1
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Pereira SM, Barreto FR, de Souza RA, de Souza Teles Santos CA, Pereira M, da Paixão ES, de Jesus Lima CCO, da Natividade MS, Lindoso AABP, Fernandes EG, Junior EBC, Pescarini JM, de Andrade KVF, de Souza FM, de Britto EA, Nunes C, Ichihara MY, Dalcolmo M, Trajman A, Barral-Netto M, Abubakar I, Barreto ML, de Alencar Ximenes RA, Rodrigues LC. Previous BCG vaccination is associated with less severe clinical progression of COVID-19. BMC Med 2023; 21:145. [PMID: 37055776 PMCID: PMC10099006 DOI: 10.1186/s12916-023-02859-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/03/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND BCG vaccination, originally used to prevent tuberculosis, is known to "train" the immune system to improve defence against viral respiratory infections. We investigated whether a previous BCG vaccination is associated with less severe clinical progression of COVID-19 METHODS: A case-control study comparing the proportion with a BCG vaccine scar (indicating previous vaccination) in cases and controls presenting with COVID-19 to health units in Brazil. Cases were subjects with severe COVID-19 (O2 saturation < 90%, severe respiratory effort, severe pneumonia, severe acute respiratory syndrome, sepsis, and septic shock). Controls had COVID-19 not meeting the definition of "severe" above. Unconditional regression was used to estimate vaccine protection against clinical progression to severe disease, with strict control for age, comorbidity, sex, educational level, race/colour, and municipality. Internal matching and conditional regression were used for sensitivity analysis. RESULTS BCG was associated with high protection against COVID-19 clinical progression, over 87% (95% CI 74-93%) in subjects aged 60 or less and 35% (95% CI - 44-71%) in older subjects. CONCLUSIONS This protection may be relevant for public health in settings where COVID-19 vaccine coverage is still low and may have implications for research to identify vaccine candidates for COVID-19 that are broadly protective against mortality from future variants. Further research into the immunomodulatory effects of BCG may inform COVID-19 therapeutic research.
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Affiliation(s)
| | | | | | - Carlos Antonio de Souza Teles Santos
- Center for Data and Knowledge Integration for Health (CIDACS), Fiocruz, Salvador, Brazil
- Department of Exact Sciences, State University of Feira de Santana, Bahia, Salvador, Brazil
| | - Marcos Pereira
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil.
| | - Enny Santos da Paixão
- Center for Data and Knowledge Integration for Health (CIDACS), Fiocruz, Salvador, Brazil
- Faculty of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | - Julia Moreira Pescarini
- Center for Data and Knowledge Integration for Health (CIDACS), Fiocruz, Salvador, Brazil
- Faculty of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Elisangela Alves de Britto
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- State Department of Health of Bahia, Institute Couto Maia, Salvador, Brazil
| | - Ceuci Nunes
- State Department of Health of Bahia, Institute Couto Maia, Salvador, Brazil
| | - Maria Yuri Ichihara
- Center for Data and Knowledge Integration for Health (CIDACS), Fiocruz, Salvador, Brazil
| | - Margareth Dalcolmo
- Hélio Fraga Reference Center, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Anete Trajman
- Departamento de Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- McGill TB International Centre, McGill University, Montreal, Canada
| | - Manoel Barral-Netto
- Institute Gonçalo Moniz - Fundação Oswaldo Cruz (Fiocruz), Salvador, Brazil
- Faculdade de Medicina, Federal University of Bahia, Salvador, Brazil
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Mauricio Lima Barreto
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Fiocruz, Salvador, Brazil
| | | | - Laura Cunha Rodrigues
- Center for Data and Knowledge Integration for Health (CIDACS), Fiocruz, Salvador, Brazil
- Faculty of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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2
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Efficacy of BCG Vaccination against COVID-19: Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2023; 12:jcm12031154. [PMID: 36769802 PMCID: PMC9917948 DOI: 10.3390/jcm12031154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023] Open
Abstract
Beneficial off-target effects of the Bacillus Calmette-Guérin (BCG) vaccination might offer general protection from respiratory tract infections. We conducted a systematic review and meta-analysis of published randomized controlled trials (RCTs) to ascertain BCG vaccination effectiveness against COVID-19. We looked up English RCTs from 1 January 2019 to 15 November 2022 in Embase, the Cochrane Library, and the Web of Science in this systematic review and meta-analysis. Nine RCTs, including 7963 participants, were included. The infection rate of COVID-19 was not decreased in people who were vaccinated with BCG (OR, 0.96; 95% CI, 0.82-1.13; I2 = 4%), and the BCG vaccination group did not have decreased COVID-19 related-hospitalization (OR, 0.66; 95% CI, 0.37-1.18; I2 = 42%), admission to the ICU (OR, 0.25; 95% CI, 0.05-1.18; I2 = 0%), and mortality (OR, 0.64; 95% CI, 0.17-2.44; I2 = 0%) compared with the control group. There is not sufficient evidence to support the use of BCG vaccination in the prevention of COVID-19 infection and severe COVID-19 and avoid overstating the role of BCG vaccination leading to its misuse.
