scholarly journals BCG Vaccination and Mortality of COVID-19 across 173 Countries: An Ecological Study

2020 ◽  
Vol 17 (15) ◽  
pp. 5589 ◽  
Author(s):  
Mitsuyoshi Urashima ◽  
Katharina Otani ◽  
Yasutaka Hasegawa ◽  
Taisuke Akutsu
Keyword(s):  
Urban Population ◽  
Ecological Study ◽  
Randomized Clinical Trials ◽  
Vaccine Coverage ◽  
Bcg Vaccine ◽  
Bacillus Calmette Guerin ◽  
Ecological Studies ◽  
Bcg Vaccination ◽  
Insufficient Physical Activity ◽  
Pcr Test

Ecological studies have suggested fewer COVID-19 morbidities and mortalities in Bacillus Calmette–Guérin (BCG)-vaccinated countries than BCG-non-vaccinated countries. However, these studies obtained data during the early phase of the pandemic and did not adjust for potential confounders, including PCR-test numbers per population (PCR-tests). Currently—more than four months after declaration of the pandemic—the BCG-hypothesis needs reexamining. An ecological study was conducted by obtaining data of 61 factors in 173 countries, including BCG vaccine coverage (%), using morbidity and mortality as outcomes, obtained from open resources. ‘Urban population (%)’ and ‘insufficient physical activity (%)’ in each country was positively associated with morbidity, but not mortality, after adjustment for PCR-tests. On the other hand, recent BCG vaccine coverage (%) was negatively associated with mortality, but not morbidity, even with adjustment for percentage of the population ≥ 60 years of age, morbidity, PCR-tests and other factors. The results of this study generated a hypothesis that a national BCG vaccination program seems to be associated with reduced mortality of COVID-19, although this needs to be further examined and proved by randomized clinical trials.

scholarly journals Epidemiology of childhood tuberculosis after ceasing universal Bacillus Calmette–Guérin vaccination

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sayori Kobayashi ◽  
Takashi Yoshiyama ◽  
Kazuhiro Uchimura ◽  
Yuko Hamaguchi ◽  
Seiya Kato
Keyword(s):  
Policy Change ◽  
Vaccine Coverage ◽  
Lessons Learned ◽  
Public Health Authority ◽  
Bacillus Calmette Guerin ◽  
Notification Rate ◽  
Bcg Vaccination ◽  
The Past ◽  
Childhood Tb ◽  
Selective Vaccination

AbstractUniversal Bacillus Calmette–Guérin (BCG) vaccination is recommended in countries with high tuberculosis (TB) burden. Nevertheless, several countries have ceased universal BCG vaccination over the past 40 years, with scarce comparative epidemiological analyses regarding childhood TB after the policy change. We analysed data on childhood TB in countries that ceased universal BCG vaccination. Data sources included national/international databases, published papers, annual TB reports, and public health authority websites. Childhood TB notification rate increased in one of seven countries with available data. Pulmonary TB and TB lymphadenitis were the main causes of increasing childhood cases, while changes in severe forms of TB cases were minor. Maintaining high vaccine coverage for the target group was a common challenge after shifting selective vaccination. In some countries showing no increase in childhood TB after a BCG policy change, the majority of childhood TB cases were patients from abroad or those with overseas parents; these countries had changed immigration policies during the same period. Heterogeneity in childhood TB epidemiology was observed after ceasing universal BCG vaccination; several factors might obscure the influence of vaccination policy change. Lessons learned from these countries may aid in the development of better BCG vaccination strategies.

Should Bacillus Calmette–Guérin (BCG) vaccine be used in the prophylaxis of COVID-19?

