Tuberculosis primary prevention: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Tuberculosis}} | {{Tuberculosis}} | ||
{{CMG}} | {{CMG}}; {{AE}} {{AL}} | ||
==Overview== | ==Overview== | ||
== Primary Prevention == | == Primary Prevention == | ||
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===BCG Vaccine=== | |||
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Many countries use [[Bacillus Calmette-Guérin|BCG]] vaccine as part of their TB control programs, especially for infants. This was the first vaccine for TB and developed at the [[Pasteur Institute]] in France between 1905 and 1921.<ref name=Bonah>{{cite journal |author=Bonah C |title=The 'experimental stable' of the BCG vaccine: safety, efficacy, proof, and standards, 1921–1933 |journal=Stud Hist Philos Biol Biomed Sci |volume=36 |issue=4 |pages=696–721 |year=2005 | pmid = 16337557}}</ref> However, mass vaccination with BCG did not start until after World War II.<ref name=Comstock>{{cite journal |author=Comstock G |title=The International Tuberculosis Campaign: a pioneering venture in mass vaccination and research |journal=Clin Infect Dis |volume=19 |issue=3 |pages=528-40 |year=1994 | pmid = 7811874}}</ref> The protective efficacy of BCG for preventing serious forms of TB (e.g. [[meningitis]]) in children is greater than 80%; its protective efficacy for preventing pulmonary TB in adolescents and adults is variable, ranging from 0 to 80%.<ref name=Bannon_1999>{{cite journal |author=Bannon M |title=BCG and tuberculosis |journal=Arch Dis Child |volume=80 |issue=1 |pages=80-3 |year=1999 | pmid = 10325767}}</ref> | |||
In South Africa, the country with the highest prevalence of TB, BCG is given to all children under the age of three.<ref>[http://web.archive.org/web/20070630073246/http://www.who.int/immunization_monitoring/data/south_africa.pdf WHO/UNICEF Review of National Immunization Coverage 1980–2005: South Africa] (PDF). World Health Organization (August 2006). Retrieved on 2007-06-08.</ref> However, the effectiveness of BCG is lower in areas where mycobacteria are less [[prevalence|prevalent]], therefore BCG is not given to the entire population in these countries. In the USA, for example, BCG vaccine is not recommended except for people who meet specific criteria: | In South Africa, the country with the highest prevalence of TB, BCG is given to all children under the age of three.<ref>[http://web.archive.org/web/20070630073246/http://www.who.int/immunization_monitoring/data/south_africa.pdf WHO/UNICEF Review of National Immunization Coverage 1980–2005: South Africa] (PDF). World Health Organization (August 2006). Retrieved on 2007-06-08.</ref> However, the effectiveness of BCG is lower in areas where mycobacteria are less [[prevalence|prevalent]], therefore BCG is not given to the entire population in these countries. In the USA, for example, BCG vaccine is not recommended except for people who meet specific criteria: | ||
*Infants or children with negative skin-test results who are continually exposed to untreated or ineffectively treated patients or will be continually exposed to [[Multidrug resistance|multidrug-resistant]] TB. | *Infants or children with negative skin-test results who are continually exposed to untreated or ineffectively treated patients or will be continually exposed to [[Multidrug resistance|multidrug-resistant]] TB. | ||
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Several new vaccines to prevent TB infection are being developed. The first recombinant tuberculosis [[vaccine]] entered [[clinical trial]]s in the United States in 2004, sponsored by the [[National Institute of Allergy and Infectious Diseases]] (NIAID).<ref>[[National Institute of Allergy and Infectious Diseases]] (NIAID).[http://www.nih.gov/news/pr/jan2004/niaid-26.htm First U.S. Tuberculosis Vaccine Trial in 60 Years Begins.] ''National Institutes of Health News'' 26 January 2004. Retrieved on 19 October 2007.</ref> A 2005 study showed that a [[DNA vaccine|DNA TB vaccine]] given with conventional [[chemotherapy]] can accelerate the disappearance of bacteria as well as protect against re-infection in mice; it may take four to five years to be available in humans.