Question

A child known case of HIV. His CD4 count is 50. Which vaccine is avoided in him/her?

• A. MMR
• B. TT
• C. DPT
• D. BCG

Hint:

Live attenuated vaccines are contraindicated in severely immunocompromised patients -- identify which option is a live vaccine contraindicated in severe HIV immunosuppression.

Answer 1

The Correct Option is A

Principle: Live vaccines in immunocompromised patients

HIV-positive children with severely low CD4 counts (<200 cells/mm3 or equivalent severe immunosuppression) must not receive live attenuated vaccines because the attenuated organism can replicate uncontrolled and cause vaccine-strain disease.

Vaccine classification:
- MMR (Measles-Mumps-Rubella): Live attenuated -- CONTRAINDICATED in severe immunosuppression
- TT (Tetanus Toxoid): Killed toxoid -- SAFE
- DPT: Killed combination vaccine -- SAFE
- BCG: Live attenuated (also contraindicated in symptomatic HIV, but MMR is the primary exam answer for this clinical scenario)

Contraindications for MMR include:
- Severe immunosuppression (including HIV with low CD4)
- Pregnancy
- Severe anaphylactic reaction to previous dose or vaccine component (gelatin, neomycin)

A CD4 count of 50 in this child represents severe immunodeficiency, making MMR the vaccine to avoid.

\[\boxed{\text{MMR}}\]