Figure 1 shows proportions of children fully immunized with primary and booster doses of routine vaccines. Overall, 63% (186 of 297) of primary immunizations and only 41% (61 of 149) of booster immunizations were complete in children

eligible to receive selleck products the vaccine (P<0.001). Sixty-one per cent (162 of 267) of all immunizations were complete in UK-born children compared with 47% (85 of 179) in non-UK-born children (P=0.006). Even though rates of immunization in London are lower than in the UK overall [e.g. 83% vs. 93% completed primary diphtheria, tetanus and pertussis (DTP) by age 5 years (http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles/immunisation; accessed 3 September 2009)], rates in HIV-infected children were surprisingly low. HIV-infected children may have other risk factors for incomplete immunization such as residence in disadvantaged areas, history of hospital admission [2] or coming from an immigrant family. Childhood vaccinations are free; however, specialist clinics incur costs if vaccinations are provided through them, and not all have the funding or resources to do so. Additionally, guidelines

are based on limited evidence in HIV-infected children, especially those with severe immune deficiency, causing uncertainty as to optimal practice. Approximately 20% of HIV-infected children nationally have a CD4% <20 (http://www.chipscohort.ac.uk/summary_data.asp; accessed 8 July Glutathione peroxidase 2010). This may contribute to the incomplete find more coverage observed for

MMR in our study. Few studies have assessed the immunization status of HIV-infected children in industrialized countries. Like ours, recent Swiss and Spanish studies found lower immunization coverage in this population than in the general public [3,4]. A study from Texas found no difference between HIV-infected patients and the general population for diphtheria, tetanus, acellular pertussis and inactivated polio vaccine (DTaP-IPV) and MMR, although vaccine coverage was low overall [5]. We conclude that immunization of HIV-infected children is suboptimal in this London population. Booster doses and nonroutine vaccines are most commonly omitted. Immigrant children are particularly likely to be under-immunized. As life expectancy and the proportion of immigrant HIV-infected children increase, appropriate routine and catch-up immunization becomes more important. Development of evidence-based recommendations and standards for immunization of HIV-infected children, improved accessibility of immunization records, and opportunistic immunization in clinics may all improve this situation.