BACILLUS-CALMETTE-GUERIN INFECTION AFTER VACCINATION OF HUMAN IMMUNODEFICIENCY VIRUS-INFECTED CHILDREN

The use of Mycobacterium bovis/Bacillus Calmette-Guerin (BCG) to vacci nate against tuberculosis remains controversial. The development of tu berculosis in human immunodeficiency virus (HIV)-infected children dem ands specific evaluation of the risk/benefit ratio of BCG vaccination in this situation. In our institution 9 of 68 HIV-infected children va ccinated with BCG before the diagnosis of HIV infection was suspected developed vaccine-related complications: 7 of these children had a lar ge satellite adenopathy with or without skin fistulae, whereas the oth er 2 had disseminated BCG infection beyond the satellite ganglion (inv olvement of the spleen and mesenteric and mediastinal lymph nodes in o ne case and the liver and lungs in the other). The children were vacci nated soon after birth; no particular problems were observed at that t ime, but complications appeared 3 to 35 months later. All but one of t hese children had a rapidly progressive form of HIV disease. The possi bility of delayed local or disseminated BCG infection must be consider ed in analysis of the risk/benefit ratio of vaccination of HIV-infecte d children. The prognosis of HIV infection must be taken into account, even if the child is asymptomatic when vaccination is being considere d.