Children who are HIV-infected when vaccinated with BCG at birth are at increased risk of developing disseminated BCG disease. However, if HIV-infected individuals, including children, are receiving ART, are clinically well and immunologically stable (CD4 % >25% for children aged <5 years or CD4 count ≥200 if aged >5 years) they should be vaccinated with BCG.

• In general, populations with high prevalence of HIV infection also have the greatest burden of TB; in such

populations the benefits of potentially preventing severe TB through vaccination at birth are outweighed by the risks associated with the use of BCG vaccine. Therefore, it is recommended that in such populations:

• Neonates born to women of unknown HIV status should be vaccinated as the benefits of BCG vaccination

outweigh the risks.

• Neonates of unknown HIV status born to HIV-infected women should be vaccinated if they have no clinical

evidence suggestive of HIV infection, regardless of whether the mother is receiving ART.

• Although evidence is limited, for neonates with HIV infection confirmed by early virological testing, BCG

vaccination should be delayed until ART has been started and the infant confirmed to be clinically and immunologically stable (CD4% >25%).