Bacille Calmette-Guerin vaccine-related disease in HIV-infected children: a systematic review

OBJECTIVE: To describe the characteristics and risk of bacille Calmette-Guerin (BCG) vaccine related disease in human immunodeficiency virus (HIV) infected infants. METHODS: Systematic literature review of articles published from 1950 to April 2009 in the English language. We identified all microbiologically confirmed cases of disseminated BCG disease in vertically HIV-Infected children reported ill the literature. RESULTS: Sixteen observational studies and I I case reports/series were included. Observational studies suffered front high rates of loss to follow-up and death. Loco-regional BCG disease was reported ill both HIV-infected and non-infected children. Disseminated BCG disease was reported only in children with immunodeficiency and only in studies employing sophisticated laboratory techniques. Sixty-nine cases of disseminated BCG were identified 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 100000 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 arc limited. Targeted surveillance for BCG complications employing sophisticated diagnostic techniques is required to Inform vaccination policy.