Research Article

BCG Vaccination in Early Childhood and Risk of Atopic Disease: A Systematic Review and Meta-Analysis

Table 1

Characteristics of included studies.

Reference (year of publication)DesignPopulation studiedCountrySample size (case/control)Outcomes and methodQuality assessment

Zein 2017Retrospective studyVaccination: 32,900 (42.9%) individuals received the vaccine within their first year of life, 2,712 (3.5%) were vaccinated later. Follow up: children born at 32 weeks of gestation until 20n years Quebec, Canada, 1974.Developed country893/750Asthma at least 2 asthma-related medical services or at least 1 asthma- related hospitalization (international classification of diseases, ninth revision, code 493)B

Alm 1997Retrospective studyVaccination: Before the age of 6 months, follow up: children at 3–7 years Stockholm, Sweden 1991Developed country216/358Eczema, asthma, rhinitis atopic disease in history and/or at the clinical examination, as well as skin prick test and IgE in a blood sampleB

Garcia 2005Retrospective studyVaccination: When the children were born follow up: children aged 6 and 7 years old health centers in SpainDeveloped country6762/2828Eczema, asthma, rhinitis the Spanish version of the ISAAC phase III questionnaireB

Gruber 2002Retrospective studyVaccination: When the children were born follow up: children who were starting school (mean age 6 years) Germany, 1994Developed country20383/18425Eczema, asthma, rhinitis a mandatory health surveyB

Marks 2003Retrospective studyVaccination: In the first 8 weeks of life follow up: yellow race children aged 7 to 14 years old Sydney, AustraliaDeveloped country309/442Eczema, asthma, rhinitis subjects underwent allergen SPTs, spirometry, a methacholine inhalation challenge test, a venous blood collection for IgE assay and lymphocyte studies, and a TSTB

Miyake 2008Retrospective studyVaccination: In infancy according to school records follow up: 8–11 years of age JapanDeveloped country5567/150Eczema, asthma, rhinitis a self-administered questionnaires included questions on symptoms of wheeze, asthma, atopic eczemaB

Linehan 2007Retrospective studyVaccination: Before the age of 12 weeks followed up: 6–11 years of age health care center, EnglandDeveloped country1332/1076Wheeze a parent-completed questionnaire, based on the international study of asthma and allergies in childhood asthma questionnaire 12 with some additional questionsB

da cunha 2004Cross-sectionalVaccination: When the children were born followed up: children of 12–14 years Salvador, BrazilDeveloping country1089/523Eczema, asthma, rhinitis based on self-reporting of current allergy and whether this was accompanied by sneezing and/or skin manifestationsC
Mommers 2004Nested case-control studyVaccination: When the children were born followed up: children at 7–8 years of age Netherlands and GermanyDeveloped countryCase:75Asthma ISAAC questionnaire and questions on indoor environment, specific IgE was measured in the bloodC

Mohrenschlager 2007Cross-sectional studyVaccination: Unknow followed up: at 5–7 years (preschool) augsburg GermanyDeveloped country1219/247Eczema, asthma, rhinitis skin prick test reaction more than 2 mmC

Pahari 2002Cross-sectional studyVaccination: Unknow follow up: children aged 11–18 years from secondary school EnglandDeveloped countryCase:308Asthma clinical symptomC

Thestesen 2018RCTVaccination: When the children were born follow up: from birth to 13 months of age DenmarkDeveloped country2052/1952Eczema the severity of AD was graded using SCORADB

Gruber 2001Prospective studyVaccination: Within their first weeks of life follow up: from birth to 7 years old Freiburg, GermanyDeveloped country92/682Eczema, asthma, rhinitis parents filled in a questionnaire and gave a structured interview about their children s diseases and atopic symptomsB

Soysal 2008Retrospective studyVaccination: Unknow follow up: children with recent household contact to adult given a diagnosis of sputum smear– positive pulmonary TB at one of 7 government- funded TB clinics istanbulDeveloping country290/71Eczema, asthma, rhinitis all children underwent TST and chest radiography, and gave 10-ml of venous blood sample for the RD1 ELISpot assay and total serum IgE levelB

Steenhuis 2008RCTVaccination: When the children were born Follow up: high-risk newborns in the pediatric Utrecht, NetherlandsDeveloped country62/59Eczema, asthma rhinitis an adapted version of the british medical research council questionnaire and the Dutch version of the european community respiratory health survey were usedC

Wickens 2001Case-control studyVaccination: When the children were born follow up: children aged 6–7 and 13–14 from a random selection of schools Wellington, New ZealandDeveloped country220/231Asthma the case-control study was based on the Wellington, New Zealand, arm of the ISAACC

Peleteiro 2018RCTVaccination: All individuals had been vaccinated with BCG in early childhoodFollow up: healthy undergraduate studentsSalvador, Bahia, BrazilDeveloping country46/29Eczema, asthma rhinitis sociodemographic and clinical characteristics were obtained using a standard questionnaire and the ISAAC questionnaire. Total serum IgE levels were measuredB
Park 2015Retrospective studyVaccination: unknowFollow up: adults who underwent skin pricktesting, KoreaDeveloped country135/40Asthma the results from spirometry and bronchial provocation testing conducted within one month from the date of SPTC

Singh 2013Cross-sectional studyVaccination: unknowFollow up: aged 7–14 years Chandigarh, North India.Developing country7792/1700Eczema, asthma rhinitis symptoms were assessed according to the ISAAC phase II questionnaire that asked for infor- mation on demography, symptoms of wheeze, asthma, rhinitis, and eczema, together with various possible risk factorsB

Thestesen 2017RCTVaccination: When the children were born follow up: newborns (3–13 months) DenmarkDeveloped country2100/2071Asthma at 3 and 13 months, the children were invited for a clinical examination at the study site, where study staff evaluated the child's breathing and made an auscultationB