Considerations for Use of Live Vaccines in Children With HIV Infection

Bacille Calmette–Guérin (BCG)

Not recommended in United States; internationally, may be given to HIV-exposed neonates of unknown HIV infection status

Oral poliovirus

Not available in United States but available in other parts of the world; inactivated polio vaccine given instead according to routine schedule*

Live-attenuated influenza (LAI)

Not recommended; inactivated vaccine given instead according to routine schedule*

Measles-mumps-rubella (MMR)

Can be given to children whose CD4+ T-cell percentage is ≥ 15%

Administration at 12 months of age followed by second dose within 1–3 months enhances likelihood of response before HIV-induced immunologic decline occurs

MMR plus separate varicella-zoster virus (VZV) vaccine preferred over combined MMRV vaccine to minimize adverse effects

If risk of exposure to measles is increased (eg, during an outbreak), give at a younger age (eg, 6–9 months); however, this dose not considered part of routine schedule (ie, restart at 12 months)

Rotavirus, live-attenuated

Limited evidence to date suggests that benefits of vaccine very likely outweigh its risks

Varicella-zoster virus (VZV)

Can be given to children whose CD4+ T-cell percentage is ≥ 15%

Administration at 12 months of age followed by second dose within 1–3 months enhances likelihood of response before HIV-induced immunologic decline occurs

MMR plus separate VZV vaccine preferred over combined MMRV vaccine to minimize adverse effects