BCG Vaccination in South African Hiv-Exposed Infants--Risks and Benefits (Issues in Public Health) (Report‪)‬

Until 2007, the World Health Organization (WHO) recommended that bacille Calmette-Guerin (BCG) vaccination should be contraindicated in infants with symptomatic HIV disease in countries with a high burden of tuberculosis. This recommendation was based on the perceived low risk of serious adverse events in HIV-infected infants. The WHO revised its recommendations regarding BCG vaccination in HIV-infected infants in 2007, making HIV infection a full contraindication to BCG vaccination. (1) BCG induces protective efficacy against tuberculous meningitis of 73% (67-79%) and against miliary disease of 77% (58-87%) in HIV-uninfected children. (2) The efficacy against childhood pulmonary disease is variable; (3) there is no evidence that BCG induces a protective effect against tuberculosis in HIV-infected infants and children. (4) BCG is a safe vaccine in immunocompetent infants, and severe vaccine adverse events in HIV-uninfected infants occur only with rare primary immune deficiencies in approximately 1 per million vaccinees. (5) The South African context and the risk of BCG adverse events in HIV-infected infants