vaccines traditionally delivered to the whole population (measles/mumps/rubella [MMR], diphtheria/tetanus/pertussis and meningitis C/ACWY). Pneumococcal vaccine was delivered to 54% of eligible patients, 52% of eligible individuals completed a full hepatitis B programme of vaccination and 21% (42/200) were naturally immune; hepatitis A vaccine was delivered to 36% of eligible individuals. With increasing demands on resources, it seems likely that HIV services will have to harness resources of primary care in vaccine programmes in relation to routine vaccines. By improving communication between primary and secondary care mistakes with live vaccination decisions could be avoided; HIV services should continue to perform targeted and chronic disease vaccines, i.e. for category 1 and category 2 vaccines.