Are Diabetic and People with Hypertension Immunosuppressed to BCG Vaccine?
Reportedly the objective of our study is to test BCG as a prophylactic (preventive measure), to reduce morbidity and mortality. Since elderly individuals fall under the high-risk hotspot group for both morbidity and mortality, our first inclusion criterion is individuals aged between 60 and 80 years old. diabetes and hypertension (high blood pressure) are not classic examples of immunosuppression. They are associated with lower immune responses. When we say immunosuppressed, we mean hiv or transplant patients. Their T-cell (which play a major role in immunity) count is already low. In people with diabetes and hypertension, their T-cell count is perfectly fine; only some of their responses might be impaired.
In fact, diabetic patients and people with hypertension are those we really need to target and preferably include in the study. Their T-cell count is fine and just need an extra boost, which is what we hope BCG will provide. It changes depending on the site we do the study in. In chennai, hotspots are mainly determined by the Greater chennai Corporation. We don't decide. We tell them to give us a list of wards they consider hotspots and based on this list, they help us select the places where we can identify people for the study.
Even though the hotspots are not static in nature, we select only those spots where essentially the transmission has been high enough that even if it increases or decreases, it is not going to change remarkably in the next three months. It is a very short study. The idea is not to say that one has to be always exposed (to the risk of being infected) throughout the duration of the study. That is not going to happen. We just want to select people who are at higher risk now.