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Moore BK, Graham SM, Nandakumar S, Doyle J, Maloney SA. Pediatric Tuberculosis: A Review of Evidence-Based Best Practices for Clinicians and Health Care Providers. Pathogens 2024; 13:467. [PMID: 38921765 PMCID: PMC11206390 DOI: 10.3390/pathogens13060467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024] Open
Abstract
Advances in pediatric TB care are promising, the result of decades of advocacy, operational and clinical trials research, and political will by national and local TB programs in high-burden countries. However, implementation challenges remain in linking policy to practice and scaling up innovations for prevention, diagnosis, and treatment of TB in children, especially in resource-limited settings. There is both need and opportunity to strengthen clinician confidence in making a TB diagnosis and managing the various manifestations of TB in children, which can facilitate the translation of evidence to action and expand access to new tools and strategies to address TB in this population. This review aims to summarize existing guidance and best practices for clinicians and health care providers in low-resource, TB-endemic settings and identify resources with more detailed and actionable information for decision-making along the clinical cascade to prevent, find, and cure TB in children.
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Affiliation(s)
- Brittany K. Moore
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (S.N.); (J.D.); (S.A.M.)
| | - Stephen M. Graham
- Centre for International Child Health, Department of Pediatrics, University of Melbourne, Melbourne 3052, Australia;
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne 3052, Australia
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France
| | - Subhadra Nandakumar
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (S.N.); (J.D.); (S.A.M.)
| | - Joshua Doyle
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (S.N.); (J.D.); (S.A.M.)
| | - Susan A. Maloney
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (S.N.); (J.D.); (S.A.M.)
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2
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Wajja A, Nassanga B, Natukunda A, Serubanja J, Tumusiime J, Akurut H, Oduru G, Nassuuna J, Kabagenyi J, Morrison H, Scott H, Powell Doherty R, Marshall JL, Cabrera Puig I, Cose S, Kaleebu P, Webb EL, Satti I, McShane H, Elliott AM. Optimising the vaccine strategy of BCG, ChAdOx1 85A, and MVA85A for tuberculosis control. THE LANCET. INFECTIOUS DISEASES 2024; 24:e78-e79. [PMID: 38184003 DOI: 10.1016/s1473-3099(23)00758-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 01/08/2024]
Affiliation(s)
- Anne Wajja
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; Department of Global Health and Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centers, Amsterdam, Netherlands; Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Beatrice Nassanga
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; The Jenner Institute, Old Road Campus Research Building, Oxford, UK; Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.
| | | | - Joel Serubanja
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | | | - Helen Akurut
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Gloria Oduru
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | | | | | - Hazel Morrison
- The Jenner Institute, Old Road Campus Research Building, Oxford, UK; Centre for Clinical Vaccinology and Tropical Medicine, The Jenner Institute, University of Oxford, Oxford, UK
| | - Hannah Scott
- The Jenner Institute, Old Road Campus Research Building, Oxford, UK
| | | | - Julia L Marshall
- The Jenner Institute, Old Road Campus Research Building, Oxford, UK
| | | | - Stephen Cose
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Pontiano Kaleebu
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Emily L Webb
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Iman Satti
- The Jenner Institute, Old Road Campus Research Building, Oxford, UK
| | - Helen McShane
- The Jenner Institute, Old Road Campus Research Building, Oxford, UK; Centre for Clinical Vaccinology and Tropical Medicine, The Jenner Institute, University of Oxford, Oxford, UK
| | - Alison M Elliott
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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3
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Suen TK, Moorlag SJCFM, Li W, de Bree LCJ, Koeken VACM, Mourits VP, Dijkstra H, Lemmers H, Bhat J, Xu CJ, Joosten LAB, Schultze JL, Li Y, Placek K, Netea MG. BCG vaccination induces innate immune memory in γδ T cells in humans. J Leukoc Biol 2024; 115:149-163. [PMID: 37672677 DOI: 10.1093/jleuko/qiad103] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023] Open
Abstract
Bacillus Calmette-Guérin vaccine is well known for inducing trained immunity in myeloid and natural killer cells, which can explain its cross-protective effect against heterologous infections. Although displaying functional characteristics of both adaptive and innate immunity, γδ T-cell memory has been only addressed in a pathogen-specific context. In this study, we aimed to determine whether human γδ T cells can mount trained immunity and therefore contribute to the cross-protective effect of the Bacillus Calmette-Guérin vaccine. We investigated in vivo induction of innate memory in γδ T cells by Bacillus Calmette-Guérin vaccination in healthy human volunteers by combining single-cell RNA sequencing technology with immune functional assays. The total number of γδ T cells and membrane markers of activation was not influenced by Bacillus Calmette-Guérin vaccination. In contrast, Bacillus Calmette-Guérin changed γδ T cells' transcriptional programs and increased their responsiveness to heterologous bacterial and fungal stimuli, including lipopolysaccharide and Candida albicans, as simultaneously characterized by higher tumor necrosis factor and interferon γ production, weeks after vaccination. Human γδ T cells in adults display the potential to develop a trained immunity phenotype after Bacillus Calmette-Guérin vaccination.
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Affiliation(s)
- Tsz K Suen
- Department of Molecular Immunology and Cell Biology, Life and Medical Sciences Institute, University of Bonn, Carl-Troll-Straße 31, 53115 Bonn, Germany
| | - Simone J C F M Moorlag
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 8, 6525 GA Nijmegen, Netherlands
| | - Wenchao Li
- Department of Computational Biology of Individualized Medicine, Centre for Individualized Infection Medicine (CiiM), a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, Feodor-Lynen-Straße 7, 30625 Hannover, Germany
- TWINCORE, Centre for Experimental and Clinical Infection Research, a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, Feodor-Lynen-Str. 7, 30625 Hannover, Germany
| | - L Charlotte J de Bree
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 8, 6525 GA Nijmegen, Netherlands
| | - Valerie A C M Koeken
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 8, 6525 GA Nijmegen, Netherlands
- Department of Computational Biology of Individualized Medicine, Centre for Individualized Infection Medicine (CiiM), a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, Feodor-Lynen-Straße 7, 30625 Hannover, Germany
| | - Vera P Mourits
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 8, 6525 GA Nijmegen, Netherlands
| | - Helga Dijkstra
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 8, 6525 GA Nijmegen, Netherlands
| | - Heidi Lemmers
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 8, 6525 GA Nijmegen, Netherlands
| | - Jaydeep Bhat
- Institute of Immunology, Christian-Albrechts-University Kiel & University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Cheng-Jian Xu
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 8, 6525 GA Nijmegen, Netherlands
- Department of Computational Biology of Individualized Medicine, Centre for Individualized Infection Medicine (CiiM), a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, Feodor-Lynen-Straße 7, 30625 Hannover, Germany
- TWINCORE, Centre for Experimental and Clinical Infection Research, a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, Feodor-Lynen-Str. 7, 30625 Hannover, Germany
| | - Leo A B Joosten
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 8, 6525 GA Nijmegen, Netherlands
- Department of Medical Genetics, Iuliu Haţieganu University of Medicine and Pharmacy, Strada Victor Babeș 8, Cluj-Napoca 400347, Romania
| | - Joachim L Schultze
- Department of Genomics and Immunoregulation, Life and Medical Sciences Institute, University of Bonn, Carl-Troll-Straße 31, 53115 Bonn, Germany
- Platform for Single Cell Genomics and Epigenomics at the German Center for Neurodegenerative Diseases, University of Bonn, Venusberg-Campus 1/9953127, Bonn, Germany
| | - Yang Li
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 8, 6525 GA Nijmegen, Netherlands
- Department of Computational Biology of Individualized Medicine, Centre for Individualized Infection Medicine (CiiM), a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, Feodor-Lynen-Straße 7, 30625 Hannover, Germany
- TWINCORE, Centre for Experimental and Clinical Infection Research, a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, Feodor-Lynen-Str. 7, 30625 Hannover, Germany
| | - Katarzyna Placek
- Department of Molecular Immunology and Cell Biology, Life and Medical Sciences Institute, University of Bonn, Carl-Troll-Straße 31, 53115 Bonn, Germany
| | - Mihai G Netea
- Department of Molecular Immunology and Cell Biology, Life and Medical Sciences Institute, University of Bonn, Carl-Troll-Straße 31, 53115 Bonn, Germany
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 8, 6525 GA Nijmegen, Netherlands
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4
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Koleske BN, Jacobs WR, Bishai WR. The Mycobacterium tuberculosis genome at 25 years: lessons and lingering questions. J Clin Invest 2023; 133:e173156. [PMID: 37781921 PMCID: PMC10541200 DOI: 10.1172/jci173156] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
First achieved in 1998 by Cole et al., the complete genome sequence of Mycobacterium tuberculosis continues to provide an invaluable resource to understand tuberculosis (TB), the leading cause of global infectious disease mortality. At the 25-year anniversary of this accomplishment, we describe how insights gleaned from the M. tuberculosis genome have led to vital tools for TB research, epidemiology, and clinical practice. The increasing accessibility of whole-genome sequencing across research and clinical settings has improved our ability to predict antibacterial susceptibility, to track epidemics at the level of individual outbreaks and wider historical trends, to query the efficacy of the bacille Calmette-Guérin (BCG) vaccine, and to uncover targets for novel antitubercular therapeutics. Likewise, we discuss several recent efforts to extract further discoveries from this powerful resource.
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Affiliation(s)
- Benjamin N. Koleske
- Center for Tuberculosis Research, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - William R. Jacobs
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - William R. Bishai
- Center for Tuberculosis Research, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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5
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Andrade de Souza R, Rodrigues Barreto F, Antônio de Souza Teles Santos C, Silva Nery J, Cristina Oliveira de Jesus Lima C, Soares Castelo I, Natividade M, Amaral Freire de Andrade J, Lima Barreto M, Martins Pereira S. Evolution of the Bacillus Calmette-Guérin scar Russia and Moreau strains in newborns: A brazilian cohort. Vaccine X 2023; 14:100323. [PMID: 37333053 PMCID: PMC10276274 DOI: 10.1016/j.jvacx.2023.100323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/20/2023] Open
Abstract
Background In Brazil, in 1925, the Moreau strain was introduced, and since its implementation, it has been the routine vaccine for health services. Since 2013, many countries, including Brazil, have been experiencing problems with the production of vaccines. As of January 2018, the country started to use the BCG vaccine with Russia strain, developed by the Serum Institute India. Objective To describe the evolution of the vaccine scar in neonates vaccinated by BCG-Russia compared to BCG-Moreau. Methods This was a cohort study was conducted in Salvador city, northeast Brazil. The study population consisted of newborns from the reference maternity hospital, who were vaccinated with BCG-ID strains Moreau or Russia, followed up to assess vaccine lesion evolution. Results It was observed that regardless of the vaccine strains, the evolution of the lesion was the same: wheal, reddish macula, induration, pustule, ulcer, and scar. The proportion of vaccine scar in the group vaccinated with BCG Russia was lower than that of BCG Moreau, 62.5 % and 90.9 %, respectively, with a statistically significant difference. Conclusion The evolution of the scar by BCG-Russia was similar to the Moreau scar, however different proportions were observed in different stages of lesion between the groups.
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Affiliation(s)
| | | | - Carlos Antônio de Souza Teles Santos
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Bahia, Brazil
- State University of Feira de Santana, Brazil
| | - Joilda Silva Nery
- Institute of Collective Health, Federal University of Bahia, Bahia, Brazil
| | | | | | - Marcio Natividade
- Institute of Collective Health, Federal University of Bahia, Bahia, Brazil
| | | | - Maurício Lima Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Bahia, Brazil
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6
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Villanueva P, Crawford NW, Croda MG, Collopy S, Jardim BA, de Almeida Pinto Jardim T, Manning L, Lucas M, Marshall H, Prat-Aymerich C, Sawka A, Sharma K, Troeman D, Wadia U, Warris A, Wood N, Messina NL, Curtis N, Pittet LF. Erratum: Factors influencing scar formation following Bacille Calmette-Guérin (BCG) vaccination. Heliyon 2023; 9:e15821. [PMID: 37484338 PMCID: PMC10360588 DOI: 10.1016/j.heliyon.2023.e15821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 07/25/2023] Open
Abstract
[This corrects the article DOI: 10.1016/j.heliyon.2023.e15241.].
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Affiliation(s)
- Paola Villanueva
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Infectious Diseases, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
- Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Nigel W. Crawford
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
- Immunisation Service, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Mariana Garcia Croda
- School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Simone Collopy
- Department of Pediatrics, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bruno Araújo Jardim
- Carlos Borborema Clinical Research Institute, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Tyane de Almeida Pinto Jardim
- Carlos Borborema Clinical Research Institute, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Laurens Manning
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
- School of Medicine, University of Western Australia, Perth, WA, Australia
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, WA, Australia
| | - Michaela Lucas
- School of Medicine, University of Western Australia, Perth, WA, Australia
- Department of Immunology, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Department of Immunology, Perth Children's Hospital, Perth, WA, Australia
- Department of Immunology, Pathwest, QE2 Medical Centre, Perth, WA, Australia
| | - Helen Marshall
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide and Department of Paediatrics, The Women's and Children's Health Network, Australia
| | - Cristina Prat-Aymerich
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Institut d'Investigació Germans Trias i Pujol, Departament de Genètica i Microbiologia, CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Universitat Autònoma de Barcelona, Badalona, Catalunya, Spain
| | - Alice Sawka
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Ketaki Sharma
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
- The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Darren Troeman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Ushma Wadia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
| | - Adilia Warris
- Medical Research Council Centre for Medical Mycology, University of Exeter, UK
- Great Ormond Street Hospital, London, UK
| | - Nicholas Wood
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
- The Children's Hospital at Westmead, Westmead, NSW, Australia
- The Children's Hospital at Westmead Clinical School, University of Sydney, NSW, Australia
| | - Nicole L. Messina
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Infectious Diseases, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Laure F. Pittet
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Infectious Diseases, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
- Infectious Diseases Unit, Department of Paediatrics, Gynaecology and Obstetrics, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland
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7
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Villanueva P, Crawford NW, Croda MG, Collopy S, Jardim BA, de Almeida Pinto Jardim T, Manning L, Lucas M, Marshall H, Prat-Aymerich C, Sawka A, Sharma K, Troeman D, Wadia U, Warris A, Wood N, Messina NL, Curtis N, Pittet LF. Factors influencing scar formation following Bacille Calmette-Guérin (BCG) vaccination. Heliyon 2023; 9:e15241. [PMID: 37113782 PMCID: PMC10126857 DOI: 10.1016/j.heliyon.2023.e15241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/09/2023] Open
Abstract
The prevalence of scar formation following Bacille Calmette-Guérin (BCG) vaccination varies globally. The beneficial off-target effects of BCG are proposed to be stronger amongst children who develop a BCG scar. Within an international randomised trial ('BCG vaccination to reduce the impact of coronavirus disease 2019 (COVID-19) in healthcare workers'; BRACE Trial), this nested prospective cohort study assessed the prevalence of and factors influencing scar formation, as well as participant perception of BCG scarring 12 months following vaccination . Amongst 3071 BCG-recipients, 2341 (76%) developed a BCG scar. Scar prevalence was lowest in Spain and highest in UK. Absence of post-injection wheal (OR 0.4, 95%CI 0.2-0.9), BCG revaccination (OR 1.7, 95%CI 1.3-2.0), female sex (OR 2.0, 95%CI 1.7-2.4), older age (OR 0.4, 95%CI 0.4-0.5) and study country (Brazil OR 1.6, 95%CI 1.3-2.0) influenced BCG scar prevalence. Of the 2341 participants with a BCG scar, 1806 (77%) did not mind having the scar. Participants more likely to not mind were those in Brazil, males and those with a prior BCG vaccination history. The majority (96%) did not regret having the vaccine. Both vaccination-related (amenable to optimisation) and individual-related factors affected BCG scar prevalence 12 months following BCG vaccination of adults, with implications for maximising the effectiveness of BCG vaccination.
