Vaccine against MAC?

Posted by Armando @bolso1, Nov 19, 2020

Does anybody know about a vaccine against MAC? I found the paper ["Protection against Mycobacterium avium by DNA Vaccines Expressing Mycobacterial Antigens as Fusion Proteins with Green Fluorescent Protein" (INFECTION AND IMMUNITY, Aug. 1999, Vol. 67, No. 8 p. 4243–4250)] that claimed to be "…first report of successful DNA vaccination against M. avium", but nothing else.

@bolso1

Here are a few references on the ecology of NTM that, while they do not address specifically the increase in rates of pulmonary NTM, provide information about conditions that favor such increases.
1. Health impacts of environmental mycobacteria. Todd P Primm, Christie A Lucero, Joseph O Falkinham 3rd. Clin Microbiol Rev. 2004 Jan;17(1):98-106. doi: 10.1128/cmr.17.1.98-106.2004. Abstract: Environmental mycobacteria are emerging pathogens causing opportunistic infections in humans and animals. The health impacts of human-mycobacterial interactions are complex and likely much broader than currently recognized. Environmental mycobacteria preferentially survive chlorination in municipal water, using it as a vector to infect humans. Widespread chlorination of water has likely selected more resistant environmental mycobacteria species and potentially explains the shift from M. scrofulaceum to M. avium as a cause of cervical lymphadenitis in children. Thus, human activities have affected mycobacterial ecology. While the slow growth and hydrophobicity of environmental mycobacteria appear to be disadvantages, the unique cell wall architecture also grants high biocide and antibiotic resistance, while hydrophobicity facilitates nutrient acquisition, biofilm formation, and spread by aerosolization. The remarkable stress tolerance of environmental mycobacteria is the major reason they are human pathogens. Environmental mycobacteria invade protozoans, exhibiting parasitic and symbiotic relationships. The molecular mechanisms of mycobacterial intracellular pathogenesis in animals likely evolved from similar mechanisms facilitating survival in protozoans. In addition to outright infection, environmental mycobacteria may also play a role in chronic bowl diseases, allergies, immunity to other pulmonary infections, and the efficacy of bacillus Calmette-Guerin vaccination.
2. Ecology of nontuberculous mycobacteria–where do human infections come from?Joseph O Falkinham 3rd. Semin Respir Crit Care Med. 2013 Feb;34(1):95-102. doi: 10.1055/s-0033-1333568. Epub 2013 Mar 4. Abstract: Nontuberculous mycobacteria (NTM) are environmental, opportunistic human pathogens whose reservoirs include peat-rich potting soil and drinking water in buildings and households. In fact, humans are likely surrounded by NTM. NTM are ideally adapted for residence in drinking water distribution systems and household and building plumbing as they are disinfectant-resistant, surface adherent, and able to grow on low concentrations of organic matter. For individuals at risk for NTM infection, measures can be taken to reduce NTM exposure. These include avoiding inhalation of dusts from peat-rich potting soil and aerosols from showers, hot tubs, and humidifiers. A risk analysis of the presence of NTM in drinking water has not been initiated because the virulence of independent isolates of even single NTM species (e.g., Mycobacterium avium) is quite broad, and virulence determinants have not been identified.
3. Environmental sources of nontuberculous mycobacteria. Joseph O Falkinham 3rd. Clin Chest Med. 2015 Mar;36(1):35-41. doi: 10.1016/j.ccm.2014.10.003. Abstract: Nontuberculous mycobacteria (NTM) include over 150 species. The source for human infection is the environment. NTM are normal inhabitants of soil and drinking water. NTM grow and persist in many buildings. They are not contaminants of drinking water, but members of the natural drinking water microbial population. Infection occurs because humans share the same habitats. Because the ecology, antibiotic susceptibility, and virulence of individual species differs, identifying NTM isolates to species is important. Treatment requires multiple antibiotics. NTM patients are innately sensitive to NTM infection, resulting in reinfection. Knowledge of the sources of NTM can reduce exposure to environmental NTM.
4. Current Epidemiologic Trends of the Nontuberculous Mycobacteria (NTM). Joseph O Falkinham 3rd. Curr Environ Health Rep. 2016 Jun;3(2):161-7. doi: 10.1007/s40572-016-0086-z. Abstract: The nontuberculous mycobacteria (NTM) are waterborne opportunistic pathogens of humans. They are normal inhabitants of premise plumbing, found, for example, in household and hospital shower heads, water taps, aerators, and hot tubs. The hydrophobic NTM are readily aerosolized, and pulmonary infections and hypersensitivity pneumonitis have been traced to the presence of NTM in shower heads. Hypersensitivity pneumonitis in automotive workers was traced to the presence of NTM in metal recovery fluid used in grinding operations. Recently, NTM bacteremia in heart transplant patients has been traced to the presence of NTM in water reservoirs of instruments employed in operating rooms to heat and cool patient blood during periods of mechanical circulation. Although NTM are difficult to eradicate from premise plumbing as a consequence of their disinfectant-resistance and formation of biofilms, measures such as reduction of turbidity and reduction in carbon and nitrogen for growth and the installation of microbiological filters can reduce exposure of NTM to susceptible individuals.

