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An asymptomatic 27 year old woman who is HIV positive comes to the physician requesting advice concerning immunization.All her childhood immunizations are upto date.She recieved a MMR vaccination when she was a graduate student 4 years ago.Her last tetanus vaccine was 6 years ago.A test for hep B antibody was positive 3 weeks ago.her CD4 count was 450/mm3 3 weeks ago.examination today shows no abnormalities.Which of the following immunizations is most appropriate to administer to this patient?
A.Hep A vaccine
B.Hep B vaccine
C.MMR vaccine
D.Pneumococcal Vaccine
E.Tetanus toxiod
F.No immunizations are necessary
the answer is D,but why not A????
can anyone explain??
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it is D, Pt. at risk of Pneumococcal infection as cell mediated immunity decline with HIV. Hep A vaccination is indicated in patient with liver disease or HBV OR HCV.
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I think its A too, I do not understand this
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DDD. Pneumococcal vaccine and influenza vaccine is recommended in elderly and inmunocompromised patient.
According with CDC(Center for control disease and prevention) the Hep A Vaccine is recommended for the following persons aged 1 year and older:
•You live in a community with a high rate of hepatitis A.
•You are a man and have sex with other men.
•You use street drugs.
•You work or travel to countries with high rates of hepatitis A.
•You have long-term liver disease.
•You receive blood products to help your blood clot.
•You work with HAV-infected animals or work with HAV in research setting.
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I answered hep A vaccine to another similar question and got it wrong. The correct answer there was the influenza vaccine. I was reading an older post and someone mentioned that a titer, Hep A Hep B titer, is needed before giving the vaccination. The titer wasn't mentioned in either vignette. I also agree with D. Immunocompromised patients need vaccination from encapsulated organisms. As do asplenic patients.
Not to confuse the issue, and I think I made this mistake, in my limited experience intuitively I would want to vaccinate against everything right from the start in a person who was HIV positive. As explained in the previous answer the cdc has made their recommendations and that is not the correct way to manage this case.
In retrospect pneumococcal disease seems like more of a threat as well. I imagine that Hep A can lead to cirrhosis and fulminant hepatitis, but I think that progression is a slower process when compared to a bacterial infection which can overwhelm the circulatory system and cause sepsis or septic shock.
Vaccination questions dealing with Hepatitis usually involve a labs which declare the patient to have:
...
Hep B Ag negative
Hep B IgM negative
Hep B IgG positive
...
Hopes this helps good luck!!!
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Thank you guys, so if HIV pt having sex with Man or, Iv drug user, and if pneumocccal is not an other choice I will choose Hep A in Hep B pt in HIV. From uw , HIV pt to have Hep A vaccine if they have Hep B or C ( well, this pt has Hep B ab only so that might be different from having Hep B ) , man having sex with man or IV drug user- you explained above too.
