Tuberculosis (TB)vaccines arevaccinations intended for the prevention oftuberculosis. Immunotherapy as a defence against TB was first proposed in 1890 byRobert Koch.[1] As of 2021, the only effective tuberculosis vaccine in common use is theBacillus Calmette-Guérin (BCG) vaccine, first used on humans in 1921.[2][3][4] It consists ofattenuated (weakened) strains of thecattle tuberculosis bacillus. It is recommended for babies in countries where tuberculosis is common.
About three out of every 10,000 people who get the vaccine experience side effects, which are usually minor except in severely immuno-depressed individuals. While BCG immunization provides fairly effective protection for infants and young children[5] (including defence against TB meningitis and miliary TB),[6][7] its efficacy in adults is variable,[8] ranging from 0% to 80%.[6][9] Several variables have been considered as responsible for the varying outcomes.[6] Demand for TB immunotherapy advancement exists because the disease has become increasingly drug-resistant.[1]
Other tuberculosis vaccines are at various stages of development, including:
MVA85A, aviral vector vaccine that uses an MVA virus engineered to express a tuberculosis bacillus antigen in host cells. Human and animal trials were disappointing and development ceased.[10]
rBCG30 is a version of the BCG vaccine engineered to express a higher amount of a certain antigen. It showed promise in animal tests in 2003[11] and phase I human trials in 2008.[12] However development was discontinued because of safety issues.[13]
MTBVAC,[14] an attenuated form ofMyobacterium tuberculosis. Phase II trials were completed in 2021 and 2022; phase III trials began in 2022 and will run until 2029.[15][16]
M72/AS01E, consisting of two fused tuberculosis bacillus protein antigens together with theadjuvant AS01. Promising phase II trials were completed in 2018 and phase III trials are planned (2023).[17]
GamTBVak, A subunit recombinant anti-tuberculosis vaccine for the prevention of pulmonary tuberculosis in adults, which is at the stage of clinical research. It contains Ag85A and ESAT-6-CFP-10 antigens in combination with an adjuvant. Developed by the N. F. Gamalei National Research Center for Epidemiology and Microbiology. As of May 2022, phase III clinical trials are underway, data on phase I/II studies are also published in the ClinicalTrials database. A phase I clinical trial on 12 volunteers confirmed the safety and immunological efficacy of the vaccine.
To promote successful and lasting management of the TB epidemic, effective vaccination is required.[19] Although the World Health Organization (WHO) endorses a single dose ofBCG, revaccination with BCG has been standardized in most, but not all countries.[1][8] However, improved efficacy of multiple dosages has yet to be demonstrated.[8]
Vaccine development is proceeding along several paths:[citation needed]
Development of sub-unit or booster vaccines to supplement BCG
Pre-infection
Booster to BCG
Post-infection
Therapeutic vaccine
Development of more effective routes of administration for BCG[20][21]
Since the BCG vaccine does not offer complete protection against TB, vaccines have been designed to bolster BCG's effectiveness. The industry has now transitioned from developing new alternatives, to selecting the best options currently available to advance into clinical testing.[7] MVA85A was characterized as the "most advanced 'boost' candidate" in 2007.[2] It has since fallen short of its goals.[22][23]
BCG is currentlyadministered intradermally.[2] To improve efficacy, research approaches have been directed at modifying the delivery method of vaccinations.[citation needed] For example, BCG has much higher protection rates withintravenous injection in monkeys, though some safety questions must be answered before it can be tested on humans.[21]
Patients can receive MVA85A intradermally or as an oral aerosol.[2] This particular combination proved to be protective against mycobacterial invasion in animals, and both modes are well tolerated.[2] The design incentive behind aerosol delivery is to target the lungs rapidly, easily and painlessly[9] in contrast to intradermal immunization. In murine studies, intradermal vaccination caused localized inflammation at the site of injection whereas MVA85A did not cause unfavourable effects.[2] A correlation has been found between the mode of delivery and vaccine protection efficacy.[2] Research data suggests aerosol delivery has not only physiological and economic advantages,[9] but also the potential to supplement systemic vaccination.[2]
Treatment and prevention of TB has been delayed compared to the resources and research efforts put into other diseases. Large pharmaceutical companies do not see profitable investment because of TB's association with the developing world.[6]
Progression of vaccine designs relies heavily on outcomes in animal models. Appropriate animal models are scarce because it is difficult to imitate TB in non-human species.[5][6] It is also challenging finding a species to test on a large scale.[5] Most animal testing for TB vaccines has been conducted on murine, bovine and non-primate species.[5] A 2013 study deemedzebrafish a potentially suitable model organism for preclinical vaccine development.[5]
^abc"Randomised controlled trial of single BCG, repeated BCG, or combined BCG and killed Mycobacterium leprae vaccine for prevention of leprosy and tuberculosis in Malawi. Karonga Prevention Trial Group".Lancet.348 (9019):17–24. 1996-07-06.doi:10.1016/S0140-6736(96)02166-6.ISSN0140-6736.PMID8691924.
