Editorials

Designing a vaccine for tuberculosis

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7045.1495 (Published 15 June 1996) Cite this as: BMJ 1996;312:1495
  1. Adam S Malin,
  2. Douglas B Young
  1. Clinical lecturer Department of Clinical Sciences, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  2. Professor of medical microbiology Department of Medical Microbiology, Imperial College School of Medicine at St Mary's Hospital, London W2 1PG

    Unravelling the tuberculosis genome—can we build a better BCG?

    Tuberculosis is a disease of superlatives. Mycobacterium tuberculosis causes more deaths annually than any other infectious agent.1 Globally, it is one of the major pathogens associated with HIV disease.1 The tuberculosis vaccine, BCG, has been given to more people than any other vaccine.2 3 However, although this vaccine confers clear benefit against disseminated childhood tuberculosis, its efficacy against adult pulmonary disease has varied widely in different clinical trials.2 4 Curiously, protection induced by BCG seems to improve with increasing distance from the equator.2 In a large randomised controlled trial in Madras, southern India, and a large observational study in Malawi, BCG was no better than saline.3 5 It would be good to do better.

    The reasons for the failure of BCG in adults remain unclear. Indeed, immunity to tuberculosis is poorly understood both at a cellular and molecular level.1 6 It is possible that the ability of BCG to protect against initial infection may wane with time. Alternatively, BCG may …

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