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What is next for BCG revaccination to prevent tuberculosis?

ARTICLE: What is next for BCG revaccination to prevent tuberculosis?

AUTHORS: Richard G White, Andrew J Fiore-Gartland, Willem A Hanekom, Johan Vekemans, Alberto L Garcia-Basteiro, Gavin Churchyard, Molebogeng X Rangaka, Mike Frick, Marcel A Behr, Philip C Hill, Vidya Mave

JOURNAL: Lancet Respir Med. 2024 Mar;12(3):e7-e8. doi: 10.1016/S2213-2600(24)00009-2. Epub 2024 Jan 22.

Early this year, the confirmatory phase 2b trial results on whether Bacillus Calmette–Guérin (BCG) revaccination prevents tuberculosis infection, or more accurately, whether it prevents conversion to a positive interferon-γ release assay (IGRA) test sustained over 6 months, will become available ( NCT04152161 ). Unfortunately, despite rigorous analysis, 1 the ability of BCG revaccination to prevent tuberculosis infection is not a reliable indicator of whether it would prevent tuberculosis disease.

Running a phase 3 prevention-of-disease randomised controlled trial would be ideal, but such a trial is expected to be prohibitively expensive, because the vaccine is thought only to work if given to individuals who have not been infected with tuberculosis, and few people who are initially uninfected with tuberculosis would develop tuberculosis disease, thus requiring large numbers of participants to be enrolled and followed up for many years.

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Kelsey Bennett

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