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Affiliation(s)
- Paola Villanueva
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Infectious Diseases, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
- Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Nigel W. Crawford
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
- Immunisation Service, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Mariana Garcia Croda
- School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Simone Collopy
- Department of Pediatrics, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bruno Araújo Jardim
- Carlos Borborema Clinical Research Institute, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Tyane de Almeida Pinto Jardim
- Carlos Borborema Clinical Research Institute, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Laurens Manning
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
- School of Medicine, University of Western Australia, Perth, WA, Australia
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, WA, Australia
| | - Michaela Lucas
- School of Medicine, University of Western Australia, Perth, WA, Australia
- Department of Immunology, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Departments of Immunology, Perth Children's Hospital, Perth, WA, Australia
- Department of Immunology, Pathwest, QE2 Medical Centre, Perth, WA, Australia
| | - Helen Marshall
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide and Department of Paediatrics, The Women's and Children's Health Network, Australia
| | - Cristina Prat-Aymerich
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Institut d'Investigació Germans Trias i Pujol, Departament de Genètica i Microbiologia, CIBER de enfermedades respiratorias (CIBERES), Instituto de Salud Carlos III, Universitat Autònoma de Barcelona, Catalunya, Badalona, Spain
| | - Alice Sawka
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Ketaki Sharma
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
- The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Darren Troeman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Ushma Wadia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
| | - Adilia Warris
- Medical Research Council Centre for Medical Mycology, University of Exeter, UK
- Great Ormond Street Hospital, London, UK
| | - Nicholas Wood
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
- The Children's Hospital at Westmead, Westmead, NSW, Australia
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Nicole L. Messina
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Infectious Diseases, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Laure F. Pittet
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Infectious Diseases, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
- Infectious Diseases Unit, Department of Paediatrics, Gynaecology and Obstetrics, Faculty of Medicine, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland
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8
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Singh S, Saavedra-Avila NA, Tiwari S, Porcelli SA. A century of BCG vaccination: Immune mechanisms, animal models, non-traditional routes and implications for COVID-19. Front Immunol 2022; 13:959656. [PMID: 36091032 PMCID: PMC9459386 DOI: 10.3389/fimmu.2022.959656] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/01/2022] [Indexed: 11/21/2022] Open
Abstract
Bacillus Calmette-Guerin (BCG) has been used as a vaccine against tuberculosis since 1921 and remains the only currently approved vaccine for this infection. The recent discovery that BCG protects against initial infection, and not just against progression from latent to active disease, has significant implications for ongoing research into the immune mechanisms that are relevant to generate a solid host defense against Mycobacterium tuberculosis (Mtb). In this review, we first explore the different components of immunity that are augmented after BCG vaccination. Next, we summarize current efforts to improve the efficacy of BCG through the development of recombinant strains, heterologous prime-boost approaches and the deployment of non-traditional routes. These efforts have included the development of new recombinant BCG strains, and various strategies for expression of important antigens such as those deleted during the M. bovis attenuation process or antigens that are present only in Mtb. BCG is typically administered via the intradermal route, raising questions about whether this could account for its apparent failure to generate long-lasting immunological memory in the lungs and the inconsistent level of protection against pulmonary tuberculosis in adults. Recent years have seen a resurgence of interest in the mucosal and intravenous delivery routes as they have been shown to induce a better immune response both in the systemic and mucosal compartments. Finally, we discuss the potential benefits of the ability of BCG to confer trained immunity in a non-specific manner by broadly stimulating a host immunity resulting in a generalized survival benefit in neonates and the elderly, while potentially offering benefits for the control of new and emerging infectious diseases such as COVID-19. Given that BCG will likely continue to be widely used well into the future, it remains of critical importance to better understand the immune responses driven by it and how to leverage these for the design of improved vaccination strategies against tuberculosis.
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Affiliation(s)
- Shivani Singh
- Department of Medicine, New York University School of Medicine, New York, NY, United States
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, New York, NY, United States
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, United States
- *Correspondence: Shivani Singh,
| | | | - Sangeeta Tiwari
- Department of Biological Sciences and Border Biomedical Research Center, University of Texas at El Paso, Texas, United States
| | - Steven A. Porcelli
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, New York, NY, United States
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, United States
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9
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Bannister S, Kim B, Domínguez-Andrés J, Kilic G, Ansell BRE, Neeland MR, Moorlag SJCFM, Matzaraki V, Vlahos A, Shepherd R, Germano S, Bahlo M, Messina NL, Saffery R, Netea MG, Curtis N, Novakovic B. Neonatal BCG vaccination is associated with a long-term DNA methylation signature in circulating monocytes. SCIENCE ADVANCES 2022; 8:eabn4002. [PMID: 35930640 PMCID: PMC9355358 DOI: 10.1126/sciadv.abn4002] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/23/2022] [Indexed: 05/21/2023]
Abstract
Trained immunity describes the capacity of innate immune cells to develop heterologous memory in response to certain exogenous exposures. This phenomenon mediates, at least in part, the beneficial off-target effects of the BCG vaccine. Using an in vitro model of trained immunity, we show that BCG exposure induces a persistent change in active histone modifications, DNA methylation, transcription, and adenosine-to-inosine RNA modification in human monocytes. By profiling DNA methylation of circulating monocytes from infants in the MIS BAIR clinical trial, we identify a BCG-associated DNA methylation signature that persisted more than 12 months after neonatal BCG vaccination. Genes associated with this epigenetic signature are involved in viral response pathways, consistent with the reported off-target protection against viral infections in neonates, adults, and the elderly. Our findings indicate that the off-target effects of BCG in infants are accompanied by epigenetic remodeling of circulating monocytes that lasts more than 1 year.
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Affiliation(s)
- Samantha Bannister
- Infectious Diseases, Infection and Immunity Theme, Murdoch Children’s Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Infectious Diseases Unit, The Royal Children’s Hospital, Parkville, VIC, Australia
| | - Bowon Kim
- Molecular Immunity, Infection and Immunity Theme, Murdoch Children’s Research Institute, Parkville, VIC, Australia
| | - Jorge Domínguez-Andrés
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Nijmegen Medical Center, 6500HB Nijmegen, Netherlands
| | - Gizem Kilic
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Nijmegen Medical Center, 6500HB Nijmegen, Netherlands
| | - Brendan R. E. Ansell
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Melanie R. Neeland
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Molecular Immunity, Infection and Immunity Theme, Murdoch Children’s Research Institute, Parkville, VIC, Australia
| | - Simone J. C. F. M. Moorlag
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Nijmegen Medical Center, 6500HB Nijmegen, Netherlands
| | - Vasiliki Matzaraki
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Nijmegen Medical Center, 6500HB Nijmegen, Netherlands
| | - Amanda Vlahos
- Molecular Immunity, Infection and Immunity Theme, Murdoch Children’s Research Institute, Parkville, VIC, Australia
| | - Rebecca Shepherd
- Molecular Immunity, Infection and Immunity Theme, Murdoch Children’s Research Institute, Parkville, VIC, Australia
| | - Susie Germano
- Infectious Diseases, Infection and Immunity Theme, Murdoch Children’s Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Melanie Bahlo
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Nicole L. Messina
- Infectious Diseases, Infection and Immunity Theme, Murdoch Children’s Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Richard Saffery
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Molecular Immunity, Infection and Immunity Theme, Murdoch Children’s Research Institute, Parkville, VIC, Australia
| | - Mihai G. Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Nijmegen Medical Center, 6500HB Nijmegen, Netherlands
- Department for Immunology and Metabolism, Life and Medical Science Institute (LIMES), University of Bonn, 53115 Bonn, Germany
| | - Nigel Curtis
- Infectious Diseases, Infection and Immunity Theme, Murdoch Children’s Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Infectious Diseases Unit, The Royal Children’s Hospital, Parkville, VIC, Australia
- Corresponding author. (B.N.); (N.C.)
| | - Boris Novakovic
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Molecular Immunity, Infection and Immunity Theme, Murdoch Children’s Research Institute, Parkville, VIC, Australia
- Corresponding author. (B.N.); (N.C.)
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10
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Villanueva P, Pittet LF, Nourse C, Curtis N. What is the significance of an accelerated BCG reaction in children? Arch Dis Child 2022; 107:507-512. [PMID: 35228204 DOI: 10.1136/archdischild-2022-323853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/31/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Paola Villanueva
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Laure F Pittet
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Clare Nourse
- Infection Management and Prevention Service, Queensland Children's Hospital UQ Faculty, South Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia .,Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
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11
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Dos Anjos LRB, da Costa AC, Cardoso ADRO, Guimarães RA, Rodrigues RL, Ribeiro KM, Borges KCM, Carvalho ACDO, Dias CIS, Rezende ADO, Souza CDC, Ferreira RRM, Saraiva G, Barbosa LCDS, Vieira TDS, Conte MB, Rabahi MF, Kipnis A, Junqueira-Kipnis AP. Efficacy and Safety of BCG Revaccination With M. bovis BCG Moscow to Prevent COVID-19 Infection in Health Care Workers: A Randomized Phase II Clinical Trial. Front Immunol 2022; 13:841868. [PMID: 35392074 PMCID: PMC8981724 DOI: 10.3389/fimmu.2022.841868] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
The Bacillus Calmette-Guérin (BCG) vaccine, which is widely used to protect children against tuberculosis, can also improve immune response against viral infections. This unicentric, randomized-controlled clinical trial assessed the efficacy and safety of revaccination with BCG Moscow in reducing the positivity and symptoms of COVID-19 in health care workers (HCWs) during the COVID-19 pandemic. HCWs who had negative COVID-19 IgM and IgG and who dedicated at least eight hours per week in facilities that attended to individuals suspected of having COVID-19 were included in the study and were followed for 7, 15, 30, 60, and 180 days by telemedicine. The HCWs were randomly allocated to a revaccinated with BCG group, which received the BCG vaccine, or an unvaccinated group. Revaccination with BCG Moscow was found to be safe, and its efficacy ranged from 30.0% (95.0%CI -78.0 to 72.0%) to 31.0% (95.0%CI -74.0 to 74.0%). Mycobacterium bovis BCG Moscow did not induce NK cell activation at 15–20 days post-revaccination. As hypothesized, revaccination with BCG Moscow was associated with a lower incidence of COVID-19 positivity, though the results did not reach statistical significance. Further studies should be carried out to assess whether revaccination with BCG is able to protect HCWs against COVID-19. The protocol of this clinical trial was registered on August 5th, 2020, at REBEC (Registro Brasileiro de Ensaios Clínicos, RBR-4kjqtg - ensaiosclinicos.gov.br/rg/RBR-4kjqtg/1) and the WHO (# U1111-1256-3892). The clinical trial protocol was approved by the Comissão Nacional de ética de pesquisa- CONEP (CAAE 31783720.0.0000.5078).
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Affiliation(s)
- Laura Raniere Borges Dos Anjos
- Laboratório de Bacteriologia Molecular, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brazil
| | | | | | - Rafael Alves Guimarães
- Laboratório de Bacteriologia Molecular, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brazil.,Faculdade de Enfermagem, Universidade Federal de Goiás, Goiânia, Brazil
| | | | - Kaio Mota Ribeiro
- Laboratório de Imunopatologia das Doenças Infecciosas, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brazil
| | - Kellen Christina Malheiros Borges
- Laboratório de Imunopatologia das Doenças Infecciosas, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brazil.,Departamento de Áreas Acadêmicas, Instituto Federal de Goiás, Anápolis, Brazil
| | - Ana Carolina de Oliveira Carvalho
- Laboratório de Imunopatologia das Doenças Infecciosas, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brazil
| | | | | | - Carine de Castro Souza
- Laboratório de Imunopatologia das Doenças Infecciosas, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brazil
| | | | - Guylherme Saraiva
- Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, Brazil
| | - Lilia Cristina de Souza Barbosa
- Laboratório de Bacteriologia Molecular, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brazil.,Laboratório de Imunopatologia das Doenças Infecciosas, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brazil
| | | | - Marcus Barreto Conte
- Departamento de Pesquisa Clínica, Faculdade de Medicina de Petrópolis, Petrópolis, Brazil
| | | | - André Kipnis
- Laboratório de Bacteriologia Molecular, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brazil
| | - Ana Paula Junqueira-Kipnis
- Laboratório de Imunopatologia das Doenças Infecciosas, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brazil
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12
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Pittet LF, Fritschi N, Tebruegge M, Dutta B, Donath S, Messina NL, Casalaz D, Hanekom WA, Britton WJ, Robins-Browne R, Curtis N, Ritz N. Bacille Calmette-Guérin Skin Reaction Predicts Enhanced Mycobacteria-Specific T Cell Responses in Infants. Am J Respir Crit Care Med 2022; 205:830-841. [DOI: 10.1164/rccm.202108-1892oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Laure F Pittet
- The Royal Children's Hospital Melbourne, 6453, Parkville, Victoria, Australia
- Murdoch Childrens Research Institute, 34361, Parkville, Victoria, Australia
- The University of Melbourne, 2281, Melbourne, Victoria, Australia
| | | | - Marc Tebruegge
- The University of Melbourne, 2281, Melbourne, Victoria, Australia
- University College London, 4919, London, United Kingdom of Great Britain and Northern Ireland
- Evelina London Children's Hospital, 443490, London, United Kingdom of Great Britain and Northern Ireland
| | - Binita Dutta
- Murdoch Childrens Research Institute, 34361, Parkville, Victoria, Australia
| | - Susan Donath
- Murdoch Childrens Research Institute, 34361, Parkville, Victoria, Australia
- The University of Melbourne, 2281, Melbourne, Victoria, Australia
| | - Nicole L Messina
- Murdoch Childrens Research Institute, 34361, Parkville, Victoria, Australia
- The University of Melbourne, 2281, Melbourne, Victoria, Australia
| | - Dan Casalaz
- Mercy Hospital for Women, 37244, Heidelberg, Victoria, Australia
| | | | - Warwick J. Britton
- Centenary Institute, 6022, TB Researtch Program, Sydney, New South Wales, Australia
| | - Roy Robins-Browne
- Murdoch Childrens Research Institute, 34361, Parkville, Victoria, Australia
- The Peter Doherty Institute for Infection and Immunity, 534133, Melbourne, Victoria, Australia
| | - Nigel Curtis
- The Royal Children's Hospital Melbourne, 6453, Parkville, Victoria, Australia
- Murdoch Childrens Research Institute, 34361, Parkville, Victoria, Australia
- The University of Melbourne, 2281, Melbourne, Victoria, Australia
| | - Nicole Ritz
- The University of Melbourne, 2281, Melbourne, Victoria, Australia
- University of Basel, 27209, Basel, Switzerland
- University Children’s Hospital Basel, 30280, Basel, Switzerland
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13
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da Silva ASM, Albuquerque LHP, de Ponte CGG, de Almeida MR, de Faria SER, Ribeiro MDS, Pereira ENGDS, Antas PRZ. Time to face the proofs: the BCG Moreau vaccine promotes superior inflammatory cytokine profile in vitro when compared with Russia, Pasteur, and Danish strains. Hum Vaccin Immunother 2021; 18:1989913. [PMID: 34766868 PMCID: PMC8942427 DOI: 10.1080/21645515.2021.1989913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Tuberculosis (TB) has been a major public health problem worldwide, and the Bacillus Calmette–Guérin (BCG) vaccine is the only available vaccine against this disease. The BCG vaccine is no longer a single organism; it consists of diverse strains. The early-shared strains of the BCG vaccine are stronger immunostimulators than the late-shared strains. In this study, we have employed a simple in vitro human model to broadly evaluate the differences among four widely used BCG vaccines during the characterization of strain-specific host immune responses. In general, the BCG Moreau vaccine generated a higher inflammatory cytokine profile and lower TGF-β levels compared with the Russia, Pasteur, and Danish strains in the context of early sensitization with TB; however, no changes were observed in the IL-23 levels between infected and noninfected cultures. Unsurprisingly, the BCG vaccines provided different features, and the variances among those strains may influence the activation of infected host cells, which ultimately leads to distinct protective efficacy to tackle TB.
