Vaccination of children with proven HIV infection should take into account their clinical and immunological categories according to the table: N1, N2, N3, A1, A2, AZ ... C1, C2, N3; at not confirmed HIV-status of the child use the letter E before classification (for example, EA2 or EB1, etc.).
The National Calendar lists the method of vaccination for HIV-infected children, but omits mention of BCG for these children - obviously. This vaccine is not injected with HIV, however, it is not prescribed how to vaccinate BCG to HIV-infected children from HIV + mothers.
The main way of infection of children with HIV is perinatal, however, in modern HIV-infected pregnant women, no more than 5-10% of newborns are infected. Since newborns, regardless of whether they are infected or not, have maternal antibodies to HIV in their blood that can persist for 18 months, a diagnosis of HIV infection up to this age is made based on the detection of the virus or its antigen p24 in the blood. Thus, the children of the HIV-infected mother for the vaccine-holding person represent one heterogeneous group, which raises a number of significant problems, in particular the safety and efficacy of different vaccines in children with perinatal HIV infection (ICD B23). As well as the effectiveness of vaccination of non-HIV-infected children (according to the ICD R75), the development of the immune system of which, at least theoretically, could suffer in the body of the HIV-infected mother.
Clinical categories of HIV infection in children under 13 years of age
|
Category |
Manifestations |
|
Asymptomatic - N |
None |
|
Malosymptomnaya-A |
Lymphadenopathy, hepatosplenomegaly, parotitis, dermatitis, recurrent otitis media, chronic diarrhea |
|
Moderately expressed - B |
The first episode of Bact. Meningitis, pneumonia or sepsis, cardiomyopathy, hepatitis, opportunistic infections (CMV, candidiasis, herpes simple or surrounding, complicated chicken pox, toxoplasmosis, leiomyosarcoma, lymphoid pneumonitis, anemia with Hb <80 g / l, neutropenia <1000 in 1 μl, thrombocytopenia <100 000 in 1 μl for 1 month or more) |
|
Heavy - With |
Bacterial infections of multiple localization or recurrent, severe herpesvirus infection, pneumocystis pneumonia, disseminated forms of tuberculosis, histoplasmosis and coccidioidosis, deep mycosis, brain lymphoma, Kaposi's sarcoma, leukoencephalopathy, depletion syndrome |
Killed vaccines
All inactivated vaccines (including anatoxins), recombinant vaccines are administered to children born to HIV-infected mothers, including HIV-infected children, regardless of the stage of the disease and the number of CD4 + lymphocytes. In both groups of children they are safe, the number of side effects does not differ from that of healthy children. The immune response to IPV, diphtheria, and especially tetanus toxoid in HIV + children, differs little from those of children not infected with HIV mothers. The immune response to HBV in HIV-infected children can be reduced: even at a dose of 20 μg according to the 0-1-6 scheme, vaccination did not give protective antibody levels in 22% of children. Thus, DTP and HBV should be administered to all children of HIV-infected mothers within a calendar period, regardless of the severity of clinical manifestations and immunological classification. In addition to calendar vaccinations, it is strongly recommended that active prophylaxis of Hib infection (starting at the age of 3 months), pneumococcal infection (after 2 years) and influenza. The response to the vaccine Act-Hib in all children infected with HIV mothers did not differ from that of healthy mothers. Antibodies to pneumococcal polysaccharides in HIV-infected patients are often initially increased (due to a higher incidence), after administration of Pnevmo23 their titer increased in 81% of children (in uninfected patients it was 91%), although to a lesser extent than in other groups. Vaccination more than 2 times reduces the risk of pneumococcal infection.
In response to influenza vaccine, HIV-infected children develop antibodies as often as their uninfected peers, although their antibody levels are somewhat lower.
Immunization with live vaccines
Live vaccines are administered to children with an established diagnosis of "HIV infection" after an immunological examination to exclude immunodeficiency. In the absence of immunodeficiency, live vaccines are administered in accordance with the Calendar. In the presence of immunodeficiency, the introduction of live vaccines is contraindicated.
Six months after the initial administration of live measles, mumps, rubella vaccine to HIV-infected patients, the level of specific antibodies is assessed and, if they are not present, a repeat dose of the vaccine with a preliminary laboratory control of the immune status is administered.
The safety of vaccination against measles, as well as against rubella and mumps in HIV-infected patients was confirmed by the absence of serious adverse reactions. However, the incidence of seroconversion in HIV-infected children was only 68%, antibody titers were significantly lower than in controls and lost after 6 months. A reduced immune response to LCV was the basis for recommending the introduction of a second dose. HCV is contraindicated in children with moderate and severe immunosuppression, and with clinical category C.
The frequency of seroconversion after the introduction of the rubella vaccine differs little from that of non-infected vaccines, but their antibody levels are lower. Children of category N1 and A1 tolerate the varicella zoster vaccine and give an adequate immune response.
For children infected with HIV, WHO does not recommend vaccinating BCG. Although perinatally infected children with HIV remain immunocompetent for a long time, development of generalized BCG-ita is possible in the case of progression of the process. Moreover, as the experience of countries has shown, where BCG is massively inculcated. Children from HIV + mothers, during the chemotherapy of HIV-infected children, "inflammatory syndrome of the immunological constitution with multiple granulomatous foci develops in 15-25%. WHO does not object to the introduction of BCG to children until their HIV status is identified in regions with high tuberculosis incidence, but it is not possible to identify HIV-infected children, but for regions with such opportunities it is recommended to refrain from introducing BCG until the child's HIV status is established.
The experience of vaccinating children of HIV-infected mothers went smoothly, but new WHO data can not be ignored. At the same time, given the high incidence of tuberculosis in HIV-infected children in such families.