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3
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Faustman DL, Lee A, Hostetter ER, Aristarkhova A, Ng NC, Shpilsky GF, Tran L, Wolfe G, Takahashi H, Dias HF, Braley J, Zheng H, Schoenfeld DA, Kühtreiber WM. Multiple BCG vaccinations for the prevention of COVID-19 and other infectious diseases in type 1 diabetes. Cell Rep Med 2022; 3:100728. [PMID: 36027906 PMCID: PMC9376308 DOI: 10.1016/j.xcrm.2022.100728] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/08/2022] [Accepted: 08/08/2022] [Indexed: 04/08/2023]
Abstract
There is a need for safe and effective platform vaccines to protect against coronavirus disease 2019 (COVID-19) and other infectious diseases. In this randomized, double-blinded, placebo-controlled phase 2/3 trial, we evaluate the safety and efficacy of a multi-dose Bacillus Calmette-Guérin (BCG) vaccine for the prevention of COVID-19 and other infectious disease in a COVID-19-unvaccinated, at-risk-community-based cohort. The at-risk population is made of up of adults with type 1 diabetes. We enrolled 144 subjects and randomized 96 to BCG and 48 to placebo. There were no dropouts over the 15-month trial. A cumulative incidence of 12.5% of placebo-treated and 1% of BCG-treated participants meets criteria for confirmed COVID-19, yielding an efficacy of 92%. The BCG group also displayed fewer infectious disease symptoms and lesser severity and fewer infectious disease events per patient, including COVID-19. There were no BCG-related systemic adverse events. BCG's broad-based infection protection suggests that it may provide platform protection against new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants and other pathogens.
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Affiliation(s)
- Denise L Faustman
- Massachusetts General Hospital and Harvard Medical School, Boston, MA 02192, USA.
| | - Amanda Lee
- Massachusetts General Hospital, Boston, MA 02192, USA
| | | | | | - Nathan C Ng
- Massachusetts General Hospital, Boston, MA 02192, USA
| | | | - Lisa Tran
- Massachusetts General Hospital, Boston, MA 02192, USA
| | - Grace Wolfe
- Massachusetts General Hospital, Boston, MA 02192, USA
| | - Hiroyuki Takahashi
- Massachusetts General Hospital and Harvard Medical School, Boston, MA 02192, USA
| | - Hans F Dias
- Massachusetts General Hospital, Boston, MA 02192, USA
| | - Joan Braley
- Massachusetts General Hospital and Harvard Medical School, Boston, MA 02192, USA
| | - Hui Zheng
- Massachusetts General Hospital and Harvard Medical School, Boston, MA 02192, USA
| | - David A Schoenfeld
- Massachusetts General Hospital and Harvard Medical School, Boston, MA 02192, USA
| | - Willem M Kühtreiber
- Massachusetts General Hospital and Harvard Medical School, Boston, MA 02192, USA
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4
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Gagneux-Brunon A, Botelho-Nevers E. Que reste-t-il du BCG 100 ans après ? MÉDECINE ET MALADIES INFECTIEUSES FORMATION 2022; 1. [PMCID: PMC9181895 DOI: 10.1016/j.mmifmc.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Le BCG a fêté ses 100 ans en juillet 2021, en pleine pandémie de COVID-19, alors qu'une baisse des prises en charge de cas de tuberculose avait lieu suite à la diminution des activités de dépistage à travers le monde. Si le développement vaccinal permet d'envisager un vaccin plus efficace et mieux toléré que le BCG, on peut retenir que celui-ci réduit, lorsqu'il est administré dans l'enfance, le risque de tuberculose maladie mais aussi de mortalité toute cause, notamment dans les pays à faibles revenus. Son impact chez l'adulte reste moins évident. Cependant, l'effet protecteur observé vis-à-vis d'autres pathogènes (pressenti par Calmette lui-même) a conduit à évaluer l'efficacité de la revaccination par le BCG à l’âge adulte.
