Question

What are guidelines for pneumococcal and flu vaccines during COVID-19 crisis?

18 March 2020. Related: All topics, COVID-19, Living with HIV long-term.

Answer

For HIV positive people in the UK concerned about coronavirus and COVID-19, the flu vaccine was originally stressed as being important.

However this is not needed if, like the UK now, your country is at the end of the flu season.

The pneumococcal vaccine is still useful if you have not had this. Getting the vaccine is not urgent enough to break recommendations for social physical distancing. You can ask for this at your next physical appointment with your HIV or general doctor.

The relevant sections of the BHIVA Vaccination Guidelines are included below.

BHIVA guidelines for seasonal (annual) flu vaccine (2015)

10.7 Recommendations for HIV positive adults

We recommend that HIV positive adults be offered annual influenza vaccination with a parenteral non-replicating vaccine, and this includes HIV-positive pregnant women [1A]
We recommend the vaccine be given between September and early November [1B].
We suggest that depending on the epidemiological circumstances, there is still a potential benefit of vaccination until March [2D]
We suggest that a quadrivalent vaccine may be preferred where available [1D]
We recommend a single vaccine dose be given [1B]. There is insufficient evidence to recommend higher/more frequent doses in order to increase immunogenicity when using the inactivated influenza vaccines currently available in the UK. This area will be kept under review
We recommend that HIV services, in partnership with primary care, devise strategies to ensure prioritised patients receive annual vaccination, such as patient recall and notification [1C]
Pending further analyses of safety and efficacy, we recommend against the use of replicating live attenuated influenza vaccines in HIV positive adults [1D]. This recommendation will be kept under review.
We recommend that close contacts of HIV positive persons be offered annual influenza vaccination, which should be preferably with inactivated rather than live attenuated vaccines where the HIV-positive person is profoundly immunocompromised [1D]
We recommend that in identified circumstances of exposure, antiviral prophylaxis be considered for patients who are either unvaccinated or unlikely to benefit from vaccination (CD4 cell counts <200 cells/μL or poor match between vaccine and circulating influenza strain) if at risk of complications, particularly if profoundly immunocompromised [1D]. Expert advice should be sought.

Source: BHIVA guidelines on the use of vaccines in HIV-positive adults (2015).

BHIVA guidelines for pneumococcal vaccine (2015)

15.7 Recommendations for HIV positive adults

We recommend that HIV positive adults receive a single dose of PCV-13 irrespective of CD4 cell count, ART use, and viral load [1B]. This recommendation will be reviewed in light of the evolving epidemiology of PCV-13 type pneumococcal disease in the UK.
PCV-13 should be given at least 3 months after any use of PPV-23
We suggest that HIV positive adults who meet the indications for PPV-23 vaccination within the national programme (typically aged >65 years or with co-morbidity other than HIV) follow general guidance and also receive a single dose of PPV-23 [2C]
PPV-23 should be given at least 3 months after any PCV-13
We recommend against repeat PPV-23 or repeat PCV-13 dosing [1C]