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BCG VACCINATION IN THE CONTEXT OF HIV: POLICY AND PRACTICE. Anneke C. Hesseling DEWG Child TB Subgroup 13 October 2009 . BACKGROUND. BCG: Mycobacterium bovis BCG; live, attenuated vaccine given around birth
Anneke C. Hesseling
DEWG Child TB Subgroup
13 October 2009
Trunz, Fine, et al. Lancet 2006
global coverage at 89% in 2007 where BCG recommended
WHO – EPI, 2008
Trunz, Fine, Dye. The Lancet 2006; 367:1173-1180,
Rodrigues, Int J Epi 2002
Revised paediatric BCG disease classification
M. tb and BCG
Hesseling et al, Clin Infect Dis 2006
Multi-centre population estimates incidence rates of disseminated BCG disease in HIV-infected children, Western Cape Province, South Africa
Hesseling et al, Bull WHO, 2009
updated to reflect this change and provide guidance
to national policy-making bodies, recognizing the
complexity of the decision-making process and the lack of information as well as the necessary infrastructure to perform adequate risk assessment in individual children.
Among HIV-infected children, the benefits of potentially preventing severe TB are outweighed by the risks associated with the use of BCG vaccine. GACVS therefore advised WHO to change its recommendation such that children who are known to be HIV-infected, even if asymptomatic, should no longer be immunized with BCG vaccine.”
“Since not vaccinating an infant who is exposed to HIV but remains uninfected may increase the risk of disseminated tuberculosis, BCG vaccination should continue in settings where HIV infection and tuberculosis are both highly endemic until it is feasible to implement a policy of selective vaccination.
Clear goals should be established for the implementation of safe vaccination practices in HIV-infected infants and for reducing the burden of maternal and infant tuberculosis. More data are needed on the protective effect of BCG vaccination in HIV-infected infants and in HIV-exposed uninfected infants, as well as on the operational feasibility of deferred BCG vaccination In HIV-exposed infants.”
Acute suppurative adenitis 3 weeks after HAART and antituberculosis therapy (BCG IRIS)
2. BCG IRIS
BCG IRIS in infants with baseline CD4≥25%: Early vs. Deferred HAART (CHER study)
HAART reduced risk and improves outcome of BCG IRIS – may reduce risk of disseminated BCG?
CHER study, Rabie, Cotton et al, CROI, 2008
WHO REVISED POLICY IMPLEMENTATION CONSIDERATIONS IN HIGH-BURDEN SETTTINGS
Anneke C. Hesseling and Steve Graham
DEWG Childhood TB Subgroup Meeting 12 October 2009