171031 20260505142649.0 doi 10.1016/j.ijid.2026.108513 sideral 149150 ART-2026-149150 eng Martín, Carlos Universidad de Zaragoza (orcid)0000-0003-2993-5478 Toward tuberculosis elimination: An update on tuberculosis vaccines in clinical trials 2026 Despite major advances in diagnosis and treatment, tuberculosis (TB) control – and ultimately elimination – will remain unachieved without a vaccine capable of preventing pulmonary disease and transmission. Bacille Calmette–Guérin (BCG), a live attenuated vaccine derived from Mycobacterium bovis and the only licensed TB vaccine, has been widely implemented because of its proven efficacy against severe childhood TB. However, despite global coverage approaching 90%, BCG provides limited and inconsistent protection against pulmonary TB in adolescents and adults, the populations that sustain transmission. In response, a diverse pipeline of novel TB vaccine candidates has emerged across multiple technological platforms. This review provides an updated overview of TB vaccines in clinical development. Currently, sixteen candidates are undergoing clinical evaluation, including four in active Phase 3 efficacy trials. This review also offers critical insights into challenges shaping late-stage TB vaccine development. We argue that evolving understanding of Mycobacterium tuberculosis infection – including heterogeneity within latent infection, the contribution of subclinical disease, and limitations of binary IGRA-based classification – necessitates reassessment of current efficacy endpoints. By examining prevention-of-disease (PoD), prevention-of-infection (PoI), and prevention-of-recurrence (PoR) strategies, we highlight the need for closer alignment between biological insight, trial design, and policy objectives to ensure that new vaccines advance TB elimination. Access copy available to the general public Unrestricted info:eu-repo/grantAgreement/ES/DGA/B35-23R info:eu-repo/grantAgreement/EUR/EDCTP2/RIA2019S-2652 info:eu-repo/semantics/openAccess by-nc-nd https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Gonzalo-Asensio, Jesús Universidad de Zaragoza (orcid)0000-0001-8841-6593 Aguiló, Nacho Universidad de Zaragoza (orcid)0000-0001-7897-9173 Arbués, Ainhoa Universidad de Zaragoza (orcid)0000-0002-3377-4171 1011 630 Universidad de Zaragoza Dpto. Microb.Ped.Radio.Sal.Pú. Área Microbiología 1011 566 Universidad de Zaragoza Dpto. Microb.Ped.Radio.Sal.Pú. Área Inmunología (2026), 108513 [8 p.] Int. j. infect. dis. INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES 1201-9712 1154168 http://zaguan.unizar.es/record/171031/files/texto_completo.pdf Versión publicada 2983509 http://zaguan.unizar.es/record/171031/files/texto_completo.jpg?subformat=icon icon Versión publicada oai:zaguan.unizar.es:171031 articulos driver 2026-05-05-13:36:07 ARTICLE