Key messages
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Tuberculosis continues to kill 1·4 million people annually, and numbers of patients with drug-resistant tuberculosis have increased alarmingly
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A novel, safe, widely applicable and more effective vaccine against tuberculosis is needed for disease control
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Vaccine research and development for tuberculosis has brought forward almost 20 vaccine candidates, many of which are at different stages of the clinical trial pipeline
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Vaccines for tuberculosis can be classified according to their target population; therapeutic or preventive vaccines; composition (ie, killed mycobacteria, viable recombinant mycobacteria, viral-vectored and adjuvanted subunit vaccines); time of administration (pre-exposure and postexposure vaccines), and according to BCG (ie, replacement and heterologous prime-boost vaccines)
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Host-directed therapies aim to eliminate Mycobacterium tuberculosis in the host—eg, by augmenting focused, clinically effective anti-M tuberculosis-directed immune responses, or by limiting non-productive, tissue-damaging inflammation in tuberculosis, a strategy that could be particularly beneficial for patients with drug-resistant tuberculosis
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Host-directed therapies contain different groups of compounds, including cytokines and so-called repurposed drugs, that target biologically and clinically relevant checkpoints in anti-M tuberculosis-directed host response pathways