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Until 2007, the World Health Organization (WHO) recommended that bacille Calmette-Guerin (BCG) vaccination should be contraindicated in infants with symptomatic HIV disease in countries with a high burden of tuberculosis. This recommendation was based on the perceived low risk of serious adverse events in HIV-infected infants. The WHO revised its recommendations regarding BCG vaccination in HIV-infected infants in 2007, making HIV infection a full contraindication to BCG vaccination.1 BCG induces protective efficacy against tuberculous meningitis of 73% (67 – 79%) and against miliary disease of 77% (58 – 87%) in HIV-uninfected children.2 The efficacy against childhood pulmonary disease is variable;3 there is no evidence that BCG induces a protective effect against tuberculosis in HIV-infected infants and children.4 BCG is a safe vaccine in immunocompetent infants, and severe vaccine adverse events in HIV-uninfected infants occur only with rare primary immune deficiencies in approximately 1 per million vaccinees.5

BCG vaccination in South African HIV-exposed infants--risks and benefits.