2020 ◽  
Vol 54 ◽  
Author(s):  
Daisy O. Sanchez-Mostiero ◽  
Abigail F. Melicor
Keyword(s):  
Adverse Events ◽  
Police Officers ◽  
Cell Activity ◽  
Risk Groups ◽  
Bcg Vaccine ◽  
Bacillus Calmette Guerin ◽  
Efficacy And Safety ◽  
Insufficient Evidence ◽  
Bcg Vaccination ◽  
Cutaneous Reactions

At present, there is insufficient evidence to support the use of BCG vaccine as prophylaxis for COVID-19. Bacillus Calmette Guerin (BCG) vaccine is an attenuated microorganism derived from bovine tubercle bacillus and is being given to prevent severe tuberculosis. BCG vaccination may enhance production of antibodies and pro-inflammatory cytokines such as interleukin (IL)-1β and tumor necrosis factor (TNF). BCG may lead to increased CD4 and CD8 T-cell activity on subsequent viral infection. Ecological studies on the effect of BCG vaccination policy on COVID-19 outcomes have conflicting results and are prone to bias from confounders. There is insufficient evidence on the efficacy and safety of BCG vaccine for COVID-19 prophylaxis. Thirteen clinical trials are ongoing among high-risk groups (healthcare workers, elderly, police officers) to evaluate the efficacy and safety of BCG vaccine in preventing COVID-19 and its severe symptoms. WHO does not recommend the use of BCG vaccine as prophylaxis against COVID-19. Adverse events of BCG vaccine range from mild local cutaneous reactions to systemic adverse events such as abscess, lymphadenopathy and osteomyelitis.

scholarly journals The possible puzzles of BCG vaccine in protection against COVID-19 infection

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Basheer Abdullah Marzoog ◽  
Tatyana Ivanovna Vlasova
Keyword(s):  
Viral Infections ◽  
Vaccine Coverage ◽  
Clinical Effectiveness ◽  
Bcg Vaccine ◽  
Morbidity Rate ◽  
Main Body ◽  
Bacillus Calmette Guerin ◽  
Mortality And Morbidity ◽  
Vaccination Programs ◽  
Novel Coronavirus

Abstract Background The paper aimed to analyze and evaluate the present literature data on the clinical effectiveness of using the bacillus Calmette–Guérin (BCG) vaccine in protecting against the novel coronavirus disease 2019 (COVID-19). Main body Several novel clinical data have shown a relationship between the vaccinated population with the bacillus Calmette–Guérin (BCG) vaccine and the severity and mortality rate from coronavirus disease 2019 (COVID-19). However, the linkage between the BCG vaccine and COVID-19 infection mortality and morbidity rate is still ambiguous. The BCG has been protected previously from many other respiratory viral infections. The efficacy of the BCG vaccine in the protection against COVID-19 depends on various factors including social, economic, cultural norms, mitigation efforts, health infrastructure, and demographic differences between countries. Conclusion Thus, the literature analyses show a noticed difference between the countries that follow national vaccination programs than in countries that do not follow such programs (Italy, Netherlands, USA). However, there are not any recommendations for using BCG in the protection against severe cases of COVID-19. The severity of COVID-19 maybe depends on the age, immune state of the patient, and the level of vaccine coverage. The possible reason for BCG protection is trained immunity in both diseases.

scholarly journals Rationale for Randomized Clinical Trials Investigating the Potential of BCG Vaccination in Preventing COVID-19 Infection

2021 ◽  
pp. 1-11
Author(s):  
Magali Noval Rivas ◽  
Charles J. Rosser ◽  
Moshe Arditi
Keyword(s):  
Clinical Trials ◽  
Healthcare Workers ◽  
Randomized Clinical Trials ◽  
Innate Immune ◽  
Bcg Vaccine ◽  
Mitigation Measures ◽  
Medical Care System ◽  
Cancer Data ◽  
Bcg Vaccination ◽  
Frontline Healthcare Workers

Despite the implementation of mitigation measures, Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is still spreading worldwide, and has caused more than 1 million deaths so far. Although recent reports indicate that three vaccine candidates are effective against SARS-CoV-2, more time is needed to generate enough doses for the general population. Meanwhile, frontline healthcare workers are at high risk of SARS-CoV-2 exposure. To avoid collapse of the medical care system, there is a need to develop novel approaches to limit SARS-CoV-2 spread. Through a process called trained immunity, the Bacillus Calmette-Guerin (BCG) vaccine boosts the action of innate immune cells, resulting in a nonspecific reduction in the incidence of viral infections. Due to this immunomodulatory action, the BCG vaccine is currently used as a therapeutic in bladder cancer. Data collected from epidemiological and observational studies indicate that BCG vaccination might provide protection against COVID-19. While these observations do not provide evidence of causality and are limited by cofounding and intrinsic biases, it is crucial to explore the hypothesis that BCG vaccination may provide a nonspecific innate immune boost and therefore protect against COVID-19 in randomized controlled clinical trials, particularly for people at higher risk of developing COVID-19, such as frontline healthcare workers.

