Interventions for Tuberculosis Control and Elimination 2002

In a prospective study in South Africa among 10,000 neonates receiving
the Copenhagen strain intradermally at birth, at six weeks post vaccination
the vaccination scar had healed in more than 95% of children, 1.5%
had no vaccination scar, and in 3% adverse events were noted. 704 All
adverse events were local (oozing, abscesses, rarely combined with lymphadenopathy).
Because BCG is a live vaccine, concerns were raised early on about
the safety of its use in persons infected with HIV, 705-707 and several case
reports about disseminated mycobacteriosis 708-714 and mycobacterial meningitis
due to BCG 708,710,715 have been published. A study among motherchild
pairs with and without HIV infection has shown that children of mothers
with HIV infection who also had HIV infection themselves had a slightly
increased risk of suppurative lymphadenitis, but the manifestations were
mild and easily manageable (figure 58). 716 Apparently, living BCG can
persist for decades and cause localized 717 or disseminated 718 complications
after acquisition of immunosuppression. Nevertheless, most of these case
reports appear to be isolated events, although it has been argued that disseminated
disease attributable to BCG vaccination in HIV-infected children
might be exceedingly difficult to diagnose. 719 However, a study in Zambia
among HIV-symptomatic children with a median age of 15 months, showed
that mycobacteremia due to BCG must be exceedingly rare. 720 A recom-
Relative risk
(log scale)
7
3
1
0.7
Referent
Mother neg
Child neg
103
Mother pos
Child neg
Mother pos
Child pos
Figure 58. Relative risk of a complication following BCG vaccination among children
born to an HIV-infected mother. 716