Background and Objective: Tuberculosis remains a global leading cause of death. Tuberculous meningitis (TBM), a severe extrapulmonary manifestation caused by Mycobacterium tuberculosis infection, represents 1–2% of pediatric TB cases. Despite widespread Bacillus-Calmette Guerin (BCG) vaccination, its protective efficacy against TBM remains controversial. This meta-analysis evaluates the association between BCG vaccination and TBM incidence in pediatric populations.
Methods: A systematic review and meta-analysis was conducted across PubMed Central, ScienceDirect, and Google Scholar for the studies published during January 2014–June 2024. Inclusion criteria followed a predefined PICO framework. A fixed-effect model was employed due to minimal heterogeneity (I² = 0.00%).
Results: In total of 7 studies, 344 children with BCG vaccination history (20.28%) developed TBM, while 1352 (79.72%) did not. In the control group, 281 children (32.01%) developed TBM, and 597 (67.99%) did not. The overall incidence of TBM in the studied population was 24.28%. The pooled odds ratio (OR) for BCG vaccination and TBM incidence was 0.47 (95% CI: 0.38–0.57), suggesting a statistically significant inverse association. Cochran's Q test (Q=3.37, df=6, P=0.76) indicated no significant heterogeneity across studies.
Conclusion: This meta-analysis found a significant inverse association between BCG vaccination and the incidence of TBM in children. These findings support the continued execution of BCG vaccination programs as a potential public health strategy for reducing severe forms of TB.