WHO Consultation on HIV and Routine Childhood Immunization, Geneva, 12-13 August 1987.
A consultation in August 1987, co-sponsored by the World Health Organization (WHO) Special Program on Acquired Immunodeficiency Syndrome (AIDS) and the Expanded Program on Immunization (EPI), was called to review available information on human immunodeficiency virus (HIV) infection and immunization guidelines. Of particular concern was the safety and efficacy of the 6 EPI vaccines in children with HIV infection. Concerns have been raised that children infected with HIV who receive routine childhood immunizations may have decreased immune responses and be at greater risk of adverse effects or acceleration of HIV-induced immunosuppression. Available data, although limited, suggest that there is no risk of accelerating HIV infection by the simultaneous administration of multiple antigens, except perhaps in the case of Bacille Calmette-Guerin (BCG) immunization. In areas where exposure to measles and poliomyelitis is high, the benefits of immunization far outweigh the risks of adverse effects from immunization, even in the presence of symptomatic HIV infection. Overall, consultation participants affirmed the validity of the following EPI guidelines developed in 1986: 1) in countries where HIV infection is problematic, children should be immunized with EPI antigens according to the standard schedule, including children with asymptomatic HIV infection; and 2) unimmunized individuals with clinical AIDS in countries where the EPI target diseases remain serious risks should not receive BCG, but should be given the remaining 5 vaccines. Since vaccine-related adverse effects are minimized and vaccine responses optimized by beginning immunization before the progression of HIV-induced immunosuppression, children should be immunized as early in life as possible.