INTRODUCTION:

A group of cases subjecting to pneumonia caused due to a β-coronavirus, occurred in Wuhan, China. Later it was named as the 2019- novel coronavirus (2019-nCoV) on 12 January 2020 by World Health Organization (WHO). The Chinese scientists rapidly isolated a SARS-CoV-2 from a patient within a short time on 7 January 2020 and came out to genome sequencing of the SARS-CoV-2 [1]. As of 29 March 2020, a total of 81,439 cases of COVID-19 have been confirmed in mainland China including 3,300 deaths [2]. Studies estimated the basic reproduction number (R0) of SARS-CoV-2 to be around 2.2 [3], or even more (range from 1.4 to 6.5) [4], and familial clusters of pneumonia [5] outbreaks add to evidence of the epidemic COVID-19 steadily growing by human-to-human transmission. Coronavirus disease 2019 (COVID-19) is a respiratory illness that can spread from person to person. The virus that causes COVID-19 is a novel coronavirus that was first identified during an investigation into an outbreak in Wuhan, China. [6] However, if we compare the case ratio and the death ratio there is a difference when compared India with other. For example Italy has more social interactions and COVID-19 mortality is still high. In contrast, Japan had some of the earlier cases, but the mortality is low despite not having adopted some the more restrictive social isolation measurements. These differences are due to the medicinal standards implemented by the countries world wide. Moving further, if we look at the use of the vaccines by the countries it can be straight forward understood that the very few countries have used the vaccine. Developed countries could including Spain, France, and Switzerland, have discontinued their universal vaccine policies due to comparatively low risk for developing infections as well as the proven variable effectiveness in preventing it. Also countries such as the United States, Italy, and the Netherlands, have yet to adopt universal vaccine policies for similar reasons. Several vaccines including the BCG vaccination have been shown to produce positive “heterologous” or non-specific immune effects leading to improved response against other non-mycobacterial pathogens. By the given our current analysing current epidemiological data, this investigation aims to identify a possible correlation between the existence of universal vaccines policies and the morbidity and mortality associated to COVID-19 infections all over the world. [7]

Method:

Data collection and it’s study with reference to the the different vaccines given to the Infants, Children and Pregnant Women according to the age and by observing the particular conditions of the patient’s in India was done from the National Immunization Schedule (NIS). Later the additional data of COVID-19 cases and death per country was also obtained from https://google.org/crisisresponse/covid19.

In an account we classified countries according to their GNI per capita in 2018 using the (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups). Countries were divided in three categories: low income (L) with an annual income of 1,025 dollars or less, lower middle income with an income between 1,026 and 3,995 dollars, and middle high and high income countries, which included countries with annual incomes over 3,996 dollars.[7]

Table 1: Different vaccines given under the Particular age limit.

Age	Vaccines given
Birth	Bacillus Calmette Guerin (BCG), Oral Polio Vaccine (OPV)-0 dose, Hepatitis B birth dose
6 Weeks	OPV-1, Pentavalent-1, Rotavirus Vaccine (RVV)-1*, Fractional dose of Inactivated Polio Vaccine (fIPV)-1, Pneumococcal Conjugate Vaccine (PCV) - 1*
10 weeks	OPV-2, Pentavalent-2, RVV-2***
14 weeks	OPV-3, Pentavalent-3, fIPV-2, RVV-3*, PCV-2*
9-12 months	Measles and Rubella (MR)-1, JE-1, PCV-Booster**
16-24 months	MR-2, JE-2*, Diphtheria, Pertussis and Tetanus (DPT)-Booster-1, OPV –Booster
5-6 years	DPT-Booster-2
10 years	Tetanus Toxoid (TT)/Tetanus and adult Diphtheria (Td)
16 years	TT/Td
Pregnant Mother	TT/Td1, 2 or TT/Td Booster**

1. * JE in 231 endemic districts

2. ** One dose if previously vaccinated within 3 years

3. ***Rotavirus vaccine and PCV in selected states/districts as per details below:

Rotavirus: Andhra Pradesh, Assam, Haryana, Himachal Pradesh, Jharkhand, Madhya

Pradesh, Odisha, Rajasthan, Tamil Nadu, Tripura and Uttar Pradesh.

PCV: Bihar, Himachal Pradesh, Madhya Pradesh, Uttar Pradesh (12 districts) and Rajasthan (9 districts).

Table 2: National Immunization Schedule (NIS) for Infants, Children and Pregnant Women (Vaccine-wise)

