Chapter 14 : Breaking Transmission with Vaccines: The Case of Tuberculosis

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Tuberculosis (TB) is the biggest killer of humanity. TB has killed more human beings than any other infectious disease in history, with an estimated loss of over a billion lives in the past 200 years ( ). Despite effective treatment, in the WHO 2016 there were an estimated 10.4 million new TB cases and 1.8 million deaths attributed to the disease worldwide, surpassing those caused by AIDS ( ). Still more worrying is the rising transmission of multidrug-resistant TB (MDR-TB), caused by mycobacteria that are resistant to treatment with at least two of the most powerful first-line anti-TB drugs, isoniazid and rifampin ( ). Nearly half a million new MDR-TB cases are estimated every year, which together with increasing globalization makes TB an alarming global health problem ( ). Loss of compliance with the current treatments for TB raises the frightening idea of a return to the pre-antibiotic era, when 50% of TB patients died in the absence of an effective treatment. Dissemination of multi- and extremely drug-resistant strains has adverse implications for TB control in the 21st century.

Citation: Gonzalo-Asensio J, Aguilo N, Marinova D, Martin C. 2019. Breaking Transmission with Vaccines: The Case of Tuberculosis, p 249-261. In Baquero F, Bouza E, Gutiérrez-Fuentes J, Coque T (ed), Microbial Transmission. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.MTBP-0001-2016
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transmission. 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 .

Citation: Gonzalo-Asensio J, Aguilo N, Marinova D, Martin C. 2019. Breaking Transmission with Vaccines: The Case of Tuberculosis, p 249-261. In Baquero F, Bouza E, Gutiérrez-Fuentes J, Coque T (ed), Microbial Transmission. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.MTBP-0001-2016
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Figure 2

transmission. 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 .

Citation: Gonzalo-Asensio J, Aguilo N, Marinova D, Martin C. 2019. Breaking Transmission with Vaccines: The Case of Tuberculosis, p 249-261. In Baquero F, Bouza E, Gutiérrez-Fuentes J, Coque T (ed), Microbial Transmission. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.MTBP-0001-2016
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Figure 3

Ending TB transmission with vaccines. 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.

Citation: Gonzalo-Asensio J, Aguilo N, Marinova D, Martin C. 2019. Breaking Transmission with Vaccines: The Case of Tuberculosis, p 249-261. In Baquero F, Bouza E, Gutiérrez-Fuentes J, Coque T (ed), Microbial Transmission. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.MTBP-0001-2016
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