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Affiliation(s)
- Amandine Gagneux-Brunon
- Service d'Infectiologie CHU de Saint-Étienne, France,Auteur correspondant. Dr Amandine Gagneux-Brunon
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5
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Messina NL, Germano S, McElroy R, Rudraraju R, Bonnici R, Pittet LF, Neeland MR, Nicholson S, Subbarao K, Curtis N. Off-target effects of bacillus Calmette-Guérin vaccination on immune responses to SARS-CoV-2: implications for protection against severe COVID-19. Clin Transl Immunology 2022; 11:e1387. [PMID: 35573165 PMCID: PMC9028103 DOI: 10.1002/cti2.1387] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 01/03/2023] Open
Abstract
Background and objectives Because of its beneficial off‐target effects against non‐mycobacterial infectious diseases, bacillus Calmette–Guérin (BCG) vaccination might be an accessible early intervention to boost protection against novel pathogens. Multiple epidemiological studies and randomised controlled trials (RCTs) are investigating the protective effect of BCG against coronavirus disease 2019 (COVID‐19). Using samples from participants in a placebo‐controlled RCT aiming to determine whether BCG vaccination reduces the incidence and severity of COVID‐19, we investigated the immunomodulatory effects of BCG on in vitro immune responses to SARS‐CoV‐2. Methods This study used peripheral blood taken from participants in the multicentre RCT and BCG vaccination to reduce the impact of COVID‐19 on healthcare workers (BRACE trial). The whole blood taken from BRACE trial participants was stimulated with γ‐irradiated SARS‐CoV‐2‐infected or mock‐infected Vero cell supernatant. Cytokine responses were measured by multiplex cytokine analysis, and single‐cell immunophenotyping was made by flow cytometry. Results BCG vaccination, but not placebo vaccination, reduced SARS‐CoV‐2‐induced secretion of cytokines known to be associated with severe COVID‐19, including IL‐6, TNF‐α and IL‐10. In addition, BCG vaccination promoted an effector memory phenotype in both CD4+ and CD8+ T cells, and an activation of eosinophils in response to SARS‐CoV‐2. Conclusions The immunomodulatory signature of BCG’s off‐target effects on SARS‐CoV‐2 is consistent with a protective immune response against severe COVID‐19.
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Affiliation(s)
- Nicole L Messina
- Infectious Diseases Group, Infection and Immunity Theme Murdoch Children's Research Institute Parkville VIC Australia.,Department of Paediatrics The University of Melbourne Parkville VIC Australia
| | - Susie Germano
- Infectious Diseases Group, Infection and Immunity Theme Murdoch Children's Research Institute Parkville VIC Australia
| | - Rebecca McElroy
- Infectious Diseases Group, Infection and Immunity Theme Murdoch Children's Research Institute Parkville VIC Australia
| | - Rajeev Rudraraju
- Department of Microbiology and Immunology University of Melbourne at The Peter Doherty Institute for Infection and Immunity Parkville VIC Australia
| | - Rhian Bonnici
- Infectious Diseases Group, Infection and Immunity Theme Murdoch Children's Research Institute Parkville VIC Australia
| | - Laure F Pittet
- Infectious Diseases Group, Infection and Immunity Theme Murdoch Children's Research Institute Parkville VIC Australia.,Department of Paediatrics The University of Melbourne Parkville VIC Australia.,Paediatric Infectious Diseases Unit Faculty of Medicine Geneva University Hospitals Geneva Switzerland
| | - Melanie R Neeland
- Department of Paediatrics The University of Melbourne Parkville VIC Australia.,Molecular Immunity Group, Infection and Immunity Theme Murdoch Children's Research Institute Parkville VIC Australia
| | - Suellen Nicholson
- Victorian Infectious Diseases Reference Laboratory The Royal Melbourne Hospital The Peter Doherty Institute for Infection and Immunity Parkville VIC Australia
| | - Kanta Subbarao
- Department of Microbiology and Immunology University of Melbourne at The Peter Doherty Institute for Infection and Immunity Parkville VIC Australia.,WHO Collaborating Centre for Reference and Research on Influenza Peter Doherty Institute for Infection and Immunity Parkville VIC Australia
| | - Nigel Curtis
- Infectious Diseases Group, Infection and Immunity Theme Murdoch Children's Research Institute Parkville VIC Australia.,Department of Paediatrics The University of Melbourne Parkville VIC Australia.,Infectious Diseases The Royal Children's Hospital Melbourne Parkville VIC Australia
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6
