Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, Gelderland 6525 GA, the Netherlands.
Centre for International Health, University of Otago, Dunedin, North Dunedin 9016, New Zealand.
Med. 2022 Jan 14;3(1):6-24. doi: 10.1016/j.medj.2021.11.006. Epub 2021 Dec 31.
Bacillus Calmette-Guérin (BCG) was developed exactly 100 years ago, and it is still the only licensed tuberculosis (TB) vaccine and the most frequently administered of all vaccines worldwide. Despite universal vaccination policies in TB-endemic settings, the burden of TB remains high. Although BCG protects against Mycobacterium tuberculosis infection and TB disease, the level of protection varies greatly between age groups and settings. In this review, we present a historical perspective and describe the evidence for BCG's ability to protect against TB as well as the factors that influence protection. We also present the immunological mechanisms through which BCG vaccination induces protection, focusing on T cell, B cell, and innate immunity. Finally, we discuss several possibilities to boost BCG's efficacy, including alternative vaccination routes, BCG revaccination, and use of recombinant BCG vaccines, and describe the knowledge gaps that exist with respect to BCG's protection against TB.
卡介苗（BCG）是 100 年前开发的，它仍然是唯一获准使用的结核病（TB）疫苗，也是全世界接种最广泛的疫苗。尽管在结核病流行地区实施了普遍疫苗接种政策，但结核病负担仍然很高。虽然卡介苗可预防结核分枝杆菌感染和结核病，但在不同年龄段和不同环境下，其保护效果差异很大。在这篇综述中，我们介绍了卡介苗的历史背景，并描述了其预防结核病的能力以及影响保护效果的因素。我们还介绍了卡介苗疫苗接种诱导保护的免疫机制，重点介绍 T 细胞、B 细胞和先天免疫。最后，我们讨论了几种提高卡介苗效果的可能性，包括替代接种途径、卡介苗复种和使用重组卡介苗疫苗，并描述了卡介苗预防结核病的保护作用方面存在的知识空白。
