Search Results (325)

Background: In Uganda, COVID-19-related disruptions increased the number of children who missed scheduled routine vaccination (defaulters). Identifying and following up with defaulter children is important for improving vaccination coverage. This paper describes Uganda’s experience in revitalizing community-led defaulter tracking to improve vaccination coverage post-COVID-19 in four purposefully selected districts. Methods: During two 6-month periods in 2022 and 2024, healthcare workers (HCWs) worked with village health teams (VHTs) to review health facility-based immunization registers, identify and track defaulters aged 0 to 59 months. VHTs visited identified defaulters’ homes, reviewed vaccination histories and reminded caregivers to bring defaulters to immunization sites for catch-up vaccination. Results: Overall, 20,922 defaulters were identified by health register review; VHTs located 15,749 (75.3%) through household visits, of whom 3688 (23.4%) were verified as previously vaccinated based on their home-based vaccination records, leaving 12,061 as true defaulters. Among the true defaulters, 9662 (80.1%) received at least one catch-up vaccination after follow-up by the VHT. The most frequently administered catch-up vaccines were measles–rubella first dose (MR1) at 55.4%, followed by diphtheria–tetanus–pertussis third dose (DTP3) at 48.3% and Bacillus Calmette–Guérin (BCG) at 47.4%. Among the 2399 children who remained unvaccinated after follow-up, the most common reasons were relocation outside the original catchment area (49.5%) and caregiver intention to vaccinate later (16.3%). Conclusion: Community-led defaulter tracking was feasible and improved vaccination uptake in post-COVID-19 Uganda. Strengthening the quality and availability of health facility immunization data, along with targeted community engagement, caregiver reminders and integrated vaccination services would improve identification and follow-up of defaulters, reducing population immunity gaps. Full article

Background: In some children with immunodeficiency, Bacille Calmette–Guérin (BCG) vaccination can lead to dissemination and severe infection, including severe intracranial infection, called disseminated BCG disease (BCGosis), which is characterized by high rates of disability and mortality. However, the specific routes by which BCG crosses CNS barriers and the patterns of temporal remodeling of the CNS immune microenvironment during infection have yet to be fully elucidated. Methods: Mice were infected with BCG through tail vein injection to construct an intracerebral mycobacterial infection mouse model, wherein the brain was collected and analyzed using single-cell RNA sequencing. We profiled temporal transcriptomic changes in cell populations, pathways, and cell–cell communication associated with anti-mycobacterial activity and inflammation-induced disturbance of physiological brain activities. Results: After BCG was injected via tail vein, histopathological images and cultured colonies of brain tissue confirmed successful brain infection. Then, whole-brain tissue was dissected for 10× Genomics single-cell sequencing, and we acquired 15 cell types. Dysfunction and inflammatory responses were observed in endothelial and ependymal cells. Infection induced dynamic state transitions in microglia, enabling their differentiation into disease-related and interferon-responsive states. Along with peripheral immune cells, microglia formed temporally structured communication networks that mediated early events such as chemokine recruitment and inflammatory storms, and facilitated late-stage immune checkpoint upregulation. Conclusions: This study proposes BCSFB as a possible pathway of mycobacteria invasion and reveals the temporality of immune response processes in the pathogenesis of intracerebral mycobacterial infection. Full article

Toxoplasma gondii and Neospora caninum are apicomplexan parasites infecting cattle, with implications for public health and livestock productivity, respectively. Since effective vaccines against these parasites are not currently available, identifying epidemiological factors associated with infection is important for improving control strategies. This study aimed to estimate the seroprevalence of both parasites and to identify factors associated with seropositivity in intensive dairy cattle in central Chile. A cross-sectional study was conducted using serum samples from 567 cattle, analyzed by ELISA. Epidemiological data were collected through semi-structured surveys, and associations with seropositivity were evaluated using multivariable logistic regression models, including mixed-effects models to account for farm-level clustering. Seroprevalence was 7.6% for T. gondii and 22.4% for N. caninum. For T. gondii, factors associated with seropositivity included older age categories (OR = 7.09; 11.25) and the presence of dogs in pens (OR = 6.07). For N. caninum, straw bedding use (OR = 5.13) and cat presence (OR = 6.32) were associated with higher odds of seropositivity. An additional association with lower N. caninum seropositivity was observed for BCG vaccination (OR = 0.24). These findings provide updated epidemiological data for dairy cattle in Chile. The association observed with BCG vaccination should be interpreted cautiously, as the study design does not permit causal inference. Full article