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@bolso1 I was vaccinated against TB in 1974 or ’75 because I went to Nepal in the Peace Corps. The vaccination is not recorded in my little yellow international vaccination book, but I distinctly remember the process and being told that I might test positive for TB because of the vaccine. I have no scar, but I also have no scars from my smallpox vaccinations. In 2018, at age 70, I was diagnosed with focal bronchiectasis, nodules, and MAC after I coughed up blood while lap swimming. I have not been tested for MAC since. My only symptoms are coughing up minor sputum in the morning and occasional minor coughing during the day. (I've also had acid reflux for many years.)

I walk 2-3 miles nearly every day, and do other exercises. I stopped the lap swimming because that’s probably where I caught MAC. Until this year, we lived Michigan in summer and near Tucson in winter. This summer we sold our AZ home and are trying all year in Michigan. I love to “work” frequently on our 2 acres of woods and wetland, which I have been doing for 10 years while not wearing a mask. My only “treatment” is once/day nebulizing with 7% saline, which I started this past March because of this forum.

According to the nhs.uk: “The BCG vaccination is thought to protect up to 80% of people against the most severe forms of TB for at least 15 years, perhaps even up to 60 years.” Perhaps the old vaccine is the reason my MAC is not severe (??).

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@lorifilipek

@bolso1 I was vaccinated against TB in 1974 or ’75 because I went to Nepal in the Peace Corps. The vaccination is not recorded in my little yellow international vaccination book, but I distinctly remember the process and being told that I might test positive for TB because of the vaccine. I have no scar, but I also have no scars from my smallpox vaccinations. In 2018, at age 70, I was diagnosed with focal bronchiectasis, nodules, and MAC after I coughed up blood while lap swimming. I have not been tested for MAC since. My only symptoms are coughing up minor sputum in the morning and occasional minor coughing during the day. (I've also had acid reflux for many years.)

I walk 2-3 miles nearly every day, and do other exercises. I stopped the lap swimming because that’s probably where I caught MAC. Until this year, we lived Michigan in summer and near Tucson in winter. This summer we sold our AZ home and are trying all year in Michigan. I love to “work” frequently on our 2 acres of woods and wetland, which I have been doing for 10 years while not wearing a mask. My only “treatment” is once/day nebulizing with 7% saline, which I started this past March because of this forum.

According to the nhs.uk: “The BCG vaccination is thought to protect up to 80% of people against the most severe forms of TB for at least 15 years, perhaps even up to 60 years.” Perhaps the old vaccine is the reason my MAC is not severe (??).

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I don't know whether the vaccine helps to explain the lesser severity of MAC in your case. However, I have kept investigating and found a couple of interesting references (pdfs attached). One reports the findings in Finland where universal BCG vaccination was stopped in 2006 (Kontturi A, Soini H, Ollgren J, Salo E. Increase in Childhood Nontuberculous Mycobacterial Infections After Bacille Calmette-Guerin Coverage Drop: A Nationwide, Population-Based Retrospective Study, Finland, 1995-2016. Clin Infect Dis. 2018;67(8):1256–61), and the conclusions were "After infant BCG coverage in Finland decreased, childhood NTM infections increased drastically. As there is no other apparent cause for the increase, this indicates that BCG offers protection against childhood NTM disease. This observation adds to the understanding of childhood NTM epidemiology and might explain why the disease is emerging in some countries." The other paper is about a similar study in the Czech Republic (Trnka L, Dankova D, Svandova E. Six years’ experience with the discontinuation of BCG vaccination. 4. Protective effect of BCG vaccination against the Mycobacterium avium intracellulare complex. Tuber Lung Dis. 1994;75(5):348–52), in which the authors concluded "In non-BCG vaccinated children the incidence of lymphadenitis caused by M. avium complex was considerably higher than in vaccinated children. BCG cells possess antigenic determinants which confer protective immunity probably both against M. tuberculosis and against M. avium complex infections. It may thus be assumed that BCG vaccination protects both against pathogenic tubercle bacilli and M. avium complex. This should be taken into consideration before recommending discontinuation of mass BCG vaccination of newborns in areas with a high prevalence of M. avium complex infection."

