Tuberculosis prevention: current strategies and future directions

Anca Vasiliu; Leonardo Martinez; Rishi K Gupta; Yohhei Hamada; Tara Ness; Alexander Kay; Maryline Bonnet; Martina Sester; Stefan H E Kaufmann; Christoph Lange; Anna M Mandalakas

doi:10.1016/j.cmi.2023.10.023

Tuberculosis prevention: current strategies and future directions

Clin Microbiol Infect. 2023 Oct 31:S1198-743X(23)00533-5. doi: 10.1016/j.cmi.2023.10.023. Online ahead of print.

Authors

Affiliations

¹ Department of Pediatrics, Baylor College of Medicine, Global TB Program, Houston, TX, USA. Electronic address: anca.vasiliu@bcm.edu.
² Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA.
³ Institute of Health Informatics, University College London, London, United Kingdom.
⁴ Institute for Global Health, University College London, London, United Kingdom.
⁵ Department of Pediatrics, Baylor College of Medicine, Global TB Program, Houston, TX, USA.
⁶ University of Montpellier, TransVIHMI, IRD, INSERM, Montpellier, France.
⁷ Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany.
⁸ Department of Immunology, Max Planck Institute for Infection Biology, Berlin, Germany; Systems Immunology (Emeritus Group), Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany; Hagler Institute for Advanced Study, Texas A&M University, College Station, TX, USA.
⁹ Department of Pediatrics, Baylor College of Medicine, Global TB Program, Houston, TX, USA; Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany; Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany.
¹⁰ Department of Pediatrics, Baylor College of Medicine, Global TB Program, Houston, TX, USA; Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany.

PMID: 37918510
DOI: 10.1016/j.cmi.2023.10.023

Abstract

Background: An estimated one fourth of the world's population is infected with Mycobacterium tuberculosis, and 5-10% of those infected develop tuberculosis in their lifetime. Preventing tuberculosis is one of the most underutilized but essential components of curtailing the tuberculosis epidemic. Moreover, current evidence illustrates that tuberculosis manifestations occur along a dynamic spectrum from infection to disease rather than a binary state as historically conceptualized. Elucidating determinants of transition between these states is crucial to decreasing the tuberculosis burden and reaching the END-TB Strategy goals as defined by the WHO. Vaccination, detection of infection, and provision of preventive treatment are key elements of tuberculosis prevention.

Objectives: This review provides a comprehensive summary of recent evidence and state-of-the-art updates on advancements to prevent tuberculosis in various settings and high-risk populations.

Sources: We identified relevant studies in the literature and synthesized the findings to provide an overview of the current state of tuberculosis prevention strategies and latest research developments.

Content: We present the current knowledge and recommendations regarding tuberculosis prevention, with a focus on M. bovis Bacille-Calmette-Guérin vaccination and novel vaccine candidates, tests for latent infection with M. tuberculosis, regimens available for tuberculosis preventive treatment and recommendations in low- and high-burden settings.

Implications: Effective tuberculosis prevention worldwide requires a multipronged approach that addresses social determinants, and improves access to tuberculosis detection and to new short tuberculosis preventive treatment regimens. Robust collaboration and innovative research are needed to reduce the global burden of tuberculosis and develop new detection tools, vaccines, and preventive treatments that serve all populations and ages.

Keywords: BCG; IGRA; LTBI; Novel vaccine candidates; Preventive treatment; TB spectrum; TPT; TST; Tuberculosis control.

Publication types

Review