In addition to inducing pathogen-specific adaptive immune responses, vaccines can train the innate immune system, thereby providing broader host protection. This concept of trained immunity (TRIM) is well-established in benchtop laboratory science. This review aims to evaluate the current evidence of vaccine-induced TRIM and translate these findings into a clinical context. Various laboratory methods are used to assess TRIM; however, inconsistent results have been reported across non-BCG vaccine studies. Existing analyses lack exploration of the mechanistic basis of vaccine-induced TRIM, particularly epigenetic reprogramming and metabolic rewiring. Patterns emerge between vaccines: live-attenuated vaccines generally induce TRIM, as evidenced by increased inflammatory cytokine production upon restimulation, whereas non-live vaccines tend to demonstrate reduced trained immunity. Such findings are not consistently observed for mRNA vaccines, which show heterogeneous patterns. The limited variety of studies on non-BCG vaccines impacts the reliability of findings. A more comprehensive understanding of the mechanisms and outputs of TRIM induced by specific vaccines could better inform rational vaccine design. Furthermore, various modifiers can alter vaccine-induced TRIM responses, including sequence and route of administration, sex, and age. Consideration of these modifiers has important clinical implications in optimising vaccine administration for enhanced immune protection. Full article

Mycobacterium bovis, the causative agent of bovine tuberculosis, infects and persists within macrophages, triggering pro-inflammatory responses. While these mechanisms are well characterized for Mycobacterium tuberculosis, less is known about host responses to M. bovis. Inflammasome activation and IL-1β production have been linked to ESAT-6, a substrate of the ESX-1 secretion system present in both species. Here, we examined inflammasome activation in bovine macrophages infected with the virulent M. bovis strain Mb04-303. M. bovis AF2122/97 and NCTC10772 upregulated IL-1β transcription, whereas Mb04-303 and BCG did not. Unexpectedly, deletion of the genes encoding ESAT-6 and CFP-10 from Mb04-303 enhanced inflammasome activation, as evidenced by increased NLRP3 and IL-1β transcription. Complementation with either wild-type ESAT-6/CFP-10 or the T63A ESAT-6 variant restored downregulation of the response, indicating that this substitution does not alter inflammasome modulation. In contrast, deletion of ESAT-6/CFP-10 from an attenuated M. bovis vaccine candidate reduced IL-1β transcription. No differences were observed between M. tuberculosis H37Rv and its ESAT-6-deficient mutant in bovine macrophages. Together, these findings demonstrate that ESAT-6/CFP-10-mediated modulation of inflammasome activation in bovine macrophages is highly dependent on the mycobacterial genetic background. Full article

The Bacillus Calmette–Guérin (BCG) vaccine, originally developed for tuberculosis (TB) prevention, has recently attracted attention due to its broader immunomodulatory properties. In addition to its role in TB control, BCG induces trained immunity, a process involving epigenetic and metabolic reprogramming of innate immune cells that leads to altered systemic inflammatory responses. Increasing evidence suggests that these long-term immune adaptations may influence the central nervous system by modulating microglial activation and neuroinflammatory pathways implicated in neurodegenerative diseases. In parallel, chronic infections such as TB are associated with persistent systemic inflammation and immune dysregulation, which may contribute to microglial priming and increased vulnerability to neurodegeneration. This narrative review, based on a targeted literature search of PubMed, Scopus, Web of Science, Embase, and relevant preprint servers, synthesizes current evidence on the relationships between BCG vaccination, trained immunity, and neuroimmune interactions. We focus on studies addressing systemic immune reprogramming, microglial responses, and neuroinflammatory mechanisms relevant to neurodegenerative disorders. The available data suggest that BCG-induced immune modulation may exert context-dependent effects on the brain, with potential neuroprotective implications under certain conditions. However, the evidence remains heterogeneous and largely observational, and causality cannot yet be established. Further mechanistic and prospective studies are required to clarify whether BCG-induced trained immunity can modify the risk or progression of age-related neurodegenerative diseases. Full article