Shared files

Infections After Bacille Calmette-Guérin Coverage Drop A Nationwide, Population-Based Retrospective Study, Finland, 1995-2016 (Infections-After-Bacille-Calmette-Guerin-Coverage-Drop-A-Nationwide-Population-Based-Retrospective-Study-Finland-1995–2016.pdf)

Six years' experience with the discontinuation of BCG vaccination (Six-years-experience-with-the-discontinuation-of-BCG-vaccination.pdf)

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@bolso1

I don't know whether the vaccine helps to explain the lesser severity of MAC in your case. However, I have kept investigating and found a couple of interesting references (pdfs attached). One reports the findings in Finland where universal BCG vaccination was stopped in 2006 (Kontturi A, Soini H, Ollgren J, Salo E. Increase in Childhood Nontuberculous Mycobacterial Infections After Bacille Calmette-Guerin Coverage Drop: A Nationwide, Population-Based Retrospective Study, Finland, 1995-2016. Clin Infect Dis. 2018;67(8):1256–61), and the conclusions were "After infant BCG coverage in Finland decreased, childhood NTM infections increased drastically. As there is no other apparent cause for the increase, this indicates that BCG offers protection against childhood NTM disease. This observation adds to the understanding of childhood NTM epidemiology and might explain why the disease is emerging in some countries." The other paper is about a similar study in the Czech Republic (Trnka L, Dankova D, Svandova E. Six years’ experience with the discontinuation of BCG vaccination. 4. Protective effect of BCG vaccination against the Mycobacterium avium intracellulare complex. Tuber Lung Dis. 1994;75(5):348–52), in which the authors concluded "In non-BCG vaccinated children the incidence of lymphadenitis caused by M. avium complex was considerably higher than in vaccinated children. BCG cells possess antigenic determinants which confer protective immunity probably both against M. tuberculosis and against M. avium complex infections. It may thus be assumed that BCG vaccination protects both against pathogenic tubercle bacilli and M. avium complex. This should be taken into consideration before recommending discontinuation of mass BCG vaccination of newborns in areas with a high prevalence of M. avium complex infection."

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@bolso1 Unfortunately, the BCG vaccine is much less effective on older adults: "There's no evidence the BCG vaccine works for people over the age of 35." https://www.nhs.uk/conditions/vaccinations/when-is-bcg-tb-vaccine-needed/ and https://www.cdc.gov/tb/publications/factsheets/prevention/bcg.htm

Btw, if you'll notice from Terri's (@windwalker) comments above on various likely places one is exposed to MAC, the members of this forum have been doing lots of research on various aspects of MAC and bronchiectasis over the years. Terri alerted us (and many doctors) to the efficacy of nebulizing with 7% saline to help kill off MAC. @windwalker can give you links to the articles she's given us on that topic.

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@lorifilipek

@bolso1 Unfortunately, the BCG vaccine is much less effective on older adults: "There's no evidence the BCG vaccine works for people over the age of 35." https://www.nhs.uk/conditions/vaccinations/when-is-bcg-tb-vaccine-needed/ and https://www.cdc.gov/tb/publications/factsheets/prevention/bcg.htm

Btw, if you'll notice from Terri's (@windwalker) comments above on various likely places one is exposed to MAC, the members of this forum have been doing lots of research on various aspects of MAC and bronchiectasis over the years. Terri alerted us (and many doctors) to the efficacy of nebulizing with 7% saline to help kill off MAC. @windwalker can give you links to the articles she's given us on that topic.

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Yes, the BCG vaccine has variable efficacy on TB, but we need to know more about its efficacy on NTM. Thank you!

