The trials were part of an age de-escalation strategy, which is aimed at testing the safety and immunogenicity first in adult volunteers, thereafter in adolescents, followed by children and finally, infants. The current study follows a similar study completed in healthy adults 25. Written, informed consent was obtained from parents or legal guardians, while adolescents and, where judged appropriate, children gave written, informed assent. The protocol and amendments were approved by the Medicines Control Council of South Africa and the Research Ethics Committees of the Universities of Cape Town and Oxford. The trials were conducted according to International Conference on Harmonization-Good Clinical Practice (ICH-GCP) guidelines

and were externally BI 6727 cell line monitored by an independent contract research organization. The trials were registered on a clinical trials database: ClinicalTrials.gov ID NCT00460590 (adolescents) and NCT00679159 (children). The aim was to enroll 12 adolescents and 24 children, this website who would be vaccinated

with MVA85A. For safety assessments and immunology studies, adolescents would be followed up for 12 months and children for 6 months. Healthy adolescents aged 12–14 years, and children aged 1–10 years, were recruited from the general population of Worcester, 110 km from Cape Town, in the Western Cape Province of South Africa. All participants had received BCG vaccination at birth, as is routine in South Africa. Exclusion criteria included evidence of M.tb infection, defined as a positive ESAT-6/CFP-10 ELISpot

test, and/or a Mantoux Calpain test induration of 15 mm or more. A normal chest radiograph, to exclude active or past TB disease, and a negative HIV ELISA test were also required. Each enrolled participant received a single intradermal dose of 5×107 pfu MVA85A (contract manufactured for Oxford University at Impfstoffwerk Dessau-Tornau (IDT) Biologika, Germany). All adolescents were evaluated on days 2, 7, 14, 28, 56, 84, 168 and 364 post-vaccination and the children on days 2, 7, 28, 84 and 168. Blood was collected for safety evaluation, which included biochemistry and hematology tests, on days 7 and 84. Diary cards were given to participants or their guardians to monitor solicited and unsolicited local and systemic adverse events during the first 7 days after vaccination. Participants were also questioned about adverse events at each visit for the duration of the study. Adverse events were assessed for causality and their vaccine relatedness – classified as not related, possibly, probably or definitely related. The severity was classified based on the U.S. Toxicity Grading Scale for Healthy Adult and Adolescent Volunteers Enrolled in Preventive Vaccine Clinical Trials (70 FR 22664, May 2, 2005, http://www.fda.gov/CBER/gdlns/toxvac.pdf for adolescents. For children classification was based on the Division of AIDS Table for Grading the Severity of Adult and Pediatric Adverse Events of December 2004, http://rcc.