Vaccines Have Serious Side Effects

The Revised Authoritative Guide To Vaccine Legal Exemptions

Comprehensive, authoritative information about vaccine exemptions you can trust, from Alan Phillips, J.D., a leading vaccine rights attorney with years of experience helping clients throughout the U.S. legally avoid vaccines in a wide variety of vaccine-refusal settings. Critical details for parents, students, immigrants, healthcare employees, military personnel and contractors, agencies, attorneys and clientsvirtually anyone concerned with legally avoiding vaccines in the United States. This Guide provides and explains: Important background information about the legal system; How state and federal statutes, regulations, constitutions and legal precedent interact to define the boundaries of your legal exemption rights; How to deal with local authorities and to avoid mistakes that cost others their exemption; Where legal technicalities and practical reality differand what to do about it; Read more...

The Revised Authoritative Guide To Vaccine Legal Exemptions Overview

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See also Vaccines General Information

Bacille Calmette-Guerin (BCG) vaccine is a suspension of living tubercle bacilli of the Calmette-Guerin strain. It is used mainly prophylactically against tuberculosis, but also as a means of stimulating the immune response in malignant disease. There are variations in the characteristics of BCG vaccines, depending on the strain of BCG derived from the original BCG strain and employed for vaccine production. BCG is generally used intradermally, except for instillation in intravesical immunotherapy. The risk of adverse effects after BCG immunization is related to the BCG strain, the dose, the age of the vaccinee, the technique of immunization, and the skill of the vaccinator.

Vaccines and immunoglobulins

Vaccination and pregnancy Cholera vaccine Hemophilus influenza b (HIS) vaccine Hepatitis A vaccine Hepatitis B vaccine Human Papillomavirus (HPV) vaccine Influenza vaccine Measles and mumps vaccines Meningococcal meningitis vaccine Pneumococcal vaccination Poliomyelitis vaccine Rabies vaccine Rubella vaccine Tetanus and diphtheria vaccines Typhoid vaccine Varicella vaccine Yellow fever vaccine 2.7.1 Vaccination and pregnancy Protective and booster immunizations should be carried out before pregnancy. Even though no embryotoxic or teratogenic effects have been proven for any vaccine, the indications for immunization, especially in the first Irimester, should be limited strictly to rare situations. With live vaccincs, the risk of a fetal infection from the vaccine is more of a theoretical nature, but routine immunization should be avoided during pregnancy. Another reason for avoiding vaccinations in early pregnancy is the possible risk of maternal hyperthermia (see Chapter 2.6) as a...

Hemophilus influenza b HIB vaccine

Hemophilus b conjugate vaccine is a combination of the capsular polysaccharides or oligosaccharides purified from HIB type b bound with various proteins. Two reports and a review have described the maternal immunization with the capsular polysaccharide vaccine of HIB during the third trimester of prcgnancy to achieve passive immunity in the fetus and newborn. No adverse effects were observed in the newborns (review in Briggs 2005). Recommendation. Vaccination results in pregnancy are lacking discussion about the innoculty and effectivity are still ongoing.

Human Papilloma Virus HPV vaccine

In )une 2006 the US FDA licensed the first vaccine developed to prevent cervical cancer and other diseases in females caused by certain types of genital human papillomavirus (HPV) types (6, 11, 16 and 18), responsible for 70 of cervical cancers and 90 of genital warts. The duration of the protection is unclear. Current studies (with 5-year follow-up) indicate that (he vaccine is effective for at least 5 years (Anonymous 2006), The vaccine has not been causally associated with adverse outcomes of pregnancy or adverse reactions (o the developing fetus. However, data on vaccination in pregnancy are limited. Recommendation. The HPV vaccine is not recommended in pregnancy. Inadvertant exposure during pregnancy is not a reason for invasive diagnostics or for interruption of pregnancy.

Measles and mumps vaccines

There is insufficient documented experience with the use of these vaccines during pregnancy. Measles (rubeola) vaccine is a live attenuated virus vaccine. Although transplacental passage of this vaccine has never been demonstrated, the vaccine should not be used during pregnancy because fetal infection with the attenuated virus cannot be excluded. Because this vaccine is normally administered together with the rubella vaccinc, its contraindications arc similar. The American College of Obstetricians and Gynecologists lists the vaccine as con-traindicated in pregnancy and also recommends a 3-month interval before conception (ACOG 1993). In case of a significant exposure risk in a non-immune patient, a vaccination during the third trimester is suggested. Mumps vaccine is also a live attenuated virus vaccinc. Mumps occurring during pregnancy may result in an increased rate of firsttrimester abortion. Although a fetal risk from the vaccine has not been confirmed, the vaccine should not be...

