BCG vaccine causing illness, death among HIV-positive infants, report says

Nov 6 2007

The BCG vaccine, which aims to prevent tuberculosis among children in developing countries, might be causing illness and death among some HIV-positive infants, researchers said on Friday, the Los Angeles Times reports.

The findings are included in a report about the HIV/TB co-epidemic released Thursday by the Forum for Collaborative HIV Research (Los Angeles Times, 11/3). The report said that the "benefits of potentially preventing severe TB" among HIV-positive infants are "outweighed by the risks associated with the use of BCG vaccine."

The World Health Organization previously recommended that all healthy infants receive the BCG vaccine as soon as possible after birth. However, the agency released a report in May 2007 changing its position because of evidence that HIV-positive infants had an increased risk of developing BCG disease. The BCG vaccine is based on a weakened strain of the bacterium that causes TB in cattle. Many of the infants who receive the vaccine are born HIV-positive and subsequently have compromised immune systems that make them susceptible to BCG disease, which is caused by the bovine bacterium in the vaccine (Khamsi, NewScientist.com, 11/2).

One study found that the vaccine had a 75% mortality rate among children with BCG disease and that 70% of those children were HIV-positive, Mark Cotton -- co-author of the forum's report and an HIV/AIDS researcher at Stellenbosch University in South Africa -- said (Fox, Reuters, 11/2).

According to Cotton, an estimated 400 of every 100,000 HIV-positive infants in South Africa's Western Cape province had become ill from the BCG vaccine, and it was unclear how widespread the problem might be across Africa.

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"Clearly, this is a problem in need of immediate attention," Cotton said, adding, "It is especially a problem where [there is] delayed access to diagnosis of HIV or delayed access to antiretroviral therapy." Cotton said the optimal solution would be to have earlier diagnosis and treatment of HIV-positive infants (Reuters, 11/2). Veronica Miller, a co-author of the report and director of the forum, said there is an "urgent" need for changes to vaccination programs in sub-Saharan Africa, including improved testing to determine if infants are HIV-positive before receiving the vaccination (NewScientist.com, 11/2).