The Open Respiratory Medicine Journal




ISSN: 1874-3064 ― Volume 15, 2021
LETTER

BCG Vaccine does not Protect Against COVID-19



Mohamed F. Allam1, *, Ghada E. Amin1
1 Department of Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Abstract

A recent article by Jop de Vrieze (March 23, 2020) suggested that BCG vaccine could protect against COVID-19 infections. The arguments were that several European countries, like Italy, Spain, France, and Germany, which are badly affected by COVID-19, and the USA stopped vaccination of the general population by BCG and excluded it from their routine vaccination schedule. Many people started to receive doses of BCG based on that hypothesis even before its confirmation. We think that the BCG vaccine could not protect against COVID-19 because several countries like China and Iran, which are severely affected by COVID-19, still include the BCG vaccine in its routine vaccination schedule. Other arguments include that the BCG vaccine improves cell-mediated immunity with little effect on humoral immunity; Immunity against viruses, in general, is mainly humoral.

Keywords: Antiviral treatments, COVID-19, BCG, Vaccine, Review, Immunity.


Article Information


Identifiers and Pagination:

Year: 2020
Volume: 14
First Page: 45
Last Page: 46
Publisher Id: TORMJ-14-45
DOI: 10.2174/1874306402014010045

Article History:

Received Date: 05/6/2020
Revision Received Date: 22/8/2020
Acceptance Date: 02/9/2020
Electronic publication date: 26/11/2020
Collection year: 2020

© 2020 Allam & Amin.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at Department of Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt; Tel: + 2 01143559946; E-mail: farouk.allam@med.asu.edu.eg.





Last year, on December 31, 2019, the Chinese health authorities declared an outbreak of novel coronavirus 2019 (COVID-19). Since then, several studies and reports have discussed the possible general and specific protective measures against COVID-19, together with potential antiviral treatments [1Cascella M, Rajnik M, Cuomo A, et al. Features, Evaluation and Treatment Coronavirus (COVID-19).Stat Pearls 2020. https://www.ncbi.nlm.nih.gov/books/ NBK554776/ Updated 2020 Mar 20 Internet].

A recent article by Jop de Vrieze (March 23, 2020) suggested that the BCG vaccine could protect against COVID-19 infections. The arguments were that several European countries, like Italy, Spain, France, and Germany, which were badly affected by COVID-19, and the USA stopped vaccination of the general population by BCG and excluded it from their routine vaccination schedule [2de Vrieze J. Can a century-old TB vaccine steel the immune system against the new coronavirus? Science
[http://dx.doi.org/10.1126/science.abb8297]
].

It is hypothesized that the BCG vaccine could stimulate the immune system and thus, protect against COVID-19. Previous studies recommended the use of BCG locally for the treatment of urinary bladder cancer and preventing its recurrence [3Fuge O, Vasdev N, Allchorne P, Green JS. Immunotherapy for bladder cancer. Res Rep Urol 2015; 7: 65-79.
[http://dx.doi.org/10.2147/RRU.S63447] [PMID: 26000263]
].

Recently, a new study was proposed to be conducted in four countries to investigate the effectiveness of BCG against COVID-19 [2de Vrieze J. Can a century-old TB vaccine steel the immune system against the new coronavirus? Science
[http://dx.doi.org/10.1126/science.abb8297]
]. Many people started to receive doses of BCG based on that hypothesis even before its confirmation. We think that the BCG vaccine could not protect against COVID-19 because of the next observations:

First, China, the country where this pandemic started, still includes the BCG vaccine in its routine vaccination schedule [4Hu Y, Chen Y. Evaluating childhood vaccination coverage of nip vaccines: Coverage survey versus zhejiang provincial immunization information system. Int J Environ Res Public Health 2017; 14(7)E758
[http://dx.doi.org/10.3390/ijerph14070758] [PMID: 28696387]
].

