Novel vaccine prime and selective BCG boost: a new tuberculosis vaccine strategy for infants of HIV-infected mothers.

Novel tuberculosis vaccination strategies hinge on BCG priming, yet newborn BCG vaccination may cause BCG disease in HIV-infected infants. Viral-vectored or subunit prime vaccine, followed by delayed BCG boost only for HIV-uninfected infants, may be a safe alternative for all newborns, regardless of maternal HIV infection. This approach should be tested using new tuberculosis vaccine candidates. If safety and immunogenicity of a novel vaccine prime is established in infants of HIV-infected mothers, for whom newborn BCG carries unacceptable risk, this strategy might then be compared to conventional BCG prime and viral-vectored or subunit boost, and BCG alone, in HIV-unexposed infants.