Browsing by Author "Schaaf, H S"

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    BCG vaccination in South African HIV-exposed infants - risks and benefits
    (2009) Hesseling, A C; Caldwell, J; Cotton, M F; Eley, B S; Jaspan, H B; Jennings, K; Marais, B J; Nuttall, J; Rabie, H; Roux, P; Schaaf, H S
    Until 2007, the World Health Organization (WHO) recommended that bacille Calmette-Guérin (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. BCG induces protective efficacy against tuberculous meningitis of 73% (67 - 79%) and against miliary disease of 77% (58 - 87%) in HIV-uninfected children. 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. 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.
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    Unexplained HIV-1 infection in children — documenting cases and assessing for possible risk factors
    (HEALTH & MEDICAL PUBLISHING GROUP, 2004) Hiemstra, R; Rabie, H; Schaaf, H S; Eley, B S; Cameron, N; Mehtar, S; Janse van Rensburg, A; Cotton, M F
    Background. In the year 2000 we reported possible horizontal transmission of HIV-1 infection between two siblings. An investigation of three families, each with an HIV-infected child but seronegative parents, permitted this finding. Sexual abuse and surrogate breast-feeding were thought unlikely. The children had overlapping hospitalisation in a regional hospital. Since then several cases of unexplained HIV infection in children have been reported. A registry was established at Tygerberg Children’s Hospital for collection of data on the extent of horizontal or unexplained transmission of HIV in children. Study design. Retrospective chart review. Results. Fourteen children were identified, 12 from the Western Cape and 1 each from the Eastern Cape and KwaZulu-Natal. Thirteen (92%) had been hospitalised previously. In the Western Cape, children had been hospitalised in 8 hospitals. Ten of 13 (77%) were admitted as neonates and 9 of 13 (69%) had 2 or more admissions. Intravascular cannulation and intravenous drug administration occurred in all but 2 children before HIV diagnosis. Conclusion. We have confirmed HIV infection in a number of cases where the source of infection has been inadequately explained. Circumstantial evidence supports but does not prove nosocomial transmission. Further studies and identification of medical procedures conducive to the spread of HIV are urgently needed.