National Programs of BCG Vaccinations Are Associated with Lower Reported Incidence and Mortality from Covid-19

Covid-19 virus has infected over 785,000 people and led to over 37,000 deaths in its first 3 months. Covid-19-attributable morbidity and mortality vary by country. Many countries administer BCG live vaccine to all neonates, with the aim of reducing mortality due to tuberculosis and other infections. We examine whether BCG immunization coverage may contribute to these differences between countries.

We accessed ecologic data from multiple sources. The World Atlas of BCG maintains an open access database of BCG vaccination programmes by country, and the World Bank databank, Rand Foundation, and World Health Organization supply additional country data. We calculated cumulative incidence and case fatality rates using the European Centre for Disease Prevention and Control database of cases and deaths attributed to Covid¬19. on March 24th 2020.

178 countries were included in having data from all three sources. There were current national programmes of BCG vaccination in 131 countries; 21 countries had no current programme of national BCG vaccination; 26 countries status was unknown. Over the 15 days, incidence of Covid-19 was 38.4 per million in countries with BCG vaccination whereas the incidence of Covid-19 was 358.4 per million in the absence of such a program. The death rate was 4.28/million in countries with BCG programs and 40/million in countries without such a programme.

National programmes of whole population for BCG is associated with a lower incidence and death rate of Covid-19. This may be due to the non-TB specific immune benefits of BCG vaccination. In the absence of a specific vaccination against Covid-19, population-based BCG vaccination may have a role in reducing the impact of this disease.

Authors: Paul K. Hegarty1,2, Micaela Sandovalm3, Andrew R. DiNardo4, Helen Zafirakis5, Ashish M. Kamat6

Corresponding Author: Ashish Kamat, MD

1. Department of Urology, Mater Misericordiae University Hospital, Dublin, Ireland

2. Mater Private Hospital, Dublin, Ireland

3. UTHealth School of Public Health, Houston, TX, USA

4. The Global Tuberculosis Program, Texas Children's Hospital, Immigrant and G, Baylor College of Medicine, Houston, TX, USA

5. Department of Urology, Mater Private, Cork, Ireland

6. Department of Urology, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA

Citation: Paul Hegarty, Micaela Sandovalm, Ashish Kamat, Helen Zafirakis, and Andrew Dinardo. "National programs of BCG vaccinations are associated with lower reported incidence and mortality from Covid-19." PLoS ONE (2020). 

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