Globally, Mycobacterium tuberculosis (Mtb) remains the leading cause of death from a single infectious agent. The only licensed vaccine, Bacillus Calmette–Guérin (BCG), was developed over a century ago and does not provide consistent protection against pulmonary tuberculosis (TB). Efforts to develop more effective vaccines are hindered by an incomplete understanding of the correlates of protection and by the pathogen’s sophisticated immune-evasion strategies. Mtb systematically undermines host defenses, reprograms host cell biology, and interferes with cell–cell communication to establish a permissive niche and sustain chronic infection. An effective vaccine must elicit immune responses capable of overcoming these bacterial strategies across diverse host and pathogen backgrounds. Traditional approaches focused on boosting T cell responses have proven inadequate. In this review, we summarize innate and adaptive immune mechanisms that contain Mtb, examine how bacterial immune subversion and host–pathogen heterogeneity complicate vaccine design, and highlight emerging concepts and strategies to guide TB vaccine development. Full article

Type II toxin–antitoxin (TA) systems are significantly expanded in the Mycobacterium tuberculosis complex; however, the functional role of the VapBC40 system in Mycobacterium bovis (M. bovis) pathogenesis remains poorly characterized. This study aimed to investigate the role of VapBC40 in mycobacterial virulence and evaluate its potential as a target for rational vaccine attenuation. We performed evolutionary analysis and yeast two-hybrid assays to characterize VapBC40 system specificity, conducted in vitro macrophage infection models and in vivo murine studies to assess virulence contribution, and evaluated the immunoprotective efficacy of a VapC40 knockout strain. Evolutionary analysis revealed progressive sequence conservation and stringent homologous pairing specificity within the VapBC40 system. The VapC40 toxin correlates with enhanced intracellular bacterial survival, increased host cell death, and more severe pulmonary pathology with systemic dissemination. Based on these findings, we evaluated the vaccine potential of a vapC40 knockout strain. Immunization with this attenuated strain elicited a Th1 cellular immune response, characterized by enhanced IFN-γ production and increased frequency of CD4⁺IFN-γ⁺ T cells. Upon challenge with virulent M. bovis, the knockout strain conferred superior protection compared to the conventional BCG vaccine, significantly reducing lung pathology and restricting extrapulmonary bacterial dissemination. Although the molecular mechanisms underlying VapC40-mediated effects remain to be fully elucidated, our findings suggest an important role of the VapBC40 system in mycobacterial-host interactions and support its potential as a target for next-generation tuberculosis vaccine development. Full article

