Bacille Calmette-Guerin (BCG) vaccines have been given to more people than
any other vaccine. They have also probably resulted in as much controversy
as any other vaccine. In clinical trials, the efficacy of BCG vaccination a
gainst pulmonary TB has been widely variable. At the same time, a number of
investigators have observed phenotypic differences between BCG daughter st
rains, raising the possibility that differences between BCG products may in
some way translate into different outcomes. With recent genomic analysis o
f BCG strains, it has become possible to piece together the molecular event
s that have resulted in current BCG vaccines. Between the derivation of BCG
in 1921 and the lyophilization of BCG Pasteur 1173 in 1961,there have been
at least seven genetic events, including deletions, duplications and a sin
gle nucleotide polymorphism. The phenotypic relevance of these changes in B
CG vaccines remains to be explored. (C) 2001 Harcourt Publishers Ltd