BALTIMORE — Tuberculosis infected more than 8 million people in 2024—surpassing COVID-19 and marking a record high since 1995—as a new Johns Hopkins–developed vaccine emerges amid rising antibiotic resistance.

The nasal spray, DNA-based vaccine targets two genes to help the immune system fight drug-tolerant “persisters” that survive prolonged antibiotic therapy and contribute to relapse.

“Administered together with first-line TB drug therapy, our intranasal DNA fusion vaccine helped infected mice clear the disease bacteria faster, reduced lung inflammation and prevented relapse after treatment ended,” lead author Styliani Karanika, a faculty member of the Johns Hopkins Center for Tuberculosis Research and assistant professor of medicine at the Johns Hopkins University School of Medicine, according to a university website.

Delivering the drug as a nasal spray focuses the immune response on the mucus lining of the sinuses and lungs, where infections begin, she says.

Tuberculosis is an infectious disease caused by bacteria that typically infects the lungs after being spread by coughing, according to the World Health Organization. About 1.2 million people died from TB in 2024 among more than 10 million new infections; roughly one in four people worldwide carries the bacteria without symptoms, while 5–10% develop active disease. Babies and children are at a higher risk of developing the disease if they are infected.

Common symptoms include prolonged coughing, sometimes with blood, chest pain, weakness, fatigue, weight loss, fever and night sweats. The disease is usually treated with antibiotics and can be fatal without treatment.

More studies are needed before any human clinical trials can be approved, but Karanika said work with rhesus macaques verified successful immune activation. Her team published their findings in the Feb. 3 issue of the Journal of Clinical Investigation. The work was funded by National Institutes of Health grants, Hopkins and other sources. Tuberculosis is preventable and curable, the organization states, yet multi-drug resistant strains of TB are a growing public health crisis.

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