Meningococcal meningitis vaccine

The polyvalent meningococcal meningitis vaccine may be administered during pregnancy if the woman is entering an area where the disease is endemic. From the use of this vaccine, mostly in the third trimester of pregnancy, it is concluded that there are no indications for harm of the unborn (Letson 1998). Protecting antibodies have been found to cross the placenta. In breast milk and in the serum of the newborn, significantly higher IgA and IgG levels were found in 157 individuals vaccinated in the third trimester, in comparison with controls (Shahid 2002). Recommendation. Vaccination, if necessary, is not known to be associated with developmental disorders.

Pneumococcal vaccination

Pneumococcal vaccination during pregnancy was thought to be the way of preventing pneumococcal disease during the first month of life. From studies with 280 participants (Chaithongwongwatthana 2006), it was concluded that there was no adverse effect on pregnancy and on the health of the newborn. However, there was no evidence that pneumococcal vaccination during pregnancy reduced neonatal infection. Recommendation. There are no indications to vaccinate against neonatal pneumococcal infection during pregnancy. On the other hand, vaccination does not seem to be harmful for the fetus, and does not require any intervention,

Poliomyelitis vaccine

Oral polio vaccine (Sabin) contains attenuated live poliomyelitis viruses of all three poliovirus types. It is no longer recommended for routine vaccinations because in very rare cases it may cause poliomyelitis. The inactivated form of the vaccine (Salk), mostly in combinations with other vaccines (injection), is now preferred. When there were outbreaks of poliovirus in Israel and Finland, mass oral polio vaccinations of the population, including pregnant women, were performed. Based on the observation of more than 15 000 pregnancies, there was no increased risk of spontaneous abortion and no increase in birth defects or prematurity (Harjulehto-Mervaala 1995, Ornoy 2006, 1993, 1990). The authors consider the oral poliovirus vaccine as safe for pregnant women however, it should not be used in the last month of pregnancy, to avoid contamination of delivery rooms by the virus-shedding mother. Live attenuated poliovirus is no longer relevant as a result of practical extinction of the...

Tetanus and diphtheria vaccines

These vaccines are bacteriological vaccines that contain the relevant toxoids, and there arc no indications of embryotoxic properties in these vaccines, which have been used for many decades - also in pregnant women. The suspicion of an increased risk of funnel thorax and clubfoot as a result of tetanus toxoid, suggested about 30 years ago and never confirmed, is of anecdotal character Heinonen 1977). A large case-control pair analysis conducted in Hungary (Czeizel 1999) failed to detect any teratogenic effect of tetanus toxoid.

Combinations of vaccines

Since immunization against diphtheria, tetanus, and pertussis is recommended at the same age as immunization against Haemophilus influenzae, children must usually receive two intramuscular injections at separate sites during the same visit. Combined vaccines, for example DTP Hib vaccines, requiring one injection, could be preferable and are commercially available. Results of clinical trials comparing the safety and efficacy of combined and simultaneously administrated vaccines (Hib, DTP, MMR, IPV) have been presented (SEDA-17, 369) (SEDA-18, 330). In general, the rates of local and systemic reactions and antibody responses did not differ significantly between the groups. The immunogenicity and safety of a diphtheria-tetanus-pertussis-Hib combination vaccine (tetanus-conjugated Hib vaccine) have been compared with those of the same combination obtained by the reconstitution of lyophilized Hib vaccine with liquid DTP vaccine in 262 healthy infants randomized to receive injections at 2,...

Regimens using different conjugated vaccines for primary series

Currently most advisory bodies for immunization practice recommend that the same Hib conjugate vaccine used to initiate a priming series should be continued for the entire series. However, interest in using different vaccines for sequential doses (mixed regimens) has been long-standing. Two- or three-dose mixed regimens of Hib conjugate vaccines have been compared in two randomized trials in 140 and 181 infants (11). In both trials, a group of infants received PRP-meningococcal protein conjugate vaccine (OMP, outer membrane protein) at 2 months of age, followed by either the same or another conjugate vaccine, oligosaccharide CRM197 Hib vaccine (HbOC, Hib oligo-saccharides linked to the non-toxic diphtheria toxin variant CRM197) or PRP-tetanus toxoid Hib vaccine, either once (at 4 months of age) or twice (at 4 and 6 months of age). All the mixed regimens provided a mean anti-PRP antibody concentration that did not differ substantially compared with currently recommended regimens of...

