Drs Thomson and Dalgleish comment

Human retroviruses and paediatric diseaseSir, Thomson and Dalgleish' discuss the management of human immunodeficiency virus (HIV) positive children with regard to immunisation and state that 'HIV positive children should never be given live viral vaccines'.In a review of the medical records of 213 children with symptoms of acquired immune deficiency syndrome (AIDS) or AIDS related complex (ARC), 171 had been immunised with live oral polio vaccine and 63 with measles, mumps, and rubella vaccine with no adverse effects.At least 38 of them received live vaccines after the onset of symptoms related to HIV.2In addition, of the 71 children followed up in the European collaborative pros- pective study of infants born to mothers positive for HIV, 56 had received diphtheria/tetanus or diphtheria/tetanus/ polio vaccine (DTP), 30 Salk, 14 Sabin, eight hepatitis B, and one mumps vaccine.Of the five children who had developed AIDS or ARC, two had received DTP, two Salk, and one Sabin vaccine.No adverse reactions were reported in any child.3The potential benefit of protecting these children from natural disease before their immune system is compromised led the World Health Organization and the Immune Practices Advisory Committee of the US Public Health Service to recommend that DTP, oral live polio, and measles vaccines should be given to asymptomatic children infected with HIV.2 4 Live vaccines (oral polio, measles, and BCG) should only be withheld from children with symptoms of AIDS or ARC because of theoretical concerns about the competence of their immune system.Children, however, who live in a household with patients with AIDS or ARC should be given inactivated polio vaccine instead of oral polio vaccine because of the risk of secondary transmission.With regard to immunisation of infants positive for HIV, it is important therefore to distinguish between those who have symptoms related to HIV infection and those who do not.All available information must be used before reaching decisions which will have far reaching implications, and we urge that caution be exercised before statements are made which may influence policy.