GACVS example

The Global Advisory Committee on Vaccine Safety (GACVS) reviewed data from Argentina and South America confirming in 2007 the significantly high risk of disseminated BCG (dBCG) disease in HIV-positive infants, with rates approaching 1%. GACVS took into consideration other studies showing that infection with HIV severely impairs the BCG-specific T-cell responses during the first year of life.

Based on evidence available, and considering the significant risk of BCG disease, GACVS advised that routine BCG vaccination shall no longer recommended for infants known to be HIV-infected with or without symptoms of HIV infection.

For infants whose HIV status is unknown*, GACVS recommended that BCG vaccination should be administered regardless of HIV exposure, especially considering the high endemicity of tuberculosis in populations with high HIV prevalence. Close follow up of infants known to be born to HIV-infected mothers and who received BCG at birth was also recommended to provide early identification and treatment of any BCG-related complication. In settings with adequate HIV services that could allow for early identification and administration of antiretroviral therapy to HIV-infected children, consideration should be given to delaying BCG vaccination in infants born to mothers known to be infected with HIV until these infants are confirmed to be HIV negative. Infants who demonstrate signs or reported symptoms of HIV-infection and who are born to women known to have HIV infection should not be vaccinated.

* in infants symptoms of HIV-infection rarely appear before several months of age.