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BCG and New Vaccines for the Prevention of Tuberculosis

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  • Authors: Timothy Lahey1, C. Fordham von Reyn4
  • Editor: David Schlossberg6
  • VIEW AFFILIATIONS HIDE AFFILIATIONS
    Affiliations: 1: Dartmouth’s Geisel School of Medicine; 2: Section of Infectious Diseases and International Health, Dartmouth-Hitchcock Medical Center; 3: The Dartmouth Institute for Clinical Practice & Health Policy, Lebanon, NH 03756; 4: Dartmouth’s Geisel School of Medicine; 5: Section of Infectious Diseases and International Health, Dartmouth-Hitchcock Medical Center; 6: Philadelphia Health Department, Philadelphia, PA
  • Source: microbiolspec October 2016 vol. 4 no. 5 doi:10.1128/microbiolspec.TNMI7-0003-2016
  • Received 08 September 2016 Accepted 09 September 2016 Published 21 October 2016
  • Timothy Lahey, Timothy.Lahey@Dartmouth.edu
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  • Abstract:

    Tuberculosis infects millions of people worldwide and remains a leading global killer despite widespread neonatal administration of the tuberculosis vaccine, bacillus Calmette-Guérin (BCG). BCG has clear and sustained efficacy, but after 10 years, its efficacy appears to wane, at least in some populations. Fortunately, there are many new tuberculosis vaccines in development today, some in advanced stages of clinical trial testing. Here we review the epidemiological need for tuberculosis vaccination, including evolving standards for administration to at risk individuals in developing countries. We also examine proven sources of immune protection from tuberculosis, which to date have exclusively involved natural or vaccine exposure to whole cell mycobacteria. After summarizing evidence for the use and efficacy of BCG, we detail the most promising new candidate vaccines against tuberculosis. The global need for a new tuberculosis vaccine is acute and huge, but clinical trials to be completed in the coming few years are likely either to identify a new tuberculosis vaccine or to substantially reframe how we understand immune protection from this historical scourge.

  • Citation: Lahey T, von Reyn C. 2016. BCG and New Vaccines for the Prevention of Tuberculosis. Microbiol Spectrum 4(5):TNMI7-0003-2016. doi:10.1128/microbiolspec.TNMI7-0003-2016.

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/content/journal/microbiolspec/10.1128/microbiolspec.TNMI7-0003-2016
2016-10-21
2017-07-24

Abstract:

Tuberculosis infects millions of people worldwide and remains a leading global killer despite widespread neonatal administration of the tuberculosis vaccine, bacillus Calmette-Guérin (BCG). BCG has clear and sustained efficacy, but after 10 years, its efficacy appears to wane, at least in some populations. Fortunately, there are many new tuberculosis vaccines in development today, some in advanced stages of clinical trial testing. Here we review the epidemiological need for tuberculosis vaccination, including evolving standards for administration to at risk individuals in developing countries. We also examine proven sources of immune protection from tuberculosis, which to date have exclusively involved natural or vaccine exposure to whole cell mycobacteria. After summarizing evidence for the use and efficacy of BCG, we detail the most promising new candidate vaccines against tuberculosis. The global need for a new tuberculosis vaccine is acute and huge, but clinical trials to be completed in the coming few years are likely either to identify a new tuberculosis vaccine or to substantially reframe how we understand immune protection from this historical scourge.

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Figures

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FIGURE 1

Selected vaccines in advanced human clinical trials. P, clinical trial demonstrated protection from tuberculosis; F, clinical trial failed to show protection from tuberculosis. Based on references 127 , 135 to 138 , 191 , 202 , and 203 .

Source: microbiolspec October 2016 vol. 4 no. 5 doi:10.1128/microbiolspec.TNMI7-0003-2016
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Tables

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TABLE 1

Known sources of protection against tuberculosis in humans

Source: microbiolspec October 2016 vol. 4 no. 5 doi:10.1128/microbiolspec.TNMI7-0003-2016
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TABLE 2

Efficacy of BCG against tuberculosis: trials in newborns

Source: microbiolspec October 2016 vol. 4 no. 5 doi:10.1128/microbiolspec.TNMI7-0003-2016
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TABLE 3

Efficacy of BCG against tuberculosis: trials meeting strict methodologic criteria

Source: microbiolspec October 2016 vol. 4 no. 5 doi:10.1128/microbiolspec.TNMI7-0003-2016
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TABLE 4

Adverse effects of parenteral BCG immunization

Source: microbiolspec October 2016 vol. 4 no. 5 doi:10.1128/microbiolspec.TNMI7-0003-2016
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TABLE 5

Recommendations for BCG use in the United States

Source: microbiolspec October 2016 vol. 4 no. 5 doi:10.1128/microbiolspec.TNMI7-0003-2016
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TABLE 6

Characteristics of BCG

Source: microbiolspec October 2016 vol. 4 no. 5 doi:10.1128/microbiolspec.TNMI7-0003-2016

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