Newton001-Developing a partnership to inform UK-Brazil TB control:Investigating BCG vaccination efficacy following latent TB treatment (TBTVacc)
Lead Research Organisation:
University College London
Department Name: Infection and Population Health
Abstract
Tuberculosis (TB) is a major cause of the global disease burden. We plan to investigate whether the human immunity to tuberculosis as a result of BCG vaccination is different after individuals complete treatment for latent TB. This will allow us to test whether BCG can protect individuals following clearance of the tuberculosis bacterium. We would develop a partnership between UK and Brazilian researchers to undertake the following:
Review and summarise any published studies of BCG assessing protection after treatment for latent TB. We will use this information and expert views to try and quantify the impact of vaccinating people after TB treatment.
We would organise two workshops, one in Brazil and one in the UK that strengthen the existing collaboration between partners. We will use these workshops to develop our pilot study and to plan the grant application for a major trial. We would ensure there are training opportunities in the UK for Brazilian students, and UK students in Brazil.
We will undertake a pilot study in Brazil to investigate the feasibility of undertaking a trial over a 6 month period. The pilot study would examine immunological changes after BCG vaccination in 40 people immediately following the completion of treatment for latent TB.
Review and summarise any published studies of BCG assessing protection after treatment for latent TB. We will use this information and expert views to try and quantify the impact of vaccinating people after TB treatment.
We would organise two workshops, one in Brazil and one in the UK that strengthen the existing collaboration between partners. We will use these workshops to develop our pilot study and to plan the grant application for a major trial. We would ensure there are training opportunities in the UK for Brazilian students, and UK students in Brazil.
We will undertake a pilot study in Brazil to investigate the feasibility of undertaking a trial over a 6 month period. The pilot study would examine immunological changes after BCG vaccination in 40 people immediately following the completion of treatment for latent TB.
Technical Summary
Tuberculosis (TB) is a major cause of the global disease burden. Within the UK, a resurgence of TB has been seen since the late 1980s and there are currently over 9,000 new cases each year. While there have been major gains in TB control in Brazil, TB remains a major cause of morbidity and mortality.
We hypothesise that there would be a different immune response to BCG in individuals who have completed treatment for LTBI, compared to people with untreated LTBI. We propose to develop a collaboration bringing together major programmes of work in the UK to investigate whether BCG can protect individuals following clearance of M. tuberculosis. We would undertake the following three work packages to develop this partnership.
1. Review the state of the immunological and epidemiological evidence to support a major trial of BCG assessing protection after treatment for latent TB. We will undertake a systematic review of the literature on immunological changes after treatment of latent TB and on the epidemiological evidence for effectiveness of BCG in patients treated for LTBI.
2. We would organise two workshops, one in Brazil and one in the UK that would strengthen the existing collaboration between partners.
3. We will undertake a pilot study in Brazil to investigate the feasibility of undertaking a trial over a 6 month period. The pilot study would examine immunological changes after BCG vaccination in 40 people immediately following the completion of treatment for latent TB.
We hypothesise that there would be a different immune response to BCG in individuals who have completed treatment for LTBI, compared to people with untreated LTBI. We propose to develop a collaboration bringing together major programmes of work in the UK to investigate whether BCG can protect individuals following clearance of M. tuberculosis. We would undertake the following three work packages to develop this partnership.
1. Review the state of the immunological and epidemiological evidence to support a major trial of BCG assessing protection after treatment for latent TB. We will undertake a systematic review of the literature on immunological changes after treatment of latent TB and on the epidemiological evidence for effectiveness of BCG in patients treated for LTBI.
2. We would organise two workshops, one in Brazil and one in the UK that would strengthen the existing collaboration between partners.
3. We will undertake a pilot study in Brazil to investigate the feasibility of undertaking a trial over a 6 month period. The pilot study would examine immunological changes after BCG vaccination in 40 people immediately following the completion of treatment for latent TB.
Planned Impact
N/A
Publications
Goscé L
(2019)
BCG vaccination following latent TB treatment: Possible implications for different settings.
in International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases
| Description | The study has led to three main results: 1. We have established a link with FioCruz which is informing further studies. 2. We have completed a pilot study showing the immunological response to BCG and Latent TB Treatment in different combinations - manuscript under preparation 3. We have developed a mathematical model to examine the potential impact of latent TB treatment on the efficacy of BCG (manuscript submitted). |
| Exploitation Route | Model developed will have further application for TB in Brazil Pilot data from the study will inform future full scale trials of the intervention |
| Sectors | Healthcare |
| Description | Presentation of preliminary findings at Conference in Abuja |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | I was invited to speak about the findings of our BCG study at an international research strategy day for the National Institute for Medical Research and explore collaboration opportunities with our Brazilian partners. |
| Year(s) Of Engagement Activity | 2016 |
| Description | UK Brazil Workshop on BCG and Latent TB Infection |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | A workshop funded by the Newton Grant to discuss and agree the plan for collaborative research between Brazilian researchers and UK scientists in immunology, epidemiology and trials. |
| Year(s) Of Engagement Activity | 2015 |
| Description | Workshop - Salvador, Brazil |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | A research workshop was organised jointly with our partners - FioCruz in Brazil - to present the preliminary findings including recruitment of participants to date, mathematical modelling work and literature review undertaken. Discussions led to plans for future funding application. |
| Year(s) Of Engagement Activity | 2016 |
| Description | Workshop at FioCruz in Salvador Brazil |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Postgraduate students |
| Results and Impact | About 100 reseachers, postgraduate students and doctors attended a BCG research workshop at FioCruz Salvador, Brazil which discussed our study findings and plans for a full trial building on the findings on the pilot study. |
| Year(s) Of Engagement Activity | 2017 |
| URL | https://cursos.bahia.fiocruz.br/bcg |