Remember HIV status of a child before giving BCG….

[Guest guest]

Cape Town, 22 July, 2009. It can be dangerous for a child who is a HIV positive

to be inoculated with the world wide popular TB vaccine, the BCG.

In a special interview at Cape Town International AIDS Society Conference, Dr.

Jerald Sadoff, President and Chief Executive Officer of the Aeras Global TB

Vaccine Foundation told that the risk of disseminated BCG disease in

HIV-infected infants is considerably higher than previously estimated, although

likely to be under-estimated.

Presently, BCG is administered to approximately 75 percent of infants worldwide

but infants infected with HIV risk develops a deadly form of tuberculosis known

as disseminated BCG disease from the vaccine.

Studies revealed that the risk of disseminated BCG disease in HIV-infected

infants was three to four times higher than previously estimated, and more than

75 percent of infants who developed the disease in the study died.

The Bacilli Calmette-Guérin vaccine, known as BCG, protects children well

against deadly tuberculous meningitis, though it does less well against the lung

form. It has been in use since 1921, and the inoculated ones bear its

characteristic round scar through out their life. As it is a live vaccine, a

weakened strain of bovine tuberculosis, it can cause its own problem —

" disseminated BCG disease, " a type of bacterial infection that can rage through

the body and is fatal in more than 70 percent of cases.

Dr. Sadoff said that Multicentre surveillance data has also showed safe and

effective tuberculosis prevention strategies are needed for HIV-infected

infants. He said that there is limited evidence that BCG has a protective effect

in HIV-infected infants and children. Adverse events linked to BCG vaccination

range from mild, localized complications to more serious, systemic or

disseminated BCG disease in which M. bovis BCG is confirmed in one or more

anatomical sites far from both the site of injection and regional lymph nodes.

Dr. Sadoff added that in countries where both tuberculosis and mother-to-child

transmission of the AIDS virus is common, the vaccine gives infected children

almost no protection against tuberculosis and instead may kill them with BCG

disease. He said that although he recommends delaying vaccination but it will

not be easy.

In countries like India where babies are often not brought back at 6 weeks for a

test and 10 weeks for a shot the dangerous practice of vaccinating every baby

may continue, because it protects the uninfected ones.

Dr. Jerald Sadoff suggested that there is an urgent need for data on the

risk–benefit ratio of BCG vaccination in HIV-infected infants to inform

decision-making in settings where HIV infection and tuberculosis burdens are

high.

Reviewing current efforts to develop a TB vaccine to protect people living with

HIV, Dr. Sadoff was of the view that the current TB vaccine is unable to control

the epidemic hence a new vaccine regimen for infants, and latently infected

adolescents and adults, especially those with HIV, is desperately needed.

He said that there are four TB vaccines being tested now, all in Africa and the

initial trials in people living with HIV have demonstrated safety and

immunogenicity for two of the candidates.