The influence of previous exposure to environmental mycobacteria on the interferon‐gamma response to bacille Calmette–Guérin vaccination in southern England and northern Malawi

Summary We report a large study of the effect of BCG vaccination on the in vitro 6‐day whole blood interferon‐gamma (IFN‐γ) response to antigens from eight species of mycobacteria among schoolchildren in south‐eastern England, where bacille Calmette–Guérin (BCG) vaccination is highly protective against pulmonary tuberculosis, and among young adults in northern Malawi, where BCG vaccination is not protective. In the UK children, BCG induced an appreciable increase in IFN‐γ response to antigens from most species of mycobacteria. The degree of change was linked to the relatedness of the species to Mycobacterium bovis BCG, and provides further evidence of the cross‐reactivity of mycobacterial species in priming of the immune system. IFN‐γ responses to purified protein derivatives (PPDs) from M. tuberculosis and environmental mycobacteria were more prevalent in the Malawian than the UK group prior to vaccination; BCG vaccination increased the prevalence of responses to these PPDs in the UK group to a level similar to that in Malawi. There was no evidence that the vaccine‐induced change in IFN‐γ response was dependent upon the magnitude of the initial response of the individual to environmental mycobacteria in the United Kingdom or in Malawi. These observations should assist the development and interpretation of human clinical trials of new vaccines against M. tuberculosis in areas of both low and high exposure to environmental mycobacteria.