Dr. Neil W. Schluger's main area of academic interest has been in tuberculosis, including clinical trials, molecular epidemiology, development and evaluation of diagnostics, and human host immune responses. He is the principal investigator at Columbia University for the Tuberculosis Trials Consortium, a CDC-funded collaboration in clinical trials in which patients are enrolled in trials of treatment of latent tuberculosis infection and active tuberculosis disease. In addition, Dr. Schluger has led studies examining the transmission dynamics of tuberculosis in New York City, using tools of molecular epidemiology. He has a long standing interest in the development and evaluation of new tools for the diagnosis of tuberculosis.
More recently, in addition to his studies in tuberculosis, he has led clinical trials for the use of retinoids in the treatment of emphysema and for the use of interferon gamma in the treatment of idiopathic pulmonary fibrosis.
Question: Should we continue using the tuberculosis vaccine?
Neil Schluger: Well, the vaccine for tuberculosis called BCG vaccine is still the most widely used vaccine in the world. Actually, about 100 million people get it every year. We don’t give it in the United States for two reasons, mostly because we don’t have enough TB to make it worthwhile to vaccinate the entire population. It’s expensive and complicated to do that but around the world it’s a very widely used vaccine. It clearly-- No matter how much it works, and people argue about how well it works, it clearly doesn’t work well enough because as I said it’s the most widely used vaccine in the world, and TB is still the eighth leading cause of death and TB cases around the world have not declined at all in a very long time so we need a new vaccine for sure. Whether or not we should continue to use the one we use is an interesting question. It does protect children from severe forms of tuberculosis. That’s its major efficacy and it’s probably worth doing in countries where TB is incredibly common, but certainly we’re not going to eliminate TB with this vaccine. The bad news though is, from everything that I can see, it’ll be at least 20 years--and that might be an optimistic estimate--at least 20 years before there’s a better vaccine that’s available
Question: Will TB ever go the way of smallpox?
Neil Schluger: I would say at the rate we’re going eradication of TB globally is not within sight. We just don’t have the tools. It would probably take a really effective vaccine to do that so I don’t think anyone can really see eradication. Frankly, at the moment on a global level we’d be happy just to see it decline and in many regions of the world TB cases are declining, and the place where it’s going up the fastest is Sub-Saharan Africa where AIDS is really
driving the whole epidemic, but in many other regions TB cases are declining but I don’t think we can realistically talk about eradication for a long time.
Recorded on: 04/25/2008