Rutinsko cijepljenje protiv tuberkuloze

Tuberculosis (TB) still represents one of the leading diseases globally, causing significant morbidity and mortality. Among the possible approaches to the disease, vaccination has been considered the most important measure for its prevention. Nowadays, it comprises the use of the Bacillus Calmette-Guérin (BCG) vaccine, developed one century ago but still the first-line weapon against TB. Despite evident challenges, that include variability in efficacy, vaccination with BCG has been proven to significantly reduce the incidence of severe TB forms, particularly tuberculous meningitis and miliary TB in children, and overall, a vaccine with a favorable safety profile and a high benefit-risk ratio in immunocompetent individuals. In highburden countries, mandatory vaccination is the main strategy used to help lowering TB related mortality. Conversely, in low incidence countries, selective vaccination has been adopted, focusing on high-risk groups, in particular the so called "vulnerable" population, including immunocompromised individuals, those with liver disease, cancer patients. Beyond TB prevention, the vaccine has demonstrated nonspecific immune benefits, enhancing resistance to respiratory infections, and reducing overall child mortality. However, some limitations have been detected, including variable efficacy in adults, waning immunity against the bacillus over time, and rare but serious adverse reactions. The latest occur in fewer than one per million vaccinations, supporting the safety profile of the vaccine. As reported by several institutions worldwide, like WHO, TB represents an ongoing burden to the public health, and as such, this thesis will be focusing on the advantages, as well as limitations, of the BCG vaccine, emphasizing its role in TB prevention and containment of the disease.