Bacille Calmette–Guerin vaccine-induced disease in HIV-infected and HIV-uninfected children

Management of Bacillus Calmette-Guérin osteomyelitis/osteitis in immunocompetent children—A systematic review

“…For HIV-infected or immunocompromised children, BCG-related diseases spread more easily from local to distant sites and have higher rates of mortality. Hesseling et al suggest a 4-drug regimen for at least 9 months in order to limit the spread and achieve better outcome [22]. Until now, there have been no RCTs for BCG osteomyelitis/osteitis compared to a Cochrane review of RCTs for BCG lymphadenitis [23].…”

Reduced rate of adverse reactions to the BCG vaccine in children exposed to the vertical transmission of HIV infection and in HIV-infected children from an endemic setting in Brazil

“…Thus, in agreement with the current recommendations of the Ministry of Health of Brazil, we advocate the vaccination of all newborns with BCG, independently of their exposure to HIV or HIV infection, always observing the demand of a judicious care if the HIV infection is confirmed. In countries with a low prevalence of TB, as in the USA, the use of BCG vaccination should be reserved for selected infants and children who reside in settings in which the risk of TB is high [17]. To our knowledge, this is the first longterm prospective study on BCG disease conducted in HIVexposed/uninfected and in HIV-infected Brazilian children in an endemic setting for both TB and HIV in Brazil.…”

Outcomes of human immunodeficiency virus–infected and –exposed children undergoing surgery—a prospective study

“…The best management for these has yet to be elucidated as both surgery and medical management have potentially severe adverse effects. Systemic complications of BCG are also of growing concern [19,24]. We have seen bowel obstruction caused by ulcerating intraabdominal nodes and BCG osteitis as evidence of active BCG infection in an immunocompromised host.…”

“…Lymph node infection after immunization with BCG is well documented in both HIVinfected and non-HIV-infected children [16][17][18]. The rate of BCG infection and the extent of disease with HIV coinfection, however, are of significant concern [19]. The complications of node infection in HIV individuals may represent actual infection or may represent an immune reconstitution inflammatory syndrome [20][21][22][23].…”