{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T20:36:19Z","timestamp":1772138179939,"version":"3.50.1"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2020,8,23]],"date-time":"2020-08-23T00:00:00Z","timestamp":1598140800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,5,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The bacille Calmette-Gu\u00e9rin (BCG) tuberculosis vaccine has immunity benefits against respiratory infections. Accordingly, it has been hypothesized to have a protective effect against coronavirus disease 2019 (COVID-19). Recent research found that countries with universal BCG childhood vaccination policies tend to be less affected by the COVID-19 pandemic. However, such ecological studies are biased by numerous confounders. Instead, this paper reports on a rare nationwide natural experiment that occurred in Sweden in 1975, where discontinuation of newborns\u2019 BCG vaccination led to a dramatic decrease in BCG coverage rate, thus allowing us to estimate BCG\u2019s effect without the biases associated with cross-country comparisons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Numbers of COVID-19 cases and hospitalizations were recorded for birth cohorts born just before and just after 1975, representing 1 026 304 and 1 018 544 individuals, respectively. We used regression discontinuity to assess the effect of BCG vaccination on COVID-19\u2013related outcomes. On such a large population, this method allows for a precision that would be hard to achieve using a randomized controlled trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The odds ratios (95% CI) for COVID-19 cases and COVID-19\u2013related hospitalizations were 1.0005 (.8130\u20131.1881) and 1.2046 (.7532\u20131.6560), allowing us to reject fairly modest effects of universal BCG vaccination. We can reject with 95% confidence that universal BCG vaccination reduces the number of cases by 19% and the number of hospitalizations by 25%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>While the effect of a recent vaccination must be evaluated, we provide strong evidence that receiving the BCG vaccine at birth does not have a protective effect against COVID-19 among middle-aged individuals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciaa1223","type":"journal-article","created":{"date-parts":[[2020,8,14]],"date-time":"2020-08-14T15:31:15Z","timestamp":1597419075000},"page":"e501-e505","source":"Crossref","is-referenced-by-count":28,"title":["Bacille Calmette-Gu\u00e9rin Vaccination in Infancy Does Not Protect Against Coronavirus Disease 2019 (COVID-19): Evidence From a Natural Experiment in Sweden"],"prefix":"10.1093","volume":"72","author":[{"given":"Cl\u00e9ment","family":"de Chaisemartin","sequence":"first","affiliation":[{"name":"Department of Economics, University of California, Santa Barbara, Santa Barbara, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8973-1536","authenticated-orcid":false,"given":"Luc","family":"de Chaisemartin","sequence":"additional","affiliation":[{"name":"Immunology Department, Assistance Publique - H\u00f4pitaux de Paris, Nord-Universit\u00e9 de Paris, Bichat Hospital, Paris, France"},{"name":"Universit\u00e9 Paris-Saclay, Inserm, \u201cInflammation, Microbiome, Immunosurveillance,\u201d Ch\u00e2tenay-Malabry, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,8,23]]},"reference":[{"key":"2021051810402438600_CIT0001","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1093\/cid\/cit790","article-title":"Protection by BCG vaccine against tuberculosis: a systematic review of randomized controlled trials","volume":"58","author":"Mangtani","year":"2014","journal-title":"Clin Infect Dis"},{"key":"2021051810402438600_CIT0002","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1038\/s41577-020-0338-x","article-title":"The non-specific and sex-differential effects of vaccines","volume":"20","author":"Aaby","year":"2020","journal-title":"Nat Rev Immunol"},{"key":"2021051810402438600_CIT0003","doi-asserted-by":"crossref","first-page":"1473","DOI":"10.1016\/j.cmi.2019.04.020","article-title":"Non-specific effects of BCG vaccine on viral infections","volume":"25","author":"Moorlag","year":"2019","journal-title":"Clin Microbiol Infect"},{"key":"2021051810402438600_CIT0004","doi-asserted-by":"crossref","first-page":"3482","DOI":"10.1172\/JCI128877","article-title":"Targeting innate immunity for tuberculosis vaccination","volume":"129","author":"Khader","year":"2019","journal-title":"J Clin Invest"},{"key":"2021051810402438600_CIT0005","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1093\/ije\/dyx141","article-title":"The duration of protection of school-aged BCG vaccination in England: a population-based case-control study","volume":"47","author":"Mangtani","year":"2018","journal-title":"Int J Epidemiol"},{"key":"2021051810402438600_CIT0006","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/S1473-3099(15)00400-4","article-title":"Duration of BCG protection against tuberculosis and change in effectiveness with time since vaccination in Norway: a retrospective population-based cohort study","volume":"16","author":"Nguipdop-Djomo","year":"2016","journal-title":"Lancet Infect Dis"},{"key":"2021051810402438600_CIT0007","article-title":"Correlation between universal BCG vaccination policy and reduced morbidity and mortality for COVID-19: an epidemiological study","author":"Miller","year":"2020","journal-title":"medRxiv"},{"key":"2021051810402438600_CIT0008","first-page":"207","article-title":"Stop