Adverse events after vaccination among HIV-positive persons, 1990–2016

Abstract

Human immunodeficiency virus (HIV) causes immune dysregulation, potentially affecting response to vaccines in infected persons. We investigated if unexpected adverse events (AEs) or unusual patterns of AEs after vaccination were reported among HIV-positive persons. We searched for domestic reports among HIV-positive persons to the Vaccine Adverse Event Reporting System (VAERS) during 1990–2016. We analyzed reports by age group (<19 and ≥19 years), sex, serious or non-serious status, live vaccine type (live versus inactivated), AEs reported, and CD4 counts. Of 532,235 reports received, 353 (0.07%) described HIV-positive persons, of whom 67% were aged ≥19 years, and 57% were male; most reports (75%) were non-serious. The most commonly reported inactivated vaccines were pneumococcal polysaccharide (27%) and inactivated influenza (27%); the mostly reported common live virus vaccines were combination measles, mumps, and rubella (8%) and varicella (6%). Injection site reactions were commonly reported (39%). Of 67 reports with CD4 counts available, 41 (61%) described persons immunocompromised at time of vaccination (CD4 count <500 cells/mm3), and differed from overall reports only in that varicella was the most common live virus vaccine (4 reports). Of 22 reports describing failure to protect against infection, 6 described persons immunocompromised at time of vaccination, among whom varicella vaccine was most common (3 reports). Of 66 reports describing live virus vaccines, 7 described persons with disseminated infection: 6 had disseminated varicella, 3 of whom had vaccine strain varicella-zoster virus. Of 18 reported deaths, 7 resulted from disseminated infection: 6 were among immunocompromised persons, 1 of whom had vaccine strain varicella-zoster virus. We identified no unexpected or unusual patterns of AEs among HIV-positive persons. These data reinforce current vaccine recommendations for this risk group. However, healthcare providers should know their HIV-positive patients’ immune status because immunocompromising conditions can potentially increase the risk of rare, but severe, AEs following vaccination with live virus vaccines.

Measles Vaccine Virus RNA in Children More Than 100 Days after Vaccination

“…Being a live virus vaccine, administration of the measles vaccine is contraindicated for patients with immunodeficiencies. Individuals with HIV are still recommended to receive a measles-containing-vaccine unless there is indication of immunosuppression at time of vaccination [27]. There is one report of an unknown immunodeficiency leading to measles inclusion body encephalitis following vaccination [28].…”

Immune‐mediated adverse reactions to vaccines

“…105 While these cases are exceedingly rare amongst the general population, they are more common amongst those with either primary or acquired immunodeficiencies. 98,104,106 Severe T-cell immunodeficiency or a household member with a similar immunodeficiency is therefore a strict contraindication to immunization with any form of live vaccines (Figure 4). 107,108 Similarly, vaccination with mucosally-administered vaccines (oral typhoid, oral polio, live attenuated influenza) and yellow fever vaccines is contraindicated in severe humoral immunodeficiency.…”

Corticosteroids Contribute to Serious Adverse Events Following Live Attenuated Varicella Vaccination and Live Attenuated Zoster Vaccination

“…With regard to children with untreated HIV infection, there are several reports of disseminated varicella vaccine infection after immunization. However, most reports are so brief that we cannot determine if any patient also received corticosteroids [ 30 ]. We found one longer report of a 16-month-old boy who was admitted because of fever and respiratory distress [ 31 ].…”