HIV infection
- Patients with HIV have both increased susceptibility to infection and an altered response to vaccination.
- Caution is needed with live vaccines.
- Current National Health and Medical Research Council (NHMRC) guidelines are that yellow fever and live attenuated typhoid vaccination are contraindicated.
- Inactivated poliomyelitis vaccine (IPV) is preferable to oral polio vaccine.
- Measles, mumps, rubella vaccine has been used in HIV infected children without evidence of harm, but has caused disease in adults.
- Vaccines without live organisms such as hepatitis A, polysaccharide typhoid vaccines and hepatitis B are safe but efficacy may be lessened.
- Other killed vaccines for travel are also safe.
- The NHMRC recommendation is to give double the normal dose of hepatitis B vaccine at the normal dosage intervals.
- As well as vaccination, passive protection against hepatitis A with human immune globulin may be indicated.
- Annual influenza vaccination is recommended. Response rates in HIV are around 80% and less than 50% in those with AIDS.
- Pneumococcal vaccine is also recommended for HIV infected adults and children over two years.
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Immune status
- Travellers on short courses of corticosteroids (less than 2 weeks) are immunocompetent.
- Patients with surgical or functional asplenia are at increased risk of malaria and ideally should avoid travel to malaria endemic areas.
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