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Immunisation of children with HIV
  1. A Dhesi1,
  2. S Bandi1,
  3. K Blake1,
  4. S Welch1,
  5. M Thompson2
  1. 1Paediatric Department, University Hospital Coventry and Warwickshire, Coventry, UK
  2. 2Public Health Department, Coventry Primary Care Trust, Coventry, UK

Abstract

Background HIV infected children are at increased risk of vaccine preventable diseases. Guidelines recommend that all HIV positive children with or without symptoms should be given routine and additional childhood immunisations. Our aim was to ascertain whether children with HIV are receiving adequate vaccinations.

Method A retrospective audit was conducted where 19 patients were identified at University Hospital Coventry age range from 4 years to 16 years. Data was collected from clinical records, GP records and the national child health record system.

Results Figure 1 shows the percentage of children receiving routine immunisations if they were eligible:

Abstract G32(P) Figure 1

Percentage of children with HIV completing immunisations

DTP – Diptheria/tetanus/pertussis, Hib – Haemophilus influenza type B, PCV – Pneumococcal conjugate vaccine, Men C – Meningococcal C, MMR – Measles/mumps/rubella, HPV- Human papilloma Virus.

42% had an adequate response to the pneumococcal vaccine but 42% have not had their response checked. The remaining 16% had an inadequate response of which 10% have had the vaccine repeated since and need responses rechecking. 47% patients had an inadequate response to the MMR vaccine but 44% of these had their MMR vaccine repeated since and needed their responses rechecking. For additional vaccines, 95% had at least one influenza vaccine. However, only 17% had been vaccinated annually 5 times or more. 53% had received the swine flu vaccine. Only 21% patients received a full course of Hepatitis B vaccination. 42% received an incomplete course and 32% have not had it. 85% have an inadequate response to the Hepatitis B vaccination. 15% patients also received the Varicella Zoster Vaccine.

Conclusions Immunisation of children with HIV is inadequate. It is difficult to ascertain vaccination status due to poor documentation in GP records, clinics and the central vaccination database. Non routine vaccinations are more commonly missed.

Recommendations

  • To improve communication and documentation

  • Letters related to immunisation to be addressed to parents/carers and copied to GPs

  • Explore the possibility of opportunistic immunisation in HIV clinic

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