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Immune responses to tuberculosis in developing countries: implications for new vaccines.

Rook GA, Dheda K, Zumla A

Centre for Infectious Diseases and International Health, Windeyer Institute for Medical Sciences, University College London, London W1T 4JF, UK. g.rook@ucl.ac.uk

Tuberculosis is out of control in developing countries, where it is killing millions of people every year. In these areas, the present vaccine - Mycobacterium bovis bacillus Calmette-Guérin (BCG) - is failing. Progressive tuberculosis occurs because the potentially protective T helper 1 (T(H)1)-cell response is converted to an immunopathological response that fails to eliminate the bacteria. Here, we discuss the data indicating that the problem in developing countries is not a lack of adequate T(H)1-cell responses but, instead, an exaggerated tendency to switch to immunopathological responses. We propose that a successful vaccine needs to block this immunopathology, because it is not the quantity of T(H)1-cell activity that matters but, rather, its context.

Published 1 August 2005 in Nat Rev Immunol, 5(8): 661-7.
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