Ritz Nicole, Hanekom Willem A, Robins-Browne Roy, Britton Warwick J, Curtis Nigel
Department of Paediatrics, The University of Melbourne, Australia.
FEMS Microbiol Rev. 2008 Aug;32(5):821-41. doi: 10.1111/j.1574-6976.2008.00118.x. Epub 2008 Jul 9.
The Bacille Calmette-Guérin (BCG) vaccine has been used for more than 80 years to protect against tuberculosis. Worldwide, over 90% of children are immunized with BCG, making it the most commonly administered vaccine, with more than 120 million doses used each year. Although new tuberculosis vaccines are under investigation, BCG will remain the cornerstone of the strategy to fight the worsening tuberculosis pandemic for the foreseeable future. The recent delineation of genetic differences between BCG vaccine strains has renewed interest in the influence of the vaccine strain on the protective efficacy against tuberculosis. This review critically examines the data from animal and human studies comparing BCG vaccine strains. Although there is good evidence to support the notion that the induced immune response and protection afforded against tuberculosis differs between BCG vaccine strains, currently, there are insufficient data to favour or recommend one particular strain. Identifying BCG strains with superior protection would have a dramatic effect on tuberculosis control at a population level: a small increment in protection provided by BCG immunization will prevent large numbers of cases of severe tuberculosis and deaths, particularly in children.
卡介苗（BCG）疫苗已被用于预防结核病80多年。在全球范围内，超过90%的儿童接种了卡介苗，使其成为最常用的疫苗，每年使用剂量超过1.2亿剂。尽管新型结核病疫苗正在研究中，但在可预见的未来，卡介苗仍将是应对日益严重的结核病疫情战略的基石。最近对卡介苗疫苗株之间基因差异的描述，重新引发了人们对疫苗株对结核病保护效力影响的兴趣。这篇综述批判性地审视了比较卡介苗疫苗株的动物和人体研究数据。虽然有充分证据支持这样的观点，即不同卡介苗疫苗株诱导的免疫反应以及对结核病的保护作用存在差异，但目前，没有足够的数据支持或推荐某一特定菌株。确定具有更高保护力的卡介苗菌株将对人群层面的结核病控制产生巨大影响：卡介苗免疫提供的保护力稍有提高，就能预防大量严重结核病病例和死亡，尤其是在儿童中。
