Immune Reconstitution Inflammatory Syndrome due to Mycobacterium bovis Bacillus Calmette-Guerin in Infants Receiving Highly Active Antiretroviral Therapy: A Call for Universal Perinatal Rapid HIV Testing Prior to Administration of BCG Immunization of Neonates

Koppel, Alexander; Leonardo-Guerrero, José; Rives, Sarah; Paniagua-Torres, Noemí; Sparrow, Céline; Beck-Sagué, Consuelo M.

doi:10.1093/tropej/fmp115

Cited by 7 publications

(4 citation statements)

References 21 publications

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“…Similar to other large SCID series published 15 16 , the majority of patients in our cohort (63%) were diagnosed with SCID within the first 6 months of life. Until safer and more efficient forms of anti-tuberculosis vaccines become available 17 , delaying BCG vaccination beyond one month of age is likely to have a favorable impact in this highly vulnerable population, as well as other susceptible neonates (e.g., HIV positive infants) 18 . Moreover, delaying BCG vaccination would also benefit the clinical impact of neonatal SCID screening, preventing application of an absolutely contraindicated vaccine prior to establishing the diagnosis of SCID.…”

Section: Discussionmentioning

confidence: 99%

BCG vaccination in patients with severe combined immunodeficiency: Complications, risks, and vaccination policies

Marciano

Huang

Joshi

et al. 2014

Journal of Allergy and Clinical Immunology

214

209

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Background SCID is a syndrome characterized by profound T cell deficiency. BCG vaccine is contraindicated in SCID patients. Because most countries encourage BCG vaccination at birth, a high percent of SCID patients are vaccinated before their immune defect is detected. Objectives To describe the complications and risks associated with BCG vaccination in SCID patients. Methods An extensive standardized questionnaire evaluating complications, therapeutics, and outcome regarding BCG in patients diagnosed with SCID was widely distributed. Summary statistics and association analysis was performed. Results Data on 349 BCG vaccinated SCID patients from 28 centers in 17 countries was analyzed. Fifty-one percent of the patients developed BCG complications, 34% disseminated and 17% localized (a 33,000 and 400 fold increase, respectively, over the general population). Patients receiving early vaccination (≤ 1 month) showed an increased prevalence of complications (p=0.006) and death due to BCG complications (p<0.0001). The odds of experiencing complications among patients with T cells ≤ 250/uL at diagnosis was 2.1 times higher (95% CI, 1.4-3.4; p = 0.001) than among those with T cells > 250/uL. BCG complications were reported in 2/78 patients who received anti-mycobacterial therapy while asymptomatic and no deaths due to BCG complications occurred in this group. In contrast 46 BCG-associated deaths were reported among 160 patients treated with anti-mycobacterial therapy for a symptomatic BCG infection (p<0.0001). Conclusions BCG vaccine has a very high rate of complications in SCID patients, which increase morbidity and mortality rates. Until safer and more efficient anti-tuberculosis vaccines become available, delay in BCG vaccination should be considered to protect highly vulnerable populations from preventable complications.

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Section: Discussionmentioning

confidence: 99%

BCG vaccination in patients with severe combined immunodeficiency: Complications, risks, and vaccination policies

Marciano

Huang

Joshi

et al. 2014

Journal of Allergy and Clinical Immunology

214

209

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“…El presente estudio es la serie nacional más amplia de casos SIRI-BCG en niños con VIH. El perfil clínico encontrado es de un niño menor de 2 años con VIH, infectado verticalmente, con inicio reciente de TARGA, estadio de inmunosupresión severa y con carga viral mayor a 5log 10 de copias/mm 3 , datos similares a lo encontrado en la literatura internacional (7)(8)(9) .…”

