A 2-month-old infant is due for the first doses of IPV, pentavalent vaccine, and rotavirus vaccine. The mother is HIV-positive on ART; the infant's HIV PCR at 6 weeks was negative. Which vaccine modification is MOST appropriate for this 2-month HIV-exposed but uninfected infant?

• A Administer all routine vaccines on schedule including oral rotavirus vaccine; BCG already given at birth ✓
• B Defer all live attenuated vaccines until HIV status is definitively confirmed as negative
• C Replace oral rotavirus vaccine with killed parenteral rotavirus only
• D Skip IPV and give OPV instead for stronger intestinal immunity

Explanation

An HIV-exposed but uninfected (HEI) infant with a negative HIV PCR at 6 weeks is presumed uninfected and should receive all routine vaccines on the standard schedule. BCG is given at birth if the infant is asymptomatic and not confirmed HIV-positive. Oral rotavirus vaccine (Rotarix or Rotateq) is a live attenuated vaccine that is safe in HEI infants. IAP and WHO guidelines permit all routine vaccines including live vaccines (rotavirus, MMR, varicella) for HEI infants with confirmed negative HIV status. OPV is no longer used in India's national schedule (IPV replaced); IPV should be given as scheduled. Deferring live vaccines is only necessary if the infant is confirmed HIV-infected with CD4 <25%.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.