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Affiliation(s)
- Andreon Santos Machado da Silva
- Laboratório de Imunologia Clínica, Instituto Oswaldo Cruz, Rio de Janeiro, andInstituto Nacional de Ciência e Tecnologia em Tuberculose (INCT-TB)
| | - Lawrence Henrique Paz Albuquerque
- Laboratório de Imunologia Clínica, Instituto Oswaldo Cruz, Rio de Janeiro, andInstituto Nacional de Ciência e Tecnologia em Tuberculose (INCT-TB)
| | - Carlos Germano Garrido de Ponte
- Laboratório de Imunologia Clínica, Instituto Oswaldo Cruz, Rio de Janeiro, andInstituto Nacional de Ciência e Tecnologia em Tuberculose (INCT-TB)
| | - Matheus Rogério de Almeida
- Laboratório de Imunologia Clínica, Instituto Oswaldo Cruz, Rio de Janeiro, andInstituto Nacional de Ciência e Tecnologia em Tuberculose (INCT-TB)
| | - Sandra Elizabete Ribeiro de Faria
- Laboratório de Imunologia Clínica, Instituto Oswaldo Cruz, Rio de Janeiro, andInstituto Nacional de Ciência e Tecnologia em Tuberculose (INCT-TB)
| | | | | | - Paulo Renato Zuquim Antas
- Laboratório de Imunologia Clínica, Instituto Oswaldo Cruz, Rio de Janeiro, andInstituto Nacional de Ciência e Tecnologia em Tuberculose (INCT-TB)
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14
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Villanueva P, Pittet LF, Curtis N. Management of Bacille Calmette-Guérin Lymphadenitis and Abscess in Immunocompetent Children: A Systematic Review. Pediatr Infect Dis J 2021; 40:1037-1045. [PMID: 34636800 DOI: 10.1097/inf.0000000000003237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is no consensus on managing common adverse reactions to Bacille Calmette-Guérin (BCG) vaccination. We systematically reviewed the management of BCG-associated regional lymphadenitis and injection site abscess in immunocompetent individuals. METHODS Searches of Medline, Embase and PubMed were done until November 2020. Randomized controlled trials (RCTs) and cohort studies that compared management strategies for complications of intradermal BCG vaccination were included. RESULTS Of 1338 individual articles, 15 met inclusion criteria. Six RCTs, 4 prospective and 4 retrospective cohort studies compared management in 1022 children with BCG-associated lymphadenitis. For nonsuppurative lymphadenitis, no antimicrobial was found to significantly impact on time to resolution or prevention of suppuration. For suppurative lymphadenitis, there was some evidence that needle aspiration shortens time to resolution and prevents sinus tract formation. Surgical excision (mainly offered for persistent suppurative lymphadenitis) generally had favorable outcome. Two cohort studies (including 1 aforementioned) compared management strategies in up to 36 children with BCG injection site abscess; one showed no difference in outcome in children treated with antibiotics and the other reported complete resolution without treatment. CONCLUSIONS Evidence does not support a role for antimicrobial therapy in the management of localized reactions to BCG vaccination in immunocompetent children. Needle aspiration may shorten the recovery period for BCG-associated suppurative lymphadenitis. BCG injection site abscess usually heals without treatment. However, studies are limited and cases are not well defined. Growing research into novel BCG applications provides opportunities to investigate optimal management strategies for adverse reactions in a prospective manner using active safety surveillance.
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Affiliation(s)
- Paola Villanueva
- From the Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Laure F Pittet
- From the Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Infectious Diseases Unit, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Nigel Curtis
- From the Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Infectious Diseases Unit, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
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15
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Shpilsky GF, Takahashi H, Aristarkhova A, Weil M, Ng N, Nelson KJ, Lee A, Zheng H, Kühtreiber WM, Faustman DL. Bacillus Calmette-Guerin 's beneficial impact on glucose metabolism: evidence for broad based applications. iScience 2021; 24:103150. [PMID: 34646988 PMCID: PMC8501688 DOI: 10.1016/j.isci.2021.103150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/03/2021] [Accepted: 09/16/2021] [Indexed: 11/25/2022] Open
Abstract
Bacillus Calmette-Guerin (BCG) vaccinations improve glycemic control in juvenile-onset Type I diabetes (T1D), an effect driven by restored sugar transport through aerobic glycolysis. In a pilot clinical trial, T1D, but not latent autoimmune diabetes of adults (LADA), exhibited lower blood sugars after multidose BCG. Using a glucose transport assay, monocytes from T1D subjects showed a large stimulation index with BCG exposures; LADA subjects showed minimal BCG-induced sugar responsiveness. Monocytes from T1D, type 2 diabetes (T2D), and non-diabetic controls (NDC) were all responsive in vitro to BCG by augmented sugar utilization. Adults with prior neonatal BCG vaccination show accelerated glucose transport decades later. Finally, in vivo experiments with the NOD mouse (a T1D model) and obese db/db mice (a T2D model) confirm BCG's blood-sugar-lowering and accelerated glucose metabolism with sufficient dosing. Our results suggest that BCG's benefits for glucose metabolism may be broadly applicable to T1D and T2D, but less to LADA. A pilot trial of BCG vaccinations to T1D showed reduced blood sugars but not in LADA Monocytes from T1D and to some degree T2D display stimulated glucose transport BCG vaccinations at birth show accelerated glucose transport decades later In vivo mouse models of both T1D and T2D demonstrate BCG-induced blood sugar lowering
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Affiliation(s)
- Gabriella F Shpilsky
- Massachusetts General Hospital, Immunobiology Laboratories, Boston, MA 02129, USA
| | - Hiroyuki Takahashi
- Massachusetts General Hospital, Immunobiology Laboratories, Boston, MA 02129, USA
| | - Anna Aristarkhova
- Massachusetts General Hospital, Immunobiology Laboratories, Boston, MA 02129, USA
| | - Michele Weil
- Massachusetts General Hospital, Diabetes Unit, Boston, MA 02129, USA
| | - Nathan Ng
- Massachusetts General Hospital, Immunobiology Laboratories, Boston, MA 02129, USA
| | - Kacie J Nelson
- Massachusetts General Hospital, Immunobiology Laboratories, Boston, MA 02129, USA
| | - Amanda Lee
- Massachusetts General Hospital, Immunobiology Laboratories, Boston, MA 02129, USA
| | - Hui Zheng
- Massachusetts General Hospital and Harvard Medical School, Statistics Department, Boston, MA 02129, USA
| | - Willem M Kühtreiber
- Massachusetts General Hospital, Immunobiology Laboratories, Boston, MA 02129, USA.,Massachusetts General Hospital and Harvard Medical School, Immunobiology Laboratories, Boston, MA 02129, USA
| | - Denise L Faustman
- Massachusetts General Hospital, Immunobiology Laboratories, Boston, MA 02129, USA.,Massachusetts General Hospital and Harvard Medical School, Immunobiology Laboratories, Boston, MA 02129, USA
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16
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Prentice S, Dockrell HM. BCG Specific and Nonspecific Effects: Different Questions, Similar Challenges. J Infect Dis 2021; 224:1105-1108. [PMID: 34244763 PMCID: PMC8514176 DOI: 10.1093/infdis/jiab307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/10/2021] [Indexed: 12/17/2022] Open
Affiliation(s)
- Sarah Prentice
- Department of Paediatrics and Neonatology, East and North Hertfordshire NHS Trust, Stevenage, United Kingdom
| | - Hazel M Dockrell
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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17
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COVID-19 and Beyond: Exploring Public Health Benefits from Non-Specific Effects of BCG Vaccination. Microorganisms 2021; 9:microorganisms9102120. [PMID: 34683441 PMCID: PMC8539044 DOI: 10.3390/microorganisms9102120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 12/23/2022] Open
Abstract
Bacille Calmette–Guérin (BCG) vaccination, widely used throughout the world to protect against infant tuberculous meningitis and miliary tuberculosis (TB), can provide broad non-specific protection against infectious respiratory diseases in certain groups. Interest in BCG has seen a resurgence within the scientific community as the mechanisms for non-specific protection have begun to be elucidated. The impact of the COVID-19 pandemic on nearly every aspect of society has profoundly illustrated the pressure that respiratory infections can place on a national healthcare system, further renewing interest in BCG vaccination as a public health policy to reduce the burden of those illnesses. However, the United States does not recommend BCG vaccination due to its variable effectiveness against adult TB, the relatively low risk of Mycobacterium tuberculosis infection in most of the United States, and the vaccine’s interference with tuberculin skin test reactivity that complicates TB screening. In this review, we explore the broad immune training effects of BCG vaccination and literature on the effects of BCG vaccination on COVID-19 spread, disease severity, and mortality. We further discuss barriers to scheduled BCG vaccination in the United States and how those barriers could potentially be overcome.
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18
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Lobo N, Brooks NA, Zlotta AR, Cirillo JD, Boorjian S, Black PC, Meeks JJ, Bivalacqua TJ, Gontero P, Steinberg GD, McConkey D, Babjuk M, Alfred Witjes J, Kamat AM. 100 years of Bacillus Calmette-Guérin immunotherapy: from cattle to COVID-19. Nat Rev Urol 2021; 18:611-622. [PMID: 34131332 PMCID: PMC8204595 DOI: 10.1038/s41585-021-00481-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 02/07/2023]
Abstract
Bacillus Calmette-Guérin (BCG) is the most widely used vaccine worldwide and has been used to prevent tuberculosis for a century. BCG also stimulates an anti-tumour immune response, which urologists have harnessed for the treatment of non-muscle-invasive bladder cancer. A growing body of evidence indicates that BCG offers protection against various non-mycobacterial and viral infections. The non-specific effects of BCG occur via the induction of trained immunity and form the basis for the hypothesis that BCG vaccination could be used to protect against the severity of coronavirus disease 2019 (COVID-19). This Perspective article highlights key milestones in the 100-year history of BCG and projects its potential role in the COVID-19 pandemic.
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Affiliation(s)
- Niyati Lobo
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Nathan A Brooks
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Alexandre R Zlotta
- Division of Urology, Department of Surgery, Sinai Health System, University of Toronto, Toronto, ON, Canada
- Department of Surgical Oncology, Division of Urology, Princess Margaret Cancer Centre, University of Toronto and University Health Network, Toronto, ON, Canada
| | - Jeffrey D Cirillo
- Department of Microbial Pathogenesis and Immunology, Texas A&M Health Science Center, Bryan, TX, USA
| | | | | | - Joshua J Meeks
- Northwestern University School of Medicine, Chicago, IL, USA
| | - Trinity J Bivalacqua
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Paolo Gontero
- Division of Urology, Molinette Hospital, University of Torino School of Medicine, Torino, Italy
| | | | - David McConkey
- Johns Hopkins Greenberg Bladder Cancer Institute, Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Marko Babjuk
- Department of Urology, Hospital Motol, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - J Alfred Witjes
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Ashish M Kamat
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA.
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19
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Prentice S, Nassanga B, Webb EL, Akello F, Kiwudhu F, Akurut H, Elliott AM, Arts RJW, Netea MG, Dockrell HM, Cose S. BCG-induced non-specific effects on heterologous infectious disease in Ugandan neonates: an investigator-blind randomised controlled trial. THE LANCET. INFECTIOUS DISEASES 2021; 21:993-1003. [PMID: 33609457 PMCID: PMC8222005 DOI: 10.1016/s1473-3099(20)30653-8] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/14/2020] [Accepted: 08/07/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Trials done in infants with low birthweight in west Africa suggest that BCG vaccination reduces all-cause mortality in the neonatal period, probably because of heterologous protection against non-tuberculous infections. This study investigated whether BCG alters all-cause infectious disease morbidity in healthy infants in a different high-mortality setting, and explored whether the changes are mediated via trained innate immunity. METHODS This was an investigator-blind, randomised, controlled trial done at one hospital in Entebbe, Uganda. Infants who were born unwell (ie, those who were not well enough to be discharged directly home from the labour ward because they required medical intervention), with major congenital malformations, to mothers with HIV, into families with known or suspected tuberculosis, or for whom cord blood samples could not be taken, were excluded from the study. Any other infant well enough to be discharged directly from the labour ward was eligible for inclusion, with no limitation on gestational age or birthweight. Participants were recruited at birth and randomly assigned (1:1) to receive standard dose BCG 1331 (BCG-Danish) on the day of birth or at age 6 weeks (computer-generated randomisation, block sizes of 24, stratified by sex). Investigators and clinicians were masked to group assignment; parents were not masked. Participants were clinically followed up to age 10 weeks and contributed blood samples to one of three immunological substudies. The primary clinical outcome was physician-diagnosed non-tuberculous infectious disease incidence. Primary immunological outcomes were histone trimethylation at the promoter region of TNF, IL6, and IL1B; ex-vivo production of TNF, IL-6, IL-1β, IL-10, and IFNγ after heterologous stimulation; and transferrin saturation and hepcidin levels. All outcomes were analysed in the modified intention-to-treat population of all randomly assigned participants except those whose for whom consent was withdrawn. This trial is registered with the International Standard Randomised Controlled Trial Number registry (#59683017). FINDINGS Between Sept 25, 2014, and July 31, 2015, 560 participants were enrolled and randomly assigned to receive BCG at birth (n=280) or age 6 weeks (n=280). 12 participants assigned to receive BCG at birth and 11 participants assigned to receive BCG at age 6 weeks were withdrawn from the study by their parents shortly after randomisation and were not included in analyses. During the first 6 weeks of life before the infants in the delayed vaccination group received BCG vaccination, physician-diagnosed non-tuberculous infectious disease incidence was lower in infants in the BCG at birth group than in the delayed group (98 presentations in the BCG at birth group vs 129 in the delayed BCG group; hazard ratio [HR] 0·71 [95% CI 0·53-0·95], p=0·023). After BCG in the delayed group (ie, during the age 6-10 weeks follow-up), there was no significant difference in non-tuberculous infectious disease incidence between the groups (88 presentations vs 76 presentations; HR 1·10 [0·87-1·40], p=0·62). BCG at birth inhibited the increase in histone trimethylation at the TNF promoter in peripheral blood mononuclear cells occurring in the first 6 weeks of life. H3K4me3 geometric mean fold-increases were 3·1 times lower at the TNF promoter (p=0·018), 2·5 times lower at the IL6 promoter (p=0·20), and 3·1 times lower at the IL1B promoter (p=0·082) and H3K9me3 geometric mean fold-increases were 8·9 times lower at the TNF promoter (p=0·0046), 1·2 times lower at the IL6 promoter (p=0·75), and 4·6 times lower at the IL1B promoter (p=0·068), in BCG-vaccinated (BCG at birth group) versus BCG-naive (delayed BCG group) infants. No clear effect of BCG on ex-vivo production of TNF, IL-6, IL-1β, IL-10, and IFNγ after heterologous stimulation, or transferrin saturation and hepcidin concentration, was detected (geometric mean ratios between 0·68 and 1·68; p≥0·038 for all comparisons). INTERPRETATION BCG vaccination protects against non-tuberculous infectious disease during the neonatal period, in addition to having tuberculosis-specific effects. Prioritisation of BCG on the first day of life in high-mortality settings might have significant public-health benefits through reductions in all-cause infectious morbidity and mortality. FUNDING Wellcome Trust. TRANSLATIONS For the Luganda and Swahili translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Sarah Prentice
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK; MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.
