Grüber C, Meinlschmidt G, Bergmann R, Wahn U, Stark K (2002): Is early BCG-vaccination associated with less atopic disease? An epidemiological study in German preschool children with different ethnic backgrounds
Ped. Allerg. Immunol. 13: 177-181.

We investigated the association of BCG-vaccination and atopic manifestations among children. Since many children in the study area were from minority ethnic groups, the effect of ethnicity on disease prevalence was also analyzed. A mandatory health survey included all pre-school children from Berlin in 1994. Parents were asked by trained medical personnel whether their child had ever had a diagnosis of atopic eczema (AE), bronchial asthma (BA), and hay fever (HF) or symptoms suggestive of these conditions. BCG vaccination status was recorded from official vaccination documents. Ethnicity of the child was defined by maternal citizenship. We included 38,808 children in our study (20,813 children from former west Berlin) on average aged six years. The proportion of children with a foreign family background was 2.1% in east Berlin and 27.5% in west Berlin. BCG-vaccination was more common in east Berlin than in west Berlin (94.2% vs 16.5%) and in west Berlin more common among children with a foreign family background compared to Germans (25.3% vs 13.2%). The adjusted odds ratio (95%CI) for BA was 0.85 (0.71-1.00) for BCG-vaccinated individuals. BCG-vaccination was not significantly associated with AE or HF. Among non-German children, the odds ratios were 0.35 (0.30-0.42) for AE, 0.58 (0.48-0.70) for BA, and 0.72 (0.54-0.92) for HF. The OR for AE among children living in eastern Berlin was 1.19 (1.04-1.36), no significant regional differences were found for BA or HF. This study demonstrated a weak protective effect of BCG-vaccination against asthma but a much stronger protective effect of non-German ethnicity against atopic manifestations among pre-school children from Germany.