\documentclass[10pt]{article}

\usepackage{fullpage}
\usepackage{setspace}
\usepackage{parskip}
\usepackage{titlesec}
\usepackage[section]{placeins}
\usepackage{xcolor}
\usepackage{breakcites}
\usepackage{lineno}
\usepackage{hyphenat}





\PassOptionsToPackage{hyphens}{url}
\usepackage[colorlinks = true,
            linkcolor = blue,
            urlcolor  = blue,
            citecolor = blue,
            anchorcolor = blue]{hyperref}
\usepackage{etoolbox}
\makeatletter
\patchcmd\@combinedblfloats{\box\@outputbox}{\unvbox\@outputbox}{}{%
  \errmessage{\noexpand\@combinedblfloats could not be patched}%
}%
\makeatother


\usepackage{natbib}




\renewenvironment{abstract}
  {{\bfseries\noindent{\abstractname}\par\nobreak}\footnotesize}
  {\bigskip}

\titlespacing{\section}{0pt}{*3}{*1}
\titlespacing{\subsection}{0pt}{*2}{*0.5}
\titlespacing{\subsubsection}{0pt}{*1.5}{0pt}


\usepackage{authblk}


\usepackage{graphicx}
\usepackage[space]{grffile}
\usepackage{latexsym}
\usepackage{textcomp}
\usepackage{longtable}
\usepackage{tabulary}
\usepackage{booktabs,array,multirow}
\usepackage{amsfonts,amsmath,amssymb}
\providecommand\citet{\cite}
\providecommand\citep{\cite}
\providecommand\citealt{\cite}
% You can conditionalize code for latexml or normal latex using this.
\newif\iflatexml\latexmlfalse
\providecommand{\tightlist}{\setlength{\itemsep}{0pt}\setlength{\parskip}{0pt}}%

\AtBeginDocument{\DeclareGraphicsExtensions{.pdf,.PDF,.eps,.EPS,.png,.PNG,.tif,.TIF,.jpg,.JPG,.jpeg,.JPEG}}

\usepackage[utf8]{inputenc}
\usepackage[english]{babel}



\usepackage{float}








\begin{document}

\title{BCG vaccination for COVID-19: Evidence-based medicine approach}



\author[1]{Mina Kelleni}%
\affil[1]{Minia University}%


\vspace{-1em}



  
  \date{June 12, 2024}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
\maketitle
\endgroup








\sloppy


A peer reviewed updated version has been published

\url{https://www.tandfonline.com/doi/abs/10.1080/21645515.2021.1885281}

Multiple reports all over the world are hypothesizing a possible
relationship between BCG vaccination, and a lesser incidence of and
mortality from COVID-19\textsuperscript{1}. China is considered as one
of the heavily affected countries and it was the first to report
COVID-19, the author will examine this hypothesis using China as an
example.

According to the WHO global tuberculosis report 2019\textsuperscript{2},
it's stated that in 2018, among 180 countries for which data were
collected, 153 countries have properly reported administration of BCG
vaccination as a standard part of childhood immunization programmes, of
which 113 reported coverage of [?]90\% (Figure 1). In the same report,
China has accomplished a 99\% BCG vaccination coverage, to be considered
as one of the top countries providing this coverage rate all over the
world. Moreover, the reported estimates for the global BCG coverage
according to the WHO monitoring system for vaccine-preventable diseases
has revealed that BCG vaccination coverage in China to be either 99\% or
100\% for the years 2009 to 2018\textsuperscript{3}. Thus, we may
reasonably consider that all children, currently 10 years old or younger
and living in China, are efficiently covered and immunized by BCG
vaccination.

Interestingly, as of the 11\textsuperscript{th} of February, 2020 the
Chinese Center for Disease Control and Prevention has reported 416
laboratory-confirmed pediatric cases; aged 0--9
years\textsuperscript{4}. Moreover, another study, published about one
month later, has researched 2143 pediatric Chinese patients who were
both laboratory-confirmed as well as suspected cases, and concluded that
children at all ages appeared susceptible to COVID-19 and it's also
reported that the proportion of severe and critical cases was 10.6 \%,
7.3\%, 4.2\% for the age group of \textless{}1, 1-5, 6-10, respectively.
Noteworthy, this study has suggested that the majority of COVID-19
pediatric patients were less severe in their medical condition than
adults' cases because children are usually well cared for at home and
might have relatively less opportunities to expose themselves to SARS
CoV-2\textsuperscript{5}.

Thus, basing on the above analysis, the author suggests that stating
that BCG vaccination could prevent COVID-19 infection should be
considered as a myth. Moreover, the author considers stating that
countries which have adopted childhood BCG vaccination might be the
reason for a lower morbidity or mortality of COVID-19 for adults
immunized at birth, should be also considered as another myth, as
revealed by the incidence of adults' morbidity and mortality rates
reported in China as well as several other countries that have adopted
childhood BCG vaccination. However, BCG vaccination given once a month
for three consecutive months has previously showed a benefit against
adult upper respiratory tract infections in the
elderly\textsuperscript{6} and it might prove the same benefits against
COVID-19 if administered to unimmunized adults or re-administered to
previously immunized adults waiting for the results of the undergoing
clinical trials\textsuperscript{7}. On the other hand, BCG vaccination
might or might not have some ameliorative benefits for immunized
children affected by COVID-19 and this suggested positive association is
highly unlikely to be properly proved because of multiple confounding
factors. Finally, please keep and remain vigilant till the world finds a
cure for COVID-19, this is an evidence-based medicine piece of advice.

Funding:

None

Conflict of interests:

None

Financial disclosure:

None\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image1/image1}

\end{center}
\end{figure}

Fig (1): GLOBAL BCG VACCINATION POLICIES AND PRACTICES

Source: The BCG World Atlas 2nd Edition, http://www.bcgatlas.org/,
accessed 5 May, 2020.

Conflict of interests:

None

References:

1. Redelman-Sidi G. Could BCG be used to protect against
COVID-19?\emph{Nature Reviews Urology} 2020 doi:
10.1038/s41585-020-0325-9

2. WHO. Global tuberculosis report 2019 2019, October 17 {[}Available
from:
https://apps.who.int/iris/bitstream/handle/10665/329368/9789241565714-eng.pdf?ua=1.

3. WHO. WHO vaccine-preventable diseases: monitoring system. 2019 global
summary 2019, December 10 {[}Available from:
https://apps.who.int/immunization\_monitoring/globalsummary/coverages?c=CHN.

4. Choi SH, Kim HW, Kang JM, et al. Epidemiology and Clinical Features
of Coronavirus disease 2019 in Children. \emph{Clin Exp Pediatr} 2020
doi: 10.3345/cep.2020.00535 {[}published Online First: 2020/04/07{]}

5. Dong Y, Mo X, Hu Y, et al. Epidemiological Characteristics of 2143
Pediatric Patients With 2019 Coronavirus Disease in
China.\emph{Pediatrics} 2020:e20200702. doi: 10.1542/peds.2020-0702

6. Wardhana, Datau EA, Sultana A, et al. The efficacy of Bacillus
Calmette-Guerin vaccinations for the prevention of acute upper
respiratory tract infection in the elderly. \emph{Acta Med
Indones}2011;43(3):185-90. {[}published Online First: 2011/10/08{]}

7. ClinicalTrials.gov. 7 Studies found for: BCG \textbar{} COVID-19
2020, May 2 {[}Available from:
https://clinicaltrials.gov/ct2/results?cond=COVID-19\&term=BCG\&cntry=\&state=\&city=\&dist=\&Search=Search.

\selectlanguage{english}
\FloatBarrier
\end{document}

