A 9-month-old HIV-infected infant who has never received antiretroviral therapy is brought for vaccination. The infant's CD4% is 18%. Which vaccine is ABSOLUTELY CONTRAINDICATED at this visit?

• A Measles-containing vaccine (MR/MMR) ✓
• B Inactivated polio vaccine (IPV)
• C Pneumococcal conjugate vaccine (PCV13)
• D Hepatitis B vaccine

Explanation

Live vaccines are generally contraindicated in severely immunocompromised HIV-infected individuals. Measles vaccine (live attenuated) is absolutely contraindicated when CD4% is <15% (severe immunosuppression) due to risk of vaccine-strain measles pneumonitis. This child has CD4% of 18%, which falls in the category of moderate immunosuppression — guidelines differ but WHO recommends MR vaccine when CD4% ≥15% and child is on ART with immune reconstitution. However, if not yet on ART and CD4 is borderline/falling, it remains high-risk. IPV, PCV, and HepB are inactivated vaccines safe in HIV.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.