Introduction

• Tuberculosis (TB)à remains India's biggest public health challenge despite decades of control efforts.
• India accounts for the highest TB burden globally.
• Recent findings from the ICMR-led PreVenTB Trial have highlighted the potential role of innovative vaccines such as VPM1002 and Immuvac in strengthening India's TB elimination strategy.

Challenges in TB Elimination

• High burden of latent and active TB infections.
• Difficulty in diagnosing Extra-pulmonary Tuberculosis (EPTB).
• Delayed detection of subclinical TB.
• High prevalence of malnutrition, reducing immunity.
• Unequal access to healthcare and preventive treatment.
• Absence of an effective vaccination strategy beyond infancy.

Significance of the PreVenTB Trial

• Conducted at 18 sites involving over 12,700 participants
• Evaluated efficacy against both Pulmonary TB (PTB) and Extrapulmonary TB (EPTB).
• VPM1002 showed 50.4% efficacy against EPTB.
• More than 60% efficacy observed in children and adolescents.
• Provides evidence for possible booster-dose vaccination strategies.
• Addresses a neglected area, as most previous trials focused only on PTB

Need for a Multi-Pronged Strategy

• Early Detectionà Improved diagnostics for latent and subclinical TB.
• Preventive Therapyà Treatment of latent infection before disease progression.
• Targeted VaccinationàDeployment among household contacts and high-risk groups.
• Nutritional Supportà Addressing low BMI and undernutrition to improve vaccine effectiveness.
• Public Health Investmentà Strengthening healthcare infrastructure and surveillance systems.

Conclusion

• TB elimination requires a combination of early diagnosis, preventive therapy, targeted vaccination, nutritional interventions, and sustained policy support.
• The PreVenTB Trial offers a promising pathway and demonstrates that pragmatic, evidence-based interventions can accelerate India's journey towards a TB-free India.