Second, Iran, one of the most affected countries worldwide with 356,792 infected patients, as of 22 August 2020 [5CoronaTracker. https://www.coronatracker.com/ [last access 22 August 2020];], vaccinates their children with BCG with a coverage rate of 99%, and the vaccine was included in their vaccination program since its establishment [6WHO vaccine-preventable diseases: Monitoring system. global summary 2019.https://apps.who.int/immunization_monitoring/globalsummary/countries?countrycriteria%5Bcountry%5D%5B%5D=IRN&commit=OK]. Similarly, Egypt, the most affected country in Africa with 97.148 infected patients, till 22 August 2020, had BCG vaccination coverage of 95% [5CoronaTracker. https://www.coronatracker.com/ [last access 22 August 2020];, 6WHO vaccine-preventable diseases: Monitoring system. global summary 2019.https://apps.who.int/immunization_monitoring/globalsummary/countries?countrycriteria%5Bcountry%5D%5B%5D=IRN&commit=OK].

Third, Spain included the BCG vaccine in their routine vaccination program from 1924 till early 1980s, when it was excluded and hence the elderly population who are mostly affected are vaccinated. The Basque Country, located in Northern Spain, continued vaccinating its population till 2013 [7Tuberculosis. Available Vaccines [Vacunas Disponibles] Spanish Association of Vaccination [Asociación Española de Vacunología] https://www.mscbs.gob.es/profesionales/saludPublica/prevPromocion/PlanTuberculosis/docs/PlanTB2019.pdf [(last access 30 March 2020)]; [Article in Spanish]]. Basque Country is the eighth largest region in Spain, regarding the number of population. Basque Country is ranked the third most affected region in Spain with the most number of cases and deaths, after Madrid and Catalonia [8Confirmed Case of Coronavirus in Spain and Worldwide. https://elpais.com/sociedad/2020/03/30/actualidad/1585589827_546714.html], thus continuing vaccination with BCG in Basque Country for 25-30 years after other regions stoppage of routine BCG vaccination was not protective.

Fourth, a recent cohort study of 5933 adults aged 35 to 41 years (3064 vaccinated and 2869 unvaccinated) showed no statistically significant difference in the proportion of positive COVID-19 test results in the BCG-vaccinated group vs. the unvaccinated group [9Hamiel U, Kozer E, Youngster I. SARS-CoV-2 rates in BCG-Vaccinated and unvaccinated young adults. JAMA 2020; 323(22): 2340-1.
[http://dx.doi.org/10.1001/jama.2020.8189] [PMID: 32401274]
]. The results of this study agree with the official position of the World Health Organization, since 12 April 2020 till date, that there is no evidence that the BCG vaccine could be protective against COVID-19 [10WHO Scientific Brief 2020. https://apps.who.int/iris/bitstream/ handle/10665/331745/WHO-2019-nCoV-Sci_Brief-BCGvaccination-2020.1-eng.pdf?sequence=1&isAllowed=y].

Fifth, several reports showed that BCG vaccine improves cell-mediated immunity. Only a few studies reported little effects of the BCG vaccine on humoral immunity [11Tanner R, Villarreal-Ramos B, Vordermeier HM, McShane H. The humoral immune response to BCG vaccination. Front Immunol 2019; 10: 1317.
[http://dx.doi.org/10.3389/fimmu.2019.01317] [PMID: 31244856]
]. Immunity against viruses, in general, is humoral [12Janeway CA Jr, Travers P, Walport M, et al. Immunobiology: The immune system in health and disease. Chapter 9, The Humoral Immune Response 5th edition. 2001. https://www.ncbi.nlm.nih.gov /books/NBK10752/]. A recent report recommended the use of plasma of recovered COVID-19 patients to treat severe COVID-19 symptoms because of high levels of specific immunoglobulin against COVID-19 [13Roback JD, Guarner J. Convalescent plasma to treat COVID-19: Possibilities and challenges. JAMA Published online March 27 2020.
[http://dx.doi.org/10.1001/jama.2020.4940]
].

