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Vaccinations

Vaccinations

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Updated: Jul 9, 2026

Sublingual Immunotherapy as an Alternative to Induce Protection Against Acute Respiratory Infections

Sublingual Immunotherapy as an Alternative to Induce Protection Against Acute Respiratory Infections

Published on: August 30, 2014

Delayed-type hypersensitivity, mycobacterial vaccines and protective immunity

P E Fine¹, J A Sterne, J M Pönnighaus

¹Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine, UK.

Lancet (London, England)

|November 5, 1994

Summary

Delayed-type hypersensitivity to mycobacterial antigens offers protection against leprosy, but not tuberculosis. Low-level sensitivity may indicate environmental exposure and protection, while persistent vaccine-induced hypersensitivity does not correlate with BCG vaccine efficacy.

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Area of Science:

Immunology
Infectious Diseases
Vaccinology

Background:

The role of delayed-type hypersensitivity in immunity to mycobacterial infections remains debated.
Understanding correlates of vaccine-induced immunity is crucial for improving vaccines like BCG.
BCG vaccine efficacy varies significantly across populations.

Purpose of the Study:

To investigate the implications of delayed-type hypersensitivity for protection against tuberculosis and leprosy.
To identify correlates of vaccine-induced protective immunity against mycobacterial diseases.
To clarify the relationship between hypersensitivity and BCG vaccine effectiveness.

Main Methods:

A large-scale prospective study involving over 70,000 individuals in Malawi.
Skin testing with mycobacterial antigens (tuberculin and leprosy bacilli antigens).
Five-year follow-up for tuberculosis and leprosy incidence, with analysis of incidence rate ratios adjusted for covariates.

Main Results:

BCG vaccination provided protection against leprosy independent of delayed-type hypersensitivity.
In unvaccinated individuals, hypersensitivity to mycobacterial antigens was linked to strong protection against leprosy.
A J-shaped relationship was observed between tuberculin hypersensitivity and tuberculosis rates, with low-grade sensitivity associated with the lowest incidence.

Conclusions:

Delayed-type hypersensitivity has differential implications for tuberculosis and leprosy.
Low-level hypersensitivity, potentially from environmental mycobacteria, is associated with protection.
Persistent vaccine-induced hypersensitivity is not a reliable correlate of BCG-induced protection against mycobacterial diseases.