Dowd Jennifer B, Fletcher Helen A, Boccia Delia
Department of Global Health and Social Medicine, King's College London, London, UK.
CUNY Graduate School of Public Health and Health Policy, New York, NY, USA.
F1000Res. 2018 Feb 23;7:224. doi: 10.12688/f1000research.14085.1. eCollection 2018.
A high burden of TB mortality persists despite the long-term availability of the bacillus Calmette-Guérin (BCG) vaccine, whose efficacy has been highly variable across populations. Innovative and alternative approaches to TB prevention are urgently needed while optimal biomedical tools continue to be developed. We call for new interdisciplinary collaborations to expand and integrate our understanding of how social determinants influence the biological processes that lead to TB disease, how this translates into differential BCG efficacy and, ultimately, how social protection interventions can play a role in reducing the global burden of TB. After providing an overview of the immune pathways important for the establishment of a response to the BCG vaccine, we outline how social determinants and psychosocial stressors can contribute to the observed variation in BCG efficacy above and beyond these biological factors. We conclude by proposing a new interdisciplinary research model based on the integration of social epidemiology theories with biomedical knowledge.
尽管长期以来一直有卡介苗（BCG）疫苗，但结核病死亡率仍然很高，其在不同人群中的疗效差异很大。在继续开发最佳生物医学工具的同时，迫切需要创新和替代的结核病预防方法。我们呼吁开展新的跨学科合作，以扩大和整合我们对以下方面的理解：社会决定因素如何影响导致结核病的生物过程，这如何转化为卡介苗疗效的差异，以及社会保护干预措施最终如何在减轻全球结核病负担方面发挥作用。在概述了对卡介苗疫苗产生反应所重要的免疫途径后，我们概述了社会决定因素和心理社会压力源如何在这些生物学因素之外导致观察到的卡介苗疗效差异。我们最后提出了一种基于社会流行病学理论与生物医学知识整合的新的跨学科研究模型。