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Gong W, Mao Y, Li Y, Qi Y. BCG Vaccination: A potential tool against COVID-19 and COVID-19-like Black Swan incidents. Int Immunopharmacol 2022; 108:108870. [PMID: 35597119 PMCID: PMC9113676 DOI: 10.1016/j.intimp.2022.108870] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/07/2022] [Accepted: 05/12/2022] [Indexed: 12/17/2022]
Abstract
The severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2), the causative agent of the coronavirus
disease 2019 (COVID-19), and its variants have brought unprecedented
impacts to the global public health system, politics, economy, and other
fields. Although more than ten COVID-19 specific vaccines have been
approved for emergency use, COVID-19 prevention and control still face
many challenges. Bacille Calmette–Guérin (BCG) is the only authorized
vaccine used to fight against tuberculosis (TB), it has been hypothesized
that BCG may prevent and control COVID-19 based on BCG-induced
nonspecific immune responses. Herein, we summarized: 1) The nonspecific
protection effects of BCG, such as prophylactic protection effects of BCG
on nonmycobacterial infections, immunotherapy effects of BCG vaccine, and
enhancement effect of BCG vaccine on unrelated vaccines; 2) Recent
evidence of BCG's efficacy against SARS-COV-2 infection from ecological
studies, analytical analyses, clinical trials, and animal studies; 3)
Three possible mechanisms of BCG vaccine and their effects on COVID-19
control including heterologous immunity, trained immunity, and
anti-inflammatory effect. We hope that this review will encourage more
scientists to investigate further BCG induced non-specific immune
responses and explore their mechanisms, which could be a potential tool
for addressing the COVID-19 pandemic and COVID-19-like “Black Swan”
events to reduce the impacts of infectious disease outbreaks on public
health, politics, and economy.
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Affiliation(s)
- Wenping Gong
- Tuberculosis Prevention and Control Key Laboratory/Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Senior Department of Tuberculosis, The 8(th) Medical Center of PLA General Hospital, Beijing 100091, China
| | - Yingqing Mao
- Huadong Research Institute for Medicine and Biotechniques, Nanjing 210002, Jiangsu Province, China
| | - Yuexi Li
- Huadong Research Institute for Medicine and Biotechniques, Nanjing 210002, Jiangsu Province, China.
| | - Yong Qi
- Huadong Research Institute for Medicine and Biotechniques, Nanjing 210002, Jiangsu Province, China.
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7
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Jansson MK, Neuber K, Rudolf H, Podbielski A, Virchow JC, Warnke P. Childhood Bacille Calmette-Guérin vaccination seems to selectively protect adult males from COVID-19 infection. Allergy 2022; 77:1285-1287. [PMID: 34812526 PMCID: PMC9011414 DOI: 10.1111/all.15186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/21/2021] [Accepted: 11/20/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Moritz K. Jansson
- Institute of Medical Microbiology, Virology and Hygiene University Medicine Rostock Rostock Germany
| | - Kerstin Neuber
- Gesundheitsamt Rostock (Rostock Public Health Authority) Rostock Germany
| | - Henrik Rudolf
- Institute for Biostatistics and Informatics in Medicine and Ageing Research University Medicine Rostock Rostock Germany
| | - Andreas Podbielski
- Institute of Medical Microbiology, Virology and Hygiene University Medicine Rostock Rostock Germany
| | - J. Christian Virchow
- Departments of Pneumology and Critical Care Medicine University Medicine Rostock Rostock Germany
| | - Philipp Warnke
- Institute of Medical Microbiology, Virology and Hygiene University Medicine Rostock Rostock Germany
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8
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Hilligan KL, Namasivayam S, Clancy CS, O’Mard D, Oland SD, Robertson SJ, Baker PJ, Castro E, Garza NL, Lafont BA, Johnson R, Ronchese F, Mayer-Barber KD, Best SM, Sher A. Intravenous administration of BCG protects mice against lethal SARS-CoV-2 challenge. J Exp Med 2022; 219:e20211862. [PMID: 34889942 PMCID: PMC8669500 DOI: 10.1084/jem.20211862] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/05/2021] [Accepted: 11/30/2021] [Indexed: 12/24/2022] Open
Abstract