CONCLUSION

In conclusion, further investigation is required to state whether or not BCG vaccine is related to COVID-19, and before the implementation of the BCG vaccine as a protection against COVID-19.

REFERENCES

[1] Cascella M, Rajnik M, Cuomo A, et al. Features, Evaluation and Treatment Coronavirus (COVID-19).Stat Pearls 2020. https://www.ncbi.nlm.nih.gov/books/ NBK554776/ Updated 2020 Mar 20 Internet
[2] de Vrieze J. Can a century-old TB vaccine steel the immune system against the new coronavirus? Science
[http://dx.doi.org/10.1126/science.abb8297]
[3] Fuge O, Vasdev N, Allchorne P, Green JS. Immunotherapy for bladder cancer. Res Rep Urol 2015; 7: 65-79.
[http://dx.doi.org/10.2147/RRU.S63447] [PMID: 26000263]
[4] Hu Y, Chen Y. Evaluating childhood vaccination coverage of nip vaccines: Coverage survey versus zhejiang provincial immunization information system. Int J Environ Res Public Health 2017; 14(7)E758
[http://dx.doi.org/10.3390/ijerph14070758] [PMID: 28696387]
[5] CoronaTracker. https://www.coronatracker.com/ [last access 22 August 2020];
[6] WHO vaccine-preventable diseases: Monitoring system. global summary 2019.https://apps.who.int/immunization_monitoring/globalsummary/countries?countrycriteria%5Bcountry%5D%5B%5D=IRN&commit=OK
[7] Tuberculosis. Available Vaccines [Vacunas Disponibles] Spanish Association of Vaccination [Asociación Española de Vacunología] https://www.mscbs.gob.es/profesionales/saludPublica/prevPromocion/PlanTuberculosis/docs/PlanTB2019.pdf [(last access 30 March 2020)]; [Article in Spanish]
[8] Confirmed Case of Coronavirus in Spain and Worldwide. https://elpais.com/sociedad/2020/03/30/actualidad/1585589827_546714.html
[9] Hamiel U, Kozer E, Youngster I. SARS-CoV-2 rates in BCG-Vaccinated and unvaccinated young adults. JAMA 2020; 323(22): 2340-1.
[http://dx.doi.org/10.1001/jama.2020.8189] [PMID: 32401274]
[10] WHO Scientific Brief 2020. https://apps.who.int/iris/bitstream/ handle/10665/331745/WHO-2019-nCoV-Sci_Brief-BCGvaccination-2020.1-eng.pdf?sequence=1&isAllowed=y
[11] Tanner R, Villarreal-Ramos B, Vordermeier HM, McShane H. The humoral immune response to BCG vaccination. Front Immunol 2019; 10: 1317.
[http://dx.doi.org/10.3389/fimmu.2019.01317] [PMID: 31244856]
[12] Janeway CA Jr, Travers P, Walport M, et al. Immunobiology: The immune system in health and disease. Chapter 9, The Humoral Immune Response 5th edition. 2001. https://www.ncbi.nlm.nih.gov /books/NBK10752/
[13] Roback JD, Guarner J. Convalescent plasma to treat COVID-19: Possibilities and challenges. JAMA Published online March 27 2020.
[http://dx.doi.org/10.1001/jama.2020.4940]
Track Your Manuscript:


Endorsements



"Open access will revolutionize 21st century knowledge work and accelerate the diffusion of ideas and evidence that support just in time learning and the evolution of thinking in a number of disciplines."


Daniel Pesut
(Indiana University School of Nursing, USA)

"It is important that students and researchers from all over the world can have easy access to relevant, high-standard and timely scientific information. This is exactly what Open Access Journals provide and this is the reason why I support this endeavor."


