Question
Can HIV+ people use the yellow fever vaccine? – and COVID-19 ?
24 August 2021. Related: All topics, Complications and coinfections, COVID-19.
Answer
Thanks for your question and for letting us answer this online.
The yellow fever vaccine is a replicating live attenuated vaccine that can only be used by some HIV positive people. This means you need to have a good CD4 count that is at least above 200 cells/mm3. It should NOT be used in HIV positive people older than 60 years old.
When thinking about having the yellow fever vaccine, you should also consider the risk of contracting yellow fever based on individual travel plans. For example, this might be different depending on which country and region you plan to visit. Or if this is in the city or countryside.
Some countries allow a visa waiver for medical reasons, but other do not.
The detailed information below is from the 2015 BHIVA guidelines in vaccination (see page 91).
This question on COVID-19 vaccines is easy.
YES!
Vaccines against COVID-19 are strongly recommended for all HIV positive people. This is really important as we are at higher risk of worse outcomes if we do catch COVID-19, including death.
See this link for more info about COVID-19 vaccines for HIV positive people:
https://i-base.info/qa/16330
BHIVA also have draft guidelines on COVID-19 vaccination:
https://www.bhiva.org/COVID-19-immunisation-guidelines-consultation
These generally recommend leaving at least a week between the COVID-19 vaccine and other vaccines. This is a caution because of limited data. This decision should be made by a doctor.
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BHIVA guidelines on the use of vaccines in HIV-positive adults (2015) – page 91
https://www.bhiva.org/vaccination-guidelines
24.6 Yellow Fever vaccine in HIV-positive adults
A Cochrane review evaluated the risk and benefits of YFV vaccination in HIV-positive patients [6]. The review included three cohort studies [7–9] and reported that vaccination can produce protective levels of neutralising antibodies in HIV-positive people, although immunogenicity is less than in HIV-negative people.
In one of the included studies, 83% of HIV-positive people had protective YFV neutralising antibodies titres (NT) 1 year after vaccination, compared with 97% of HIV-negative people [8]. NT were significantly lower and declined more rapidly during follow-up in HIV-positive patients. Another study demonstrated high NT 1 year after immunisation (98%) with a marginal decrease after 10 years (92%) [9]. Having a higher CD4 cell count (>200 cells/μL) and lower viral load at the time of vaccination were key associations with development of NT.
The Cochrane review reported that none of the 484 HIV positive persons included in the review suffered serious adverse events as a result of vaccination [6]. The data cautiously support the safety of YF vaccination in HIV-positive patients with CD4 cell counts >200 cells/μL and following viral load suppression on ART.
The small numbers of patients included limit conclusions, particularly the very low numbers (n=21) with a CD4 cell count <200 cells/μL. There has been only one report of death after receiving YF 17D vaccine in a Thai man with symptomatic HIV infection and a CD4 cell count of 108 cells/μL, probably from YEL-AND [10].
24.7 Recommendations for HIV positive adults
- We recommend that HIV-positive persons aged <60 years and with CD4 cell counts >200 cells/μL who are due to travel to countries in which there is a recognised risk of exposure to YFV should be offered the choice of vaccination [1C]
- We recommend patients receive counselling about the benefits and risks of vaccination in relation to the risk of exposure, emphasising that a high CD4 cell count and a suppressed viral load on ART are likely to maximise safety and efficacy of vaccination [1C]
- If international travel requirements and not true exposure risk are the only reasons to vaccinate, a certificate of exemption can be given (some countries may not accepts waiver certificates) [1C]
- We recommend one vaccine dose at least 2 weeks before travel. Vaccine recipients should be monitored closely after vaccination [1C]
- We recommend a booster after 10 years for those at continued risk, providing the recipient remains aged <60 years, the CD4 cell count is >200 cells/μL, and following risk assessment and counselling [1C]
- We suggest that a serological test may precede vaccination and guide boosting requirements in those at greater risk of side effects [2C]
- We recommend that until more data are available on vaccine safety, HIV-positive adults with CD4 cell counts <200 cells/μL or >60 years of age and pregnant women should not receive YFV vaccination, and should be discouraged from travel to destinations that present a true risk of infection [1C]
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