<ref name=Ha_2005>{{cite journal |author=Ha S, Jeon B, Youn J, Kim S, Cho S, Sung Y |title=Protective effect of DNA vaccine during chemotherapy on reactivation and reinfection of Mycobacterium tuberculosis |journal=Gene Ther |volume=12 |issue=7 |pages=634-8 |year=2005 | pmid = 15690060}}</ref> A very promising TB vaccine, [[MVA85A]], is currently in [[clinical trial|phase II trials]] in South Africa by a group led by Oxford University,<ref name=Ibanga_2006>{{cite journal |author=Ibanga H, Brookes R, Hill P, Owiafe P, Fletcher H, Lienhardt C, Hill A, Adegbola R, McShane H |title=Early clinical trials with a new tuberculosis vaccine, MVA85A, in tuberculosis-endemic countries: issues in study design |journal=Lancet Infect Dis |volume=6 |issue=8 |pages=522-8 |year=2006 |url=http://linkinghub.elsevier.com/retrieve/pii/S1473309906705527| pmid = 16870530}}</ref> and is based on a genetically modified [[vaccinia]] virus. Because of the limitations of current vaccines, researchers and policymakers are promoting new economic models of vaccine development including prizes, tax incentives and [[advance market commitments]].<ref>Webber, David and Kremer, Michael. [http://www.who.int/bulletin/archives/79(8)735.pdf Stimulating Industrial R&D for Neglected Infectious Diseases: Economic Perspectives (PDF).] ''Bulletin of the World Health Organization'' 79(8), 2001, pp. 693–801.</ref><ref>Barder, Owen; Kremer, Michael; Williams, Heidi. [http://www.bepress.com/ev/vol3/iss3/art1 "Advance Market Commitments: A Policy to Stimulate Investment in Vaccines for Neglected Diseases,"] ''The Economists' Voice'', Vol. 3 (2006) Issue 3.</ref> | Several new vaccines to prevent TB infection are being developed. The first recombinant tuberculosis [[vaccine]] entered [[clinical trial]]s in the United States in 2004, sponsored by the [[National Institute of Allergy and Infectious Diseases]] (NIAID).<ref>[[National Institute of Allergy and Infectious Diseases]] (NIAID).[http://www.nih.gov/news/pr/jan2004/niaid-26.htm First U.S. Tuberculosis Vaccine Trial in 60 Years Begins.] ''National Institutes of Health News'' 26 January 2004. Retrieved on 19 October 2007.</ref> A 2005 study showed that a [[DNA vaccine|DNA TB vaccine]] given with conventional [[chemotherapy]] can accelerate the disappearance of bacteria as well as protect against re-infection in mice; it may take four to five years to be available in humans.<ref name=Ha_2005>{{cite journal |author=Ha S, Jeon B, Youn J, Kim S, Cho S, Sung Y |title=Protective effect of DNA vaccine during chemotherapy on reactivation and reinfection of Mycobacterium tuberculosis |journal=Gene Ther |volume=12 |issue=7 |pages=634-8 |year=2005 | pmid = 15690060}}</ref> A very promising TB vaccine, [[MVA85A]], is currently in [[clinical trial|phase II trials]] in South Africa by a group led by Oxford University,<ref name=Ibanga_2006>{{cite journal |author=Ibanga H, Brookes R, Hill P, Owiafe P, Fletcher H, Lienhardt C, Hill A, Adegbola R, McShane H |title=Early clinical trials with a new tuberculosis vaccine, MVA85A, in tuberculosis-endemic countries: issues in study design |journal=Lancet Infect Dis |volume=6 |issue=8 |pages=522-8 |year=2006 |url=http://linkinghub.elsevier.com/retrieve/pii/S1473309906705527| pmid = 16870530}}</ref> and is based on a genetically modified [[vaccinia]] virus. Because of the limitations of current vaccines, researchers and policymakers are promoting new economic models of vaccine development including prizes, tax incentives and [[advance market commitments]].<ref>Webber, David and Kremer, Michael. [http://www.who.int/bulletin/archives/79(8)735.pdf Stimulating Industrial R&D for Neglected Infectious Diseases: Economic Perspectives (PDF).] ''Bulletin of the World Health Organization'' 79(8), 2001, pp. 693–801.</ref><ref>Barder, Owen; Kremer, Michael; Williams, Heidi. [http://www.bepress.com/ev/vol3/iss3/art1 "Advance Market Commitments: A Policy to Stimulate Investment in Vaccines for Neglected Diseases,"] ''The Economists' Voice'', Vol. 3 (2006) Issue 3.</ref> | ||
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==References== | ==References== | ||
Revision as of 13:57, 24 September 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]