Melbourne School of Population Health, University of Melbourne, Department of Paediatrics, Royal Children's Hospital, Melbourne, Victoria, Australia.
Int J Tuberc Lung Dis. 2009 Nov;13(11):1331-44.
To describe the characteristics and risk of bacille Calmette-Guérin (BCG) vaccine related disease in human immunodeficiency virus (HIV) infected infants.
Systematic literature review of articles published from 1950 to April 2009 in the English language. We identified all microbiologically confirmed cases of disseminated BCG disease in vertically HIV-infected children reported in the literature.
Sixteen observational studies and 11 case reports/series were included. Observational studies suffered from high rates of loss to follow-up and death. Loco-regional BCG disease was reported in both HIV-infected and non-infected children. Disseminated BCG disease was reported only in children with immunodeficiency and only in studies employing sophisticated laboratory techniques. Sixty-nine cases of disseminated BCG were identified in the literature: 47 cases were reported in six observational studies, the majority (41/47) from the Western Cape of South Africa. A Brazilian cohort study reported no cases of disseminated BCG amongst 66 HIV-infected children observed over a 7-year period. A recent South African surveillance study reported 32 cases of disseminated BCG over a 3-year period, estimating the risk of disseminated BCG to be 992 per 100,000 vaccinations in HIV-infected children. Few cases of severe disseminated TB were reported in the cohort studies among HIV-infected children vaccinated with BCG.
Data on the risk of BCG vaccination in HIV-infected children are limited. Targeted surveillance for BCG complications employing sophisticated diagnostic techniques is required to inform vaccination policy.
描述人类免疫缺陷病毒（HIV）感染婴儿中卡介苗（BCG）疫苗相关疾病的特征和风险。
对 1950 年至 2009 年 4 月期间以英文发表的文献进行系统性文献回顾。我们在文献中确定了所有经微生物学证实的垂直感染 HIV 的儿童中播散性 BCG 疾病的病例。
纳入了 16 项观察性研究和 11 项病例报告/系列研究。观察性研究存在高失访率和死亡率。局部 BCG 疾病在 HIV 感染和非感染儿童中均有报道。播散性 BCG 疾病仅在免疫缺陷儿童中报告，且仅在采用复杂实验室技术的研究中报告。文献中共报道了 69 例播散性 BCG 病例：6 项观察性研究中有 47 例，其中大多数（41/47）来自南非西开普省。一项巴西队列研究报告称，在 7 年的观察期内，66 例 HIV 感染儿童中未发现播散性 BCG 病例。最近的南非监测研究报告称，在 3 年期间发现 32 例播散性 BCG 病例，估计在 HIV 感染儿童中，接种 BCG 疫苗后播散性 BCG 的风险为每 10 万人 992 例。在接种 BCG 的 HIV 感染儿童的队列研究中，有少数严重播散性结核病病例报告。
关于 HIV 感染儿童接种 BCG 疫苗风险的数据有限。需要采用复杂的诊断技术对 BCG 并发症进行有针对性的监测，以告知疫苗接种政策。