Tuberculosis (TB) remains a leading cause of morbidity and mortality worldwide, with children representing a particularly vulnerable population in whom diagnosis is often challenging. Pediatric TB is typically paucibacillary and presents with non-specific clinical manifestations, limiting the sensitivity of microbiological confirmation and increasing reliance on immunological tests. The Tuberculin Skin Test (TST) and Interferon-Gamma Release Assays (IGRAs) are the most widely used tools for detecting Mycobacterium tuberculosis infection, yet both have important limitations, especially in young children and in Bacillus Calmette–Guérin (BCG)-vaccinated populations. TST lacks specificity due to cross-reactivity with BCG and environmental mycobacteria, while IGRAs, although more specific, require laboratory infrastructure and may have reduced sensitivity in early childhood. The Tuberculosis Skin Test (TBST), based on M. tuberculosis-specific antigens such as ESAT-6 and CFP-10, has emerged as a promising alternative that combines the operational simplicity of TST with the antigenic specificity of IGRA. This paper reviews the immunological principles, diagnostic performance, and practical considerations of TBST in pediatric populations, with direct comparison to TST and IGRA. Evidence from recent studies suggests that TBST may offer improved specificity over TST, with broadly comparable diagnostic accuracy to IGRA in some settings, although findings are not fully consistent across studies. Particular attention is given to its performance in BCG-vaccinated children and, based on emerging evidence, in those under five years of age. The potential role of TBST in clinical algorithms and public health strategies is discussed, along with current evidence gaps and future research priorities. Full article

Tuberculosis (TB) is the leading cause of infectious disease-related death globally. Most TB vaccine strategies have focused on conventional CD4 T cell responses, but to date, these have failed to deliver durable sterilizing protection. Donor unrestricted T cells (DURTs), including CD1-restricted T cells, HLA-E-restricted T cells, MR1-restricted T cells and γδ T cells represent an attractive complementary target for future TB vaccine development. They recognize antigens through conserved, non-polymorphic restricting elements and are therefore broadly targetable across genetically diverse populations. They are also enriched at mucosal sites, have rapid effector and cytotoxic capacities and recognize conserved mycobacterial ligands. Emerging human and animal data support their participation in antimycobacterial immunity and suggest they can be shaped by BCG vaccination and other immunization strategies. Here, we review the evidence for DURT involvement in TB host defense, assess their strengths and current limitations as vaccine targets, and discuss how DURT-directed approaches may help to enable faster, broader, and more durable protection against Mycobacterium tuberculosis. Full article

Background: The steady increase in allergic diseases among children has coincided with increased global vaccination coverage and the expansion of routine childhood immunization programs. This has contributed to the widespread belief that there is a possible link between immunoprophylaxis and allergic diseases. However, a number of scientific studies have demonstrated the protective effect of early neonatal immunization on the development of nonspecific immunological protection against infections. This is believed to be due to a shift in the immune response from the Th2 type, traditionally predominant in newborns, to the Th1 type, which reduces the risk of developing allergic diseases. Methods: This prospective cohort study analyzed the medical records of 2279 children born between 2018 and 2022 to evaluate the impact of neonatal BCG-M and hepatitis B (HepB) vaccination on the incidence of atopic dermatitis (AD) by 36 months of age. Factors analyzed included family history of allergy, cesarean section, prematurity, delayed initiation of breastfeeding, maternal antibiotic use during pregnancy, and antibiotic use in the child during the first three years of life. Results: The cumulative incidence of AD by 36 months of age was 19.9%. Timely neonatal vaccination coverage was 76.2% for BCG-M and 69.2% for HepB; by 12 months of age, these rates increased to 90.2% and 88.5%, respectively. A full-term birth demonstrated a significant protective effect (OR 0.52; 95% CI 0.30–0.93). A positive family history of allergy was the strongest predictor of AD (OR 21.49; 95% CI 14.4–32.9). Cesarean section was also significantly associated with AD (OR 1.30; 95% CI 1.01–1.65). AD incidence was comparable between vaccinated (20.5%) and non-vaccinated (17.5%) children (chi-squared with Yates’ correction, p = 0.192), indicating no statistically significant overall impact of immunization on AD risk. Conclusions: The development of AD is primarily driven by hereditary predisposition and specific perinatal factors rather than by routine immunization. These findings confirm that neonatal BCG-M and HepB vaccination does not increase the risk of AD, providing a scientific basis to address vaccine hesitancy. Full article