| | | | - Emily L Webb
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Fred Kiwudhu
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Hellen Akurut
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Alison M Elliott
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK; MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Rob J W Arts
- Department of Internal Medicine and Radboud Centre for Infectious Disease, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Centre for Infectious Disease, Radboud University Medical Centre, Nijmegen, Netherlands; Department for Genomics and Immunoregulation, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Hazel M Dockrell
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Stephen Cose
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK; MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
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20
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Schaltz-Buchholzer F, Berendsen M, Roth A, Jensen KJ, Bjerregaard-Andersen M, Kjær Sørensen M, Monteiro I, Aaby P, Stabell Benn C. BCG skin reactions by 2 months of age are associated with better survival in infancy: a prospective observational study from Guinea-Bissau. BMJ Glob Health 2021; 5:bmjgh-2020-002993. [PMID: 32978212 PMCID: PMC7520814 DOI: 10.1136/bmjgh-2020-002993] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 01/03/2023] Open
Abstract
Introduction Receiving Bacille Calmette-Guérin (BCG)-Denmark vaccine at birth has been associated with ~40% reductions in all-cause neonatal mortality. We evaluated determinants of BCG skin reaction characteristics by age 2 months and tested the association with subsequent mortality. Methods Prospective observational study amalgamating five trials providing BCG-at-birth that were conducted between 2002 and 2018 in Guinea-Bissau. The reaction status and size were evaluated at home-visits by 2 months of age among 6012 neonates; mortality from 2 to 12 months was assessed at subsequent visits. Reaction determinants were evaluated by binomial regression providing risk ratios (RRs). In Cox-models providing adjusted mortality rate ratios (aMRRs), we assessed the association between (1) having a 2-month reaction (yes/no) and (2) reaction size tertiles and subsequent all-cause mortality risk. A subgroup had their BCG reaction evaluated and were bled at age 4 weeks; their samples underwent in vitro analysis for specific and non-specific cytokine responses. Results The BCG strain was the main determinant for developing a 2-month reaction and the reaction size: the BCG-Russia/BCG-Denmark RR for large-reaction was 0.38 (0.30–0.47) and the BCG-Russia/BCG-Japan RR was 0.61 (0.51–0.72). 5804 infants (96.5%) were reactors by age 2 months; 208 (3.5%) were non-reactors. The 2–12 months mortality risk was 4.8% (10/208) for non-reactors, 2.9% (64/2213) for small reactors, 1.8% (30/1710) for medium reactors and 0.8% (15/1881) for large reactors. The reactor/non-reactor aMRR was 0.49 (0.26–0.95) and there was a linear trend of decreasing mortality with increasing reaction size (p for trend <0.001). BCG reactors had higher 4-week specific and non-specific cytokine responses, responses that were highest among those with large reactions. Conclusion Among BCG-vaccinated infants, having a BCG skin reaction by age 2 months was associated with markedly better survival, as was the reaction size. Our findings thus support that BCG has substantial effects on all-cause mortality. Emphasising at-birth vaccination with immunogenic BCG strains and revaccinating non-reactors and small reactors could have major public health benefits. Trial registration numbers NCT00146302, NCT00168610, NCT00625482, NCT01989026 and NCT02447536.
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Affiliation(s)
- Frederik Schaltz-Buchholzer
- Bandim Health Project, Institute of Clinical Research, Uni. Southern Denmark and Odense University Hospital, Odense, Denmark .,Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.,Research Centre for Vitamins and Vaccines, Copenhagen, Denmark
| | - Mike Berendsen
- Bandim Health Project, Institute of Clinical Research, Uni. Southern Denmark and Odense University Hospital, Odense, Denmark.,Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.,Research Centre for Vitamins and Vaccines, Copenhagen, Denmark.,Department of Internal Medicine, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Adam Roth
- Public Health Agency of Sweden, Solna, Sweden.,Institution for Translational Medicine, Lund University, Malmö, Sweden
| | - Kristoffer Jarlov Jensen
- Bandim Health Project, Institute of Clinical Research, Uni. Southern Denmark and Odense University Hospital, Odense, Denmark.,Experimental and Translational Immunology, Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Morten Bjerregaard-Andersen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.,Research Centre for Vitamins and Vaccines, Copenhagen, Denmark
| | - Marcus Kjær Sørensen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.,Research Centre for Vitamins and Vaccines, Copenhagen, Denmark
| | - Ivan Monteiro
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Peter Aaby
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Christine Stabell Benn
- Bandim Health Project, Institute of Clinical Research, Uni. Southern Denmark and Odense University Hospital, Odense, Denmark.,Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.,Research Centre for Vitamins and Vaccines, Copenhagen, Denmark.,Danish Institute of Advanced Science, University of Southern Denmark, Odense, Denmark
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21
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Klinger D, Hill BL, Barda N, Halperin E, Gofrit ON, Greenblatt CL, Rappoport N, Linial M, Bercovier H. Bladder Cancer Immunotherapy by BCG Is Associated with a Significantly Reduced Risk of Alzheimer's Disease and Parkinson's Disease. Vaccines (Basel) 2021; 9:vaccines9050491. [PMID: 34064775 PMCID: PMC8151667 DOI: 10.3390/vaccines9050491] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 12/16/2022] Open
Abstract
Bacillus Calmette–Guerin (BCG) is a live attenuated form of Mycobacterium bovis that was developed 100 years ago as a vaccine against tuberculosis (TB) and has been used ever since to vaccinate children globally. It has also been used as the first-line treatment in patients with nonmuscle invasive bladder cancer (NMIBC), through repeated intravesical applications. Numerous studies have shown that BCG induces off-target immune effects in various pathologies. Accumulating data argue for the critical role of the immune system in the course of neurodegenerative diseases such as Alzheimer’s disease (AD) and Parkinson’s disease (PD). In this study, we tested whether repeated exposure to BCG during the treatment of NMIBC is associated with the risk of developing AD and PD. We presented a multi-center retrospective cohort study with patient data collected between 2000 and 2019 that included 12,185 bladder cancer (BC) patients, of which 2301 BCG-treated patients met all inclusion criteria, with a follow-up of 3.5 to 7 years. We considered the diagnosis date of AD and nonvascular dementia cases for BC patients. The BC patients were partitioned into those who underwent a transurethral resection of the bladder tumor followed by BCG therapy, and a disjoint group that had not received such treatment. By applying Cox proportional hazards (PH) regression and competing for risk analyses, we found that BCG treatment was associated with a significantly reduced risk of developing AD, especially in the population aged 75 years or older. The older population (≥75 years, 1578 BCG treated, and 5147 controls) showed a hazard ratio (HR) of 0.726 (95% CI: 0.529–0.996; p-value = 0.0473). While in a hospital-based cohort, BCG treatment resulted in an HR of 0.416 (95% CI: 0.203–0.853; p-value = 0.017), indicating a 58% lower risk of developing AD. The risk of developing PD showed the same trend with a 28% reduction in BCG-treated patients, while no BCG beneficial effect was observed for other age-related events such as Type 2 diabetes (T2D) and stroke. We attributed BCG’s beneficial effect on neurodegenerative diseases to a possible activation of long-term nonspecific immune effects. We proposed a prospective study in elderly people for testing intradermic BCG inoculation as a potential protective agent against AD and PD.
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Affiliation(s)
- Danielle Klinger
- Department of Biological Chemistry, Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem 91904, Israel;
| | - Brian L. Hill
- Department of Computer Science, University of California Los Angeles, Los Angeles, CA 90095-1596, USA; (B.L.H.); (E.H.)
| | - Noam Barda
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat-Gan 6578898, Israel;
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA 02115, USA
| | - Eran Halperin
- Department of Computer Science, University of California Los Angeles, Los Angeles, CA 90095-1596, USA; (B.L.H.); (E.H.)
| | - Ofer N. Gofrit
- Department of Urology, Hadassah University Hospital, Jerusalem 91904, Israel;
| | - Charles L. Greenblatt
- Department of Microbiology and Molecular Genetics, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91904, Israel; (C.L.G.); (H.B.)
| | - Nadav Rappoport
- Department of Software and Information Systems Engineering, Faculty of Engineering Sciences, Ben-Gurion University of the Negev, Beer Sheva 84105, Israel;
| | - Michal Linial
- Department of Biological Chemistry, Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem 91904, Israel;
- Correspondence: ; Tel.: +972-54-882-0035
| | - Hervé Bercovier
- Department of Microbiology and Molecular Genetics, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91904, Israel; (C.L.G.); (H.B.)
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22
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Ahmed A, Rakshit S, Adiga V, Dias M, Dwarkanath P, D'Souza G, Vyakarnam A. A century of BCG: Impact on tuberculosis control and beyond. Immunol Rev 2021; 301:98-121. [PMID: 33955564 DOI: 10.1111/imr.12968] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/13/2021] [Accepted: 03/13/2021] [Indexed: 12/14/2022]
Abstract
BCG turns 100 this year and while it might not be the perfect vaccine, it has certainly contributed significantly towards eradication and prevention of spread of tuberculosis (TB). The search for newer and better vaccines for TB is an ongoing endeavor and latest results from trials of candidate TB vaccines such as M72AS01 look promising. However, recent encouraging data from BCG revaccination trials in adults combined with studies on mucosal and intravenous routes of BCG vaccination in non-human primate models have renewed interest in BCG for TB prevention. In addition, several well-demonstrated non-specific effects of BCG, for example, prevention of viral and respiratory infections, give BCG an added advantage. Also, BCG vaccination is currently being widely tested in human clinical trials to determine whether it protects against SARS-CoV-2 infection and/or death with detailed analyses and outcomes from several ongoing trials across the world awaited. Through this review, we attempt to bring together information on various aspects of the BCG-induced immune response, its efficacy in TB control, comparison with other candidate TB vaccines and strategies to improve its efficiency including revaccination and alternate routes of administration. Finally, we discuss the future relevance of BCG use especially in light of its several heterologous benefits.
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Affiliation(s)
- Asma Ahmed
- Laboratory of Immunology of HIV-TB co-infection, Centre for Infectious Disease Research, Indian Institute of Science, Bangalore, India
| | - Srabanti Rakshit
- Laboratory of Immunology of HIV-TB co-infection, Centre for Infectious Disease Research, Indian Institute of Science, Bangalore, India
| | - Vasista Adiga
- Laboratory of Immunology of HIV-TB co-infection, Centre for Infectious Disease Research, Indian Institute of Science, Bangalore, India
| | - Mary Dias
- Division of Infectious Diseases, St John's Research Institute, Bangalore, India
| | | | - George D'Souza
- Division of Infectious Diseases, St John's Research Institute, Bangalore, India.,Department of Pulmonary Medicine, St John's Medical College, Bangalore, India
| | - Annapurna Vyakarnam
- Laboratory of Immunology of HIV-TB co-infection, Centre for Infectious Disease Research, Indian Institute of Science, Bangalore, India.,Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, Guy's Hospital, King's College London, London, UK
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23
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Bitencourt J, Sarno A, Oliveira C, Souza RAD, Lima CC, Takenami I, Pereira SM, Arruda S. Comparing cytokine production and clinical response following vaccination with BCG Moreau and BCG Russia strains in a Brazilian infant population. Vaccine 2021; 39:3189-3196. [PMID: 33965255 DOI: 10.1016/j.vaccine.2021.04.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/23/2021] [Accepted: 04/15/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION BCG is the only licensed vaccine against tuberculosis (TB) and, in Brazil, comprises part of the recommended vaccine schedule within the first month of life. Due to a local manufacturing shortage of BCG Moreau, BCG Russia was introduced in 2017 by the Brazilian Ministry of Health. OBJECTIVE To evaluate differences in immune responses induced by BCG Moreau and BCG Russia in infants, in addition to scar formation. METHODS The present case series involved 15 healthy infants who were vaccinated within the first seven days of life with one of two strains of BCG, then followed for 12 weeks or longer. Cytokine levels were measured before and after vaccination in whole blood culture supernatants previously stimulated in vitro with either BCG strain, heat-killed M. tuberculosis H37Rv or in the absence of stimulation. BCG scarring was also documented. RESULTS Infants vaccinated with BCG Moreau exhibited increased background IL-2, IL-10 and IL-4 production, yet no differences were found in those vaccinated with BCG Russia. Although both strains induced higher levels of IL-2 and IFN-γ, elevated IL-6, TNF and IL-10 production was also seen in response to BCG Russia. In contrast, no specific responses were observed against heat-killed M. tuberculosis H37Rv, with the exception of increased IL-2 following BCG Moreau vaccination. Although documented in both groups, scarring was milder and less frequent following BCG Russia vaccination. CONCLUSIONS Similar Th1 profiles were found following immunization with either type of BCG vaccine evaluated herein, with more pronounced cytokine production detected in response to the Russia strain. Overall, vaccination was well-tolerated and scarring evolved as expected for both BCG strains.
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Affiliation(s)
- Julia Bitencourt
- Laboratório Avançado de Saúde Pública, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (IGM/Fiocruz), Salvador, Bahia 40296 710, Brazil.
| | - Alice Sarno
- Laboratório Avançado de Saúde Pública, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (IGM/Fiocruz), Salvador, Bahia 40296 710, Brazil.
| | - Carlos Oliveira
- Laboratório Avançado de Saúde Pública, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (IGM/Fiocruz), Salvador, Bahia 40296 710, Brazil.
| | - Ramon Andrade de Souza
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Salvador, Bahia 40110-040, Brazil.
| | - Carla Cristina Lima
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Salvador, Bahia 40110-040, Brazil.
| | - Iukary Takenami
- Colegiado de Medicina, Universidade Federal do Vale do São Francisco (UNIVASF), Paulo Afonso, BA 48607 190, Brazil.
| | - Susan M Pereira
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Salvador, Bahia 40110-040, Brazil.
| | - Sérgio Arruda
- Laboratório Avançado de Saúde Pública, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (IGM/Fiocruz), Salvador, Bahia 40296 710, Brazil; Departamento de Ciências da Vida, Universidade Estadual da Bahia (UNEB), Salvador, BA 41150 000, Brazil.
