BACILLUS-CALMETTE-GUERIN COMPLICATIONS IN CHILDREN BORN TO HIV-1-INFECTED WOMEN WITH A REVIEW OF THE LITERATURE

Objective. To compare the risk of complications following Bacillus Cal mette-Guerin (BCG) vaccination among children by maternal and infant H IV-1 infection status as part of an investigation of an outbreak of BC G complications. Methods. A nonconcurrent cohort study of BCG complica tions among 125 infants born to HIV-1 seropositive and 166 infants bor n to HIV-1 seronegative mothers was conducted in Cite Soleil, Haiti. I nfants were examined at regular intervals until 15 months of age, and complications from BCG were documented. An investigation of BCG vaccin ation practices was conducted. Results. Mild or moderate complications occurred among 16 of 166 (9.6%) infants born to HIV-1 seronegative mo thers compared with 4 of 13 HIV-1-infected infants (30.8%, P =.04) and 10 of 75 (13.3%, P =.39) uninfected infants born to HIV-1-infected mo thers. No serious complications were noted. The outbreak of complicati ons was associated with administration of 2.0 to 2.5 times the recomme nded dose of BCG vaccine. Conclusions. This and five other cohort stud ies indicate that there may be a small increased risk of complications following BCG vaccination among HIV-1-infected children, but the reac tions are usually mild and the risk does not outweigh the benefits of BCG vaccination in populations at high risk of tuberculosis during inf ancy and childhood.