July 18: 90 Years of Tuberculosis Vaccination
July 18, 2011, marks an important anniversary in the history of infectious disease and vaccines—on July 18, 1921, the tuberculosis vaccine was first given to a human. The vaccine, developed by French scientists Albert Calmette and Camille Guérin, was an oral preparation of Bacillus Calmette-Guérin, or BCG in shorthand. BCG is a weakened form of a tuberculosis bacterium that causes the disease in cows. Benjamin Weill-Hall (1875-1958), French pediatrician and bacteriologist, fed the vaccine to an infant in Paris who were at risk for the disease in this first use of the vaccine.
Albert Calmette (1863-1933) had acquired the Mycobacterium bovis strain of tuberculosis, which had been isolated from the milk of an infected cow, in 1904. In 1908, at the Institut Pasteur in Lille, France, he and veterinarian Jean-Marie Camille Guérin (1872-1961) began attenuating M. bovis by passing it through a growth medium they had developed specifically for this purpose. Their immediate goal was to weaken the bacteria to the point where they could no longer kill a guinea pig. In the end, the researchers hoped to produce an attenuated strain of the bacillus that would safely confer immunity to an uninfected human host. It would be 13 years before they saw the fruits of their efforts.
The League of Nations endorsed the oral BCG vaccine in 1928. Intradermal (injected) BCG vaccine began to be used in 1927; this became the most common mode of delivery of the vaccine. Today, BCG vaccine is not routinely used in the United States, but is given to about 100 million children worldwide each year. The vaccine does not prevent primary tuberculosis infection (though it does protect children from certain severe forms of tuberculosis). As the World Health Organization says in its position paper on tuberculosis vaccine, “Despite its shortcomings, BCG vaccination is considered a life-saving and important part of standard TB control measures in most endemic countries.”
More than 9.4 million new cases of tuberculosis are diagnosed each year, and one in three individuals worldwide is infected. An estimated 1.7 million people died from tuberculosis in 2009. Thus the need for new, more effective TB vaccines is clear, and many groups are working toward this goal. One of the concepts being studied is a so-called prime-boost regimen, in which one vaccine is given to ready the immune system to recognize TB and another vaccine follows that stimulates the body’s memory immune cells. (This approach has been applied to HIV vaccines and resulted in encouraging results in one large-scale trial.) The Aeras Global TB Vaccine Foundation, a nonprofit organization devoted to TB prevention, is one of the leading groups in developing and testing TB vaccines.
Aeras Global TB Foundation. Vaccine Science: TB Vaccine. http://www.aeras.org/about-tb/vaccine-science.php
Plotkin SA, Orenstein WA, Offit PA. Vaccines, 5th ed. Philadelphia: Saunders, 2008.
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World Health Organization. Vaccine Position Papers: BCG. http://www.who.int/wer/2004/en/wer7904.pdf
World Health Organization. Tuberculosis. http://www.who.int/mediacentre/factsheets/fs104/en/