Evidence behind the WHO Guidelines: Hospital Care for Children: What is the Evidence that BCG Vaccination Should Not be Used in HIV-infected Children?

Abstract

The World Health Organization has produced guidelines for the management of common illnesses in hospitals with limited resources. This series reviews the scientific evidence behind WHOs recommendations. The WHO guidelines and more reviews are available at: http://www.ichrc.org. This review addresses the question: What is the evidence that BCG vaccination should not be used in HIV-infected children? The limited evidence currently available has been the basis of the WHO recommendation that BCG vaccination should not be used in HIV-positive children as severe complications appear more commonly in HIV-infected individuals [8]. This decision is supported by the findings from the Fallo [13] and Hesseling [18 20] studies. Although the WHO have suggested that HIV-infected infants should not be vaccinated this is obviously difficult in countries where BCG vaccination is administered before HIV status can be detected. Many high HIV-burden countries do not have viral-specific testing (such as PCR) routinely available to adequately assess the infection status of every new born infant. More research needs to be undertaken in this area to clarify the situation and treating clinicians need to be made aware of this issue with all its complexity. The WHO recommendation highlights the need for viral-specific testing to be widely available in developing countries. This will ensure HIV-infected infants are not exposed to BCG which may be potentially dangerous and HIV-exposed but uninfected infants are not denied this important vaccine.