BCG vaccination history associates with decreased SARS-CoV-2 seroprevalence across a diverse cohort of health care workers
Magali Noval Rivas, … , Susan Cheng, Moshe Arditi
Magali Noval Rivas, … , Susan Cheng, Moshe Arditi
Published November 19, 2020
Citation Information: J Clin Invest. 2021;131(2):e145157. https://doi.org/10.1172/JCI145157.
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Clinical Medicine COVID-19 Vaccines

BCG vaccination history associates with decreased SARS-CoV-2 seroprevalence across a diverse cohort of health care workers

Abstract

BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused more than 1 million deaths worldwide; thus, there is an urgent need to develop preventive and therapeutic strategies. The antituberculosis vaccine bacillus Calmette-Guérin (BCG) demonstrates nonspecific, protective innate immune–boosting effects. Here, we determined whether a history of BCG vaccination was associated with decreased SARS-CoV-2 infection and seroconversion in a longitudinal, retrospective observational study of a diverse cohort of health care workers (HCWs).METHODS We assessed SARS-CoV-2 seroprevalence and collected medical questionnaires, which included information on BCG vaccination status and preexisting demographic and clinical characteristics, from an observational cohort of HCWs in a multisite Los Angeles health care organization. We used multivariate analysis to determine whether a history of BCG vaccination was associated with decreased rates of SARS-CoV-2 infection and seroconversion.RESULTS Of the 6201 HCWs, 29.6% reported a history of BCG vaccination, whereas 68.9% had not received BCG vaccination. Seroprevalence of anti–SARS-CoV-2 IgG as well as the incidence of self-reported clinical symptoms associated with coronavirus disease 2019 (COVID-19) were markedly decreased among HCWs with a history of BCG vaccination compared with those without BCG vaccination. After adjusting for age and sex, we found that a history of BCG vaccination, but not meningococcal, pneumococcal, or influenza vaccination, was associated with decreased SARS-CoV-2 IgG seroconversion.CONCLUSIONS A history of BCG vaccination was associated with a decrease in the seroprevalence of anti–SARS-CoV-2 IgG and a lower number of participants who self-reported experiencing COVID-19–related clinical symptoms in this cohort of HCWs. Therefore, large randomized, prospective clinical trials of BCG vaccination are urgently needed to confirm whether BCG vaccination can confer a protective effect against SARS-CoV-2 infection.

Authors

Magali Noval Rivas, Joseph E. Ebinger, Min Wu, Nancy Sun, Jonathan Braun, Kimia Sobhani, Jennifer E. Van Eyk, Susan Cheng, Moshe Arditi

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Figure 1

Flow chart of this retrospective observational study.

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Flow chart of this retrospective observational study. A total of 6679 HC...
A total of 6679 HCWs were recruited in this study. Self-reported information about a previous COVID-19 diagnosis, a positive or negative SARS-CoV-2 RT-PCR test, experience of COVID-19–related symptoms, as well as BCG, meningococcal, Pneumovax, and influenza vaccination status were collected retrospectively with an electronic survey. Among the 6679 participants, 478 did not provide a blood sample to measure the anti–SARS-CoV-2 IgG index and were thus excluded from the analysis. Of the remaining 6201 participants, 1836 reported a previous history of BCG vaccination, 1842 reported a previous meningococcal vaccination, 1007 reported receiving a Pneumovax vaccination, and 6014 reported receiving an influenza vaccination.