Modern practices of immunizing children exposed to HIV and HIV-infected
Authors: Kukarkina Vera A. , Golubkova Alla A. , Podymova Anzhelika S. 
Published: September 2020

The purpose of the study is to adjust the tactics of immunization of children exposed to HIV and HIV-infected people on the basis of studying modern vaccination practices within the framework of the National Calendar of Preventive Vaccinations (NCPV).Materials and methods. According to the information in the patient's outpatient card, the card of preventive vaccinations and the history of the child's development, the completeness and timeliness of immunization of 216 children exposed to HIV and 198 HIV-infected children were analyzed. The control group consisted of 100 children born to mothers with negative HIV status. In order to study adherence to vaccines, a survey was conducted among 160 parents of children registered in the dispensary for HIV infection.Results. It was established that, despite the delayed immunization, the coverage of vaccination against the major infections from NCPV among children ranged from 94.4% to 97.5%. The greatest difficulties in the implementation of the NCPV arose when immunizing children under 2 years of age. The “missed opportunities” during immunization subsequently led to a violation of the calendar terms of vaccinations and their implementation at an older age. The number of “missed vaccinations” in the study cohort did not exceed the criteria recommended by WHO (10%) and amounted to 5.8% for certain types of vaccines (DTP and polio).The proportion of children vaccinated against tuberculosis in the maternity hospital in the HIV-exposed group was 2 times less compared to the control group, however, there were no differences in the incidence of vaccine induced allergy.During the vaccination of children with HIV on the highly active antiretroviral therapy (HAART), the number of CD4 lymphocytes corresponded to the parameters of the age norm. Compared to baseline data, no changes in the immune status of vaccinees were recorded.Organizational omissions in immunizing children with HIV infection were the use of live polio vaccine, a 3-dose vaccination schedule against viral hepatitis B in children at risk, and vaccination against tuberculosis in the absence of a three-stage chemoprevention of mother-to-child transmission of HIV.When assessing parental vaccine adherence, it was found that 85% of respondents considered vaccination necessary for the prevention of infectious diseases, 11.3% found it difficult to answer, due to the possible risk of vaccine reactions and the lack of guaranteed protection, and 3.8% were against vaccination, citing own opinion.The most authoritative source of information for most respondents, both positive for vaccination and those who doubted its need, was medical workers (98.5 and 72.7%, respectively). In 33.3% of those who are negatively related to vaccines, health workers were also a source of information.Conclusion. The analysis of the completeness and timeliness of vaccinations in a cohort of HIV-infected and exposed to HIV revealed the most problematic issues regarding vaccinations within the time periods regulated by the NCPV. Children with HIV infection who have the 1st category of immune disorders on the background of HAART are subject to vaccination in the framework of the National calendar of vaccinations to full extent. The use of combined vaccines will make it possible to reduce the manipulation load in this cohort, overcome the identified inconsistencies and optimize the vaccination calendar.