scholarly journals Exercising caution in correlating COVID-19 incidence and mortality rates with BCG vaccination policies due to variable rates of SARS CoV-2 testing

2020 ◽  
Author(s):  
Janine Hensel ◽  
Kathleen M. McAndrews ◽  
Daniel J. McGrail ◽  
Dara P. Dowlatshahi ◽  
Valerie S. LeBleu ◽  
...  
Keyword(s):  
Mortality Rates ◽  
Bcg Vaccine ◽  
The Novel ◽  
Bacillus Calmette Guerin ◽  
Vaccination Policy ◽  
Bcg Vaccination ◽  
The Past ◽  
Incidence And Mortality ◽  
Novel Coronavirus ◽  
A Current

ABSTRACTThe Bacillus Calmette-Guerin (BCG) vaccine provides protection against tuberculosis (TB), and is proposed to provide protection to non-TB infectious diseases. The COVID-19 outbreak results from infection with the novel coronavirus SARS-CoV-2 (CoV-2) and was declared a pandemic on March 11th, 2020. We queried whether the BCG vaccine offers protection against CoV-2 infection. We observed that countries with a current universal BCG vaccination policy have a significantly lower COVID-19 incidence than countries which never had a universal BCG policy or had one in the past. However, population density, median age, TB incidence, urban population, and, most significantly, CoV-2 testing rate, were also connected with BCG policy and could potentially confound the analysis. By limiting the analysis to countries with high CoV-2 testing rates, defined as greater than 2,500 tests per million inhabitants, these parameters were no longer statistically associated with BCG policy. When analyzing only countries with high testing rates, there was no longer a significant association between the number of COVID-19 cases per million inhabitants and the BCG vaccination policy. Although preliminary, our analyses indicate that the BCG vaccination may not offer protection against CoV-2 infection. While reporting biases may confound our observations, our findings support exercising caution in determining potential correlation between BCG vaccination and COVID-19 incidence, in part due significantly lower rates of CoV-2 testing per million inhabitants in countries with current universal BCG vaccination policy.

scholarly journals Relationship between Bacillus Calmette Guerin Vaccination Policy and Coronavirus Disease-2019 (COVID-19) Incidence

2021 ◽  
Author(s):  
Soheila Alyasin ◽  
Zahra Kanannejad ◽  
Hossein Esmaeilzadeh ◽  
Hesamedin Nabavizadeh ◽  
Mohammad Amin Ghatee ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Large Scale ◽  
Mortality Rates ◽  
Epidemiological Studies ◽  
Bcg Vaccine ◽  
Confounding Factors ◽  
Protective Effects ◽  
Bacillus Calmette Guerin ◽  
Vaccination Policy ◽  
Bcg Vaccination

Bacillus Calmette Guerin (BCG) was designed for protecting children against tuberculosis. Also, it can protect against other infectious diseases through the induction of trained immunity. Due to its heterologous protective effects, the BCG vaccine has been proposed as a treatment option for coronavirus disease-2019 (COVID-19). Epidemiological studies have found that countries without BCG vaccination policy have experienced higher mortality rates related to COVID-19 infection than those with BCG vaccination policy. However, there are some confounding factors such as age, population intensity, immigration, the pandemic phase, and data accuracy that may affect these results. Therefore, this hypothesis should be evaluated by clinical trial studies. Large-scale clinical trials are in progress to investigate if the BCG vaccine could be used as a useful tool for protection against COVID-19 infection.

scholarly journals Decreased varicella and increased herpes zoster incidence at a sentinel medical deputising service in a setting of increasing varicella vaccine coverage in Victoria, Australia, 1998 to 2012

2014 ◽  
Vol 19 (41) ◽  
Author(s):  
H A Kelly ◽  
K A Grant ◽  
H Gidding ◽  
K S Carville
Keyword(s):  
Herpes Zoster ◽  
Indirect Effect ◽  
Ecological Study ◽  
Vaccine Coverage ◽  
Varicella Vaccine ◽  
Ecological Studies ◽  
Incidence Risk ◽  
The Impact ◽  
Herpes Zoster Incidence ◽  
Ongoing Monitoring

