Indian Pediatrics 1999; 36:431-432
Q 1. BCG vaccination is contra-indicated in immunodeficiency including HIV infection. I seek clarification on the following two points:
A. In developed countries ceI1ain live vaccines, including BCG, are not administered to HIV-infected children(1). However, these recommendations may not apply to those in developing countries where tuberculosis is endemic. Though there are isolated case reports of disseminated BCG infection in HIVinfected patients, reports from Haiti and Africa suggest that there is no significant. increased risk from BCG vaccination of HIV infected infants, as compared to uninfected infants(2,3). Our own experience in VeIlore has been the same. Therefore, in developing countries where tuberculosis is the major opportunistic infection in the HIV -infected population, the benefits of BCG vaccination in young infants outweigh the potential risk. Our own policy has been to administer BCG to all. newborn infants. of HIV infected. mothers. However, in older children with advanced stages of the infection, one may need to be more cautious and weigh the. benefits and risks of vaccination carefully. Thus, my response to Dr. Yash Paul's query would be that it would be safe to administer BCG vaccination to all newborns, irrespective of their HIV status. In older children who have obvious clinical features of immunodeficiency it may be prudent to avoid BCG vaccination whether or not they have HIV (since BCG may be equally dangerous in other T-cell immunodeficiency disorders). It is also important to remember that while BCG would provide some measure of protection against tuberculosis, especially against disseminated disease, it may not be fully protective particularly as the level of immunodeficiency increases with progression of infection. Intrafamilial contact poses the highest risk for infection because of the high incidence of bacillary tuberculosis in HIV infected adults and also the close contact within the household. Therefore, even BCG vaccinated children of HIV infected parents need to be carefully monitored, especially when the parents are known to have tuberculosis. Screening with PPD at regular intervals and preventive therapy will be useful in children who are not anergic. For those who are immunodeficient, and therefore anergic, a high index of suspicion needs to be maintained for early diagnosis and treatment of tuberculosis.
1. Centers for Disease Control. General recommendations on immunizations. Advisory Committee on Immunization Practice (ACIP). MMWR 1994; 3 (RR-1): 1-38.
2. O'Brien KL, Ruff AJ, Louis MA. Bacillus Calmette-Guerin complications in children born to HIV -1 infected women with a review of the literature. Pediatrics 1995; 95: 414-418.
Hassig 5, Onorato J, DeForest A. Safety
and immunogenicity of Bacille CalmetteGuerin, diphtheria-pertussis-tetanus
and oral polio vaccine in newborn children in Zaire with human
immunodeficiency virus type 1. J Pediatr 1993; 122: