Delayed complications of Bacillus Calmette Gurin BCG vaccination in HIVinfected children

1
Delayed complications of Bacillus Calmette-
Guérin (BCG) vaccination in HIV-infected children
?
Fallo A, Torrado L, Sánchez A, Cerqueiro C,
Schargrodsky L, López EL.1

• 1 Childrens Hospital Ricardo Gutiérrez
• Buenos Aires, Argentina

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Introduction

• Tuberculosis is a leading cause of mortality in
  developing countries.
• Bacillus Calmette-Guérin, an attenuated strain of
  Mycobacterium bovis is extensively used
  throughout the world as immunoprophylaxis against
  severe tuberculosis disease.
• The World Health Organization and UNICEF
  encourage BCG vaccination in developing
  countries.

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Introduction

• In Argentina intradermally BCG vaccine is given
  to all children in the first month of life
• Localized adverse events of BCG vaccine in normal
  hosts is an entity known since a long time ago,
  with almost 400 cases/million doses reported
• Disseminated infections were reported in 0.2
  cases/million doses.
• Risk is increased for immunodeficient patients.

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Objective

• To report the risk of BCG complications in
  perinatally HIV-infected children followed up at
  a Childrens Hospital .

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Material and Methods I

• A retrospective study in 310 BCG vaccinated
  patients of 374 perinatally HIV -infected
  children.
• Period 1992 - 2004.

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Material and Methods II

• Definitions
• Localized Adverse Event Abscess at the site of
  vaccination and/or ipsilateral adenitis.
• Disseminated Form other sites involved beyond
  the satellite node.
• Biochemical identification of M.bovis-BCG was
  performed at The National Reference Laboratory
  (Instituto Malbrán).

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Results Study Population
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Tuberculosis in HIV-infected children
n 51/374 (12.5)
7
44
11 vs 14 p NS
Fallo et al. Presented in part at 38th Annual
Meeting of the Infectious Diseases Society of
America (IDSA2001) Abstract 788. .
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BCG Vaccinated Patients
n 310
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Study Population
General Findings
N 28/ 310 (9)
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BCG Complications
N 28
Disseminated Complications
Localized Complications
12
Localized complications 24 (86)

• Abscess at the site of vaccination 4
• Axillary Lymphadenitis 6
• Chronic Suppurative Lymphadenitis 14 (58)

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Disseminated cases 4 (14)

Fallo et al. IJID 2005 9 96-103.
INH, RMP, EMB
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Localized vs. Disseminated Cases
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Discussion Literature

 
 

• Milstien, JB Gibson JJ Bull WHO 1990 6893-108.
• Lotte A et al Bull Int Union Tuber Lung Dis
  1988 6347-57

 
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At least other 12 case reports about
disseminated BCG infections are published.
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Conclusions

• No differences in frequency of TB disease
  between vaccinated and non-vaccinated patients
  were found
• a high frequency of complications (9) and an
  increased risk of severe disease was observed in
  our population of perinatally HIV-infected
  children, specially in patients with lower CD4.

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Conclusions

• Therefore, taking into account this and other
  similar reports, we believe that BCG vaccination
  should be reconsidered in children at risk of HIV
  infection, specially in countries where early
  diagnosis and adequate control of HIV infection
  is possible.