Ask the Doc: Vaccines

Ask the Doc is back, with patient care expert Dr. Howard Grossman of New York City's AlphaBetterCare. And in this column, he discusses vaccines -- whether you need one for the recent meningitis outbreak, for pneumococcal pneumonia, for HPV, or even just a yearly flu shot to protect yourself. Send your questions on HIV healthcare to him at [email protected]

Do I Need a Vaccine for Meningitis?

Q: I have heard about the meningitis outbreak in the US but I'm confused. I thought it had to do with contaminated steroids, but I hear that HIV-positive men are being told to get vaccinated. What does one thing have to do with the other?

A: That's a very good question that I think a lot of people might be curious about. What you've heard about are actually two different meningitis outbreaks. The big story most recently in the news is a large number of cases that is the result of contamination of a drug prepared in a compounding pharmacy in Massachusetts. Due to poor oversight and regulation they dispensed steroids used for spinal injections in people with back pain and those steroids were contaminated.

?The second meningitis outbreak that has been affecting gay and HIV-positive men that you probably heard about was announced just before the larger contamination one. In the past two years or so there have been clusters of cases of aggressive bacterial meningitis in the gay community. All of the cases have been in HIV-positive men. A few of them have died, most recently a 32-year-old man who was well-known in the community. The New York City and New York State Health Departments have issued recommendations for HIV-positive men to get vaccinated if they meet certain criteria in response to this.

The recommendations are that men who have had intimate contact with any of the men who have come down with meningitis should get vaccinated. In addition, it is recommended that all HIV-positive men who have had intimate contact, and that includes sexual contact, with another man met at a bar, party, or on the Internet since September 1 should also get the vaccine.

The meningitis vaccine is two shots that are given 8 weeks apart. There is a different vaccine available for men over 65 years of age. Discuss your specific concerns with your doctor to see if you should get vaccinated. Many doctors have stocks of the vaccine. If yours does not, you can get a vaccine at any New York City hospital and can call the Department of Health and Mental Hygiene to find out more.

I've Just Been Diagnosed with HIV. Can Vaccines Help Me Optimize My Health?

Q: I've just been diagnosed with HIV. Are there specific vaccines that I should get to protect myself?

A: Yes, there are. Everyone should be up-to-date on vaccines, but if you are HIV-positive you should do everything possible to optimize your health. The first thing you should do is establish a relationship with a primary care doctor that has experience treating people with HIV infection. He or she will be able to coordinate your care and make sure that you stay healthy!

It is very important to be proactive and get vaccinated every year for influenza if your CD4 (T cell) count is over 200. The annual flu shot is usually available beginning in September, so don't wait. Get it as soon as you can. For those with a T helper count less than 200, the flu vaccine is not recommended -- it is much less effective and it may cause a temporary rise in viral load and drop in CD4 count or T cells. In that case, being vigilant and considering taking medications at the first signs of influenza would be a better choice.

Make sure that you are immune to all the diseases that are routinely vaccinated for: measles, mumps, rubella, varicella (chicken pox), hepatitis A and B and tetanus.

It is recommended that those with HIV (as well as those over 65, smokers and those with other chronic illness) get vaccinated against pneumococcal pneumonia, the most common form of community-acquired bacterial pneumonia that people can get. Those with HIV infection are at higher risk for this.

New guidelines have come out recommending two separate pneumonia vaccines, a newer one, known as "13 valent" and "23 valent" which has been around for years. If you have already had 23, you need to wait until a year has passed before getting 13. But if you haven't had either of them, get 13 first, and then you can get 23 at least 8 weeks later.

In addition, in our practice we recommend HPV vaccination for all those under the age of 26. For those over 26, the recommendations are less strong. The federal advisory committee that makes recommendations strongly suggested that the HPV vaccine be "considered" in men who have sex with men.

While this has let some insurance companies justify not paying for the vaccine, we suggest that all of our sexually active patients consider it, regardless of age. HPV has long been linked to warts and cervical cancer and there is increasing evidence of its link to anal, penile and head and neck cancers. The data is not yet in on treating those older than 26 but there is every reason to believe that it may help.

You can always get vaccination information from the web. The CDC website has all the recommendations and information, so check it out! http://www.cdc.gov/vaccines/default.htm

This story is part of our special report: "Ask the Doc". Want to read more? Here's the full list.

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