Background/Objectives: Tuberculosis remains one of the preventable causes of mortality among liver transplant recipients. The prevalence of tuberculosis in solid organ transplant recipients is higher than in the general population. The aim of this study was to evaluate the incidence of latent tuberculosis infection (LTBI) and active tuberculosis after liver transplantation. Methods: This is a retrospective, single-center, case–control study. Adult liver transplant candidates who were evaluated between 1 January 2016 and 31 December 2022 were retrospectively assessed. Patients with pre-transplant tuberculin skin test (TST) and/or interferon-gamma release assay (IGRA) results who underwent transplantation were included in this study. Results: A total of 111 liver transplant recipients with available IGRA and/or TST results were included; 70 were men (63.1%) and 41 were women (36.9%), with a mean age of 53.5 ± 11.3 years. Demographic, clinical, and laboratory characteristics were evaluated. The most common indication for liver transplantation was viral hepatitis (33.3%), followed by cryptogenic cirrhosis (19.8%) and hepatocellular carcinoma (10.8%). All patients had a Bacillus Calmette–Guérin (BCG) vaccination scar. Ten patients received grafts from deceased donors, while 101 underwent living-donor liver transplantation. No patient received LTBI treatment before transplantation, whereas LTBI treatment was initiated in four patients after transplantation. None of the patients had a diagnosis of active tuberculosis prior to transplantation. Thoracic computed tomography revealed findings compatible with tuberculosis sequelae in 11 patients (9.9%). During a median follow-up period of 49 [27–64] months after transplantation, no cases of active tuberculosis were observed among patients with positive TST and/or IGRA results. Patients were divided into two groups according to their TST and IGRA results. Group 1 consisted of patients with IGRA positivity and/or a TST ≥ 5 mm, while Group 2 included patients with a TST < 5 mm and negative IGRA results. The only statistically significant difference between the groups was the administration of LTBI treatment (p = 0.027); four patients in Group 1 received LTBI therapy. None of these patients were able to continue prophylaxis due to treatment-related adverse effects. Conclusions: Prophylaxis with hepatotoxic agents poses a substantial risk in liver transplant candidates. Since the hepatotoxicity may cause early cessation of LTBI treatment, the risk–benefit ratio of post-transplant LTBI therapy should be carefully assessed. In situations where LTBI treatment is deferred, close clinical monitoring is strongly recommended. Full article

Background/Objectives: Tuberculosis (TB) remains a major global health challenge, requiring standardized animal models to evaluate vaccine-induced immune responses. This study characterized time-dependent immune responses following Bacillus Calmette–Guérin (BCG) vaccination in BALB/c mice. Methods: BALB/c mice were vaccinated with BCG, and the immune responses and protective efficacy were evaluated at 4, 6, and 8 weeks post-immunization. The cytokine expression in serum, lung, and spleen tissues was analyzed using ELISA, quantitative PCR, and immunohistochemistry. Protective efficacy was assessed via colony-forming unit (CFU) enumeration and the immunohistochemical detection of Mycobacterium TB after aerosol challenge. Results: The BCG vaccination induced time-dependent and tissue-specific cytokine responses. Pulmonary IL-1β and splenic IFN-γ levels were significantly increased four weeks post-vaccination. At 8 weeks, serum IL-2, pulmonary IL-2, and TNF-α were significantly increased, whereas no significant changes in cytokines were observed at 6 weeks. After the challenge, BCG-vaccinated mice exhibited reduced bacterial burdens compared with controls, but the differences among the 4-, 6-, and 8-week groups were modest. Conclusions: Immune responses became detectable starting four weeks after BCG vaccination, with temporal differences observed in cytokine expression. Week 8 may serve as a reference point for monitoring cytokine dynamics rather than as an optimal time for protection. Full article