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24
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Mawa PA, Hasso-Agopsowicz M, Lubyayi L, Nabakooza G, Nakibuule M, Blitz R, Dun L, Govind A, Kaleebu P, Webb EL, Elliott AM, Dockrell HM, Cose S, Smith SG. Immune Responses Following BCG Immunization of Infants in Uganda and United Kingdom Are Similar for Purified Protein Derivative but Differ for Secretory Proteins of Mycobacterium tuberculosis. Front Immunol 2021; 12:637114. [PMID: 33815390 PMCID: PMC8017231 DOI: 10.3389/fimmu.2021.637114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/22/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: The immunogenicity of BCG vaccination in infants differs between populations. We hypothesized that prenatal exposure to mycobacterial antigens might explain the differences in immune responses to BCG seen in other studies of infants in Africa and the United Kingdom (UK) and we explored this in birth cohorts in Uganda and the UK. Materials and Methods: Blood samples were obtained from BCG-immunized infants of mothers with (n = 110) and without (n = 121) latent Mycobacterium tuberculosis infection (LTBI) in Uganda and BCG-immunized infants of mothers without LTBI (n = 25) in the UK at 10 and 52 weeks after birth. Cytokine and chemokine responses to PPD were measured to assess responses to BCG immunization, and to ESAT6/CFP10 to assess exposure to or infection with M. tuberculosis or non-tuberculous mycobacteria (NTM) in 6-day whole blood culture supernatants by a 17-plex Luminex assay. Median responses were compared between Ugandan infants (together, and separated by maternal LTBI status) and UK infants. Results: The IFN-γ response to BCG vaccination was similar between Ugandan and UK infants at 10 and 52 weeks. At week 52, TNF production was marginally higher in Ugandan infants, but after adjusting for multiple comparisons this difference was not significant. At weeks 10 and 52, stimulation of blood with ESAT6/CFP10 produced significantly higher IFN-γ, TNF, IL-12p40, IL-1α, IL-1β, IL-1Ra, IP-10, MIP-1α, MIP-1β, and GM-CSF in Ugandan compared to UK infants. Stimulation of blood with ESAT6/CFP10 produced significantly higher amounts of IL-8 (p = 0.0001), IL-10 (p = 0.0022), and IL-13 (p = 0.0020) in the UK than in Ugandan infants of mothers without LTBI at week 10, but not at week 52. Conclusions: Immune responses to mycobacterial antigens following BCG immunization are similar for PPD, but differ for ESAT6/CFP10, between infants in Uganda and the UK. Neither maternal LTBI nor infant exposure to or infection with mycobacteria impacts the response to BCG. The observed global differences in immune response to BCG immunization are likely to be due to other causes.
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Affiliation(s)
- Patrice A. Mawa
- Immunomodulation and Vaccines Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Immunology, Uganda Virus Research Institute, Entebbe, Uganda
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mateusz Hasso-Agopsowicz
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lawrence Lubyayi
- Immunomodulation and Vaccines Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Grace Nabakooza
- Immunomodulation and Vaccines Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Marjorie Nakibuule
- Immunomodulation and Vaccines Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Rose Blitz
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Li Dun
- Fetal Medicine Unit, Gynaecology and Obstetrics Department, North Middlesex University Hospital National Health Service Trust, London, United Kingdom
| | - Abha Govind
- Fetal Medicine Unit, Gynaecology and Obstetrics Department, North Middlesex University Hospital National Health Service Trust, London, United Kingdom
| | - Pontiano Kaleebu
- Immunomodulation and Vaccines Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Immunology, Uganda Virus Research Institute, Entebbe, Uganda
| | - Emily L. Webb
- Medical Research Council Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Alison M. Elliott
- Immunomodulation and Vaccines Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hazel M. Dockrell
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stephen Cose
- Immunomodulation and Vaccines Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Steven G. Smith
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Broset E, Pardo-Seco J, Kanno AI, Aguilo N, Dacosta AI, Rivero-Calle I, Gonzalo-Asensio J, Locht C, Leite LCC, Martin C, Martinón-Torres F. BCG vaccination improves DTaP immune responses in mice and is associated with lower pertussis incidence in ecological epidemiological studies. EBioMedicine 2021; 65:103254. [PMID: 33711798 PMCID: PMC7960937 DOI: 10.1016/j.ebiom.2021.103254] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The Bacillus Calmette-Guérin (BCG), the only vaccine against tuberculosis (TB) currently in use, has shown beneficial effects against unrelated infections and to enhance immune responses to vaccines. However, there is little evidence regarding the influence of BCG vaccination on pertussis. METHODS Here, we studied the ability of BCG to improve the immune responses to diphtheria, tetanus, and acellular (DTaP) or whole-cell pertussis (DTwP) vaccination in a mouse model. We included MTBVAC, an experimental live-attenuated vaccine derived from Mycobacterium tuberculosis, in our studies to explore if it presents similar heterologous immunity as BCG. Furthermore, we explored the potential effect of routine BCG vaccination on pertussis incidence worldwide. FINDINGS We found that both BCG and MTBVAC when administered before DTaP, triggered Th1 immune responses against diphtheria, tetanus, and pertussis in mice. Immunization with DTaP alone failed to trigger a Th1 response, as measured by the production of IFN-γ. Humoral responses against DTaP antigens were also enhanced by previous immunization with BCG or MTBVAC. Furthermore, exploration of human epidemiological data showed that pertussis incidence was 10-fold lower in countries that use DTaP and BCG compared to countries that use only DTaP. INTERPRETATION BCG vaccination may have a beneficial impact on the protection against pertussis conferred by DTaP. Further randomized controlled trials are needed to properly define the impact of BCG on pertussis incidence in a controlled setting. This could be a major finding that would support changes in immunization policies. FUNDING This work was supported by the Ministry of "Economía y Competitividad"; European Commission H2020 program, "Gobierno de Aragón"; CIBERES; "Fundação Butantan"; Instituto de Salud Carlos III and "Fondo FEDER".
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Affiliation(s)
- Esther Broset
- Grupo de Genetica de Micobacterias, Departamento de Microbiología y Medicina Preventiva, Facultad de Medicina, Universidad de Zaragoza, IIS-Aragón, Zaragoza 50009, Spain; CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
| | - Jacobo Pardo-Seco
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; GENVIP Research Group (www.genvip.org), Instituto de Investigación Sanitaria de Santiago (SERGAS), University of Santiago de Compostela, Galicia, Spain
| | - Alex I Kanno
- Laboratório de Desenvolvimento de Vacinas, Instituto Butantan, Av. Vital Brasil 1500, São Paulo 05503-900, Brazil
| | - Nacho Aguilo
- Grupo de Genetica de Micobacterias, Departamento de Microbiología y Medicina Preventiva, Facultad de Medicina, Universidad de Zaragoza, IIS-Aragón, Zaragoza 50009, Spain; CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Isabel Dacosta
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; GENVIP Research Group (www.genvip.org), Instituto de Investigación Sanitaria de Santiago (SERGAS), University of Santiago de Compostela, Galicia, Spain
| | - Irene Rivero-Calle
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; GENVIP Research Group (www.genvip.org), Instituto de Investigación Sanitaria de Santiago (SERGAS), University of Santiago de Compostela, Galicia, Spain
| | - Jesus Gonzalo-Asensio
- Grupo de Genetica de Micobacterias, Departamento de Microbiología y Medicina Preventiva, Facultad de Medicina, Universidad de Zaragoza, IIS-Aragón, Zaragoza 50009, Spain; CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Instituto de Biocomputación y Física de Sistemas Complejos (BIFI), Zaragoza, Spain
| | - Camille Locht
- Center of Infection and Immunity of Lille, Institut Pasteur de Lille, Lille 59019, France; Inserm U1019, Lille 59019, France; CNRS UMR8204, Lille 59019, France; Univ. Lille, Lille 59019, France
| | - Luciana C C Leite
- Laboratório de Desenvolvimento de Vacinas, Instituto Butantan, Av. Vital Brasil 1500, São Paulo 05503-900, Brazil
| | - Carlos Martin
- Grupo de Genetica de Micobacterias, Departamento de Microbiología y Medicina Preventiva, Facultad de Medicina, Universidad de Zaragoza, IIS-Aragón, Zaragoza 50009, Spain; CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiología, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; GENVIP Research Group (www.genvip.org), Instituto de Investigación Sanitaria de Santiago (SERGAS), University of Santiago de Compostela, Galicia, Spain
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26
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Can what have we learnt about BCG vaccination in the last 20 years help us to design a better tuberculosis vaccine? Vaccine 2021; 40:1525-1533. [PMID: 33583672 PMCID: PMC8899334 DOI: 10.1016/j.vaccine.2021.01.068] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/20/2021] [Accepted: 01/27/2021] [Indexed: 01/22/2023]
Abstract
The BCG vaccine provides variable protection against tuberculosis. Correlates of protection remain elusive, but IFNγ can measure immunogenicity. BCG vaccination induces innate immune training as well as antigen-specific immunity. Many factors may contribute to the variable responses to BCG vaccination. Prior BCG vaccination or factors modulating its efficacy may affect new TB vaccines. Innate training may also provide non-specific protection against infectious diseases. New TB vaccines should not lose BCG's beneficial non-specific effects.
The BCG vaccine will, in 2021, have been in use for 100 years. Much remains to be understood, including the reasons for its variable efficacy against pulmonary tuberculosis in adults. This review will discuss what has been learnt about the BCG vaccine in the last two decades, and whether this new information can be exploited to improve its efficacy, by enhancing its ability to induce either antigen-specific and/or non-specific effects. Many factors affect both the immunogenicity of BCG and its protective efficacy, highlighting the challenges of working with a live vaccine in man, but new insights may enable us to exploit better what BCG can do.
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27
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Benn CS, Roth A, Garly ML, Fisker AB, Schaltz-Buchholzer F, Timmermann A, Berendsen M, Aaby P. BCG scarring and improved child survival: a combined analysis of studies of BCG scarring. J Intern Med 2020; 288:614-624. [PMID: 32301189 DOI: 10.1111/joim.13084] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 03/11/2020] [Accepted: 03/15/2020] [Indexed: 11/30/2022]
Abstract
Bacillus Calmette-Guérin (BCG) vaccine against tuberculosis (TB) is recommended at birth in TB-endemic areas. Currently, BCG vaccination programmes use "BCG vaccination coverage by 12 months of age" as the performance indicator. Previous studies suggest that BCG-vaccinated children, who develop a scar, have better overall survival compared with BCG-vaccinated children, who do not develop a scar. We summarized the available studies of BCG scarring and child survival. A structured literature search for studies with original data and analysis of BCG scarring and mortality were performed. Combined analyses on the effect of BCG scarring on overall mortality. We identified six studies covering seven cohorts, all from Guinea-Bissau, West Africa, with evaluation of BCG scarring amongst BCG-vaccinated children and follow-up for mortality. Determinants of BCG scarring were BCG strain, intradermal injection route, size of injection wheal, and co-administered vaccines and micronutrients. In a combined analysis, having a BCG scar vs. no BCG scar was associated with a mortality rate ratio (MRR) of 0.61 (95% CI: 0.51-0.74). The proportion with a BCG scar varied from 52 to 93%; the estimated effect of a BCG scar was not associated with the scar prevalence. The effect was strongest in the first (MRR = 0.48 (0.37-0.62)) and second (MRR = 0.63 (0.44-0.92)) year of life, and in children BCG-vaccinated in the neonatal period (MRR = 0.45 (0.36-0.55)). The effect was not explained by protection against TB. Confounding and genetic factors are unlikely to explain the strong association between BCG scarring and subsequent survival. Including "BCG scar prevalence" as a BCG vaccination programme performance indicator should be considered. The effect of revaccinating scar-negative children should be studied.
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Affiliation(s)
- C S Benn
- From the, Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.,Research Centre for Vitamins and Vaccines (CVIVA), Statens Serum Institute, Copenhagen S, Denmark.,OPEN, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark
| | - A Roth
- Public Health Agency of Sweden, Solna, Sweden.,Institution for Translational Medicine, Lund University, Malmö, Sweden
| | - M-L Garly
- From the, Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - A B Fisker
- From the, Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.,OPEN, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark
| | - F Schaltz-Buchholzer
- From the, Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.,OPEN, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark
| | - A Timmermann
- Research Unit of Environmental Medicine, University of Southern Denmark, Odense C, Denmark
| | - M Berendsen
- From the, Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.,OPEN, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark.,Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - P Aaby
- From the, Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.,Research Centre for Vitamins and Vaccines (CVIVA), Statens Serum Institute, Copenhagen S, Denmark
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28
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Wannigama DL, Jacquet A. NOD2-dependent BCG-induced trained immunity: A way to regulate innate responses to SARS-CoV2? Int J Infect Dis 2020; 101:52-55. [PMID: 32980554 PMCID: PMC7832069 DOI: 10.1016/j.ijid.2020.09.1429] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/14/2020] [Accepted: 09/19/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Dhammika Leshan Wannigama
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Antimicrobial Resistance and Stewardship Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Alain Jacquet
- Center of Excellence in Vaccine Research and Development, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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29
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Messina NL, Netea MG, Curtis N. The impact of human single nucleotide polymorphisms on Bacillus Calmette-Guérin responses. Vaccine 2020; 38:6224-6235. [PMID: 32826104 DOI: 10.1016/j.vaccine.2020.07.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 06/29/2020] [Accepted: 07/13/2020] [Indexed: 02/06/2023]
Abstract
The influence of genetic variability on human immune responses has major implications for the understanding of disease mechanisms and host-pathogen interactions. Bacillus Calmette-Guérin (BCG) vaccine, which is given globally to protect against tuberculosis, has high variability in its protective efficacy against mycobacteria and its beneficial off-target (heterologous) effects. Single nucleotide polymorphisms (SNPs) are major cause of genetic variation and have been strongly associated with susceptibility to tuberculosis and outcomes following BCG immunotherapy for cancer. This review discusses the contribution of SNPs to the variability in mycobacterial-specific and off-target BCG responses, and the implications for this on development of novel TB vaccines and strategies to harness the beneficial off-target effects of BCG.
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Affiliation(s)
- Nicole L Messina
- Infectious Diseases & Microbiology Research Group, Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia.
