Volume 119, Issue 5, Pages 1079-1085 (May 2007)


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Is the prevalence of wheeze in children altered by neonatal BCG vaccination?

Mary F. Linehan, PhDa, Timothy L. Frank, MDa, Michelle L. Hazell, PhDa, Helen C. Francis, PhDb, Julie A. Morris, MScc, David N. Baxter, PhDd, Robert M. Niven, MDb
Received 10 October 2006; received in revised form 18 December 2006; accepted 19 December 2006 published online 12 April 2007.

Manchester, United Kingdom

Background
The prevalence of asthma and atopic disease has increased in recent decades, but precise reasons for this increase are unknown. BCG vaccination is thought to be among a group of vaccines capable of manipulating the immune system toward TH1 dominance and therefore reducing the likelihood of atopic disease.

Objective
The aim of this study was to determine the influence of neonatal BCG vaccination on the prevalence of wheeze in a large community population of children.

Method
In a historical cohort study, a parent-completed questionnaire was used to identify the prevalence of wheeze in BCG-vaccinated and nonvaccinated children in Manchester, England.

Results
There were 2414 participants aged between 6 and 11 years. In a univariate analysis neonatal BCG vaccination was associated with a significantly lower prevalence of wheeze (odds ratio, 0.69; 95% CI, 0.55-0.86), and statistical significance was retained when the analysis was adjusted for potential confounders (odds ratio, 0.68; 95% CI, 0.53-0.87).

Conclusion
These results demonstrate an association between asthma symptom prevalence and neonatal BCG vaccination, relating to a possible 27% reduction in prevalence, and are therefore of considerable public health importance.

Clinical implications
The capacity of neonatal BCG vaccination to reduce the prevalence of respiratory symptoms in children warrants further investigation.

Key words: Wheeze, children, BCG, questionnaire, prevalence
Abbreviations used: OR, Odds ratio, PCT, Primary Care Trust