Background: Tuberculosis (TB) remains a major global health challenge, with Mycobacterium tuberculosis (M. tuberculosis) causing significant morbidity and mortality mainly in high-burden countries. Following exposure to M. tuberculosis, individuals may become infected, developing TB infection (TBI) through inhalation of the bacillus: this affects approximately one-fourth of the global population and serves as a critical reservoir for potential disease reactivation and transmission. The risk of being infected with M. tuberculosis is shaped by bacterial load of people with TB, contact patterns, environmental factors, and host susceptibility, particularly in high-risk congregate settings. Elucidating these determinants is instrumental for optimising TB prevention and control strategies. Methods: A preliminary PubMed search was conducted on 25 August 2024, using the keywords “latent tuberculosis infection,” “risk factors,” and “systematic review.” Targeted reviews were then performed in November 2024 to examine factors influencing progression from exposure to M. tuberculosis to TBI. Systematic reviews published between January 2000 and November 2024 were included. Results: The scoping review analysed eight systematic reviews, grouping findings into three key themes: (1) proximity and behavioural risk factors; (2) environmental risk factors; and (3) host immune vulnerabilities. Close contact with people with TB in crowded settings, such as dormitories, healthcare facilities, and prisons, was strongly associated with an elevated risk of TBI. Healthcare workers travelling from low- to high-incidence regions faced the highest risk due to frequent exposure to M. tuberculosis, while military personnel and general travellers had lower risks. Environmental exposures, including second-hand smoke and inadequate ventilation, further heightened susceptibility among children and adults. Host immune risk factors, such as advanced age, low body mass index, lack of BCG vaccination, and metabolic disorders such as diabetes, markedly increase susceptibility to TBI. The interplay between proximity, behavioural and environmental risk factors, and host immune vulnerabilities highlights the multifactorial nature of TBI risk. Conclusion: Effective TBI control demands a multifaceted approach, combining robust infection prevention and control measures, comorbidity management, and mitigation of behavioural risk factors like smoking. Tailored strategies are crucial for high-risk settings such as healthcare facilities and prisons. Multisectoral collaboration is essential to address key risk factors and protect vulnerable populations from progressing to TBI. Full article

Background: Patients with latent tuberculosis infection are mainly asymptomatic, but they still carry a notable risk of developing active TB, particularly when the host becomes immunosuppressed. Hence, appropriate diagnosis and management for LTBI are essential. Tuberculin skin test (TST) and interferon-gamma release assays (IGRAs) are among the most commonly utilized methods for detecting LTBI. Until now, no agreement has been established regarding the most effective diagnostic test, either TST or IGRA, so our study aims to evaluate the diagnostic utility of TST versus IGRA in detecting LTBI. Methods: An extensive literature search was executed in several databases from inception till June 2024. We included all the available studies that compared TST versus IGRA concurrently applied to the same study participants, utilizing one of the following proxy reference standards: previous contact with a tuberculosis patient, tuberculosis history, chest x-ray suggestive of tuberculosis, or a combination of them. The sensitivity (SN) and specificity (SP) were imputed with their 95% confidence interval (CI). A bivariate random-effects model within the OpenMeta-Analyst software was utilized for data analysis. Results: We included 39 studies, and our primary analysis regarding LTBI revealed that TST has an SN of 0.320 (95% CI [0.254–0.393]) and an SP of 0.808 (95% CI [0.752–0.854]). Nevertheless, the IGRA exhibited a higher SN estimated at 0.362 (95% CI [0.295–0.434]) and a lower SP estimated at 0.758 (95% CI [0.700–0.808]). Regarding the adult population, TST consistently showed a lower SN and a higher SP relative to IGRA. However, within the pediatric population, TST showed higher SN and lower SP when compared to IGRA. Furthermore, TST also showed a lower SN and a higher SP within hemodialysis and organ transplant patients than IGRA. Conclusions: Our diagnostic test meta-analysis revealed that TST was associated with a lower SN and a higher SP than IGRA. Clinicians should interpret these findings with caution, considering the substantial heterogeneity observed across the included studies, the reliance on proxy reference standards, the potential influence of BCG vaccination status, and the considerable overlap in confidence intervals between TST and IGRA estimates across most analyses. Full article