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands; Department for Genomics & Immunoregulation, Life and Medical Sciences Institute (LIMES), University of Bonn, 53115 Bonn, Germany; Human Genomics Laboratory, Craiova University of Medicine and Pharmacy, Craiova, Romania
| | - Nigel Curtis
- Infectious Diseases & Microbiology Research Group, Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia; Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Australia
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30
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Angelidou A, Diray-Arce J, Conti MG, Smolen KK, van Haren SD, Dowling DJ, Husson RN, Levy O. BCG as a Case Study for Precision Vaccine Development: Lessons From Vaccine Heterogeneity, Trained Immunity, and Immune Ontogeny. Front Microbiol 2020; 11:332. [PMID: 32218774 PMCID: PMC7078104 DOI: 10.3389/fmicb.2020.00332] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 02/14/2020] [Indexed: 12/11/2022] Open
Abstract
Vaccines have been traditionally developed with the presumption that they exert identical immunogenicity regardless of target population and that they provide protection solely against their target pathogen. However, it is increasingly appreciated that vaccines can have off-target effects and that vaccine immunogenicity can vary substantially with demographic factors such as age and sex. Bacille Calmette-Guérin (BCG), the live attenuated Mycobacterium bovis vaccine against tuberculosis (TB), represents a key example of these concepts. BCG vaccines are manufactured under different conditions across the globe generating divergent formulations. Epidemiologic studies have linked early life immunization with certain BCG formulations to an unanticipated reduction (∼50%) in all-cause mortality, especially in low birthweight males, greatly exceeding that attributable to TB prevention. This mortality benefit has been related to prevention of sepsis and respiratory infections suggesting that BCG induces "heterologous" protection against unrelated pathogens. Proposed mechanisms for heterologous protection include vaccine-induced immunometabolic shifts, epigenetic reprogramming of innate cell populations, and modulation of hematopoietic stem cell progenitors resulting in altered responses to subsequent stimuli, a phenomenon termed "trained immunity." In addition to genetic differences, licensed BCG formulations differ markedly in content of viable mycobacteria key for innate immune activation, potentially contributing to differences in the ability of these diverse formulations to induce TB-specific and heterologous protection. BCG immunomodulatory properties have also sparked interest in its potential use to prevent or alleviate autoimmune and inflammatory diseases, including type 1 diabetes mellitus and multiple sclerosis. BCG can also serve as a model: nanoparticle vaccine formulations incorporating Toll-like receptor 8 agonists can mimic some of BCG's innate immune activation, suggesting that aspects of BCG's effects can be induced with non-replicating stimuli. Overall, BCG represents a paradigm for precision vaccinology, lessons from which will help inform next generation vaccines.
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Affiliation(s)
- Asimenia Angelidou
- Division of Newborn Medicine, Boston Children’s Hospital and Beth Israel Deaconess Medical Center, Boston, MA, United States
- Precision Vaccines Program, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Joann Diray-Arce
- Precision Vaccines Program, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA, United States
| | - Maria Giulia Conti
- Precision Vaccines Program, Boston Children’s Hospital, Boston, MA, United States
- Department of Maternal and Child Health, Sapienza University of Rome, Rome, Italy
| | - Kinga K. Smolen
- Precision Vaccines Program, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA, United States
| | - Simon Daniël van Haren
- Precision Vaccines Program, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA, United States
| | - David J. Dowling
- Precision Vaccines Program, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA, United States
| | - Robert N. Husson
- Harvard Medical School, Boston, MA, United States
- Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA, United States
| | - Ofer Levy
- Precision Vaccines Program, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA, United States
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31
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Namakula R, de Bree LCJ, A. Tvedt TH, Netea MG, Cose S, Hanevik K. Monocytes from neonates and adults have a similar capacity to adapt their cytokine production after previous exposure to BCG and β-glucan. PLoS One 2020; 15:e0229287. [PMID: 32084227 PMCID: PMC7034882 DOI: 10.1371/journal.pone.0229287] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 02/03/2020] [Indexed: 12/27/2022] Open
Abstract
The Bacillus Calmette-Guérin (BCG) vaccine is administered at birth in tuberculosis (TB) endemic countries. BCG vaccination is also associated with protective non-specific effects against non-tuberculous infections. This seems at least in part mediated through induction of innate immune memory in myeloid cells, a process termed trained immunity. β-glucan, a component of the fungal cell wall from Candida albicans, induces a trained immunity phenotype in human monocytes with hyper-responsiveness against unrelated pathogens. We aimed to study the capacity of BCG and β-glucan to induce a similar phenotype by examining cytokine production in cord blood monocytes following re-stimulation. We used a well-known model of in vitro induction of trained immunity. Adherent mononuclear cells from neonates and adults, which consist mainly of monocytes, were stimulated in vitro with BCG or β-glucan for one day, after which the stimulus was washed away. Cells were rested for 5 days, then restimulated with LPS. Cytokine levels were measured using ELISA. Neonate and adult monocytes responded similarly in terms of cytokine production. BCG significantly increased IL-6 responses to LPS in both neonate and adult monocytes, while β-glucan induced increases of IL-6, IL-10 and TNF production capacity. The BCG and β-glucan induced increase in cytokine production, reminiscent of trained immunity, showed similar levelsin neonatal and adult monocytes. BCG mediated changes in cytokine production shows the feasibility of this in vitro assay for further studies regarding non-specific effects of vaccines.
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Affiliation(s)
- Rhoda Namakula
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Bergen, Norway
| | - L. Charlotte J. de Bree
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Tor Henrik A. Tvedt
- Department of Medicine, Section for Hematology, Haukeland University Hospital, Bergen, Norway
| | - Mihai G. Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Stephen Cose
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Kurt Hanevik
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Medicine, Norwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
- * E-mail:
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32
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Angelidou A, Conti MG, Diray-Arce J, Benn CS, Shann F, Netea MG, Liu M, Potluri LP, Sanchez-Schmitz G, Husson R, Ozonoff A, Kampmann B, van Haren SD, Levy O. Licensed Bacille Calmette-Guérin (BCG) formulations differ markedly in bacterial viability, RNA content and innate immune activation. Vaccine 2020; 38:2229-2240. [PMID: 32005538 PMCID: PMC7556328 DOI: 10.1016/j.vaccine.2019.11.060] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 10/24/2019] [Accepted: 11/25/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bacille Calmette-Guérin (BCG), the live attenuated tuberculosis vaccine, is manufactured under different conditions across the globe generating formulations that may differ in clinical efficacy. Innate immune recognition of live BCG contributes to immunogenicity suggesting that differences in BCG viability may contribute to divergent activity of licensed formulations. METHODS We compared BCG-Denmark (DEN), -Japan (JPN), -India (IND), -Bulgaria (BUL) and -USA in vitro with respect to a) viability as measured by colony-forming units (CFU), mycobacterial membrane integrity, and RNA content, and b) cytokine/chemokine production in newborn cord and adult peripheral blood. RESULTS Upon culture, relative growth was BCG-USA > JPN ≫ DEN > BUL = IND. BCG-IND and -BUL demonstrated >1000-fold lower growth than BCG-JPN in 7H9 medium and >10-fold lower growth in commercial Middlebrook 7H11 medium. BCG-IND demonstrated significantly decreased membrane integrity, lower RNA content, and weaker IFN-γ inducing activity in whole blood compared to other BCGs. BCG-induced whole blood cytokines differed significantly by age, vaccine formulation and concentration. BCG-induced cytokine production correlated with CFU, suggesting that mycobacterial viability may contribute to BCG-induced immune responses. CONCLUSIONS Licensed BCG vaccines differ markedly in their content of viable mycobacteria possibly contributing to formulation-dependent activation of innate and adaptive immunity and distinct protective effects.
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Affiliation(s)
- Asimenia Angelidou
- Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA; Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA.
| | - Maria-Giulia Conti
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA; Department of Pediatrics, Sapienza University of Rome, Rome 00185, Italy.
| | - Joann Diray-Arce
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
| | - Christine S Benn
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark.
| | - Frank Shann
- Department of Pediatrics, Royal Children's Hospital, University of Melbourne, Victoria 3052 Australia.
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands; Department for Genomics & Immunoregulation, Life and Medical Sciences Institute (LIMES), University of Bonn, 53115 Bonn, Germany.
| | - Mark Liu
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Lakshmi Prasad Potluri
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
| | - Guzman Sanchez-Schmitz
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA.
| | - Robert Husson
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA.
| | - Al Ozonoff
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA.
| | - Beate Kampmann
- Vaccine Centre, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; Vaccines & Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, PO Box 273, Banjul, Gambia.
| | - Simon Daniël van Haren
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA.
| | - Ofer Levy
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA; Broad Institute of MIT & Harvard, Cambridge, MA 02142, USA.
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33
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Messina NL, Gardiner K, Donath S, Flanagan K, Ponsonby AL, Shann F, Robins-Browne R, Freyne B, Abruzzo V, Morison C, Cox L, Germano S, Zufferey C, Zimmermann P, Allen KJ, Vuillermin P, South M, Casalaz D, Curtis N. Study protocol for the Melbourne Infant Study: BCG for Allergy and Infection Reduction (MIS BAIR), a randomised controlled trial to determine the non-specific effects of neonatal BCG vaccination in a low-mortality setting. BMJ Open 2019; 9:e032844. [PMID: 31843845 PMCID: PMC6924750 DOI: 10.1136/bmjopen-2019-032844] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/31/2019] [Accepted: 11/01/2019] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION BCG vaccination reduces all-cause infant mortality in high-mortality settings by more than can be attributed to protection against tuberculosis. This is proposed to result from non-specific protection against non-vaccine targeted ('off-target') infections. There is also evidence that BCG protects against allergic diseases. METHODS AND ANALYSIS The Melbourne Infant Study: BCG for Allergy and Infection Reduction is a phase III multicentre, single-blinded, randomised controlled trial. A total of 1438 healthy neonates will be randomised to receive either BCG vaccination or no BCG vaccination in the first 10 days of life. Measures of allergy, eczema, infection and asthma will be obtained from parent-completed questionnaires 3 monthly in the first year and 6 monthly from 1 to 5 years of age, and clinical assessments at 1 and 5 years of age. Biological samples will also be collected for future immunological studies. ANALYSIS PRIMARY OUTCOME The proportion of participants with measures of allergy and infection (atopic sensitisation, eczema, lower respiratory tract infection) at 1 and 5 years of age, and asthma at 5 years of age. SECONDARY OUTCOMES (1) the proportion of participants with additional measures of allergy, eczema, asthma and infections; (2) medication use for eczema and asthma; (3) the severity and age of onset of eczema and asthma; (4) the number of episodes of infection; (5) hospitalisations for infections and (6) laboratory measures of immune responses. ETHICS AND DISSEMINATION This trial has ethical and governance approval from Mercy Health Human Research Ethics Committee (HREC, No. R12-28) and Royal Children's Hospital HREC (No. 33025) with additional governance approval from Barwon Health and St John of God, Geelong, Victoria. Results of this trial will be published in peer-reviewed journals and presented at scientific conferences. TRIAL REGISTRATION NUMBER NCT01906853.
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Affiliation(s)
- Nicole L Messina
- Infectious Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Kaya Gardiner
- Infectious Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Susan Donath
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Katie Flanagan
- School of Health Sciences, University of Tasmania, Hobart, Tasmania, Australia
- School of Health and Biomedical Science, RMIT University, Melbourne, Victoria, Australia
| | - Anne-Louise Ponsonby
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
- Center for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Frank Shann
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
- Intensive Care Unit, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Roy Robins-Browne
- Infectious Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Microbiology and Immunology, University of Melbourne, Melbourne, Victoria, Australia
| | - Bridget Freyne
- Infectious Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Veronica Abruzzo
- Infectious Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Clare Morison
- Infectious Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Lianne Cox
- Infectious Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Susie Germano
- Infectious Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Christel Zufferey
- Infectious Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Petra Zimmermann
- Infectious Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Katie J Allen
- Formerly of Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Peter Vuillermin
- School of Medicine, Deakin University, Geelong, Victoria, Australia
- Child Health Research Unit, Barwon Health, Geelong, Victoria, Australia
| | - Mike South
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
- Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Dan Casalaz
- Neonatal Intensive Care Unit, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Nigel Curtis
- Infectious Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
- Infectious Diseases, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
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Koti M, Chenard S, Nersesian S, Vidotto T, Morales A, Siemens DR. Investigating the STING Pathway to Explain Mechanisms of BCG Failures in Non-Muscle Invasive Bladder Cancer: Prognostic and Therapeutic Implications. Bladder Cancer 2019. [DOI: 10.3233/blc-190228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Madhuri Koti
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Canada
- Department of Obstetrics and Gynecology, Kingston Health Sciences Center, Queen’s University, Kingston, Canada
- Cancer Biology and Genetics, Queen’s Cancer Research Institute, Queen’s University, Kingston, Canada
- Department of Urology, Kingston Health Sciences Center, Queen’s University, Kingston, Canada
| | - Stephen Chenard
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Canada
- Cancer Biology and Genetics, Queen’s Cancer Research Institute, Queen’s University, Kingston, Canada
- Department of Urology, Kingston Health Sciences Center, Queen’s University, Kingston, Canada
| | | | - Thiago Vidotto
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alvaro Morales
- Department of Urology, Kingston Health Sciences Center, Queen’s University, Kingston, Canada
| | - D. Robert Siemens
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Canada
- Cancer Biology and Genetics, Queen’s Cancer Research Institute, Queen’s University, Kingston, Canada
- Department of Urology, Kingston Health Sciences Center, Queen’s University, Kingston, Canada
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Schaltz-Buchholzer F, Bjerregaard-Andersen M, Øland CB, Golding C, Stjernholm EB, Monteiro I, Aaby P, Benn CS. Early Vaccination With Bacille Calmette-Guérin-Denmark or BCG-Japan Versus BCG-Russia to Healthy Newborns in Guinea-Bissau: A Randomized Controlled Trial. Clin Infect Dis 2019; 71:1883-1893. [DOI: 10.1093/cid/ciz1080] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/29/2019] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Bacille Calmette-Guérin (BCG) vaccination remains a cornerstone against tuberculosis. Randomized controlled trials (RCTs) have demonstrated that BCG-Denmark lowers all-cause mortality, but a recent RCT found no effect of BCG-Russia. Observational studies indicate that the genetically divergent BCG strains have different effects.
Methods
This was a parallel-group, open-label RCT conducted at the National Hospital in Guinea-Bissau. Healthy neonates were randomized 1:1 to BCG-Denmark (2851 randomized, 2840 analyzed) vs BCG-Russia (2845 randomized, 2837 analyzed). We hypothesized that BCG-Denmark would reduce morbidity (primary outcome) and mortality while inducing more BCG reactions and purified protein derivative (PPD) responses (secondary outcomes). Halfway through the trial, production of BCG-Denmark was halted, and the trial continued comparing BCG-Japan (3191 neonates randomized, 3184 analyzed) with BCG-Russia (3170 randomized, 3160 analyzed). Mortality and morbidity data were collected by telephone, at home visits, and at the National Hospital and assessed in Cox models providing 6-week mortality rate ratios (MRRs) and hospitalization incidence rate ratios (IRRs).
Results
By age 6 weeks, there were 140 and 130 admissions among neonates vaccinated with BCG-Denmark and BCG-Russia, respectively (IRR, 1.08 [95% confidence interval {CI}, .84–1.37]). For BCG-Japan, there were 185 admissions vs 161 admissions for BCG-Russia (IRR, 1.15 [95% CI, .93–1.43]). The 6-week mortality did not differ: BCG-Denmark/BCG-Russia (MRR, 1.15 [95% CI, .74–1.80]); BCG-Japan/BCG-Russia (MRR, 0.71 [95% CI, .43–1.19]). BCG-Denmark and BCG-Japan induced more BCG scars and PPD reactions than BCG-Russia.
Conclusions
BCG strains did not affect morbidity. BCG-Denmark and BCG-Japan were more immunogenic than BCG-Russia by the measures traditionally viewed as surrogates for successful immunization. The implications of strain differences for tuberculosis protection and overall health warrant further study.
Clinical Trials Registration
NCT02447536.