We performed an ecological study using sentinel consultation data from a medical deputising service to assess the impact of increasing coverage with childhood varicella vaccine on the incidence risk of varicella and zoster in the population served by the deputising service in Victoria, Australia from 1998 to 2012. Following a successful vaccination programme, the incidence of varicella in Australia was modelled to decrease and the incidence of zoster to increase, based on a theoretical decrease in boosting of zoster immunity following a decrease in wild varicella virus circulation due to vaccination. Incidence risks (consultation proportions for varicella and zoster) were directly age-standardised to the Melbourne population in 2000, when varicella vaccine was first available. Age-standardised varicella incidence risk peaked in 2000 and halved by 2012. Age-standardised zoster incidence risk remained constant from 1998 to 2002, but had almost doubled by 2012. The increase in zoster consultations largely reflected increases in people younger than 50 years-old. Although causality cannot be inferred from ecological studies, it is generally agreed that the decrease in varicella incidence is due to increasing varicella vaccine coverage. The possible indirect effect of the vaccine on zoster incidence is less clear and ongoing monitoring of zoster is required.

scholarly journals The influence of vaccination against tuberculosis with the Bacillus-Calmette-Guérin(BCG) vaccine on COVID-19 incidence and mortality – review of the literature

2020 ◽  
pp. 290-302 ◽  
Author(s):  
Gabriela Ręka ◽  
Anna Korzeniowska ◽  
Halina Piecewicz-Szczęsna
Keyword(s):  
Respiratory Infections ◽  
Epidemiological Data ◽  
Bcg Vaccine ◽  
Bacillus Calmette Guerin ◽  
Review Of The Literature ◽  
Bcg Vaccination ◽  
Incidence And Mortality ◽  
Mortality Review ◽  
The Moment ◽  
Mandatory Vaccination

THE AIM OF THE STUDY. Is to present the state of knowledge from April and May 2020 about the influence of Bacillus-Calmette-Guérin vaccination against tuberculosis on incidence and mortality due to COVID-19. MATERIAL AND METHODS. A review of the latest literature till 9 May 2020 has been made. PubMed and ResearchGate databases and WHO reports were used. RESULTS. Immunomodulatory properties of the tuberculosis vaccine which protects against severe cases of tuberculosis and partly against other infections are indicated, including viral and respiratory infections. The BCG vaccine induces heterologous immunity and trained innate immunity. It was noted that in countries which maintain obligatory BCG vaccination COVID-19 incidence and mortality are lower than in countries that have stopped or never introduced BCG as mandatory vaccination. Most analysis confirmed this relationship, but they indicated the possible impact of other factors, such as genetics in the population, the type of strain from BCG vaccine, the level of health care and the wealth of a nation, the structure of migration, co-morbidities and a policy of introducing social distance. CONCLUSIONS. At the moment, we do not have enough evidence to support or deny the hypothesis of COVID-19 reduction in incidence and mortality in countries maintaining obligatory BCG vaccination. Other factors that might affect the results should be considered in further analysis. The results of clinical trials will provide more reliable proofs than analysis of epidemiological data. WHO does not recommend BCG vaccination to prevent COVID-19 and recommends it to newborns from areas with a higher incidence of tuberculosis.

Explore the Possible Impact of BCG Vaccination Policy on the Morbidity, Mortality, and Recovery Rates due to COVID-19 Infection. (Preprint)

2020 ◽  
Author(s):  
Yue-Cune Chang
Keyword(s):  
Odds Ratio ◽  
Randomized Clinical Trials ◽  
Vaccination Policy ◽  
Bacille Calmette Guerin ◽  
Recovery Rates ◽  
Bcg Vaccination ◽  
The World ◽  
New Form ◽  
The Relationship ◽  
Disease Specific

