Factors determining COVID‐19 pneumonia severity in a country with routine BCG vaccination

• Published in: Clinical and experimental immunology Vol. 202; no. 2; pp. 220 - 225
• Main Authors: Aksu, K., Naziroğlu, T., Özkan, P.
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.11.2020; John Wiley and Sons Inc
• Subjects: Adult; Age; Age Factors; Aged; Bacillus Calmette-Guerin vaccine; bacillus Calmette–Guérin; BCG; BCG Vaccine - immunology; Betacoronavirus - physiology; Body mass index; Collection: COVID‐19; Coronaviridae; Coronavirus Infections - epidemiology; Coronaviruses; COVID-19; Cross-Sectional Studies; Diabetes mellitus; Disease; Disease Progression; Female; Humans; hypertension; Immunization; income; Low income groups; Male; Middle Aged; Multivariate analysis; Original; Pandemics; Pneumonia; Pneumonia, Viral - epidemiology; Polymerase chain reaction; Population studies; Poverty; Retrospective Studies; Risk; SARS-CoV-2; Severe acute respiratory syndrome; severity; Severity of Illness Index; smoking; Turkey - epidemiology; Vaccination; Vaccination - statistics & numerical data; Turkey; COVID-19; income; severity; SARS-CoV-2; bacillus Calmette-Guérin; smoking; diabetes mellitus; hypertension
• ISSN: 0009-9104; 1365-2249
• DOI: 10.1111/cei.13507

Sociodemographic features, body mass index, smoking status, concomitant diseases, income rates, and BCG vaccination status of subjects were analyzed in 123 patients diagnosed with COVID‐19 pneumonia in a state hospital in Istanbul, Turkey. BCG vaccination is not associated with disease severity in COVID‐19 pneumonia. Age and low income are the main determinants of severe COVID‐19 pneumonia. Summary Background The impact of countries’ bacillus Calmette–Guérin (BCG) vaccination policies on the course of coronavirus disease (COVID‐19) outbreak is a curiosity. In this study, the relationship between BCG vaccination status and severity of COVID‐19 pneumonia and the factors affecting disease severity were investigated. Methods A retrospective cross‐sectional study was conducted between March and June 2020 in patients diagnosed with COVID‐19 pneumonia, confirmed by severe acute respiratory syndrome coronavirus‐2 polymerase chain reaction positivity in a nasopharyngeal sample and pulmonary infiltrates in computed chest tomography, in a state hospital in Istanbul, Turkey. Socio‐demographic features, body mass index, smoking status, concomitant diseases, income rates and BCG vaccination status of subjects were analyzed. Result The study population comprised 123 adults with COVID‐19 pneumonia [mean age = 49·7 years, standard deviation = 13·3 years; 82 (66·7%) male]. While the rate of cases vaccinated with BCG is lower (68·5 versus 88·2%, P = 0·026), mean age (54·0 ± 11·5 years versus 38·3 ± 10·7 years; P < 0·001), diabetes (32·6 versus 5·9%, P = 0·002) and low income (84·3 versus 52·9%, P < 0·001) are higher in patients with severe disease compared to those with mild disease. According to multivariate analysis increasing age [odds ratio (OR) = 1·119; 95% confidence interval (CI) = 1·062–1·178, P < 0·001] and low income (OR = 3·209; 95% CI = 1·008–10·222, P = 0·049) are associated with severe disease in COVID‐19 pneumonia. Conclusion This study reveals that BCG vaccination is not associated with disease severity in COVID‐19 pneumonia. Age and low income are the main determinants of severe COVID‐19 pneumonia.