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Affiliation(s)
- Frederik Schaltz-Buchholzer
- Institute of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
| | - Morten Bjerregaard-Andersen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
| | | | - Christian Golding
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
| | - Elise Brenno Stjernholm
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
| | - Ivan Monteiro
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Peter Aaby
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Christine Stabell Benn
- Institute of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
- Danish Institute of Advanced Science, University of Southern Denmark, Odense, Denmark
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36
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Kiravu A, Osawe S, Happel AU, Nundalall T, Wendoh J, Beer S, Dontsa N, Alinde OB, Mohammed S, Datong P, Cameron DW, Rosenthal K, Abimiku A, Jaspan HB, Gray CM. Bacille Calmette-Guérin Vaccine Strain Modulates the Ontogeny of Both Mycobacterial-Specific and Heterologous T Cell Immunity to Vaccination in Infants. Front Immunol 2019; 10:2307. [PMID: 31649662 PMCID: PMC6793433 DOI: 10.3389/fimmu.2019.02307] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/12/2019] [Indexed: 01/24/2023] Open
Abstract
Differences in Bacille Calmette-Guérin (BCG) immunogenicity and efficacy have been reported, but various strains of BCG are administered worldwide. Since BCG immunization may also provide protection against off-target antigens, we sought to identify the impact of different BCG strains on the ontogeny of vaccine-specific and heterologous vaccine immunogenicity in the first 9 months of life, utilizing two African birth cohorts. A total of 270 infants were studied: 84 from Jos, Nigeria (vaccinated with BCG-Bulgaria) and 187 from Cape Town, South Africa (154 vaccinated with BCG-Denmark and 33 with BCG-Russia). Infant whole blood was taken at birth, 7, 15, and 36 weeks and short-term stimulated (12 h) in vitro with BCG, Tetanus and Pertussis antigens. Using multiparameter flow cytometry, CD4+ T cell memory subset polyfunctionality was measured by analyzing permutations of TNF-α, IL-2, and IFN-γ expression at each time point. Data was analyzed using FlowJo, SPICE, R, and COMPASS. We found that infants vaccinated with BCG-Denmark mounted significantly higher frequencies of BCG-stimulated CD4+ T cell responses, peaking at week 7 after immunization, and possessed durable polyfunctional CD4+ T cells that were in a more early differentiated memory stage when compared with either BCG-Bulgaria and BCG-Russia strains. The latter responses had lower polyfunctional scores and tended to accumulate in a CD4+ T cell naïve-like state (CD45RA+CD27+). Notably, BCG-Denmark immunization resulted in higher magnitudes and polyfunctional cytokine responses to heterologous vaccine antigens (Tetanus and Pertussis). Collectively, our data show that BCG strain was the strongest determinant of both BCG-stimulated and heterologous vaccine stimulated T cell magnitude and polyfunctionality. These findings have implications for vaccine policy makers, manufacturers and programs worldwide and also suggest that BCG-Denmark, the first vaccine received in many African infants, has both specific and off-target effects in the first few months of life, which may provide an immune priming benefit to other EPI vaccines.
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Affiliation(s)
- Agano Kiravu
- Division of Immunology, Institute of Infectious Diseases and Molecular Medicine, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sophia Osawe
- Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Anna-Ursula Happel
- Division of Immunology, Institute of Infectious Diseases and Molecular Medicine, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Trishana Nundalall
- Division of Immunology, Institute of Infectious Diseases and Molecular Medicine, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jerome Wendoh
- Division of Immunology, Institute of Infectious Diseases and Molecular Medicine, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sophie Beer
- Faculty of Biological Sciences, Friedrich Schiller University, Jena, Germany
| | - Nobomi Dontsa
- Division of Immunology, Institute of Infectious Diseases and Molecular Medicine, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Olatogni Berenice Alinde
- Division of Immunology, Institute of Infectious Diseases and Molecular Medicine, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Pam Datong
- Institute of Human Virology Nigeria, Abuja, Nigeria
| | - D William Cameron
- Divisions of Infectious Diseases and Respirology, University of Ottawa at the Ottawa Hospital, Ottawa, ON, Canada
| | - Kenneth Rosenthal
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Alash'le Abimiku
- Institute of Human Virology Nigeria, Abuja, Nigeria.,Institute of Human Virology, Department of Epidemiology and Prevention, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Heather B Jaspan
- Division of Immunology, Institute of Infectious Diseases and Molecular Medicine, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Paediatrics and Global Health, University of Washington, Seattle, WA, United States
| | - Clive M Gray
- Division of Immunology, Institute of Infectious Diseases and Molecular Medicine, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa
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Biering-Sørensen S, Aaby P, Lund N, Monteiro I, Jensen KJ, Eriksen HB, Schaltz-Buchholzer F, Jørgensen ASP, Rodrigues A, Fisker AB, Benn CS. Early BCG-Denmark and Neonatal Mortality Among Infants Weighing <2500 g: A Randomized Controlled Trial. Clin Infect Dis 2019; 65:1183-1190. [PMID: 29579158 PMCID: PMC5849087 DOI: 10.1093/cid/cix525] [Citation(s) in RCA: 197] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 06/07/2017] [Indexed: 11/14/2022] Open
Abstract
Background BCG vaccine may reduce overall mortality by increasing resistance to nontuberculosis infections. In 2 randomized trials in Guinea-Bissau of early BCG-Denmark (Statens Serum Institut) given to low-weight (LW) neonates (<2500 g at inclusion) to reduce infant mortality rates, we observed a very beneficial effect in the neonatal period. We therefore conducted the present trial to test whether early BCG-Denmark reduces neonatal mortality by 45%. We also conducted a meta-analysis of the 3 BCG-Denmark trials. Methods In 2008–2013, we randomized LW neonates to “early BCG-Denmark” (intervention group; n = 2083) or “control” (local policy for LW and no BCG-Denmark; n = 2089) at discharge from the maternity ward or at first contact with the health center. The infants were randomized (1:1) without blinding in blocks of 24. Data was analyzed in Cox hazards models providing mortality rate ratios (MRRs). We had prespecified an analysis censoring follow-up at oral poliovirus vaccine campaigns. Results Early administration of BCG-Denmark was associated with a nonsignificant reduction in neonatal mortality rate (MRR, 0.70; 95% confidence interval [CI], .47–1.04) and a 34% reduction (0.66; .44–1.00) when censoring for oral poliovirus vaccine campaigns. There was no reduction in mortality rate for noninfectious diseases, but a 43% reduction in infectious disease mortality rate (MRR, 0.57; 95% CI, .35–.93). A meta-analysis of 3 BCG trials showed that early BCG-Denmark reduced mortality by 38% (MRR, 0.62; 95% CI, .46–.83) within the neonatal period and 16% (0.84; .71–1.00) by age 12 months. Conclusion Early administration of BCG-Denmark in LW infants is associated with major reductions in mortality rate. It is important that all LW infants receive early BCG in areas with high neonatal mortality rates. Clinical Trials Registration NCT00625482.
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Affiliation(s)
- Sofie Biering-Sørensen
- Research Center for Vitamins & Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,Projécto de Saúde Bandim, INDEPTH Network, Bissau, Guinea-Bissau
| | - Peter Aaby
- Projécto de Saúde Bandim, INDEPTH Network, Bissau, Guinea-Bissau
| | - Najaaraq Lund
- Research Center for Vitamins & Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,Projécto de Saúde Bandim, INDEPTH Network, Bissau, Guinea-Bissau
| | - Ivan Monteiro
- Projécto de Saúde Bandim, INDEPTH Network, Bissau, Guinea-Bissau
| | - Kristoffer Jarlov Jensen
- Research Center for Vitamins & Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,Department of Immunology and Vaccinology, National Veterinary Institute, Technical University of Denmark, Frederiksberg and
| | - Helle Brander Eriksen
- Research Center for Vitamins & Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,Projécto de Saúde Bandim, INDEPTH Network, Bissau, Guinea-Bissau
| | | | | | | | - Ane Bærent Fisker
- Research Center for Vitamins & Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,Projécto de Saúde Bandim, INDEPTH Network, Bissau, Guinea-Bissau
| | - Christine Stabell Benn
- Research Center for Vitamins & Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,Odense Patient Data Explorative Network, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, Denmark
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Stensballe LG, Ravn H, Birk NM, Kjærgaard J, Nissen TN, Pihl GT, Thøstesen LM, Greisen G, Jeppesen DL, Kofoed PE, Pryds O, Sørup S, Aaby P, Benn CS. BCG Vaccination at Birth and Rate of Hospitalization for Infection Until 15 Months of Age in Danish Children: A Randomized Clinical Multicenter Trial. J Pediatric Infect Dis Soc 2019; 8:213-220. [PMID: 29635419 DOI: 10.1093/jpids/piy029] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 03/02/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND The bacillus Calmette-Guérin (BCG) vaccine against tuberculosis might reduce the non-tuberculosis-related child mortality rate in low-income settings. We tested the hypothesis that BCG vaccination at birth would reduce early childhood hospitalization for infection in Denmark, a high-income setting. Hospitalization for infection was a secondary outcome in a randomized trial with the primary aim to estimate the potential non-specific effects of BCG vaccination at birth on all-cause hospitalization. METHODS A total of 4262 children included in the Danish Calmette Study were assigned randomly to either receive the BCG vaccine or not and were followed through the Danish National Patient Register. The outcome was number of hospitalizations for infection until the age of 15 months. Data were analyzed by Cox regression in intention-to-treat (ITT) and per-protocol (PP) analyses. RESULTS In the ITT analysis, we observed 588 hospitalizations for infection (mean, 0.28 hospitalization per child) among the 2129 children allocated to receive the BCG vaccine and 595 hospitalizations for infection (mean, 0.28 hospitalization per child) among the 2133 children allocated to the control group (hazard ratio [HR], 0.99 [95% confidence interval (CI), 0.85-1.15]). The PP analysis yielded an HR of 1.00 (95% CI, 0.86-1.16).Predefined interaction ITT analyses showed that among 740 children with a BCG-vaccinated mother, the HR for BCG-vaccinated children was 0.65 (95% CI, 0.45-0.94); the HR for children who had a non-BCG-vaccinated mother was 1.10 (95% CI, 0.93-1.29) (P = .01, test of no interaction). Cesarean delivery modified the effect of BCG vaccination (HRs, 0.73 [95% CI, 0.54-0.99] in children born by cesarean section vs 1.10 [95% CI, 0.92-1.30] in other children; P = .02). When the outcome was defined as time to first hospitalization, the HR for premature children after BCG vaccination was 1.81 (95% CI, 0.95-3.43), whereas the HR was 0.94 (95% CI, 0.82-1.08) for children born at term (P = .05). CONCLUSION BCG vaccination did not affect the rate of hospitalization for infection up to the age of 15 months in Danish children. In future studies, the role of maternal BCG-vaccination, premature birth, and cesarean delivery needs further exploration.
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Affiliation(s)
- Lone Graff Stensballe
- Child and Adolescent Clinic, Juliane Marie Centret, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej, Copenhagen Ø, Denmark
| | - Henrik Ravn
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej, Copenhagen S, Denmark.,OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark
| | - Nina Marie Birk
- Department of Pediatrics, Copenhagen University Hospital, Hvidovre, Kettegaard Allé, Hvidovre, Denmark
| | - Jesper Kjærgaard
- Research Unit Womens' and Childrens' Health, Child and Adolescent Clinic, Juliane Marie Centret, Rigshospitalet, Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Thomas Nørrelykke Nissen
- Department of Pediatrics, Copenhagen University Hospital, Hvidovre, Kettegaard Allé, Hvidovre, Denmark
| | - Gitte Thybo Pihl
- Department of Pediatrics, Kolding Hospital, Skovvangen, Kolding and Institute of Regional Health Research, University of Southern Denmark
| | - Lisbeth Marianne Thøstesen
- Department of Pediatrics, Kolding Hospital, Skovvangen, Kolding and Institute of Regional Health Research, University of Southern Denmark
| | - Gorm Greisen
- Neonatal Department, Juliane Marie Centret, Rigshospitalet, Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Dorthe Lisbeth Jeppesen
- Department of Pediatrics, Copenhagen University Hospital, Hvidovre, Kettegaard Allé, Hvidovre, Denmark
| | - Poul-Erik Kofoed
- Department of Pediatrics, Kolding Hospital, Skovvangen, Kolding and Institute of Regional Health Research, University of Southern Denmark
| | - Ole Pryds
- Department of Pediatrics, Copenhagen University Hospital, Hvidovre, Kettegaard Allé, Hvidovre, Denmark
| | - Signe Sørup
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej, Copenhagen S, Denmark
| | - Peter Aaby
- Bandim Health Project, Statens Serum Institut, Copenhagen S, Denmark
| | - Christine Stabell Benn
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark.,Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, Copenhagen S, Denmark
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The influence of neonatal Bacille Calmette-Guérin (BCG) immunisation on heterologous vaccine responses in infants. Vaccine 2019; 37:3735-3744. [PMID: 31153688 DOI: 10.1016/j.vaccine.2019.03.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/10/2019] [Accepted: 03/11/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Bacillus Calmette-Guérin vaccine (BCG), one of the most widely used vaccines, does not only provide protection against tuberculosis and other mycobacterial infections, but also has non-specific (heterologous) immunomodulatory effects. In participants in a randomised trial, we investigated the effect of neonatal BCG immunisation on antibody responses to routine infant vaccines given in the first year of life. METHODS Antibodies against antigens in the diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b (Hib), and the 13-valent pneumococcal conjugate vaccines were measured in 91 (45 BCG-vaccinated, 46 BCG-naïve) infants one month after, and in 310 (169 BCG-vaccinated, 141 BCG-naïve) infants seven months after immunisation at 6 weeks, 4 and 6 months of age. In addition, antibodies against meningococcus C, Hib, measles, mumps, and rubella were measured in 147 (78 BCG-vaccinated, 69 BCG-naïve) infants one month after immunisation at 12 months of age. The seroprotection rates for each vaccine and the geometric mean concentrations (GMC) of antibodies were compared in BCG-vaccinated and BCG-naïve infants. RESULTS At 7 months of age, seroprotection rates were high in both BCG-vaccinated and BCG-naïve infants. At 13 months of age, seroprotection rates were lower than at 7 months of age, particularly for pertussis and a number of pneumococcal antigens, with generally higher rates for the latter in BCG-vaccinated infants. Although not statistically significant, antibody responses in BCG-vaccinated infants were consistently higher against diphtheria, tetanus, and pneumococcal antigens at both 7 and 13 months of age, and against measles and mumps at 13 months of age, but were lower against Hib one month after immunisation at both 7 and 13 months of age. CONCLUSION The immunomodulatory effect of BCG on antibody responses to heterologous vaccines adds to the evidence that BCG immunisation at birth has broad heterologous effects on the infant immune system.
