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Sublingual Immunotherapy as an Alternative to Induce Protection Against Acute Respiratory Infections
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Hipersensibilidad de tipo tardío, vacunas micobacterianas e inmunidad protectora.

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
PubMed
Resumen

La hipersensibilidad de tipo retrasado a los antígenos micobacterianos ofrece protección contra la lepra, pero no contra la tuberculosis. La sensibilidad de bajo nivel puede indicar exposición y protección ambiental, mientras que la hipersensibilidad inducida por la vacuna persistente no se correlaciona con la eficacia de la vacuna BCG.

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Área de la Ciencia:

  • Inmunología Inmunología.
  • Enfermedades infecciosas Enfermedades infecciosas.
  • Vacunología Vacunología.

Sus antecedentes:

  • El papel de la hipersensibilidad de tipo tardío en la inmunidad a las infecciones micobacterianas sigue siendo objeto de debate.
  • Comprender los correlatos de la inmunidad inducida por la vacuna es crucial para mejorar las vacunas como la BCG.
  • La eficacia de la vacuna BCG varía significativamente entre las poblaciones.

Objetivo del estudio:

  • Investigar las implicaciones de la hipersensibilidad de tipo tardío para la protección contra la tuberculosis y la lepra.
  • Para identificar correlatos de la inmunidad protectora inducida por la vacuna contra las enfermedades micobacterianas.
  • Aclarar la relación entre la hipersensibilidad y la efectividad de la vacuna BCG.

Principales métodos:

  • Un estudio prospectivo a gran escala que involucró a más de 70.000 personas en Malawi.
  • Pruebas cutáneas con antígenos micobacterianos (antígenos del bacilo de la tuberculina y la lepra).
  • Seguimiento de cinco años para la incidencia de tuberculosis y lepra, con análisis de los ratios de tasa de incidencia ajustados por covariables.

Principales resultados:

  • La vacunación con BCG proporcionó protección contra la lepra independientemente de la hipersensibilidad de tipo tardío.
  • En individuos no vacunados, la hipersensibilidad a los antígenos micobacterianos se relacionó con una fuerte protección contra la lepra.
  • Se observó una relación en forma de J entre la hipersensibilidad a la tuberculina y las tasas de tuberculosis, con una sensibilidad de bajo grado asociada con la incidencia más baja.

Conclusiones:

  • La hipersensibilidad de tipo tardío tiene implicaciones diferenciales para la tuberculosis y la lepra.
  • La hipersensibilidad de bajo nivel, potencialmente por micobacterias ambientales, se asocia con la protección.
  • La hipersensibilidad persistente inducida por la vacuna no es un correlato confiable de la protección inducida por el BCG contra las enfermedades micobacterianas.