ten Dam H G, Pio A
Tubercle. 1982 Sep;63(3):225-33. doi: 10.1016/s0041-3879(82)80036-6.
Among the hypotheses offered to explain the conflicting results of various trials of BCG vaccination, the one invoking gross differences in the immunogenic properties of the various BCG vaccines (strains) has received most attention. Indeed, for many years research in BCG vaccination has been directed almost entirely towards improving the quality of vaccines. the anticipated benefit of this work, however, is not borne out by the results of the latest trial in India. Whereas it cannot be excluded that technological advances may have resulted in the worst vaccines ever, it also remains possible that the basic hypothesis was less relevant than presumed. the quality of the vaccine may be of little importance and a different explanation should be sought for the observed differences in protection. One possible lead is the observation that BCG vaccination consistently appeared to be of poor efficacy under conditions where, in a vaccination programme, even an effective vaccine would have little impact on the tuberculosis problem, i.e. where the majority of cases originated from the population already infected. The hypothesis offered is that in such populations the pathogenesis of tuberculosis is different from that prevailing under the clearly exceptional conditions under which BCG vaccination was effective. Rather than being the direct result of primary infection, tuberculous disease (observed) may be the result of reinfection. In this case BCG vaccination cannot be expected to have a protective effect.
在为解释卡介苗接种各种试验结果相互矛盾所提出的假说中，那种认为各种卡介苗（菌株）免疫原性存在显著差异的假说受到了最多关注。的确，多年来卡介苗接种研究几乎完全致力于提高疫苗质量。然而，印度最新试验结果并未证实这项工作预期的益处。虽然不能排除技术进步可能导致了有史以来最差的疫苗，但也有可能基本假说是不如所设想的那样相关。疫苗质量可能并不重要，应该为观察到的保护差异寻找不同的解释。一个可能的线索是观察到，在疫苗接种计划中，即使是一种有效的疫苗对结核病问题影响也很小的情况下，即在大多数病例源自已经感染人群的情况下，卡介苗接种始终显示出效果不佳。所提出的假说是，在这类人群中，结核病的发病机制与卡介苗接种有效的明显特殊条件下盛行的发病机制不同。观察到的结核疾病可能不是原发感染的直接结果，而是再感染的结果。在这种情况下，不能期望卡介苗接种具有保护作用。
