Abstract
Bacille Calmette–Guérin (BCG) vaccination, widely used throughout the world to protect against infant tuberculous meningitis and miliary tuberculosis (TB), can provide broad non-specific protection against infectious respiratory diseases in certain groups. Interest in BCG has seen a resurgence within the scientific community as the mechanisms for non-specific protection have begun to be elucidated. The impact of the COVID-19 pandemic on nearly every aspect of society has profoundly illustrated the pressure that respiratory infections can place on a national healthcare system, further renewing interest in BCG vaccination as a public health policy to reduce the burden of those illnesses. However, the United States does not recommend BCG vaccination due to its variable effectiveness against adult TB, the relatively low risk of Mycobacterium tuberculosis infection in most of the United States, and the vaccine’s interference with tuberculin skin test reactivity that complicates TB screening. In this review, we explore the broad immune training effects of BCG vaccination and literature on the effects of BCG vaccination on COVID-19 spread, disease severity, and mortality. We further discuss barriers to scheduled BCG vaccination in the United States and how those barriers could potentially be overcome.
Highlights
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While this study found that Bacille Calmette–Guérin (BCG) coverage did not correlate with COVID-19 cases or deaths, BCG coverage showed a moderate reduction of cases and deaths in high-income countries when stratified by income level
Studies were determined to have a positive conclusion if they determined that BCG vaccination slows the rate of epidemic spread or decreases hospitalizations, disease severity, or mortality for COVID-19 for at least one demographic group at one stage in the pandemic
Summary
It is one of the most widely used vaccines globally, achieving. BCG vaccination is not a scheduled or recommended vaccine in the United States (U.S.), due to the low incidence of Mycobacterium tuberculosis (Mtb) infection in infants, a U.S tuberculosis control strategy focused around early detection of Mtb infection and interruption of transmission, and extensive use of the low-cost tuberculin (purified protein derivative, PPD) skin test to screen for Mtb exposure or infection [6]. We review the history of the BCG vaccine, how its non-specific effects were found to protect from more than just tuberculosis (TB), and research into the mechanisms behind. Literature covering BCG’s protective effects against pulmonary diseases and all-cause-mortality are reviewed, focusing on BCG’s potential as a tool against COVID-19. BCG vaccination in the U.S as a tool for reducing the public health impacts of pandemics, similar to that caused by SARS-CoV-2
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