The finding fits with the idea that a Th-1 type response is predominant following vaccination [28] but contrasts with previous studies of cytotoxic T-cell activity during measles or after vaccination which reveal this response NVP-AUY922 in vitro to be mainly due to CD8 T-cells [30]. Stimulation with 20-mer rather than shorter peptides may have favoured a CD4 T-cell response

particularly in very young children. Early two dose schedules of measles vaccine given at 6 and 9 months of age were recommended by WHO to control outbreaks and for use in countries with high attack rates of measles in infancy. Now WHO recommends such schedules in areas with a high incidence of HIV and measles [31]. However once measles is controlled in endemic areas the proportion of vaccinated mothers who have low levels of measles antibody will increase along with the proportion of unprotected infants. At present such children can only be protected by raising herd protection by supplemental measles vaccinations.

Roxadustat nmr Others have argued that if measles is to be eliminated and ultimately eradicated it would be better to strengthen routine services to achieve high coverage before deploying mass immunization [32] and [33]. An early two dose schedule would fit well into this scheme: it protects the very young [5] and the HIV infected [34], increases coverage [4] and enhances child survival [6]. Additional doses could be given if outbreaks occur or if measles is to be eliminated or eradicated. We thank Sally Savage and her staff for their staunch support at Sukuta Health Centre; MRC field workers for their expertise in the field and clinic; Elisha Roberts, Chilel Sanyang and Matt Cotten for skilled help in the laboratory and Sarah Crozier for statistical analyses. Conflict of interest statement: None reported. Funding: This work was

supported by the Medical Research Council (UK) as part of a 5 year program grant from 2007 to 2011. Grant number SCC 948. “
“BCG (Bacille Calmette–Guérin), derived from Mycobacterium bovis in 1926 [1], is the most widely administered vaccine in the world, with 90.8% global coverage in 2009 [2]. Several phenotypically diverse strains are in use, arising from independent subculture of attenuated mycobacteria in laboratories across the world not [3], [4] and [5]. Reported efficacy of BCG has varied considerably, ranging from 0 to 80% [6], [7] and [8], with tropical countries reporting lower protection against tuberculosis [8] and [9]. Several factors that vary with latitude may alter BCG potency, including exposure to environmental mycobacteria [6] and other common infections in the tropics [10]. Although BCG strain alone cannot account for the extent of variation in efficacy [8], it may account for some of the variation observed in common clinical and immunological outcomes used in research, such as BCG scarring and cytokine responses.