Published online November 1, 2007
PEDIATRICS Vol. 120 No. 5 November 2007, pp. e1269-e1277 (doi:10.1542/peds.2006-3569)
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ARTICLE

Is Childhood Vaccination Associated With Asthma? A Meta-analysis of Observational Studies

Ran D. Balicer, MD, MPHa, Itamar Grotto, MD, MPHa, Marc Mimouni, MDb,c and Daniel Mimouni, MDc,d

a Department of Epidemiology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
b Schneider Children's Medical Centre of Israel, Petach Tikva, Israel
c Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
d Department of Dermatology, Rabin Medical Center, Petach Tikva, Israel

BACKGROUND. The possible link between immunization and atopic diseases has been under intense debate in the last decade.

OBJECTIVE. The aim of this study was to systematically review the available evidence on the association of whole-cell pertussis and BCG vaccination with the risk of asthma in childhood and adolescence.

METHODS. The major medical electronic databases (Medline, National Library of Medicine Gateway, and Cochrane Library) were searched, and reference lists of the relevant publications were reviewed for relevant birth-cohort studies and randomized, controlled trials from 1966 to March 2006. Only studies that directly compared vaccinated and unvaccinated children, validated vaccination status by medical charts, and used preset criteria to define asthma were included. Data were abstracted by using a standardized protocol and computerized report form. Results were analyzed by applying a fixed-effect or random-effect model, according to the heterogeneity of the studies. Sensitivity analyses by scoring criteria were performed.

RESULTS. Seven studies of pertussis vaccination (with a total of 186663 patients) and 5 studies of BCG vaccination (with a total of 41479 patients) met our inclusion criteria. No statistically significant association was detected between either whole-cell pertussis or BCG vaccination and incidence rates of asthma during childhood and adolescence. This lack of a significant association proved to be robust on sensitivity analyses for BCG but not for pertussis vaccine.

CONCLUSIONS. Currently available data, based on observational studies, do not support an association, provocative or protective, between receipt of the BCG or whole-cell pertussis vaccine and risk of asthma in childhood and adolescence.

Key Words: vaccination • asthma • meta-analysis

Abbreviations: DTP—diphtheria-tetanus-pertussis • BCG—bacille Calmette-Guérin • OR—odds ratio • CI—confidence interval • Th—T helper

Accepted Apr 26, 2007.