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@lorifilipek

@bolso1 Unfortunately, the BCG vaccine is much less effective on older adults: "There's no evidence the BCG vaccine works for people over the age of 35." https://www.nhs.uk/conditions/vaccinations/when-is-bcg-tb-vaccine-needed/ and https://www.cdc.gov/tb/publications/factsheets/prevention/bcg.htm

Btw, if you'll notice from Terri's (@windwalker) comments above on various likely places one is exposed to MAC, the members of this forum have been doing lots of research on various aspects of MAC and bronchiectasis over the years. Terri alerted us (and many doctors) to the efficacy of nebulizing with 7% saline to help kill off MAC. @windwalker can give you links to the articles she's given us on that topic.

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I don't think that the 7% saline is used to kill MAC, but rather to help with the bronchiectasis (https://erj.ersjournals.com/content/54/1/1802143.short).

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@bolso1

I don't think that the 7% saline is used to kill MAC, but rather to help with the bronchiectasis (https://erj.ersjournals.com/content/54/1/1802143.short).

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@bolso1 It's good for both bronchiectasis and MAC. Please see table 2 in this paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4850692/

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@bolso1

Yes, the BCG vaccine has variable efficacy on TB, but we need to know more about its efficacy on NTM. Thank you!

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@bolso1 The thing with BCG and TB is ( and I’m sure you know this) is that it is used in third world countries especially China and is a live virus unlike in the US. It can cause positive TB skin tests which it does in two of my six Chinese children. They were given Isoniazid for nine months to confirm no active disease even though their lungs were clear. You are probably correct about the saline and bronchiectasis only as MAC loves water. That is something I have questions about. At this point I just want something to cure us all! irene5

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@irene5

@bolso1 The thing with BCG and TB is ( and I’m sure you know this) is that it is used in third world countries especially China and is a live virus unlike in the US. It can cause positive TB skin tests which it does in two of my six Chinese children. They were given Isoniazid for nine months to confirm no active disease even though their lungs were clear. You are probably correct about the saline and bronchiectasis only as MAC loves water. That is something I have questions about. At this point I just want something to cure us all! irene5

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Thank you! The BCG (Bacillus Calmette–Guérin) is a live (although weakened) bacteria, not virus, though.

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@bolso1

I don't think that the 7% saline is used to kill MAC, but rather to help with the bronchiectasis (https://erj.ersjournals.com/content/54/1/1802143.short).

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Bolso, Excellent article. I understand it to say Hypertonic saline may not kill the NTM but certainly keep it under control which is a wonderful thing for patients who can not tolerate the antibiotics. But only good in certain situations.
To quote the authors "Since hypertonic saline (HS) inhalation is safe and has shown a clinical effect in bronchiectasis patients we have included HS inhalation in our local NTM treatment protocol. In clinical practice, we advise patients with nodular-bronchiectatic disease to start with HS inhalation two times daily as the only therapy for the first 3 months. When patients tolerate HS and when there are no clinical signs of disease deterioration, we continue HS as the only treatment with close observation of possible disease progression"
I have been using 7% saline for about a year now with excellent results. It is a part of my daily airway clearance. A big thanks to all the members here who have promoted this therapy.
I believe that while the NTM/MAC is being kept under control by the HS, the body's immune system may kick in and actually kill the bacteria, a good reason to have a healthy lifestyle. Just my opinion, I can not cite any studies.

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Well people, here's our hope for the future! Science is finally beginning to acknowledge the water-borne aspect of MAC/NTM/Pseudomonas and other organisms. https://www.cnn.com/2020/12/16/health/waterborne-diseases-cdc-study-wellness/index.html
With this attention, we could be on our way to recognition of these bio-film supported bacteria, and perhaps a way to break down the biofilm so they can be easily washed away, and not lurk everywhere. Airborne transmission through dust we can more easily manage on our own with masks, filters, etc.
Sue

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@sueinmn

Well people, here's our hope for the future! Science is finally beginning to acknowledge the water-borne aspect of MAC/NTM/Pseudomonas and other organisms. https://www.cnn.com/2020/12/16/health/waterborne-diseases-cdc-study-wellness/index.html
With this attention, we could be on our way to recognition of these bio-film supported bacteria, and perhaps a way to break down the biofilm so they can be easily washed away, and not lurk everywhere. Airborne transmission through dust we can more easily manage on our own with masks, filters, etc.
Sue

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@sueinmn that is an excellent article. “And then came the dawn with a clap of thunder and a bolt of lightning!” Tis about time! Thank you. irene5

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Haven’t heard of any but would be a help

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