The Impact of the Bacillus Calmette-Guerin Vaccination on COVID-19: A Systematic Review and Meta-Analysis

Iqra Kazi, Ali M. Kara, Kedzie Arrington, Shubhang Bhalla, Jorge L. Cervantes

Abstract


Background: The Bacillus Calmette-Guerin (BCG) vaccine has been known to confer nonspecific benefits beyond its target pathogen, including immunoprotective effects against other respiratory infections and cancer. Recent evidence has shown that BCG vaccination could explain lower-than-expected coronavirus disease 2019 (COVID-19) incidence and mortality rates. The objective of this study is to compare the mortality and incidence for COVID-19 in both BCG-vaccinated and nonvaccinated populations.

Methods: A systematic review and meta-analysis were performed to identify relevant studies since the start of the COVID-19 pandemic according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The strictly standardized mean difference was calculated to measure the effect size of BCG vaccination on COVID-19 incidence and mortality rates.

Results: A total of 49 articles were reviewed, and eight eligible comparative studies were used in the meta-analysis. The results showed an overall protective effect of BCG vaccination against COVID-19 mortality and incidence rates. The strictly standardized mean difference for mortality rate was 348.76. An I2 value of 91.57 was found for mortality rates with BCG vaccination and of 65.56 for mortality rates without BCG vaccination. Five studies were analyzed regarding COVID-19 incidence rates. The strictly standardized mean difference for incidence rates was 1,273,584.117. An I2 value of 2.84 was found for incidence rates with BCG vaccination and of 78.23 for incidence rates without BCG vaccination.

Conclusions: Our study shows that populations with BCG vaccination programs have lower COVID-19 incidence and mortality rates and highlights the need for future studies to investigate if other variables may be behind the observed protective effect of BCG vaccination on COVID-19.




Clin Infect Immun. 2022;7(1):10-16
doi: https://doi.org/10.14740/cii148

Keywords


Bacille Calmette-Guerin; COVID-19; SARS-CoV-2

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