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40
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Amaruddin AI, Wahyuni S, Hamid F, Chalid MT, Yazdanbakhsh M, Sartono E. BCG scar, socioeconomic and nutritional status: a study of newborns in urban area of Makassar, Indonesia. Trop Med Int Health 2019; 24:736-746. [PMID: 30884012 PMCID: PMC6849812 DOI: 10.1111/tmi.13232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective To investigate factors that determine the response to Bacille Calmette–Guérin (BCG) vaccination in urban environments with respect to socioeconomic status (SES), prenatal exposure to infections or newborn's nutritional status. Methods The study was conducted in an urban area, in Makassar, Indonesia. At baseline, 100 mother and newborns pair from high and low SES communities were included. Intestinal protozoa, soil transmitted helminths, total IgE, anti‐Hepatitis A Virus IgG and anti‐Toxoplasma IgG were measured to determine exposure to infections. Information on gestational age, birth weight/height and delivery status were collected. Weight‐for‐length z‐score, a proxy for newborns adiposity, was calculated. Leptin and adiponectin from cord sera were also measured. At 10 months of age, BCG scar size was measured from 59 infants. Statistical modelling was performed using multiple linear regression. Results Both SES and birth nutritional status shape the response towards BCG vaccination at 10 months of age. Infants born to low SES families have smaller BCG scar size compared to infants born from high SES families and total IgE contributed to the reduced scar size. On the other hand, infants born with better nutritional status were found to have bigger BCG scar size but this association was abolished by leptin levels at birth. Conclusion This study provides new insights into the importance of SES and leptin levels at birth on the development of BCG scar in 10 months old infants.
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Affiliation(s)
- Aldian Irma Amaruddin
- Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.,Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sitti Wahyuni
- Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Firdaus Hamid
- Department of Microbiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Maisuri T Chalid
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Maria Yazdanbakhsh
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Erliyani Sartono
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
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41
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Two Randomized Trials of the Effect of the Russian Strain of Bacillus Calmette-Guérin Alone or With Oral Polio Vaccine on Neonatal Mortality in Infants Weighing <2000 g in India. Pediatr Infect Dis J 2019; 38:198-202. [PMID: 30256314 DOI: 10.1097/inf.0000000000002198] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In randomized trials in Guinea-Bissau, the Danish strain of Bacillus Calmette-Guérin (BCG) reduces neonatal mortality, primarily by reducing deaths from pneumonia and sepsis. Because World Health Organization-prequalified BCG-Denmark was not available in India, we conducted 2 randomized trials to test whether BCG-Russia alone or with oral polio vaccine (OPV) has similar effects to BCG-Denmark. METHODS We randomized neonates weighing <2000 g to a control group that was not vaccinated before 28 days of age or to receive either BCG-Russia alone (first trial) or BCG-Russia with OPV (second trial) soon after birth. We performed intention-to-treat analysis using Cox hazards models with age as the underlying time and adjusted for weight, sex and inborn versus outborn status. RESULTS Administration of BCG-Russia alone had no effect on neonatal mortality (to 28 days of age): 15.6% of 1537 infants died in the BCG-Russia group and 16.1% of 1535 died in the control group; the adjusted hazard ratio was 0.95 [95% confidence interval (CI): 0.80-1.13]. Administration of BCG-Russia with OPV also had no effect on neonatal mortality: 18.0% of 1103 infants died in the BCG-OPV group and 17.6% of 1104 died in the control group; the adjusted hazard ratio was 1.01 (95% CI: 0.83-1.23). The adjusted hazard ratio for the 2 trials combined was 0.98 (95% CI: 0.85-1.11). CONCLUSIONS BCG-Russia with or without OPV had no effect on neonatal mortality. It is important to determine which strains of BCG have the greatest specific effects (on tuberculosis) and nonspecific effects (on infections other than tuberculosis) in high-mortality regions.
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Butkeviciute E, Jones CE, Smith SG. Heterologous effects of infant BCG vaccination: potential mechanisms of immunity. Future Microbiol 2018; 13:1193-1208. [PMID: 30117744 PMCID: PMC6190278 DOI: 10.2217/fmb-2018-0026] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The current antituberculosis vaccine, BCG, was derived in the 1920s, yet the mechanisms of BCG-induced protective immunity and the variability of protective efficacy among populations are still not fully understood. BCG challenges the concept of vaccine specificity, as there is evidence that BCG may protect immunized infants from pathogens other than Mycobacterium tuberculosis – resulting in heterologous or nonspecific protection. This review summarizes the up-to-date evidence for this phenomenon, potential immunological mechanisms and implications for improved childhood vaccine design. BCG induces functional changes in infant innate and adaptive immune compartments, encouraging their collaboration in the first year of life. Understanding biological mechanisms beyond heterologous BCG effects is crucial to improve infant protection from infectious diseases.
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Affiliation(s)
- Egle Butkeviciute
- Department of Immunology & Infection, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - Christine E Jones
- Faculty of Medicine & Institute for Life Sciences, University of Southampton & University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, United Kingdom.,Paediatric Infectious Diseases Research Group, St George's, University of London, Cranmer Terrace, London, SW17 0RE, United Kingdom
| | - Steven G Smith
- Department of Immunology & Infection, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
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de Bree LCJ, Koeken VACM, Joosten LAB, Aaby P, Benn CS, van Crevel R, Netea MG. Non-specific effects of vaccines: Current evidence and potential implications. Semin Immunol 2018; 39:35-43. [PMID: 30007489 DOI: 10.1016/j.smim.2018.06.002] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/05/2018] [Accepted: 06/08/2018] [Indexed: 12/17/2022]
Abstract
Besides protection against specific microorganisms, vaccines can induce heterologous or non-specific effects (NSE). Epidemiological data suggest that vaccination with live-attenuated vaccines such as Bacillus Calmette-Guérin (BCG), measles vaccine, and oral polio vaccine results in increased overall childhood survival, and several of these observations have been confirmed in randomized trials. Immunological mechanisms mediating NSE include heterologous lymphocyte effects and induction of innate immune memory (trained immunity). Trained immunity induces long-term functional upregulation of innate immune cells through epigenetic and metabolic reprogramming. An overview of the epidemiological evidence of non-specific effects of vaccines and the latest insights regarding the biological mechanisms behind this phenomenon is presented, and future research priorities and potential implications are discussed.
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Affiliation(s)
- L C J de Bree
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands; Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark; Odense Patient Data Explorative Network, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Valerie A C M Koeken
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Leo A B Joosten
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter Aaby
- Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark; Odense Patient Data Explorative Network, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Christine Stabell Benn
- Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark; Odense Patient Data Explorative Network, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands; Department for Genomics & Immunoregulation, Life and Medical Sciences Institute (LIMES), University of Bonn, Bonn, Germany.
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Zimmermann P, Curtis N. The influence of BCG on vaccine responses – a systematic review. Expert Rev Vaccines 2018; 17:547-554. [DOI: 10.1080/14760584.2018.1483727] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Petra Zimmermann
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- Infectious Diseases Unit, The Royal Children’s Hospital Melbourne, Parkville, Australia
- Infectious Diseases & Microbiology Research Group, Murdoch Children’s Research Institute, Parkville, Australia
- Infectious Diseases Unit, University of Basel Children’s Hospital, Basel, Switzerland
| | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- Infectious Diseases Unit, The Royal Children’s Hospital Melbourne, Parkville, Australia
- Infectious Diseases & Microbiology Research Group, Murdoch Children’s Research Institute, Parkville, Australia
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Can colony-forming unit testing be used to extend the shelf life of BCG vaccines? Tuberculosis (Edinb) 2018; 111:188-192. [DOI: 10.1016/j.tube.2018.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/28/2018] [Accepted: 06/04/2018] [Indexed: 11/18/2022]
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Tuberculin skin test reaction is related to memory, but not naive CD4 + T cell responses to mycobacterial stimuli in BCG-vaccinated young adults. Vaccine 2018; 36:4566-4577. [PMID: 29909133 DOI: 10.1016/j.vaccine.2018.05.068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/11/2018] [Accepted: 05/13/2018] [Indexed: 12/31/2022]
Abstract
Bacillus Calmette-Guérin (BCG) is the only vaccine available against tuberculosis and the tuberculin skin test (TST) is the most widely used method to detect BCG take. However, subjects may remain TST-negative, even after several BCG administrations. To investigate some of the potential reasons underlying this inability of developing tuberculin sensitivity in response to BCG we compared the effect of different mycobacterial stimuli in the groups differently responding to tuberculin. TST was performed on 71 healthy adults aged 25-30 years, who had received BCG in their childhood, and considered TST-positive at ≥10 mm. Dendritic cells (DCs) were incubated with PPD, live BCG or rBCGhIL-18, producing human IL-18. The latter strain was used to investigate whether the production of IL-18 could overcome some of the immune read-out limitations in the TST-negative subjects. CD86, CD80, CD40, and DC-specific intracellular adhesion molecule-3 grabbing nonintegrin (DC-SIGN) expression was analysed by flow cytometry and IL-10, IL-23 and IP-10 secretion in culture supernatants by ELISA. In DCs-T cell co-cultures with naive and memory CD4+ T cells, the IFN-γ and IL-10 levels were determined by ELISA. We found no difference in IL-10 and IFN-γ production by naive T cells between the TST-negative and TST-positive subjects. However, IFN-γ was produced in significantly higher amounts by memory T cells incubated with PPD, BCG or rBCGhIL-18-pulsed DCs in TST-positive than in TST-negative subjects, whereas the numbers of the IFN-γ-producing T cells were similar in both groups. This difference may be partially due to a decreased CD40 and enhanced reduction in DC-SIGN expression by DCs of TST-negative versus TST-positive subjects. A strong effect of IL-18 expression by rBCGhIL-18 on IL-23 production by the DC was seen in both groups, which likely was the reason for the increased IFN-γ production by naïve T cells upon incubation with mycobacteria-pulsed DC, regardless of the TST status.
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Bacillus Calmette-Guerin (BCG) vaccine in Iran. J Clin Tuberc Other Mycobact Dis 2018; 11:22. [PMID: 31720387 PMCID: PMC6830148 DOI: 10.1016/j.jctube.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 02/23/2018] [Indexed: 11/23/2022] Open
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Funch KM, Thysen SM, Rodrigues A, Martins CL, Aaby P, Benn CS, Fisker AB. Determinants of BCG scarification among children in rural Guinea-Bissau: A prospective cohort study. Hum Vaccin Immunother 2018; 14:2434-2442. [PMID: 29293396 PMCID: PMC6284494 DOI: 10.1080/21645515.2017.1421879] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Bacillus Calmette-Guérin (BCG) vaccination may have beneficial non-specific effects on child survival, the effects being stronger for children developing a scar. In a prospective cohort study, we examined determinants for not developing a BCG scar within 6 months of vaccination. Methods: Bandim Health Project (BHP) runs a Health and Demographic Surveillance System site in rural Guinea-Bissau. BHP provides BCG at monthly visits. We studied determinants for not developing a BCG scar using binomial regression models to obtain relative risks (RR). Results: From May 2012 until October 2014, BHP nurses vaccinated 2415 infants with BCG. We assessed BCG scar between 6 and 12 months of age for 2156 (89%) of these children and 2115 (98%) had developed a scar. In comparison, among 785 children BCG vaccinated elsewhere, 622 (79%) had a scar, the RR of not having a scar being 10.91 (7.52-15.85) compared with children vaccinated by BHP. Among children vaccinated by BHP, those receiving the Russian BCG strain were more likely not to develop a scar (RR = 2.98 (1.52–5.81)) compared with children receiving Danish BCG strain. Children with no post-injection wheal or a wheal <3 mm were more likely to not develop a scar (RR = 9.05 (3.69–22.20) and RR = 4.74 (1.96–11.45), respectively). Nutritional status and socioeconomic status were not associated with scarification. Conclusion: Vaccination technique and vaccine strain were associated with BCG scar development while nutritional status and socioeconomic status were not. Scarring rate may therefore be a better indicator of vaccination programme performance than coverage.
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Affiliation(s)
- Katarina M Funch
- a Bandim Health Project, Indepth Network , Guinea-Bissau.,b Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut , Copenhagen , Denmark
| | - Sanne M Thysen
- a Bandim Health Project, Indepth Network , Guinea-Bissau.,b Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut , Copenhagen , Denmark.,c Center for Global Health, Department of Public Health , Aarhus University , Denmark
| | | | | | - Peter Aaby
- a Bandim Health Project, Indepth Network , Guinea-Bissau.,b Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut , Copenhagen , Denmark
| | - Christine S Benn
- a Bandim Health Project, Indepth Network , Guinea-Bissau.,b Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut , Copenhagen , Denmark.,d OPEN, Odense Patient data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark , Denmark
| | - Ane B Fisker
- a Bandim Health Project, Indepth Network , Guinea-Bissau.,b Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut , Copenhagen , Denmark.,d OPEN, Odense Patient data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark , Denmark
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Darboe F, Adetifa JU, Reynolds J, Hossin S, Plebanski M, Netea MG, Rowland-Jones SL, Sutherland JS, Flanagan KL. Minimal Sex-Differential Modulation of Reactivity to Pathogens and Toll-Like Receptor Ligands following Infant Bacillus Calmette-Guérin Russia Vaccination. Front Immunol 2017; 8:1092. [PMID: 28951731 PMCID: PMC5599783 DOI: 10.3389/fimmu.2017.01092] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/21/2017] [Indexed: 11/13/2022] Open
Abstract
Bacillus Calmette–Guérin (BCG), the only licensed vaccine against tuberculosis, has been shown to provide heterologous protection against unrelated pathogens and enhance antibody responses to several routine expanded program on immunization (EPI) vaccines. Understanding these heterologous effects is important for the development of optimal vaccination strategies. We set out to assess the effect of vaccination with BCG Russia of 6-week-old infants on in vitro reactivity to a panel of toll-like receptor (TLR) agonists (TLR2, 4, and 7/8) and heat-killed pathogens [Streptococcus pneumoniae, Candida albicans (CA), and Escherichia coli], and antibody responses to other EPI vaccines compared to BCG naïve infants. We observed no effect of BCG vaccination on innate (TNF-α) or Th2 (IL-4) cytokine responses, but found enhanced CA-specific CD8+IFN-γ+ responses in BCG vaccinated males and females 1 week after vaccination and decreased IFN-γ:IL4 ratio to SP in females. By 12 weeks (but not 1 week) of post-vaccination, there was significant downmodulation of Th1 cytokine responses in BCG vaccinated infants; and TLR-stimulated IL-10 and IL-17 responses declined in BCG vaccinated females but not males. Significant changes also occurred in the BCG naïve group, mainly at 18 weeks, including decreased Th1 and increased IL-10 responses. The effects at 18 weeks were most likely a result of immune modulation by the intervening EPI vaccines given at 8, 12, and 16 weeks of age. There was no effect of BCG vaccination on EPI antibody levels at either time point. Taken together, our results support minimal early heterologous immune modulation by BCG Russia vaccination that did not persist 12 weeks after vaccination.
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Affiliation(s)
| | | | - John Reynolds
- Biostatistics Consulting Platform, Faculty of Medicine, Nursing and Health Sciences, Monash University, Prahran, VIC, Australia
| | | | - Magdalena Plebanski
- Department of Immunology and Pathology, Monash University, Prahran, VIC, Australia.,Monash Institute of Medical Engineering, Monash University, Prahran, VIC, Australia
| | - Mihai G Netea
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Nijmegen University Nijmegen Medical Center, Nijmegen, Netherlands
| | - Sarah L Rowland-Jones
- Vaccines and Immunity Theme, MRC Unit, Fajara, Gambia.,Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Katie L Flanagan
- Vaccines and Immunity Theme, MRC Unit, Fajara, Gambia.,Department of Immunology and Pathology, Monash University, Prahran, VIC, Australia.,School of Medicine, University of Tasmania, Hobart, TAS, Australia
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