Abstract

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_H1)-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_H1-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_H1-cell activity that matters but, rather, its context.

Author affiliations

1. Graham A. W. Rook, Keertan Dheda and Alimuddin Zumla are at the Centre for Infectious Diseases and International Health, Windeyer Institute for Medical Sciences, University College London, London W1T 4JF, UK

Correspondence to: Graham A. W. Rook¹ Email: g.rook@ucl.ac.uk

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