BCG protects against COVID-19? A word of caution

Szigeti, Réka; Kellermayer, Domos; Kellermayer, Richárd

doi:10.1101/2020.04.09.20056903

Cited by 25 publications

(26 citation statements)

References 18 publications

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“…20 However, countries like Iceland where BCG is not a part of routine vaccination policy have not seen signi cant morbidity or mortality in COVID-19, questioning the cross protectivity of BCG vaccine in SARS-CoV-2 infection. 21 The available epidemiologic data has also formed a base for postulation of the Rubella component of MMR vaccine conferring protection against SARS-CoV-2 infection. Also, the previous consideration of live measles vaccine as a base for other Coronavirus vaccines including SARS due to possible cross-over reactivity has formed the basis to encourage further research on the role of MMR against SARS-CoV-2.…”

Section: Discussionmentioning

confidence: 99%

Epidemiological and clinical characteristics of COVID-19 in Indian children in the initial phase of the pandemic: A cross-sectional study

Sarangi

Reddy

Oswal

et al. 2020

Preprint

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Background: India saw the largest and the most stringent lockdown in the world when the number of COVID-19 cases reached around 550. With some early benefits in containing the surge and restricting the R0 of the virus, the current relaxation of lockdown norms has witnessed an exponential rise in positive cases. With scarcity of Pediatric data from the Indian subcontinent, early observations in the pandemic are pivotal in improving the understanding of physiologic behaviors, identifying risks, and guiding clinicians in assessing time-tested interventions and augmenting the awareness in the masses about the manifold clinical profiles of an evolving disease.Objective: To assess the epidemiological and clinical characteristics of children admitted with COVID-19 infection early in the pandemic.Study Design: A cross-sectional studyParticipants: Fifty children between one month and 18 years of age whose nasopharyngeal swab tested positive for SARS-CoV-2 by RT- PCR. Results: 28 (56%) children were male. 41 (82%) came from government declared containment zones with only one child having history of travel to affected area. Home overcrowding was observed in 33 (66%). Of the 50 children, 29 (58%) were asymptomatic while 20 (40%) and one (2%) had mild and moderate symptoms respectively. Fever, cough, and sore throat were the most common symptoms. 49 (98%) children had BCG scar. Leucopenia was seen in three (6%) only. Mean (SD) Neutrophil-Lymphocyte-Ratio (NLR) was 0.78 (0.48) while mean (SD) CRP was 10.98 (23.90). All 50 (100%) were cured. Conclusion: Our study reasserts the increasing pediatric burden of COVID-19 with all age groups affected and overcrowding as a risk factor for continued community transmission, thus beckoning that public health policies be directed to ensuring further preventive measures. It also re-iterates the milder disease pattern in children with COVID-19 in the initial phase of the pandemic with a high proportion of asymptomatic and mild illness. Though abnormal CRP values are synonymous with the illness in children; leucopenia may not be a consistent finding.

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Section: Discussionmentioning

confidence: 99%

Epidemiological and clinical characteristics of COVID-19 in Indian children in the initial phase of the pandemic: A cross-sectional study

Sarangi

Reddy

Oswal

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Szigeti et al was unable to establish correlation between COVID 19 case fatality rates and the period of introduction of universal BCG vaccination programs. [27] Meena et al adjusted for confounding variables like age, comorbidities like diabetes mellitus, cardiovascular diseases, gross domestic product, hospital beds and number of beds as per population but failed to nd signi cant correlation between BCG vaccination rates and COVID-19 burden . [20] However, there is no control group in the study done by Meena et al Therefore, the conclusion of no correlation can't be drawn from this study.…”

Section: Discussionmentioning

confidence: 99%

BCG vaccination provides protection against COVID 19: A Systematic review and meta-analysis

Khera

Chugh

Khasbage

et al. 2020

Preprint

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Context: Lower morbidity and mortality in few geographic locations on the globe suffering with SARS-CoV-2 has been associated with the existing or previously followed long standing BCG vaccination policy amongst infants. But does that hold true that today after years of BCG vaccination few adults have better prognosis or is it just confounding due to differential disease burden, population density, testing facilities or improper reporting. The purpose was to evaluate and correlate this effect systematically.Evidence acquisition: Detailed electronic search for randomised controlled trials and observational studies in PubMed, Cochrane database and clinicaltrials.gov for eligible studies was performed. We performed a meta-analysis to provide pooled esimate of correlation of mortality with BCG vaccination policy from 4 studies.Results: 114 number of studies were yielded on search strategy and 28 observational studies were finally included for analysis. From our results we can say that BCG vaccination causes a decrease in COVID-19 incidence and mortality. But these results must be interpreted cautiously as lot of confounding factors were present in included studies, which can affect the outcome.Conclusion: The evidence of BCG vaccination for protection against COVID-19 can’t be ruled out as evidence from many studies support the hypothesis but the evidence of well conducted RCTs and observational studies can strengthen the evidence.

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“…Finally, a series of preprints has identified a potential link between BCG vaccination practice for Tuberculosis and COVID-19 mortality; see, for example, [64,65]. However, accounting for confounding factors such as age or testing policies, this correlation seems to be rather weak [66,67]; cf. a recent overview [68].…”

Section: Cumulative Mortality and Lockdownmentioning

confidence: 99%

Interpreting, analysing and modelling COVID-19 mortality data

et al. 2020

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We present results on the mortality statistics of the COVID-19 epidemic in a number of countries. Our data analysis suggests classifying countries in five groups, (1) Western countries, (2) East Block, (3) developed Southeast Asian countries, (4) Northern Hemisphere developing countries and (5) Southern Hemisphere countries. Comparing the number of deaths per million inhabitants, a pattern emerges in which the Western countries exhibit the largest mortality rate. Furthermore, comparing the running cumulative death tolls as the same level of outbreak progress in different countries reveals several subgroups within the Western countries and further emphasises the difference between the five groups. Analysing the relationship between deaths per million and life expectancy in different countries, taken as a proxy of the preponderance of elderly people in the population, a main reason behind the relatively more severe COVID-19 epidemic in the Western countries is found to be their larger population of elderly people, with exceptions such as Norway and Japan, for which other factors seem to dominate. Our comparison between countries at the same level of outbreak progress allows us to identify and quantify a measure of efficiency of the level of stringency of confinement measures. We find that increasing the stringency from 20 to 60 decreases the death count by about 50 lives per million in a time window of 20 days. Finally, we perform logistic equation analyses of deaths as a means of tracking the dynamics of outbreaks in the “first wave” and estimating the associated ultimate mortality, using four different models to identify model error and robustness of results. This quantitative analysis allows us to assess the outbreak progress in different countries, differentiating between those that are at a quite advanced stage and close to the end of the epidemic from those that are still in the middle of it. This raises many questions in terms of organisation, preparedness, governance structure and so on.

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BCG protects against COVID-19? A word of caution

Cited by 25 publications

References 18 publications

Epidemiological and clinical characteristics of COVID-19 in Indian children in the initial phase of the pandemic: A cross-sectional study

Epidemiological and clinical characteristics of COVID-19 in Indian children in the initial phase of the pandemic: A cross-sectional study

BCG vaccination provides protection against COVID 19: A Systematic review and meta-analysis

Interpreting, analysing and modelling COVID-19 mortality data

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