Vaccine	To to give	Dose	Route	Site
For Women
Tetanus Toxoid (TT)/Tetanus and adult Diphtheria (Td)-1	Early in pregnancy	0.5 ml	Intra-muscular	Upper Arm
TT/Td-2	4 weeks after TT-1	0.5 ml	Intra-muscular	Upper Arm
TT/Td- Booster	If received 2 TT doses in a pregnancy within the last 3 years*	0.5 ml	Intra-muscular	Upper Arm
For Infants
Bacillus Calmette Guerin (BCG)	At birth or as early as possible till one year of age	0.1ml (0.05ml until 1 month)	Intra-dermal	Left Upper Arm
Hepatitis B - Birth dose	At birth or as early as possible within 24 hours	0.5 ml	Intra-muscular	Antero-lateral side of mid- thigh
Oral Polio Vaccine (OPV)- 0	At birth or as early as possible within the first 15 days	2 drops	Oral	Oral
OPV 1, 2 and 3	At 6 weeks, 10 weeks and 14 weeks (OPV can be given till 5 years of age)	2 drops	Oral	Oral
Pentavalent 1, 2 and 3	At 6 weeks, 10 weeks and 14 weeks (can be given till one year of age)	0.5 ml	Intra-muscular	Antero-lateral side of mid- thigh
Pneumococcal Conjugate Vaccine (PCV)^{^}	Two primary doses at 6 and 14 weeks followed by Booster dose at 9-12 months.	0.5 ml	Intra-muscular	Antero-lateral side of mid- thigh
Rotavirus (RVV)^	At 6 weeks, 10 weeks and 14 weeks (can be given till one year of age)	3	Oral	Oral
Inactivated Polio Vaccine (IPV)	Two fractional dose at 6 and 14 weeks of age	0.1 ml ID	Intra dermal two fractional dose	Intra-dermal: Right upper arm
Measles Rubella ^(MR) 1^st dose	9 completed months-12 months. (Measles can be given till 5 years of age)	0.5 ml	Sub-cutaneous	Right upper Arm
Japanese Encephalitis (JE) - 1**	9 completed months-12 months.	0.5 ml	Sub-cutaneous	Left upper Arm
Vitamin A (1^st dose)	At 9 completed months with measles-Rubella	1 ml (1 lakh IU)	Oral	Oral
For Children
Diphtheria, Pertussis and	16-24 months	0.5 ml	Intra-muscular	Antero-lateral side of mid-
Vaccine	When to give	Dose	Route	Site
Tetanus (DPT) booster-1				thigh
MR 2^nd dose	16-24 months	0.5 ml	Sub-cutaneous	Right upper Arm
OPV Booster	16-24 months	2 drops	Oral	Oral
JE-2	16-24 months	0.5 ml	Sub-cutaneous	Left Upper Arm
Vitamin A* (2nd to 9th dose)**	16-18 months. Then one dose every 6 months up to the age of 5 years.	2 ml (2 lakhIU)	Oral	Oral
DPT Booster-2	5-6 years	0.5 ml.	Intra-muscular	Upper Arm
TT/Td	10 years and 16 years	0.5 ml	Intra-muscular	Upper Arm

1. *One dose if previously vaccinated within 3 years

2. **JE Vaccine is introduced in select endemic districts after the campaign.

3. *** The 2nd to 9th doses of Vitamin A can be administered to children 1-5 years old during biannual rounds, in collaboration with ICDS.

^Rotavirus vaccine and PCV in selected states/districts as per details below:

Rotavirus: Andhra Pradesh, Assam, Haryana, Himachal Pradesh, Jharkhand, Madhya Pradesh, Odisha,

Rajasthan, Tamil Nadu, Tripura and Uttar Pradesh.

PCV: Bihar, Himachal Pradesh, Madhya Pradesh, Uttar Pradesh (12 districts) and Rajasthan (9 districts).

RESULT AND DISCUSSION:

When we look at the above chart it is clear that different vaccines are used in India as per the recommendation. We have shown the graph in fig 1 indicating the differences in morbidity and mortality produced by COVID-19 across countries who never used the BCG vaccine. Our data suggests that BCG vaccination seem to significantly reduce mortality associated with COVID-19. We also found that the earlier that a country established a BCG vaccination policy, the stronger the reduction in their number of deaths per million inhabitants, consistent with the idea that protecting the elderly population might be crucial in reducing mortality. However, there is still not proof that BCG inoculation at old age would boost defences in elderly humans, but it seems to do so in Guinea pigs against M. tuberculosis .BCG vaccination has been shown to produce broad protection against viral infections and sepsis raising the possibility that the protective effect of BCG might be not directly related to actions on COVID-19 but on associated co-occurring infections or sepsis. However, we also found that BCG vaccination was correlated with a reduction in the number of COVID-19 reported infections in a country suggesting that BCG might confer some protection specifically against COVID-19. The broad use of the BCG vaccine across a population could reduce the number of carriers, and combined with other measures could act to slow down or stop the spread of COVID-19. [7]

CONCLUSION:

The correlation between the beginning of universal BCG vaccination and the protection against COVID-19 suggests not only vaccine but also other vaccines might confer long-lasting protection against the current strain of coronavirus. However, randomized controlled trials using BCG are required to determine how fast an immune response develops that protects against COVID-19.

Fig 1: Higher death rates were presented in countries that never implemented a universal BCG vaccination policy.

REFERENCES:

1. WHO. Coronavirus disease (COVID-2019) situation reports. 2020. https://www.who.int/emergencies/diseases/novel-coronavirus, 2019/situation reports. Accessed 5 Mar 2020.

2. Yin Y, Wunderink RG. MERS, SARS and other coronaviruses as causes of pneumonia. Respirology. 2018;23(2):130–7.

3. Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020. https://doi.org/10.1038/s41586-020-2012-7.

4. Hampton T. Bats may be SARS reservoir. JAMA. 2005;294(18):2291.

5. Banerjee A, Kulcsar K, Misra V, Frieman M, Mossman K. Bats and coronaviruses. Viruses. 2019;11(1): E41. https://doi.org/ 10.3390/v11010041.

6. Stohlman, S.A. and Hinton, D.R. Viral induced demyelination. Brain Pathol. 11, 92–106 (2001).

7. Aaron Miller, Mac Josh Reandelar, Kimberly Fasciglione, et.al, Violeta, Correlation between universal BCG vaccination policy and reduced morbidity and mortality for COVID-19: an epidemiological study. https://doi.org/10.1101/2020.03.24.20042937.

Received on 20.07.2020 Modified on 14.08.2020

Research J. Science and Tech. 2020; 12(4):285-288.

DOI: 10.5958/2349-2988.2020.00038.8