Co-administration of Oal Polio Vaccine and Bacillus Calmette Guerin in Infants: Systematic Review of Low and Middle-income Countries

Abstract

Background Immunization decreases 2 to 3 million deaths annually; however, an additional 1.5 million deaths could be avoided if global vaccination coverage improves. Immunization is one of the cornerstone interventions to reach the Millennium Development Goals (MDGs), especially the goal to decrease deaths among children under five years old. Childhood vaccinations have been illustrated to be effective in protecting children against vaccine preventable diseases in low and middle income countries. As one of the earliest vaccines of the World Health Organization’s (WHO) Expanded Program on Immunization established in 1974, Bacillus Calmette-GuA©rin (BCG) is a main stone of childhood vaccination. Administering OPV together with BCG might down regulate the response to BCG vaccine (Kaur 2002; Faridi 2015). Reviewing different studies, it has reported that this may downregulate response to BCG in the form of fewer numbers of scar formation, reduced scar size, reduced in vivo response to purified protein derivative (PPD) and significantly lower IL-13 and IFN-I³ and a tendency to have lower IL-10 in response to PPD at 6 weeks following immunization. Objectives To investigate whether co-administration of BCG and oral polio vaccine increase infant mortality rate. To investigate whether co-administration of oral polio vaccine and BCG attenuate the immune response to BCG compared to the administration of BCG alone. Search methods We searched through the following databases: MEDLINE, Register of Controlled Trials (CENTRAL); Scopus; CINAHL (EBSCO); Google scholar; Clinicaltrials.gov and WHO International Clinical Trials Registry Platform (ICTRP). Main results We found 1777 studies were through systematic electronic search. Therefore 1356 studies remained after excluding duplicated studies. We assessed and screened 855 studies and only 11 articles were fully assessed. Among them, 6 studies were included in mata-analysis There is high evidence that infant mortality rate was reduced by 22 % in BCG group compared to BCG-OPV group with p-value of 0.09. Therefore, the evidence was moderate and low in specific mortality rate respectively boys and girls. Then, the mortality rate was reduced by 28% and 15 % respectively in boys and girls (p-value of 0.09 and 0.31). Local immune reaction (scar) was 41 % less likely present in BCG-OPV group compared to BCG alone. ). Therefore, the 95% CI is very wide and including the null value. Authors' conclusions An increasing number of vaccines targeting some of the leading causes of morbidity and mortality are reaching the world’s children. Evidence suggests that receipt of BCG reduce overall infant mortality. This review has shown that co-administration BCG-OPV could increase infant mortality. Therefore, the results could be considered in a context of several limitations. .