{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T15:37:07Z","timestamp":1773329827046,"version":"3.50.1"},"reference-count":10,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2021,3,16]],"date-time":"2021-03-16T00:00:00Z","timestamp":1615852800000},"content-version":"unspecified","delay-in-days":74,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2021]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>We investigated whether countries with higher coverage of childhood live vaccines [BCG or measles-containing-vaccine (MCV)] have reduced risk of coronavirus disease 2019 (COVID-19)-related mortality, while accounting for known systems differences between countries. In this ecological study of 140 countries using publicly available national-level data, higher vaccine coverage, representing estimated proportion of people vaccinated during the last 14 years, was associated with lower COVID-19 deaths. The associations attenuated for both vaccine variables, and MCV coverage became no longer significant once adjusted for published estimates of the Healthcare access and quality index (HAQI), a validated summary score of healthcare quality indicators. The magnitude of association between BCG coverage and COVID-19 death rate varied according to HAQI, and MCV coverage had little effect on the association between BCG and COVID-19 deaths. While there are associations between live vaccine coverage and COVID-19 outcomes, the vaccine coverage variables themselves were strongly correlated with COVID-19 testing rate, HAQI and life expectancy. This suggests that the population-level associations may be further confounded by differences in structural health systems and policies. Cluster randomised studies of booster vaccines would be ideal to evaluate the efficacy of trained immunity in preventing COVID-19 infections and mortality in vaccinated populations and on community transmission.<\/jats:p>","DOI":"10.1017\/s0950268821000571","type":"journal-article","created":{"date-parts":[[2021,3,16]],"date-time":"2021-03-16T03:18:12Z","timestamp":1615864692000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":11,"title":["Association between live childhood vaccines and COVID-19 outcomes: a national-level analysis"],"prefix":"10.1017","volume":"149","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2166-8152","authenticated-orcid":false,"given":"Chikara","family":"Ogimi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pingping","family":"Qu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Boeckh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6167-1447","authenticated-orcid":false,"given":"Rachel A.","family":"Bender Ignacio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sahar Z.","family":"Zangeneh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2021,3,16]]},"reference":[{"key":"S0950268821000571_ref5","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0b013e3182465be8"},{"key":"S0950268821000571_ref4","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/S0140-6736(17)30818-8","article-title":"Healthcare access and quality index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990\u20132015: a novel analysis from the global burden of disease study 2015","volume":"390","author":"Access","year":"2017","journal-title":"Lancet"},{"key":"S0950268821000571_ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2020.08.045"},{"key":"S0950268821000571_ref9","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S129728"},{"key":"S0950268821000571_ref10","doi-asserted-by":"publisher","DOI":"10.15252\/emmm.202012661"},{"key":"S0950268821000571_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2020.08.013"},{"key":"S0950268821000571_ref2","first-page":"207","article-title":"Stop playing with data: there is no sound evidence that bacille Calmette-Guerin may avoid SARS-CoV-2 infection (for now)","volume":"91","author":"Ricco","year":"2020","journal-title":"Acta BioMedica"},{"key":"S0950268821000571_ref1","doi-asserted-by":"publisher","DOI":"10.1038\/s41577-020-0337-y"},{"key":"S0950268821000571_ref8","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.17395"},{"key":"S0950268821000571_ref7","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.2008410117"}],"container-title":["Epidemiology and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0950268821000571","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,30]],"date-time":"2021-03-30T03:16:35Z","timestamp":1617074195000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0950268821000571\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021]]},"references-count":10,"alternative-id":["S0950268821000571"],"URL":"https:\/\/doi.org\/10.1017\/s0950268821000571","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2020.10.17.20214510","asserted-by":"object"}]},"ISSN":["0950-2688","1469-4409"],"issn-type":[{"value":"0950-2688","type":"print"},{"value":"1469-4409","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021]]},"assertion":[{"value":"Copyright \u00a9 The Author(s), 2021. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e75"}}