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HIV-infected children should be protected from vaccine-preventable diseases. If inactivated vaccines are indicated for persons with altered immunocompetence, the usual doses and schedules are recommended.
However, the effectiveness of such vaccinations might be suboptimal 30. Persons with severe cell-mediated immune deficiency should not receive live attenuated vaccines.
However, children with HIV infection are at higher risk than immunocompetent children for complications of varicella, herpes zoster, and measles.
On the basis of limited safety, immunogenicity, and efficacy data among HIV-infected children, varicella and measles-mumps-rubella vaccines can be considered for HIV-infected children who are not severely immunosuppressed i.
Pneumonia was the most common bacterial infection 11 per 100 child-years, followed by bacteremia 3 per 100 child-years, and urinary tract infection 2 per 100 child-years. Acute pneumonia, often presumptively diagnosed in children, was associated with increased risk for long-term mortality among HIV-infected children in one study during the pre-HAART era 51.
HIV-infected children with pneumonia are more likely to be bacteremic and to die than are HIV-uninfected children with pneumonia 52.
Chronic lung disease might predispose persons to development of acute pneumonia; in one study, the incidence of acute lower respiratory tract infection in HIV-infected children with chronic lymphoid interstitial pneumonitis was approximately 10-fold higher than in a community-based study of HIV-uninfected children 53.
Chronically abnormal airways probably are more susceptible to infectious exacerbations similar to those in children and adults with bronchiectasis or cystic fibrosis caused by typical respiratory bacteria Streptococcus pneumoniae, nontypeable Haemophilus influenzae and Pseudomonas spp.
HIV-infected children have a markedly higher risk for pneumococcal infection than do HIV-uninfected children 58,59. Reports among children without HIV infection have not demonstrated a difference in the case-fatality rate between those with penicillin-susceptible and those with nonsusceptible pneumococcal infections case-fatality rate was associated with severity of disease and underlying illness 65.
Invasive disease caused by penicillin-nonsusceptible pneumococcus was associated with longer fever and hospitalization but not with greater risk for complications or poorer outcome in a study of HIV-uninfected children 66.
Since routine use of seven-valent pneumococcal conjugate vaccine PCV in, the overall incidence of drug-resistant pneumococcal infections has stabilized or decreased. In a population-based study of invasive meningococcal disease in Atlanta, Georgia 72, as expected, the annual rate of disease was higher for 18- to 24-year-olds 1.