BCG 对 SARS-CoV-2 感染提供长期保护吗？加拿大魁北克的一项病例对照研究。
Does BCG provide long-term protection against SARS-CoV-2 infection? A case-control study in Quebec, Canada.
机构信息
Department of Microbiology and Infectious Diseases, Université de Sherbrooke, 3001, 12ième Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada.
Hôpital Maisonneuve-Rosemont - CIUSSS de l'Est-de-l'Ile-de-Montréal, 5415 Boulevard de l'Assomption, Montreal, Quebec H1T 2M4, Canada; Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Pavillon Roger-Gaudry, 2900 Boulevard Edouard Montpetit, Montreal, Quebec H3T 1J4, Canada.
出版信息
Vaccine. 2021 Dec 8;39(50):7300-7307. doi: 10.1016/j.vaccine.2021.08.019. Epub 2021 Aug 11.
BACKGROUND
Early in the coronavirus disease 2019 (COVID-19) pandemic, before severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines became available, it was hypothesized that BCG (Bacillus Calmette-Guérin), which stimulates innate immunity, could provide protection against SARS-CoV-2. Numerous ecological studies, plagued by methodological deficiencies, revealed a country-level association between BCG use and lower COVID-19 incidence and mortality. We aimed to determine whether BCG administered in early life decreased the risk of SARS-CoV-2 infection in adulthood and the severity of COVID-19.
METHODS
This case-control study was conducted in Quebec, Canada. Cases were patients with a positive SARS-CoV-2 nucleic acid amplification test performed at two hospitals between March-October 2020. Controls were identified among patients with non-COVID-19 samples processed by the same microbiology laboratories during the same period. Enrolment was limited to individuals born in Quebec between 1956 and 1976, whose vaccine status was accessible in a computerized registry of 4.2 million BCG vaccinations.
RESULTS
We recruited 920 cases and 2123 controls. Fifty-four percent of cases (n = 424) and 53% of controls (n = 1127) had received BCG during childhood (OR: 1.03; 95% CI: 0.89-1.21), while 12% of cases (n = 114) and 11% of controls (n = 235) had received two or more BCG doses (OR: 1.14; 95% CI: 0.88-1.46). After adjusting for age, sex, material deprivation, recruiting hospital and occupation there was no evidence of protection conferred by BCG against SARS-CoV-2 (AOR: 1.01; 95% CI: 0.84-1.21). Among cases, 77 (8.4%) needed hospitalization and 18 (2.0%) died. The vaccinated were as likely as the unvaccinated to require hospitalization (AOR: 1.01, 95% CI: 0.62-1.67) or to die (AOR: 0.85, 95% CI: 0.32-2.39).
CONCLUSIONS
BCG does not provide long-term protection against symptomatic COVID-19 or severe forms of the disease.
背景
在 2019 年冠状病毒病（COVID-19）大流行早期，在严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）疫苗可用之前，人们假设刺激先天免疫的卡介苗（BCG）可以提供针对 SARS-CoV-2 的保护。许多存在方法学缺陷的生态学研究表明，BCG 的使用与较低的 COVID-19 发病率和死亡率之间存在国家层面的关联。我们旨在确定婴儿期接种的 BCG 是否会降低成年人感染 SARS-CoV-2 的风险以及 COVID-19 的严重程度。
方法
这是一项在加拿大魁北克进行的病例对照研究。病例是在 2020 年 3 月至 10 月期间在两家医院进行的 SARS-CoV-2 核酸扩增检测呈阳性的患者。对照组是在同一时期由同一家微生物实验室处理的非 COVID-19 样本的患者中确定的。招募仅限于 1956 年至 1976 年期间在魁北克出生的个体，他们的疫苗接种状态可在一个包含 420 万剂 BCG 接种的计算机化登记处中获得。
结果
我们招募了 920 例病例和 2123 例对照。54%的病例（n=424）和 53%的对照（n=1127）在儿童时期接受过 BCG（比值比：1.03；95%置信区间：0.89-1.21），而 12%的病例（n=114）和 11%的对照（n=235）接受过两剂或更多 BCG 剂量（比值比：1.14；95%置信区间：0.88-1.46）。在调整了年龄、性别、物质剥夺、招募医院和职业等因素后，BCG 并未为 SARS-CoV-2 提供保护（调整后的比值比：1.01；95%置信区间：0.84-1.21）。在病例中，有 77 例（8.4%）需要住院治疗，18 例（2.0%）死亡。接种疫苗的人与未接种疫苗的人一样可能需要住院治疗（调整后的比值比：1.01；95%置信区间：0.62-1.67）或死亡（调整后的比值比：0.85；95%置信区间：0.32-2.39）。
结论
BCG 不能提供针对有症状的 COVID-19 或严重疾病形式的长期保护。
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