BCG vaccination–induced emergency granulopoiesis provides rapid protection from neonatal sepsis

Neonatal administration of BCG vaccine rapidly increases neutrophil production to reduce mortality from sepsis. The vaccine that keeps on giving Bacille Calmette-Guérin (BCG) is a tuberculosis vaccine that is frequently given to infants in countries with a high incidence of tuberculosis infection. However, emerging evidence suggests that this vaccine may have additional beneficial effects for the infants. Following on previous observations of reduced neonatal mortality in BCG-vaccinated infants, Brook et al. performed a systematic study of mouse models and human infants in multiple countries. The authors demonstrated that BCG vaccine given during the neonatal period protected the infants from death due to sepsis and showed that this could be attributed to a rapid increase in neutrophils driven by the vaccine. Death from sepsis in the neonatal period remains a serious threat for millions. Within 3 days of administration, bacille Calmette-Guérin (BCG) vaccination can reduce mortality from neonatal sepsis in human newborns, but the underlying mechanism for this rapid protection is unknown. We found that BCG was also protective in a mouse model of neonatal polymicrobial sepsis, where it induced granulocyte colony-stimulating factor (G-CSF) within hours of administration. This was necessary and sufficient to drive emergency granulopoiesis (EG), resulting in a marked increase in neutrophils. This increase in neutrophils was directly and quantitatively responsible for protection from sepsis. Rapid induction of EG after BCG administration also occurred in three independent cohorts of human neonates.