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Does BCG vaccination protect against the development of childhood asthma? A systematic review and meta-analysis of epidemiological studies
International Journal of Epidemiology, 10/14/09

El–Zein M et al. – These results strengthen the epidemiological evidence in support of the hypothesis that exposure to the BCG vaccine in early life prevents asthma, possibly through a modulation of the immune maturation process.

• Eligible studies were identified using a search strategy that included a computerized literature search and a manual search of each article's reference list, up to June 2008.
• A total of 23 studies were included (10 cohort, 5 case–control and 8 cross–sectional). Each study was summarized and rated for methodological quality.
• Three indicators of BCG exposure were considered including BCG vaccination, tuberculin response and scar diameter.

• The pooled estimate of association for 23 studies reporting on any of the three indicators suggested a protective effect of BCG exposure on childhood asthma occurrence.
• The studies were heterogeneous, especially when tuberculin response was considered.
• Restriction to a subgroup of 16 studies that considered BCG vaccination indicated a protective effect with no evidence of heterogeneity.
• The overall pooled OR using an FE model was 0.86. Exclusion of three studies with the lowest quality scores showed a similar association.

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