人类免疫缺陷病毒(HIV)阳性的儿童和HIV阳性母亲的新生儿接种疫苗的策略

Immunization of Children With HIV Infection and Infants Born to HIV-Infected Mother

对世界卫生组织和部分国家或地区人类免疫缺陷病毒(Human Immunodeficiency Virus,HIV)阳性儿童和HIV阳性母亲的新生儿,接种疫苗推荐的免疫程序,以及接种疫苗的安全性、免疫原性、有效性的文献进行了回顾。HIV感染的儿童免疫反应较正常儿童弱,但一般疫苗的接种是安全有效的。出现症状的HIV感染儿童暂缓接种卡介苗和黄热减毒活疫苗。尽管有个别儿童接种麻疹减毒活疫苗(Measles Vaccine,Live;MV)、口服脊髓灰质炎减毒活疫苗(Oral Poliomylitis Vaccine,Live;OPV)出现并发症,但不能证明减毒活疫苗一定会增加接种的风险,并且MV和OPV接种的受益远远大于其风险。

This paper reviews the WHO and some national guidelines for immunizing children with HIV infection and infants born to HIV-infected women, and literature on the safety, immunogenicity and effectiveness in the same condition. Immunization is generally safe and beneficial for children infected with HIV,although HIV-induced immune suppression reduces the benefit compared with that obtained in HIV-uninfected children. BCG and yellow fever vaccines should be withheld from symptomatic HIV-infected children. Only one serious complication（fatal pneumonia） has been attributed to measles vaccine administered to a severely immunocompromised adult. Although two HIV-infected infants have developed vaccine-associated paralytic poliomyelitis, several million infected children have been vaccinated and the evidence does not suggest that there is an increased risk. The benefits of measles and poliovirus vaccines far outweigh the potential risks in HIV-infected children.