Chapter 10 : BCG and New Vaccines against Tuberculosis

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Several tuberculosis vaccines have been shown to reduce the risk of disease and death due to tuberculosis in humans, but only one is used in global immunization programs: bacillus Calmette-Guerin (BCG). The development of new tuberculosis vaccines has been informed by evolving data on the natural history of tuberculosis, by new data on the immunology of infection with and immunization against , by reanalysis of the role of nontuberculous mycobacteria (NTM) in protection against tuberculosis, by a clearer understanding of the benefits and risks of BCG, and by molecular techniques that have permitted identification of immunodominant antigens of and new methods of antigen delivery. This chapter talks about tuberculosis in children, older children, adults, elderly, and immunocompromised hosts, health care providers and other International travelers. At least partial immune protection from tuberculosis disease results from prior mycobacterial infection, whether naturally acquired or vaccine induced. The chapter discusses mechanisms of immune control of tuberculosis, and talks about BCG vaccine. Immunization with BCG induces a mild systemic infection in healthy hosts. It has been shown that immune responses to BCG are impaired in infants with human immunodeficiency virus (HIV) infection. The efficacy of BCG against tuberculosis is described. The favorable and unfavorable characteristics of BCG are summarized. There is wide consensus that additional tuberculosis vaccine development should focus on identifying a booster vaccine to follow BCG immunization, or on developing a completely novel two-vaccine booster regimen.

Citation: Lahey T, Reyn C. 2011. BCG and New Vaccines against Tuberculosis, p 162-181. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch10

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Generic image for table
Table 1.

Known sources of protection against tuberculosis in humans

Citation: Lahey T, Reyn C. 2011. BCG and New Vaccines against Tuberculosis, p 162-181. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch10
Generic image for table
Table 2.

Efficacy of BCG against tuberculosis: trials in newborns

Citation: Lahey T, Reyn C. 2011. BCG and New Vaccines against Tuberculosis, p 162-181. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch10
Generic image for table
Table 3.

Efficacy of BCG against tuberculosis: trials meeting strict methodologic criteria

Citation: Lahey T, Reyn C. 2011. BCG and New Vaccines against Tuberculosis, p 162-181. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch10
Generic image for table
Table 4.

Adverse effects of parenteral BCG immunization

Citation: Lahey T, Reyn C. 2011. BCG and New Vaccines against Tuberculosis, p 162-181. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch10
Generic image for table
Table 5.

Recommendations for BCG use in the United States

Citation: Lahey T, Reyn C. 2011. BCG and New Vaccines against Tuberculosis, p 162-181. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch10
Generic image for table
Table 6.

Characteristics of BCG

Citation: Lahey T, Reyn C. 2011. BCG and New Vaccines against Tuberculosis, p 162-181. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch10
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Table 7.

Selected promising tuberculosis candidate vaccines

Citation: Lahey T, Reyn C. 2011. BCG and New Vaccines against Tuberculosis, p 162-181. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch10

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