Measles, Mumps, and Rubella - Centers for Disease Control and ...

Vol. 47 / No. RR-8 MMWR 21SPECIAL CONSIDERATIONS FOR VACCINATIONPersons Infected with Human Immunodeficiency Virus (HIV)Although the risk for measles exposure is currently low in most areas of the UnitedStates and the Western Hemisphere, this risk remains high in many other regions andmeasles continues to be imported into the United States. HIV-infected persons are atincreased risk for severe complications if infected with measles (126,127 ). AmongHIV-infected persons who did not have evidence of severe immunosuppression(Table 2), no serious or unusual adverse events have been reported after measles vaccination(123–126 ). Therefore, MMR vaccination is recommended for all asymptomaticHIV- infected persons who do not have evidence of severe immunosuppressionand for whom measles vaccination would otherwise be indicated. MMR vaccinationshould also be considered for all symptomatic HIV-infected persons who donot have evidence of severe immunosuppression (Table 2) (128,129 ). Testing asymptomaticpersons for HIV infection is not necessary before administering MMR or othermeasles-containing vaccine (130 ).Transient increases in HIV viral load have been observed after administration ofother vaccines to HIV-infected persons (131,132 ). The clinical significance of theseincreases is not known. Theoretically, a similar increase also may occur after MMRvaccination of HIV-infected persons.Because the immunologic response to live and killed-antigen vaccines may decreaseas HIV disease progresses, vaccination early in the course of HIV infection maybe more likely to induce an immune response (133 ). Therefore, HIV-infected infantswithout severe immunosuppression should routinely receive MMR vaccine as soon aspossible upon reaching the first birthday (i.e., at age 12 months)(130 ). Considerationshould be given to administering the second dose of MMR vaccine as soon as 28 days(i.e., 1 month) after the first dose rather than waiting until the child is ready to enterkindergarten or first grade. In addition, if at risk for exposure to measles, HIV-infectedinfants who are not severely immunocompromised should be administered singleantigenmeasles vaccine or MMR vaccine at age 6–11 months. These children shouldreceive another dose, administered as MMR vaccine, as soon as possible upon reachingthe first birthday, provided at least 1 month has elapsed since the administrationTABLE 2. Age-specific CD4+ T-lymphocye count and percent of total lymphocytes ascriteria for severe immunosuppression in persons infected with humanimmunodeficiency virus (HIV)Total CD4+ T-lymphocytesORCD4+ T-lymphocytes (as % oftotal lymphocytes)Age