playing with data: there is no sound evidence that bacille Calmette-Gu\u00e9rin may avoid SARS-CoV-2 infection (for now)","volume":"91","author":"Ricc\u00f2","year":"2020","journal-title":"Acta Biomed"},{"key":"2021051810402438600_CIT0009","doi-asserted-by":"crossref","first-page":"109816","DOI":"10.1016\/j.mehy.2020.109816","article-title":"Relation between BCG coverage rate and COVID-19 infection worldwide","volume":"142","author":"Macedo","year":"2020","journal-title":"Med Hypotheses"},{"key":"2021051810402438600_CIT0010","doi-asserted-by":"crossref","first-page":"1824","DOI":"10.1111\/all.14344","article-title":"Is BCG vaccination affecting the spread and severity of COVID-19?","volume":"75","author":"Ozdemir","year":"2020","journal-title":"Allergy"},{"key":"2021051810402438600_CIT0011","doi-asserted-by":"crossref","first-page":"17720\u20136","DOI":"10.1073\/pnas.2008410117","article-title":"BCG vaccine protection from severe coronavirus disease 2019 (COVID-19)","volume":"117","author":"Escobar","year":"2020","journal-title":"Proc Natl Acad Sci USA"},{"key":"2021051810402438600_CIT0012","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1007\/s13312-020-1872-0","article-title":"Demystifying BCG vaccine and COVID-19 relationship","volume":"57","author":"Kumar","year":"2020","journal-title":"Indian Pediatr"},{"key":"2021051810402438600_CIT0013","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1257\/jel.48.2.281","article-title":"Regression discontinuity designs in economics","volume":"48","author":"Lee","year":"2010","journal-title":"J Econ Lit"},{"key":"2021051810402438600_CIT0014","first-page":"127","article-title":"Empirical tests of the validity of the regression discontinuity design","volume":"91","author":"Cook","year":"2008","journal-title":"Ann Econ Stat"},{"key":"2021051810402438600_CIT0015","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.3982\/QE864","article-title":"When does regression discontinuity design work? Evidence from random election outcomes","volume":"9","author":"Hyytinen","year":"2018","journal-title":"Quant Econ"},{"key":"2021051810402438600_CIT0016","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/0962-8479(92)90149-E","article-title":"The impact of changing BCG coverage on tuberculosis incidence in Swedish-born children between 1969 and 1989","volume":"73","author":"Romanus","year":"1992","journal-title":"Tuber Lung Dis"},{"key":"2021051810402438600_CIT0017","author":"Folkh\u00e4lsomyndigheten"},{"key":"2021051810402438600_CIT0018","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1016\/j.jeconom.2007.05.001","article-title":"Regression discontinuity designs: a guide to practice","volume":"142","author":"Imbens","year":"2008","journal-title":"J Econom"},{"key":"2021051810402438600_CIT0019","doi-asserted-by":"crossref","first-page":"2295","DOI":"10.3982\/ECTA11757","article-title":"Robust nonparametric confidence intervals for regression-discontinuity designs","volume":"82","author":"Calonico","year":"2014","journal-title":"Econometrica"},{"key":"2021051810402438600_CIT0020","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1177\/1536867X1401400413","article-title":"Robust data-driven inference in the regression-discontinuity design","volume":"14","author":"Calonico","year":"2014","journal-title":"Stata J"},{"key":"2021051810402438600_CIT0021","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1136\/bmj.319.7211.670","article-title":"What is meant by intention to treat analysis? Survey of published randomised controlled trials","volume":"319","author":"Hollis","year":"1999","journal-title":"BMJ"},{"key":"2021051810402438600_CIT0022","doi-asserted-by":"crossref","first-page":"467","DOI":"10.2307\/2951620","article-title":"Identification and estimation of local average treatment effects","volume":"62","author":"Imbens","year":"1994","journal-title":"Econometrica"},{"key":"2021051810402438600_CIT0023","doi-asserted-by":"crossref","first-page":"e1001012","DOI":"10.1371\/journal.pmed.1001012","article-title":"The BCG World Atlas: a database of global BCG vaccination policies and practices","volume":"8","author":"Zwerling","year":"2011","journal-title":"PLoS Med"},{"key":"2021051810402438600_CIT0024","author":"Bacille Calmette-Gu\u00e9rin (BCG) vaccination and COVID-19"},{"key":"2021051810402438600_CIT0025","doi-asserted-by":"crossref","first-page":"e28","DOI":"10.1016\/S2214-109X(18)30474-1","article-title":"Global shortages of BCG vaccine and tuberculous meningitis in children","volume":"7","author":"du Preez","year":"2019","journal-title":"Lancet Glob Health"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciaa1223\/33851135\/ciaa1223.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/cid\/article-pdf\/72\/10\/e501\/37950702\/ciaa1223.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/cid\/article-pdf\/72\/10\/e501\/37950702\/ciaa1223.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,18]],"date-time":"2021-05-18T06:58:40Z","timestamp":1621321120000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/72\/10\/e501\/5896039"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,23]]},"references-count":25,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2020,8,23]]},"published-print":{"date-parts":[[2021,5,18]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciaa1223","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2020.06.22.20137802","asserted-by":"object"}]},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,5,15]]},"published":{"date-parts":[[2020,8,23]]}}}