University of Manchester, Manchester Academic Health Science Centre, University Hospital South Manchester NHS Foundation Trust, NIHR South Manchester Respiratory and Allergy Clinical Research Facility, Manchester, United Kingdom.
Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom.
J Allergy Clin Immunol. 2014 Mar;133(3):688-95.e14. doi: 10.1016/j.jaci.2013.08.007. Epub 2013 Sep 29.
The Manchester Community Asthma Study (MANCAS) found a protective effect against the risk of wheeze at age 6 to 11 years for children given neonatal BCG vaccination. Our subsequent systematic review and meta-analysis suggested that BCG vaccination did not protect against allergic sensitization but might have exerted a protective effect against nonatopic asthma.
We sought to assess whether the protective effect of BCG vaccination on wheeze observed in the MANCAS cohort was maintained at age 13 to 17 years and to incorporate the findings from this final MANCAS analysis into an updated systematic review and meta-analysis.
BCG vaccination status was determined from health records and respiratory outcomes from questionnaire responses. We updated the systematic review and used fixed-effects and random-effects modeling to undertake meta-analyses.
There were 1608 participants in the final MANCAS analysis. The 12-month prevalence of wheeze was 15.1%. There was no difference in prevalence between those who were and were not BCG vaccinated (15.8% vs 14.3%; relative risk, 1.05; 95% CI, 0.94-1.19). The updated meta-analysis incorporated 4 new studies: this showed that the protective effect of BCG vaccination against the development of asthma identified in our previous meta-analysis was attenuated (odds ratio, 0.95; 95% CI, 0.89-1.00). No protective effect of BCG was seen for sensitization, eczema/atopic dermatitis, rhinoconjunctivitis, or allergy in general.
Taken together, the final results of the MANCAS cohort and the updated systematic review and meta-analysis provide clearer evidence that any protective effect of BCG vaccination on childhood asthma is likely to be transient.
曼彻斯特社区哮喘研究（MANCAS）发现，新生儿接种卡介苗（BCG）可降低儿童 6 至 11 岁时喘息的风险。我们随后的系统评价和荟萃分析表明，BCG 接种并不能预防过敏致敏，但可能对非特应性哮喘有保护作用。
我们旨在评估 MANCAS 队列中观察到的 BCG 接种对喘息的保护作用是否在 13 至 17 岁时仍然存在，并将这一最终 MANCAS 分析结果纳入更新的系统评价和荟萃分析。
通过健康记录和问卷调查的呼吸结局来确定 BCG 接种状况。我们更新了系统评价，并使用固定效应和随机效应模型进行荟萃分析。
最终的 MANCAS 分析纳入了 1608 名参与者。喘息的 12 个月患病率为 15.1%。接种和未接种 BCG 的人群之间的患病率没有差异（15.8%对 14.3%；相对风险，1.05；95%置信区间，0.94-1.19）。更新的荟萃分析纳入了 4 项新研究：这表明，我们之前的荟萃分析中确定的 BCG 接种对哮喘发展的保护作用减弱（比值比，0.95；95%置信区间，0.89-1.00）。BCG 对致敏、特应性皮炎/湿疹、鼻结膜炎或一般过敏均无保护作用。
综上所述，Mancas 队列的最终结果以及更新的系统评价和荟萃分析提供了更清晰的证据，表明 BCG 接种对儿童哮喘的任何保护作用都可能是短暂的。