In addition to providing partial protection against pediatric tuberculosis, vaccination with bacille Calmette-Guérin (BCG) has been reported to confer nonspecific resistance to unrelated pulmonary pathogens, a phenomenon attributed to the induction of long-lasting alterations within the myeloid cell compartment. Here, we demonstrate that intravenous, but not subcutaneous, inoculation of BCG protects human-ACE2 transgenic mice against lethal challenge with SARS-CoV-2 (SCV2) and results in reduced viral loads in non-transgenic animals infected with an α variant. The observed increase in host resistance was associated with reductions in SCV2-induced tissue pathology, inflammatory cell recruitment, and cytokine production that multivariate analysis revealed as only partially related to diminished viral load. We propose that this protection stems from BCG-induced alterations in the composition and function of the pulmonary cellular compartment that impact the innate response to the virus and ensuing immunopathology. While intravenous BCG vaccination is not a clinically acceptable practice, our findings provide an experimental model for identifying mechanisms by which nonspecific stimulation of the pulmonary immune response promotes host resistance to SCV2 lethality.
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Affiliation(s)
- Kerry L. Hilligan
- Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
- Immune Cell Biology Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Sivaranjani Namasivayam
- Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Chad S. Clancy
- Rocky Mountain Veterinary Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT
| | - Danielle O’Mard
- Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Sandra D. Oland
- Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Shelly J. Robertson
- Innate Immunity and Pathogenesis Section, Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT
| | - Paul J. Baker
- Inflammation and Innate Immunity Unit, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Ehydel Castro
- Inflammation and Innate Immunity Unit, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Nicole L. Garza
- SARS-CoV-2 Virology Core, Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Bernard A.P. Lafont
- SARS-CoV-2 Virology Core, Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Reed Johnson
- SARS-CoV-2 Virology Core, Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Franca Ronchese
- Immune Cell Biology Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Katrin D. Mayer-Barber
- Inflammation and Innate Immunity Unit, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Sonja M. Best
- Innate Immunity and Pathogenesis Section, Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT
| | - Alan Sher
- Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
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9
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BCG vaccination provides protection against IAV but not SARS-CoV-2. Cell Rep 2022; 38:110502. [PMID: 35235831 PMCID: PMC8858710 DOI: 10.1016/j.celrep.2022.110502] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/30/2021] [Accepted: 02/15/2022] [Indexed: 11/25/2022] Open
Abstract
Since the vast majority of species solely rely on innate immunity for host defense, it stands to reason that a critical evolutionary trait like immunological memory evolved in this primitive branch of our immune system. There is ample evidence that vaccines such as bacillus Calmette-Guérin (BCG) induce protective innate immune memory responses (trained immunity) against heterologous pathogens. Here we show that while BCG vaccination significantly reduces morbidity and mortality against influenza A virus (IAV), it fails to provide protection against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In contrast to IAV, SARS-CoV-2 infection leads to unique pulmonary vasculature damage facilitating viral dissemination to other organs, including the bone marrow (BM), a central site for BCG-mediated trained immunity. Finally, monocytes from BCG-vaccinated individuals mount an efficient cytokine response to IAV infection, while this response is minimal following SARS-CoV-2. Collectively, our data suggest that the protective capacity of BCG vaccination is contingent on viral pathogenesis and tissue tropism.
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10
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Is the BCG Vaccine an Answer to Future Pandemic Preparedness? Vaccines (Basel) 2022; 10:vaccines10020201. [PMID: 35214660 PMCID: PMC8876484 DOI: 10.3390/vaccines10020201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/06/2022] [Accepted: 01/25/2022] [Indexed: 11/29/2022] Open
Abstract
While the development of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines was rapid, time to development and implementation challenges remain that may impact the response to future pandemics. Trained immunity via bacille Calmette-Guerin (BCG) vaccination (an antigen agnostic strategy) offers a potential intervention against future novel pathogens via an existing, safe, and widely distributed vaccine to protect vulnerable populations and preserve health system capacity while targeted vaccines are developed and implemented.
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