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《LANCET，4月30日，Considering BCG vaccination to reduce the impact of COVID-19》

  • 来源专题：COVID-19科研动态监测
  • 编译者： xuwenwhlib
  • 发布时间：2020-05-02

  • Considering BCG vaccination to reduce the impact of COVID-19

    Nigel Curtis

    Annie Sparrow

    Tedros A Ghebreyesus

    Mihai G Netea

    Published:April 30, 2020DOI:https://doi.org/10.1016/S0140-6736(20)31025-4

    In addition to its specific effect against tuberculosis, the BCG vaccine has beneficial nonspecific (off-target) effects on the immune system that protect against a wide range of other infections and are used routinely to treat bladder cancer.1, 2 This has led to the suggestion that vaccination with BCG might have a role in protecting health-care workers and other vulnerable individuals against severe coronavirus disease 2019 (COVID-19).

    Randomised controlled trials have provided evidence that the BCG vaccine's immunomodulatory properties can protect against respiratory infections. In Guinea-Bissau, a high-mortality setting, BCG-Danish reduced all-cause neonatal mortality by 38% (95% CI 17–54), mainly because there were fewer deaths from pneumonia and sepsis.3 In South Africa, BCG-Danish reduced respiratory tract infections by 73% (95% CI 39–88) in adolescents.4

  • 原文来源：https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31025-4/fulltext
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  • 《4月30日_考虑接种卡介苗以减少COVID-19的影响》
    • 来源专题：COVID-19科研动态监测
    • 编译者：zhangmin
    • 发布时间：2020-05-02
    • 1.时间：2020年4月30日 2.机构或团队：墨尔本大学、澳大利亚默多克儿童研究所、墨尔本皇家儿童医院、西奈山伊坎医学院等多家机构 3.事件概要： 墨尔本大学，澳大利亚默多克儿童研究所，墨尔本皇家儿童医院，西奈山伊坎医学院等多家机构的科研人员在The Lancet期刊发表题为“Considering BCG vaccination to reduce the impact of COVID-19”的通讯文章。 文章指出，卡介苗（BCG）疫苗除了具有抗结核的特效外，还对免疫系统具有有益的非特异性（脱靶）作用，可预防多种其他感染，并经常用于治疗膀胱癌。卡介苗疫苗接种可能在保护医护人员和其他易感人群免受COVID-19影响中发挥重要作用。 随机对照试验提供的证据表明，卡介苗疫苗的免疫调节特性可以预防呼吸道感染。在高死亡率的几内亚比绍，BCG-Danish将新生儿全因死亡率降低了38％（95％CI 17-54），这主要是因为肺炎和败血症的死亡人数减少了。在南非，BCG-Danish将青少年的呼吸道感染减少了73％（95％CI 39-88）。SARS-CoV-2是一种单链阳性RNA病毒，在对照试验中，已证明BCG疫苗可降低其他具有该结构的病毒的感染严重性。例如，在荷兰的志愿者中，BCG疫苗将黄热病疫苗的病毒血症减少了71％（95％CI 6-91），并且在两项针对小鼠的研究中，它显着降低了门戈病毒（脑心肌炎病毒）感染的严重程度。现在已经了解了BCG疫苗有益脱靶效应的许多机制。BCG疫苗和其他一些活疫苗可引起代谢和表观遗传学变化，从而增强对随后感染的先天免疫反应，这一过程称为训练后的免疫。因此，卡介苗疫苗可能会降低SARS-COV-2暴露后的病毒血症，从而减轻COVID-19的严重程度并加快恢复速度。荷兰和澳大利亚正在进行随机对照试验，以评估BCG-Danish是否能降低医护人员中COVID-19的发生率和严重程度。BCG-Tokyo可能比BCG-Danish更受欢迎。 在这些试验完成之前，有四个主要原因说明坚持WHO的建议的仅在随机对照试验中将BCG疫苗用于COVID-19的建议非常重要。首先，卡介苗疫苗已经供不应求，不加选择地使用可能危及在高风险地区保护儿童免受结核病侵袭所需的供应。第二，卡介苗是否有效仍是未知数：生态学研究的结果表明，常规进行卡介苗免疫的国家中COVID-19较少，这是一个薄弱的证据，因为它们基于人群而不是个人数据，并且容易混淆。同样，几十年前在儿童时期接种的BCG疫苗现在不太可能改善COVID-19。其原因之一是，BCG疫苗的有益脱靶作用可能会因随后施用另一种疫苗而改变。第三，如果卡介苗疫苗对COVID-19无效，则接种卡介苗可能会产生错误的安全感。第四，需要在随机试验中进行仔细的安全监测，以防止BCG上调免疫力会加重少数重症患者的COVID-19的可能性。 文章提出，如果BCG疫苗或其他经过训练的免疫诱导剂提供非特异性保护，以在开发疾病特效疫苗之前弥合差距，那么这将是应对COVID-19和未来大流行的重要工具。 4.附件： 原文链接： https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31025-4/fulltext
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  • 《MedRxiv，4月11日，BCG protects against COVID-19? A word of caution》
    • 来源专题：COVID-19科研动态监测
    • 编译者：xuwenwhlib
    • 发布时间：2020-04-12
    • BCG protects against COVID-19? A word of caution Reka Szigeti, Domos Kellermayer, View ORCID ProfileRichard Kellermayer doi: https://doi.org/10.1101/2020.04.09.20056903 Abstract The COVID-19 pandemic, caused by type 2 Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2), puts all of us to the test. Epidemiologic observations could critically aid the development of protective measures to combat this devastating viral outbreak. A recent publication, linked nation based universal Bacillus Calmette-Guerin (BCG) vaccination to potential protection against morbidity and mortality from SARS-CoV-2, and received much attention in public media, even before its peer review. We wished to validate the findings by examining the association between daily rates of COVID-19 case fatality (i.e. Death Per Case /Days of the endemic [dpc/d]) and the presence of universal BCG vaccination before 1980, or the year of the establishment of universal vaccination. There was no significant association in either analysis. In this work we emphasize caution amidst the publication surge on COVID-19, and highlight the political/economical-, arbitrary selection-, and fear/anxiety related biases, which may obscure scientific rigor. It is underscored that physical (social) distancing (i.e. quarantine) and use of personal protective equipment (PPE) are the only epidemiologic measures (Iceland being a great example, where universal BCG vaccination policy was never in place), which consistently associate with successful counteraction of morbidity and mortality during the pandemic. *注，本文为预印本论文手稿，是未经同行评审的初步报告，其观点仅供科研同行交流，并不是结论性内容，请使用者谨慎使用.
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