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Open AccessArticle

BCG Vaccination and Mortality of COVID-19 across 173 Countries: An Ecological Study

1
Division of Molecular Epidemiology, The Jikei University School of Medicine, Tokyo 105-8461, Japan
2
Advanced Therapies Innovation Department, Siemens Healthcare K.K., Tokyo 141-8644, Japan
3
Hitachi, Ltd. Research & Development Group, Tokyo 185-8601, Japan
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(15), 5589; https://doi.org/10.3390/ijerph17155589
Received: 4 July 2020 / Revised: 24 July 2020 / Accepted: 31 July 2020 / Published: 3 August 2020
(This article belongs to the Special Issue COVID-19: Prevention, Diagnosis, Therapy and Follow Up)
Ecological studies have suggested fewer COVID-19 morbidities and mortalities in Bacillus Calmette–Guérin (BCG)-vaccinated countries than BCG-non-vaccinated countries. However, these studies obtained data during the early phase of the pandemic and did not adjust for potential confounders, including PCR-test numbers per population (PCR-tests). Currently—more than four months after declaration of the pandemic—the BCG-hypothesis needs reexamining. An ecological study was conducted by obtaining data of 61 factors in 173 countries, including BCG vaccine coverage (%), using morbidity and mortality as outcomes, obtained from open resources. ‘Urban population (%)’ and ‘insufficient physical activity (%)’ in each country was positively associated with morbidity, but not mortality, after adjustment for PCR-tests. On the other hand, recent BCG vaccine coverage (%) was negatively associated with mortality, but not morbidity, even with adjustment for percentage of the population ≥ 60 years of age, morbidity, PCR-tests and other factors. The results of this study generated a hypothesis that a national BCG vaccination program seems to be associated with reduced mortality of COVID-19, although this needs to be further examined and proved by randomized clinical trials. View Full-Text
Keywords: urbanization; Bacillus Calmette–Guérin; BCG; vaccination; coronavirus disease 2019; COVID-19; SARS-CoV-2; ecological study; morbidity; mortality urbanization; Bacillus Calmette–Guérin; BCG; vaccination; coronavirus disease 2019; COVID-19; SARS-CoV-2; ecological study; morbidity; mortality
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Urashima, M.; Otani, K.; Hasegawa, Y.; Akutsu, T. BCG Vaccination and Mortality of COVID-19 across 173 Countries: An Ecological Study. Int. J. Environ. Res. Public Health 2020, 17, 5589.

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