Neonatal BCG Vaccination to Prevent Early-Life Eczema

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• This systematic review and meta-analysis identified three randomized controlled trials evaluating the effect of early-life bacillus Calmette–Guérin (BCG) vaccine administration on the incidence of atopic dermatitis. This study found an 11% reduction in the cumulative incidence of eczema after early-life BCG vaccine administration compared with placebo or no intervention. In children with one or two atopic parents, there was a 15% reduction in the risk of developing atopic dermatitis.

• The off-target effects of the BCG vaccine on the immune system may lead to a reduction in the incidence of atopic dermatitis, especially in infants with atopic parents.

–  Katherine M. Stiff, MD

Abstract 

Increasing evidence suggests that early-life bacillus Calmette-Guérin (BCG) vaccine could prevent atopic eczema through its beneficial off-target effects. In this meta-analysis, 3 randomized control trials with similar methods were included and enabled robust estimations with low heterogeneity, involving a total of 5655 children randomized to early-life BCG Denmark (n = 2832) or no BCG (n = 2823). Meta-analyses suggest a beneficial effect of BCG to prevent eczema (risk ratio [RR], 0.89; 95% confidence interval [CI], 0.82–0.98). In subgroup analyses, BCG was more beneficial in boys (RR, 0.84; 95% CI, 0.74–0.95) and in children born to 2 atopic parents (RR, 0.81; 95% CI, 0.68–0.97). The NNT to prevent one case of eczema among children of 1 or 2 atopic parent was 20 (95% CI, 12–50). Bacillus Calmette-Guérin Denmark leads to an 11% reduction in the risk of eczema in early life. A greater effect was observed with increasing predisposition. Given its well-established safety profile, neonatal BCG vaccination should be considered for children of atopic parents.

Dermatitis

Neonatal Bacillus Calmette-Guérin Vaccination to Prevent Early-Life Eczema: A Systematic Review and Meta-analysis

Dermatitis 2022 Sep 22;[EPub Ahead of Print], LF Pittet, LM Thøstesen, P Aaby, PE Kofoed, N Curtis, CS Benn 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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