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Breaking Transmission with Vaccines: The Case of Tuberculosis

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  • Authors: Jesus Gonzalo-Asensio1, Nacho Aguilo3, Dessislava Marinova5, Carlos Martin7
  • Editors: Fernando Baquero10, Emilio Bouza11, J.A. Gutiérrez-Fuentes12, Teresa M. Coque13
  • VIEW AFFILIATIONS HIDE AFFILIATIONS
    Affiliations: 1: Department of Microbiology, Preventive Medicine, and Public Health, University of Zaragoza, Zaragoza, Spain; 2: CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; 3: Department of Microbiology, Preventive Medicine, and Public Health, University of Zaragoza, Zaragoza, Spain; 4: CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; 5: Department of Microbiology, Preventive Medicine, and Public Health, University of Zaragoza, Zaragoza, Spain; 6: CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; 7: Department of Microbiology, Preventive Medicine, and Public Health, University of Zaragoza, Zaragoza, Spain; 8: CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; 9: Servicio de Microbiología, Hospital Miguel Servet, ISS Aragón, Zaragoza, Spain; 10: Hospital Ramón y Cajal (IRYCIS), Madrid, Spain; 11: Hospital Ramón y Cajal (IRYCIS), Madrid, Spain; 12: Complutensis University, Madrid, Spain; 13: Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
  • Source: microbiolspec July 2017 vol. 5 no. 4 doi:10.1128/microbiolspec.MTBP-0001-2016
  • Received 27 June 2016 Accepted 24 January 2017 Published 14 July 2017
  • Carlos Martin, carlos@unizar.es
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  • Abstract:

    Members of the complex (MTBC) have evolved causing tuberculosis (TB) in different mammalian hosts. MTBC ecotypes have adapted to diverse animal species, with being the most common cause of TB in livestock. Cattle-to-human transmission of through ingestion of raw milk was common before introduction of the pasteurization process. TB in humans is mainly caused by . This bacterium is considered a genetically clonal pathogen that has coevolved with humans due to its ability to manipulate and subvert the immune response. TB is a major public health problem due to airborne person-to-person transmission of . The essential yet unanswered question on the natural history of TB is when decides to establish latent infection in the host (resambling the lysogenic cycle of lambda phage) or to cause pulmonary disease (comparable to the lytic cycle of lambda phage). In this latter case, kills the host with the aim of achieving transmission to new hosts. Combating the TB epidemic requires stopping transmission. BCG, the present vaccine against TB, is derived from and only protects against disseminated forms of TB. Thus, a priority in TB research is development of new effective vaccines to prevent pulmonary disease. Attenuated vaccines based on as MTBVAC are potential candidates that could contribute to break the TB transmission cycle.

  • Keywords: Pulmonary tuberculosis; airborne transmission; infectiousness; MTBVAC; live attenuated M. tuberculosis vaccines

  • Citation: Gonzalo-Asensio J, Aguilo N, Marinova D, Martin C. 2017. Breaking Transmission with Vaccines: The Case of Tuberculosis. Microbiol Spectrum 5(4):MTBP-0001-2016. doi:10.1128/microbiolspec.MTBP-0001-2016.

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2017-07-14
2017-12-17

Abstract:

Members of the complex (MTBC) have evolved causing tuberculosis (TB) in different mammalian hosts. MTBC ecotypes have adapted to diverse animal species, with being the most common cause of TB in livestock. Cattle-to-human transmission of through ingestion of raw milk was common before introduction of the pasteurization process. TB in humans is mainly caused by . This bacterium is considered a genetically clonal pathogen that has coevolved with humans due to its ability to manipulate and subvert the immune response. TB is a major public health problem due to airborne person-to-person transmission of . The essential yet unanswered question on the natural history of TB is when decides to establish latent infection in the host (resambling the lysogenic cycle of lambda phage) or to cause pulmonary disease (comparable to the lytic cycle of lambda phage). In this latter case, kills the host with the aim of achieving transmission to new hosts. Combating the TB epidemic requires stopping transmission. BCG, the present vaccine against TB, is derived from and only protects against disseminated forms of TB. Thus, a priority in TB research is development of new effective vaccines to prevent pulmonary disease. Attenuated vaccines based on as MTBVAC are potential candidates that could contribute to break the TB transmission cycle.

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FIGURE 1

Infected cattle transmit bacteria (orange bacilli) to the neighboring herd members and also during milking. Before milk pasteurization was introduced, was an important cause of cattle-to-human transmission of TB. Now rarely causes TB outbreaks in humans, and transmission of strains between humans is infrequent. Vaccination with BCG (schematized as blue bacilli), starting in the 1920s, was efficient to prevent disseminated forms of TB caused by .

Source: microbiolspec July 2017 vol. 5 no. 4 doi:10.1128/microbiolspec.MTBP-0001-2016
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Image of FIGURE 2

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FIGURE 2

Humans are the only known reservoir of (red bacilli). The infectious cycle starts with the transmission of bacilli by the respiratory route from a patient with active pulmonary disease, who aerosolizes , placing contacts at risk of infection. Epidemiological data indicate that 9 of every 10 infected individuals are chronically infected in the form of LTBI (gray human shapes); therefore, LTBI constitutes a potential reservoir for transmission. People with LTBI are at risk for TB reactivation at some later time, and 1 of every 10 infected persons will develop clinical disease (black human shapes). The essential question on the natural history of TB is when decides to either infect and live with its host in the form of LTBI or to cause active pulmonary disease, which without treatment kills the host, searching the transmission to new hosts. The inner circle shows the lambda phage infectious cycles and their similarities to infection and disease. The lysogenic cycle of lambda phage resembles to LTBI, and the lytic cycle of lambda phage is similar to active TB disease caused by .

Source: microbiolspec July 2017 vol. 5 no. 4 doi:10.1128/microbiolspec.MTBP-0001-2016
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Image of FIGURE 3

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FIGURE 3

A patient with active TB disseminates (red bacilli) to neighboring individuals. One of every 10 persons is susceptible to TB (black human shapes) and therefore will develop clinical disease in the absence of vaccination. A vaccine able to protect against respiratory forms of TB (blue bacilli) will interrupt the TB transmission cycle, contributing enormously to TB control.

Source: microbiolspec July 2017 vol. 5 no. 4 doi:10.1128/microbiolspec.MTBP-0001-2016
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