Much has changed since the previous MASAC Recommendation #36. Although the changes are summarized briefly below, MASAC strongly recommends that providers refer to the source document referenced below, entitled "2001 USPHS/IDSA Guidelines for the Prevention of Opportunistic Infections in Persons Infected with Human Immunodeficiency Virus," for more detail.

Pneumococcal Vaccine
Pneumococcal vaccine (Pneumovax) is generally recommended for those with CD4+ > 200/ul. It may be offered to individuals with CD4+ count < 200/ul, although efficacy may be diminished. However, it is believed that individuals who mount an antibody response will have some protection. Revaccination five years after the first dose or sooner if the CD4+ count increases to > 200/ul is considered optional at this time. (Note: Prevnar should not be given to individuals over 5 years of age.)

Hepatitis A and B Vaccines
All anti-HAV negative individuals at increased risk for hepatitis A infection, including individuals with hemophilia or chronic liver disease due to hepatitis B or C infection, should receive the hepatitis A vaccine. All susceptible anti-HBc/anti HBs negative unvaccinated individuals at increased risk for hepatitis B infection, including individuals with hemophilia or chronic liver disease due to hepatitis C infection, should receive hepatitis B vaccine. Although there are no conclusive data demonstrating efficacy of these vaccines in the HIV-infected population, it is believed that individuals who mount an antibody response will have some protection.

Influenza Vaccine
The influenza vaccine should be administered to all HIV-infected patients annually before influenza season. Those who mount an antibody response may have some protection. During outbreaks of influenza A or B, treatment with oseltamivir is recommended. Treatment with rimantadine or amantadine is appropriate during outbreaks of influenza A, although neither is recommended for use in pregnancy.

References:
1. Centers for Disease Control and Prevention. 2001 USPHS/IDSA Guidelines for the Prevention of Opportunistic Infections in Persons with Human Immunodeficiency Virus. U.S. Public Health Service (USPHS) and Infectious Diseases Society of America (IDSA) and USPHS/IDSA Prevention of Opportunistic Infection Working Group. MMWR 2001;50:1-53. Available at http://www.hivatis.org.
2. Pickering LK, ed. 2000 red book: report of the Committee on Infectious Diseases. 25th Edition. Elk Grove Village, IL: American Academy of Pediatrics; 2000.
3. Centers for Disease Control and Prevention. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 1997;46(No. RR-8):1-24.
4. Centers for Disease Control and Prevention. Preventing pneumococcal disease among infants and young children: recommendations of the Advisory Committee on Immunization Practices. MMWR 2000;49(No. RR-9):1-38.

This material is provided for your general information only. NHF does not give medical advice or engage in the practice of medicine. NHF under no circumstances recommends particular treatment for specific individuals and in all cases recommends that you consult your physician or local treatment center before pursuing any course of treatment.

CHAPTERS: Please feel free to distribute to your members.
PHYSICIANS: Please distribute this information to all providers in your area who treat patients with bleeding disorders.