HIV-infected children who have been given BCG
(Bacille Calmette Guerin) vaccine are at high risk of developing
disseminated BCG disease, researchers from South Africa report.
Universal BCG vaccination at birth in HIV-infected areas increases
the risk of serious complications like disseminated BCG disease in HIV-
infected infants because of their suppressed immune status, Dr. Anneke
C. Hesseling and colleagues from South Africa explain in the January
issue of the journal Vaccine.
The paucity of reports on disseminated BCG infection due to possible
underreporting or lack of diagnostic facilities prompted Dr.
Hesseling's team from the Desmond Tutu Tuberculosis Centre of
Stellenbosch University, Tygerberg, to evaluate the prevalence of the
disease among infants in the Western Cape area between 2002 and 2004.
Cases of disseminated BCG infection in infants were identified using
hospital-based surveillance and confirmed by polymerase chain reaction.
The population prevalence of disseminated BCG infection was then
calculated using the mid-year projected population data and BCG
vaccination rates, while the prevalence of congenital HIV infection was
estimated using available data on mother-child HIV transmission rates.
Disseminated BCG was diagnosed in nine infants during the study
period, seven of whom were HIV positive and showed signs of disease,
the researchers report.
They estimated that the incidence of disseminated BCG among
HIV-infected infants could range from139 to 350 per 100,000 vaccinated
children under 1 year of age, depending on the mother-child HIV
transmission rates. In comparison, the estimated incidence among
HIV-negative infants was significantly lower at around 0.7 per 100,000
population during the study period, they report.
"There are not enough data on the potential benefits of BCG in
infants born to HIV-infected mothers to weigh up the risk and benefit
ratio of BCG vaccination in infants in settings with high HIV burden ,"
Dr. Hesseling told Reuters Health.
"One potential strategy, if good TB surveillance is in place and
mothers are routinely screened for TB, is to delay BCG vaccination in
HIV-exposed infants until their HIV status has been determined," Dr.
Hesseling said. "This can readily be done at 6 weeks of age, through
polymerase chain reaction. BCG can then safely be administered to
uninfected infants."
Vaccine 2007;25:14-18.
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