Editorial response: variation in clinical and immune responses to bacille Calmette-Guérin--implications for an improved tuberculosis vaccine.

Renewed concern about the worldwide problem of tubercu- BCG 1 month after inoculation (one was still shedding viable losis has stimulated efforts to define mechanisms that allow BCG 2 months after inoculation). This finding prompts a cauMycobacterium tuberculosis unequaled success as a pathogen, tionary note from the investigators that shedding of viable BCG to identify new drug targets, and to develop an improved vac- may present a hazard to contacts with AIDS, with an attendant cine. In this issue of Clinical Infectious Diseases, Hoft and risk of disseminated BCG infection in the contacts. colleagues [1] report results of their efforts to characterize the Second, the investigators found some interesting correlations response to the existing tuberculosis vaccine, BCG. Despite with the duration of vaccine-induced ulceration. Subjects with widespread use of the BCG vaccine, its effects are not well the highest in vitro lymphoproliferative response to M. tubercuunderstood, controlled clinical trials have yielded variable re- losis antigens before vaccination had the shortest duration of sults, and it has not prevented tuberculosis from causing the ulceration. This finding illustrates that before vaccination, death of more humans each year than any other single infection. healthy volunteers with negative PPD skin tests differ in their responses detected by assays that are generally taken to reflect specific acquired cellular immunity. It is interesting to speculate

对全球结核病问题的再度关注，刺激了人们去明确结核分枝杆菌作为病原体取得无与伦比成功的机制，确定新的药物靶点以及研发一种改良疫苗的努力。卡介苗（BCG）接种后1个月（有1例在接种后2个月仍排出有活力的卡介苗）。这一发现促使研究人员发出警示，即排出有活力的卡介苗可能会对艾滋病患者的接触者构成危害，接触者随之有发生播散性卡介苗感染的风险。 其次，研究人员发现了一些与疫苗诱导的溃疡持续时间有关的有趣关联。在接种疫苗前对结核分枝杆菌抗原体外淋巴细胞增殖反应最高的受试者，其溃疡持续时间最短。这一发现表明，在接种疫苗前，结核菌素纯蛋白衍生物（PPD）皮肤试验阴性的健康志愿者，通过通常被认为反映特异性获得性细胞免疫的检测方法所检测到的反应存在差异。进行推测是很有趣的。