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Reduced rate of adverse reactions to the BCG vaccine in children exposed to the vertical transmission of HIV infection and in HIV-infected children from an endemic setting in Brazil

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Abstract

We report on the adverse reactions to the Bacillus Calmette-Guérin (BCG) vaccine in BCG-vaccinated children. We examined children exposed to the vertical transmission of human immunodeficiency virus (HIV) (n = 141), who participated in a prevention program of vertical transmission, and HIV-infected children (n = 66) in a setting endemic for HIV and tuberculosis (TB) in Brazil from August 2000 to February 2008. No cases of disseminated BCG disease occurred in either group of children. While no cases of regional BCG disease were noted in exposed/uninfected children, the rate of regional BCG disease in HIV-infected children was 4.5% (3/66); the three events occurred in <1-year-old children (3/17; 17.6%). One case was associated with severe immunodepression before highly active antiretroviral therapy (HAART). Two cases were manifestations of immune reconstitution inflammatory syndrome (IRIS). Among the HIV-infected children, the accrued benefits of potentially preventing severe TB outweighed the risks associated with the use of the BCG vaccine.

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Abbreviations

AIDS:

Acquired immunodeficiency syndrome

BCG:

Bacillus Calmette-Guérin

bDNA:

Branched DNA

CDC:

Centers for Disease Control and Prevention

HAART:

Highly active antiretroviral therapy

HIV:

Human immunodeficiency virus

IRIS:

Immune reconstitution inflammatory syndrome

LIP:

Lymphocytic interstitial pneumonia

MTCT:

Mother-to-child transmission

NASBA:

Nucleic acid sequence-based amplification

PMTCT:

Prevention program of mother-to-child transmission

PPD:

Purified protein derivative

SI:

Severe immunodepression

STD:

Sexually transmitted disease

TB:

Tuberculosis

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Acknowledgments

The authors would like to thank the children and their families who participated in this study. The authors are grateful to the members of the Specialized Assistance Service for HIV/AIDS, the Voluntary Counselling and Testing Centre for HIV and AIDS of the Municipal Program for the Surveillance of STD and AIDS of the city of Campos of Goytacazes, for their support. This study was financed by the Municipal Health Department of the city of Campos dos Goytacazes, the National Program for STD/AIDS and by a grant from the Ministry of Health/UNESCO to E.M.-A.

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Authors and Affiliations

  1. Municipal Program for the Surveillance of Sexually Transmitted Diseases and Acquired Immunodeficiency Syndrome of Campos dos Goytacazes, Rua Conselheiro Otaviano 214, Campos dos Goytacazes, RJ, 28010-140, Brazil

    Regina Célia de Souza Campos Fernandes

  2. Faculty of Medicine of Campos, Avenida Alberto Torres 217, Campos dos Goytacazes, RJ, 28034-58, Brazil

    Regina Célia de Souza Campos Fernandes

  3. Guarus Municipal General Hospital, Rua José Carlos Pereira Pinto 400, Campos dos Goytacazes, RJ, 28080-790, Brazil

    Luciana Cordeiro de Araújo

  4. State University of the North Fluminense Darcy Ribeiro, Avenida Alberto Lamego 2000, Parque Califórnia, Campos dos Goytacazes, RJ, 28013-602, Brazil

    Enrique Medina-Acosta

  5. Rua Rafael Danuncio Damiano 277, Campos dos Goytacazes, RJ, 28013-035, Brazil

    Regina Célia de Souza Campos Fernandes

Authors
  1. Regina Célia de Souza Campos Fernandes
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  2. Luciana Cordeiro de Araújo
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  3. Enrique Medina-Acosta
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Corresponding author

Correspondence to Regina Célia de Souza Campos Fernandes.

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Disclosures: the authors state that they have no interests which might be perceived as posing a conflict or bias.

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de Souza Campos Fernandes, R.C., de Araújo, L.C. & Medina-Acosta, E. Reduced rate of adverse reactions to the BCG vaccine in children exposed to the vertical transmission of HIV infection and in HIV-infected children from an endemic setting in Brazil. Eur J Pediatr 168, 691–696 (2009). https://doi.org/10.1007/s00431-008-0822-y

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  • DOI: https://doi.org/10.1007/s00431-008-0822-y

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