CDC guidelines include HIV recommendations

No MMR vaccine if severely compromised

Health care workers who have evidence of severe immunosuppression due to HIV infection should not receive measles-mumps-rubella (MMR) vaccine, according to guidelines recently released by the U.S. Centers for Disease Control and Prevention.1 (See Table 4, p. 45, for specific information on this, other immune-compromising conditions, and pregnancy.)

Studies of MMR immunization in both asymptomatic and symptomatic HIV-infected people without evidence of severe immunosuppression documented no serious adverse events after vaccination, the guidelines point out. Because HIV-infected people are at increased risk for severe complications from measles, MMR vaccine is recommended for all asymptomatic HIV-infected HCWs with no evidence of severe immunosuppression.

"If you've got a healthy worker who comes to you like anybody else and you don't know his HIV status, you don't need to check it to give measles vaccine," says Raymond A. Strikas, MD, a medical epidemiologist in the CDC's National Immunization Program and co-author of the guidelines. "If they're healthy and they don't know they've got HIV infection, they can safely receive it. But if you've got someone who's obviously very ill, you're going to try to find out why, and you probably wouldn't give them live virus vaccine anyway. So, practically speaking, if an employee shows up in your office walking and talking and looking just fine and is not under medical care for anything, there should not be an issue."

As the guidelines state, measles vaccine is not recommended for HIV-infected HCWs who are severely immune-suppressed because:

· A case of progressive measles pneumonia was reported after administration of MMR vaccine to a person with severe immunosuppression from AIDS.

· Measles incidence in the United States is currently low.

· Vaccination-related morbidity was reported in severely immune-compromised people who were not HIV-infected.

· Severely immune-compromised HIV-infected people have a diminished antibody response to measles vaccination.

HCWs who are immune-suppressed due to HIV or other conditions should determine with their physicians whether the benefits of vaccination outweigh its risks, as well as the risks of exposure to vaccine-preventable diseases.

Other vaccination recommendations for HIV-infected HCWs include:

· In general, no live-virus or live-bacterial vaccines should be administered.

· Enhanced inactive poliovirus vaccine is the only poliovirus vaccine recommended.

· Influenza and pneumococcal vaccines are indicated for all HIV-infected persons.

Reference

1. Centers for Disease Control and Prevention. Immunization of health-care workers: Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR 1997; 46(No. RR-18):1-42.