BACKGROUND The Coronavirus Disease-19 (COVID-19) is the new form of an acute infectious respiratory disease and has quickly spread over most continents in the world. Recently, it has been shown that Bacille Calmette-Guerin (BCG) might protect against COVID-19. This study aims to investigate the possible correlation between BCG vaccination and morbidity/mortality/recovery rate associated with COVID-19 infection. OBJECTIVE Our findings confirm that the BCG vaccination might protect against COVID-19 virus infection. METHODS Data of COVID-19 confirmed cases, deaths, recoveries, and population were obtained from https://www.worldometers.info/coronavirus/ (Accessed on 12 June, 2020). To have meaningful comparisons among countries’ mortality and recovery rates, we only choose those countries with COVID-19 infected cases at least 200. The Poisson regression and logistic regression were used to explore the relationship between BCG vaccination and morbidity, mortality and recovery rates. RESULTS Among those 158 countries with at least 200 COVID-19 infected cases, there were 141 countries with BCG vaccination information available. The adjusted rates ratio of COVID-19 confirmed cases for Current BCG vaccination vs. non-Current BCG vaccination was 0.339 (with 95% CI= (0.338,0.340)). Moreover, the adjusted odds ratio (OR) of death and recovery after coronavirus infected for Current BCG vaccination vs. non-Current BCG vaccination were 0.258 (with 95% CI= (0.254,0.261)) and 2.151 (with 95% CI= (2.140,2.163)), respectively. CONCLUSIONS That data in this study show the BCG might provide the protection against COVID-19, with consequent less COVID-19 infection and deaths and more rapid recovery. BCG vaccine might bridge the gap before the disease-specific vaccine is developed, but this hypothesis needs to be further tested in rigorous randomized clinical trials. INTERNATIONAL REGISTERED REPORT RR2-https://doi.org/10.1101/2020.06.14.20131268

Immunobiological Markers in Prophylaxis Post-exposure with Single Dose of Rifampicin and BCG Vaccine in Contacts of Multibacillary Leprosy Cases: Study Protocol (Preprint)

2020 ◽  
Author(s):  
Camila Massae Sato ◽  
Omar Ariel Espinosa Domínguez ◽  
Gutembergue Santos de Sousa ◽  
Fabiane Verônica da Silva ◽  
Roberta Olmo Pinheiro ◽  
...  
Keyword(s):  
Single Dose ◽  
Bcg Vaccine ◽  
Reference Laboratory ◽  
Serological Response ◽  
Bacillus Calmette Guerin ◽  
Prophylactic Measure ◽  
Mato Grosso ◽  
Household Contacts ◽  
Ifn Γ ◽  
Multibacillary Leprosy

BACKGROUND Leprosy contacts are sensitive indicator of the magnitude of severity, and a high risk for infection and disease, especially if the individuals are exposed to the bacillus with multibacillary cases, which reinforces the need for chemoprophylactic measures, such as the use single-dose rifampicin (SDR) combined with BCG vaccine. OBJECTIVE Our study will analyze the serological response of anti-NDO-LID, HO-1/HMOX and serum IFN-γ concentration as a prophylactic measure after the use of single-dose rifampicin (SDR) combined with the Bacillus Calmette-Guérin vaccine (BCG) among multibacillary leprosy household contacts. METHODS Intervention study based on a prospective cohort of household contacts of new cases of multibacillary leprosy diagnosed and registered in the Information System on Diseases of Compulsory Declaration (SINAN – Sistema de Informação de Agravos de Notificação) and residents in the municipalities of Cuiabá and Cáceres, Mato Grosso, in the years 2019 and 2020. Contacts with no signs and symptoms compatible with the disease of the intervention group will receive single-dose rifampicin (SDR) combined with BCG vaccine and will be compared to the control group. The follow-up of the cohort will last 12 months. The analyses of the anti-NDO-LID, HO-1/HMOX and serum concentration of IFN-γ tests as immunological markers before, 6 and 12 months after the intervention will be conducted in a reference laboratory (FIOCRUZ). RESULTS The study is still recruiting participants and is expected to be completed in September 2020. CONCLUSIONS Our study seeks to analyze the response of anti-NDO-LID, HO-1/HMOX tests and serum IFN-γ concentration as a prophylactic measure after the use of single-dose rifampicin (SDR) combined with the Bacillus Calmette-Guérin vaccine (BCG) in home contacts of multibacillary leprosy cases. CLINICALTRIAL Brazilian Registry of Clinical Trials (ReBEC), RBR-6yg2z9. Retrospectively registered on 3 de Out. de 2019.

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