Vaccines against mycobacteria and other intracellular multiplying bacteria.

As the prototype of a vaccine against mycobacterial infection, the BCG (bacille bilié Calmette et Guérin) has been used against tuberculosis for more than 60 years. It is the only live attenuated vaccine used on humans in more than 182 countries or territories in the world, and very few changes have been made in its fabrication and distribution, except for the production of lyophilized seed-lots. However, its history is marked with controversies concerning its innocuity and efficacy. While BCG safety is no longer a matter of debate, the question of its effectiveness is still pertinent, and results in several controlled trials have shown great variability (from 0 to 80%). The studies of different variables involved in such results have shown statistical bias, and numerous factors are involved in the highly complex interrelationships between the host, the pathogen and environmental factors. World-wide research is now being conducted under the auspices of the World Health Organisation, in order to gain further knowledge of the immunology of tuberculosis and leprosy. Such results are aimed at understanding variations in BCG efficacy and producing strategies for developing new vaccines and alternative methods for prophylaxis and diagnosis. Concerning human infections due to other facultative intracellular multiplying bacteria, there are relatively few vaccines which are able to give long-lasting and efficient protection. Some controversy remains as to the live attenuated mutant GalE S. typhi Ty21a, and there is hope for the new insoluble phenol extract from Brucella abortis, strain B19. Further research is necessary on the others, for instance, Listeria monocytogenes, Chlamydia trachomatis and Legionella sp.