BCG Vaccination Strategies for Tuberculosis Prevention
Summary
The Bacille Calmette–Guérin (BCG) vaccine remains the only licensed vaccine against tuberculosis (TB) and is central to global prevention strategies. Administered predominantly at birth, BCG confers reliable protection against severe paediatric forms of TB but exhibits variable efficacy against pulmonary disease in older children and adults. Contemporary strategies aim to optimise strain selection, administration timing and delivery platforms to enhance both infection-blocking and disease-limiting effects. Advances in genomic and proteomic profiling of BCG substrains have clarified how accumulated genetic differences influence metabolic pathways, cell-wall composition and antigen expression, thereby affecting immunogenicity. Refinements in immunological assays, including interferon-γ release assays, offer more precise measures of vaccine-induced protection and may accelerate the evaluation of novel regimens. Integrated approaches now encompass neonatal vaccination schedules, booster immunisations in adolescence or adulthood, and heterologous prime-boost combinations with next-generation candidates. These strategies are driving field trials and policy deliberations, with the ultimate goal of achieving durable, broad-spectrum immunity against Mycobacterium tuberculosis and reducing the global TB burden.
Research from Nature Portfolio
A comprehensive multi-omic investigation of fourteen world-wide BCG substrains has delineated the genomic and transcriptomic variations that underpin divergent metabolic states and cell-wall architectures. Quantitative proteomics across representative strains revealed differential expression of key immunogenic proteins, informing a robust phylogeny of BCG lineages. These insights provide a rational basis for selecting or engineering substrains with optimal antigenic profiles, and for standardising vaccine production to minimise batch-to-batch variability.
BCG Vaccination Strategies for Tuberculosis Prevention publication trend
The graph below shows the total number of articles in bcg vaccination strategies for tuberculosis prevention across all publications each year (not limited to Nature Index journals).
Technical terms
Live attenuated vaccine: A vaccine composed of weakened pathogens that elicit immune responses without causing disease.
Interferon-γ release assay (IGRA): A blood test measuring T-cell release of interferon-γ in response to Mycobacterium tuberculosis antigens.
QuantiFERON conversion: The change from a negative to a positive IGRA result, indicating new immune sensitisation to TB antigens.
Tuberculin skin test (TST): An intradermal injection of purified protein derivative to detect delayed hypersensitivity to mycobacterial antigens.
Strain diversity: Genetic and phenotypic variation among BCG substrains that can influence vaccine efficacy and immunogenicity.
References
- Effect of BCG vaccination against Mycobacterium tuberculosis infection in adult Brazilian health-care workers: a nested clinical trial. The Lancet Infectious Diseases (2024).
- Effectiveness of the primary Bacillus Calmette-Guérin vaccine against the risk of Mycobacterium tuberculosis infection and tuberculosis disease: a meta-analysis of individual participant data. The Lancet Microbe (2024).
- Infant BCG vaccination and risk of pulmonary and extrapulmonary tuberculosis throughout the life course: a systematic review and individual participant data meta-analysis. The Lancet Global Health (2022).
- Genomic expression catalogue of a global collection of BCG vaccine strains show evidence for highly diverged metabolic and cell-wall adaptations. Scientific Reports (2015).
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