Bacille Calmette-Guérin vaccine-related disease in HIV-infected children: A systematic review

Peter Azzopardi, C. M. Bennett, S. M. Graham, T. .Duke

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OBJECTIVE: To describe the characteristics and risk of bacille Calmette-Guérin (BCG) vaccine related disease in human immunodefi ciency virus (HIV) infected infants. METHODS: Systematic literature review of articles published from 1950 to April 2009 in the English language. We identifi ed all microbiologically confi rmed cases of disseminated BCG disease in vertically HIV-infected children reported in the literature. RESULTS: Sixteen observational studies and 11 case reports/series were included. Observational studies suffered from high rates of loss to follow-up and death. Loco-regional BCG disease was reported in both HIVinfected and non-infected children. Disseminated BCG disease was reported only in children with immunodefi-ciency and only in studies employing sophisticated laboratory techniques. Sixty-nine cases of disseminated BCG were identifi ed in the literature: 47 cases were reported in six observational studies, the majority (41/47) from the Western Cape of South Africa. A Brazilian cohort study reported no cases of disseminated BCG amongst 66 HIV-infected children observed over a 7-year period. A recent South African surveillance study reported 32 cases of disseminated BCG over a 3-year period, estimating the risk of disseminated BCG to be 992 per 100 000 vaccinations in HIV-infected children. Few cases of severe disseminated TB were reported in the cohort studies among HIV-infected children vaccinated with BCG. CONCLUSION: Data on the risk of BCG vaccination in HIV-infected children are limited. Targeted surveillance for BCG complications employing sophisticated diagnostic techniques is required to inform vaccination policy.

Original languageEnglish
Pages (from-to)1331-1344
Number of pages14
JournalInternational Journal of Tuberculosis and Lung Disease
Issue number11
Publication statusPublished or Issued - 1 Nov 2009
Externally publishedYes


  • BCG
  • Disseminated
  • HIV
  • Review

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases

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