Immunization of children infected with HIV: a public health perspective.

The vast majority of HIV infected children in the United States are from inner city families where one or both parents have used intravenous drugs. The bulk of medical opinion indicates that in most cases these children, when they appear well, should receive their routine childhood immunizations. For children who are known to be antibody positive, or where it is known that a family member has HIV related immunodeficiency, IPV should be substituted for OPV. Measles vaccine should be given at 15 months when the child is manifesting no overt symptoms of immunodeficiency. In outbreak periods and in endemic areas measles vaccine should be given regardless of symptomatology. HIV antibody testing prior to the routine immunization of children at risk is not indicated for two reasons. First, the test is not a reliable indication of infection in the child, as passive maternal antibody may persist up to 15 months of age and cannot at this time be distinguished from the child's own antibody. Second, immunization with OPV and MMR have not yet been noted to cause adverse effects in HIV infected individuals and may be efficacious at least in the younger child who may be early in the course of disease and maintain some T and B cell function.