Jacques Descotes
(Centre Antipoison-Centre de Pharmacovigilance, France)

"Publishing research articles is the key for future scientific progress. Open Access publishing is therefore of utmost importance for wider dissemination of information, and will help serving the best interest of the scientific community."


Patrice Talaga
(UCB S.A., Belgium)

"Open access journals are a novel concept in the medical literature. They offer accessible information to a wide variety of individuals, including physicians, medical students, clinical investigators, and the general public. They are an outstanding source of medical and scientific information."


Jeffrey M. Weinberg
(St. Luke's-Roosevelt Hospital Center, USA)

"Open access journals are extremely useful for graduate students, investigators and all other interested persons to read important scientific articles and subscribe scientific journals. Indeed, the research articles span a wide range of area and of high quality. This is specially a must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals."


Debomoy K. Lahiri
(Indiana University School of Medicine, USA)

"Open access journals represent a major break-through in publishing. They provide easy access to the latest research on a wide variety of issues. Relevant and timely articles are made available in a fraction of the time taken by more conventional publishers. Articles are of uniformly high quality and written by the world's leading authorities."


Robert Looney
(Naval Postgraduate School, USA)

"Open access journals have transformed the way scientific data is published and disseminated: particularly, whilst ensuring a high quality standard and transparency in the editorial process, they have increased the access to the scientific literature by those researchers that have limited library support or that are working on small budgets."


Richard Reithinger
(Westat, USA)

"Not only do open access journals greatly improve the access to high quality information for scientists in the developing world, it also provides extra exposure for our papers."


J. Ferwerda
(University of Oxford, UK)

"Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content."


Sean L. Kitson
(Almac Sciences, Northern Ireland)

"In principle, all scientific journals should have open access, as should be science itself. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. The articles are high standard and cover a wide area."


Hubert Wolterbeek
(Delft University of Technology, The Netherlands)

"The widest possible diffusion of information is critical for the advancement of science. In this perspective, open access journals are instrumental in fostering researches and achievements."


Alessandro Laviano
(Sapienza - University of Rome, Italy)

"Open access journals are very useful for all scientists as they can have quick information in the different fields of science."


Philippe Hernigou
(Paris University, France)

"There are many scientists who can not afford the rather expensive subscriptions to scientific journals. Open access journals offer a good alternative for free access to good quality scientific information."


Fidel Toldrá
(Instituto de Agroquimica y Tecnologia de Alimentos, Spain)

"Open access journals have become a fundamental tool for students, researchers, patients and the general public. Many people from institutions which do not have library or cannot afford to subscribe scientific journals benefit of them on a daily basis. The articles are among the best and cover most scientific areas."


M. Bendandi
(University Clinic of Navarre, Spain)

"These journals provide researchers with a platform for rapid, open access scientific communication. The articles are of high quality and broad scope."


Peter Chiba
(University of Vienna, Austria)

"Open access journals are probably one of the most important contributions to promote and diffuse science worldwide."


Jaime Sampaio
(University of Trás-os-Montes e Alto Douro, Portugal)

"Open access journals make up a new and rather revolutionary way to scientific publication. This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate interpersonal communication among scientists."


Eduardo A. Castro
(INIFTA, Argentina)

"Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. The articles published in the open access journals are high quality and cover a wide range of fields."


Kenji Hashimoto
(Chiba University, Japan)

"Open Access journals offer an innovative and efficient way of publication for academics and professionals in a wide range of disciplines. The papers published are of high quality after rigorous peer review and they are Indexed in: major international databases. I read Open Access journals to keep abreast of the recent development in my field of study."


Daniel Shek
(Chinese University of Hong Kong, Hong Kong)

"It is a modern trend for publishers to establish open access journals. Researchers, faculty members, and students will be greatly benefited by the new journals of Bentham Science Publishers Ltd. in this category."


Jih Ru Hwu
(National Central University, Taiwan)


Browse Contents



Table of Contents


Webmaster Contact: info@benthamopen.net
Copyright © 2021 Bentham Open