title: Tuberculosis vaccine development at a divide.
abstract: OBJECTIVE
  Tuberculosis (TB) remains a major health threat that will only be defeated by a combination of better drugs, diagnostics and vaccines. The only licensed TB vaccine, bacille Calmette-Guérin (BCG), protects against extrapulmonary TB in infants.
  
  
  RESULTS
  Novel vaccine candidates that could protect against pulmonary TB either in TB naïve or in latent TB-infected healthy individuals have been developed and are currently being assessed in clinical trials. Subunit booster vaccines are either based on viral vectors expressing TB-specific antigens or on TB-protein antigens in adjuvants. Subunit vaccines are administered on top of BCG. Replacement vaccines for BCG are recombinant viable BCG or Mycobacterium tuberculosis. Several candidates are undergoing, or will soon start, phase IIb assessment for efficacy. The first vaccine candidate, MVA85A, to complete a phase IIb trial, unfortunately failed to show protection against TB in infants. Therapeutic vaccines composed of killed mycobacterial preparations target patients with complicated TB in adjunct to drug treatment.
  
  
  CONCLUSIONS
  With increasing numbers of TB vaccine candidates in clinical trials, financial, regulatory and infrastructural issues arise, which would be best tackled by a global strategy. In addition, selection of the most promising vaccine candidates for further clinical development gains increasing importance.
authors.affiliation: Max Planck Institute for Infection Biology, Department of Immunology, Berlin, Germany.
authors.forename: Stefan H E
authors.initials: SH
authors.lastname: Kaufmann
mesh_terms: D001500:BCG Vaccine; D015195:Drug Design; D005260:Female; D006801:Humans; D007117:Immunization, Secondary / Q000639:trends*; D008297:Male; D009169:Mycobacterium tuberculosis / Q000276:immunology*; D014376:Tuberculosis / Q000517:prevention & control*; D032581:Tuberculosis Vaccines; D014611:Vaccination / Q000639:trends*; D014614:Vaccines, Synthetic
chemical_list: D001500:BCG Vaccine; D032581:Tuberculosis Vaccines; D014614:Vaccines, Synthetic