Section: Discussionunclassified

Síndrome de reconstitución inmune por BCG en niños tratados por VIH

Miranda-Choque

Candela-Herrera

Segura

et al. 2014

Rev Peru Med Exp Salud Publica

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a Médico infectólogo; b médico pediatra; c médico magíster en Salud Pública y Epidemiología; d enfermera magíster en Salud Pública y Comunitaria, especialista en Enfermería Pediátrica; e médico cirujano Recibido: 13-03-12 Aprobado: 14-11-12 * Este artículo se basa en el informe técnico "Síndrome de reconstitución inmune por Mycobacterium bovis Bacillus Calmette-Guérin en niños peruanos con tratamiento antirretroviral por HIV" disponible en la página web del Instituto Nacional de Salud del Niño de Lima, Perú. Citar como: Miranda-Choque E, Candela-Herrera J, Segura ER, Farfán-Ramos S, Barriga A. Síndrome de reconstitución inmune por BCG en niños tratados por VIH. Rev Peru Med Exp Salud Publica. 2012;29(4):498-502.El objetivo del estudio fue describir el perfil clínico del síndrome de reconstitución inmune por Mycobacterium bovis Bacillus Calmette-Guérin (SIRI-BCG) en niños con infección VIH que reciben tratamiento antirretroviral de gran actividad (TARGA) en el Instituto Nacional de Salud del Niño de Lima, Perú. Se realizó un estudio de serie de casos, que incluyó ocho niños con SIRI-BCG, definido como la presencia de linfadenopatía regional o inflamación en sitio de inoculación de BCG con disminución de al menos un logaritmo en la carga viral o mejoría inmunológica. Todos los pacientes tenían estadio SIDA (C3). La mediana de edad de inicio del TARGA fue de 7,2 meses y el evento se produjo entre 3 a 11 semanas luego de haberlo iniciado. En siete casos se produjo adenitis axilar. Al comparar con el grupo sin SIRI-BCG se encontró asociación significativa con la edad de inicio del TARGA de un año, estado de inmunodepresión severa, y carga viral incrementada. Se concluye que el SIRI-BCG está relacionado con una rápida progresión clínica de la infección VIH/SIDA de trasmisión vertical, estadio de inmunosupresión severa, y carga viral alta al momento del inicio del TARGA.

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“…According to national guidelines, prenatal HIV testing in the DR is to be performed using rapid antibody tests; results of samples that test positive are then confirmed with another rapid test that uses a different principle, according to WHO guidelines [26], allowing infected pregnant women to receive at least presumptive, if not confirmed, positive test results in the same visit in which the sample for testing is obtained. Yet according to an observational study and a case report in some centers, samples were stored as they were collected and rapid tests run once a day; women were asked to return for their results, and posttest counseling sometimes consisted of reporting that the test “needs to be repeated” without clarifying that it was a presumptive positive test, leading to women delivering without an HIV diagnosis, MTCT, and maternal and infant HIV progression and death [14, 27, 28]. …”

Section: Discussionmentioning

confidence: 99%

Progress towards Elimination of HIV Mother-to-Child Transmission in the Dominican Republic from 1999 to 2011

Lorenzo¹,

Beck-Sagué

Bautista-Soriano³

et al. 2012

Infectious Diseases in Obstetrics and Gynecology

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In 1999, prevention of mother-to-child transmission (pMTCT) using antiretrovirals was introduced in the Dominican Republic (DR). Highly active antiretroviral therapy (HAART) was introduced for immunosuppressed persons in 2004 and for pMTCT in 2008. To assess progress towards MTCT elimination, data from requisitions for HIV nucleic acid amplification tests for diagnosis of HIV infection in perinatally exposed infants born in the DR from 1999 to 2011 were analyzed. The MTCT rate was 142/1,274 (11.1%) in 1999–2008 and 12/302 (4.0%) in 2009–2011 (P < .001), with a rate of 154/1,576 (9.8%) for both periods combined. This decline was associated with significant increases in the proportions of women who received prenatal HAART (from 12.3% to 67.9%) and infants who received exclusive formula feeding (from 76.3% to 86.1%) and declines in proportions of women who received no prenatal antiretrovirals (from 31.9% to 12.2%) or received only single-dose nevirapine (from 39.5% to 19.5%). In 2007, over 95% of DR pregnant women received prenatal care, HIV testing, and professionally attended delivery. However, only 58% of women in underserved sugarcane plantation communities (2007) and 76% in HIV sentinel surveillance hospitals (2003–2005) received their HIV test results. HIV-MTCT elimination is feasible but persistent lack of access to critical pMTCT measures must be addressed.

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Immune Reconstitution Inflammatory Syndrome due to Mycobacterium bovis Bacillus Calmette-Guerin in Infants Receiving Highly Active Antiretroviral Therapy: A Call for Universal Perinatal Rapid HIV Testing Prior to Administration of BCG Immunization of Neonates

Cited by 7 publications

References 21 publications

BCG vaccination in patients with severe combined immunodeficiency: Complications, risks, and vaccination policies

BCG vaccination in patients with severe combined immunodeficiency: Complications, risks, and vaccination policies

Síndrome de reconstitución inmune por BCG en niños tratados por VIH

Progress towards Elimination of HIV Mother-to-Child Transmission in the Dominican Republic from 1999 to 2011

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