Vaccines and Toxoids

Immunologic agents are contraindicated in patients with known hypersensitivity to the agent or any component of it. The measles, mumps, rubella, and varicella vaccines are contraindicated in patients who have ever had an allergic reaction to gelatin, neomycin, or a previous dose of one of the vaccines. The measles, mumps, rubella, and varicella vaccines are contraindicated during pregnancy, especially during the first trimester, because of the danger of birth defects. Women are instructed to wait at least 3 months before getting pregnant after receiving these vaccines. Vaccines and toxoids are contraindicated during acute febrile illnesses, leukemia, lymphoma, immunosuppressive illness or drug therapy, and non-localized cancer. See Display 54-6 for additional infor- Known allergy to vaccine or vaccine constituents, particularly gelatin, eggs, or neomycin Individuals with an immunologic deficiency should not receive a vaccine (virus is transmissible to the immunocompromised...

Vaccination as Therapy for Stomach Infections

A critical question is whether it is necessary or possible to induce local mucosal immune responses in the stomach. Synthetic, recombinant or highly purified sub-unit antigens are considered safe but are inherently of low immunogenicity. They often require effective delivery systems to reach the mucosal lymphoid tissues and mucosal adjuvants to enhance and direct the immune response (43). Mucosal delivery, in addition to being less invasive than parenteral administration, enables the antigen to be delivered to the major site of pathogen entry. Oral administration of protein antigens also requires the protein to be protected from the harsh acidic environment. Delivery systems for vaccines include adjuvant emulsions, liposomes and microspheres. A number of vaccine candidates for Helicobacter immunization have been identified, including urease, neutrophil activating protein (NAP), bacterial lysates, vacuolating cytotoxin (VacA), cytotoxin-associated antigen (CagA), and inactivated whole...

Brief History Of Vaccination

Since its discovery just over 200 years ago, vaccination has become one of the most successful ways of treating infectious diseases. Infectious diseases tormented humans indiscriminately for thousands of years until a small town English doctor named Edward Jenner popularized vaccination as a medical treatment beginning in 1796. In earlier years, people had realized that once a person survived an initial infection or disease, it seldom, if ever, came back as strong. In the midst of a major smallpox epidemic that occurred at the end of the 18th century, Dr. Jenner discovered that by injecting a small amount of cowpox into a person, the person would become slightly ill for a short time, but would then recover, becoming almost immune to the otherwise deadly smallpox. Even though Dr. Jenner did not understand how or why the technique worked, there was no doubting its effectiveness, and vaccinations for smallpox quickly swept the industrially developing world. It would take another hundred...

General Information Measles vaccine

Live measles vaccine Live measles virus vaccine is available in monovalent (measles only) form and in combinations measles-rubella (MR) and measles-mumps-rubella (MMR) vaccines. Measles vaccines based on further attenuated strains (beyond the level of the original strain, for example the Edmonston B strain or Schwarz strain) produces a mild or subclinical and non-communicable infection. Inactivated measles vaccine Inactivated measles vaccine was not distributed after 1967 (owing to lack of efficacy). Reports of the atypical measles syndrome that can occur after immunization with this vaccine type have been reviewed (SED-11, 679) (SEDA-8, 299) (SEDA-11, 291). High-titer Edmonston-Zagreb measles vaccine High-titer Edmonston-Zagreb measles vaccine is more immunogenic in young infants than measles vaccine based on other strains. It was hoped that the use of such vaccines could help to reduce the incidence of measles in infancy in developing countries. However, little was known about the...

Measlesmumpsrubella vaccine

In most industrialized countries, measles-mumps-rubella (MMR) vaccine has replaced the former use of single antigen vaccines against measles, mumps, and rubella in childhood immunization programs. Single antigen rubella vaccines are still used in postchildhood rubella prevention. Comparisons of the efficacy and safety of different MMR vaccines and monovalent versus bivalent or triva-lent vaccines have been made in various clinical trials (SEDA-14, 285). Minor symptoms (fever, rash, malaise) occurred usually after 5-14 days and lasting for 2-3 days. Occasionally, febrile convulsions have been recorded within 3 weeks of immunization, and mild parotitis occurred rarely in the third week after immunization. On average, the seroconversion rates were between 95 and 99 for measles and rubella, and less for mumps. In a crossover study among 581 twin pairs aged between 14 months and 6 years only 0.5-4 had adverse reactions to MMR vaccine. The difference between the reaction rate reported in...

Polysaccharide vaccines

Polysaccharide meningococcal vaccines in various combinations against meningococcal disease caused by meningococci of groups A, C, W135, and Y have been commercially available for many years. Studies mostly using a bivalent serogroup A + C vaccine carried out in about 15 countries, including some millions of people, have shown efficacy of 61-99 . Meningococcal group A vaccine is more immunogenic than group C vaccine in infants and small children. However, infants below 6 months of age produce a weak response, and meningo-coccal group C vaccine should not be used before the age of 2 years. Meningococcal group B polysaccharide vaccine is poorly immunogenic in humans and is therefore not available commercially. Adverse reactions are infrequent and mild, consisting of local soreness or localized erythema at the injection site, and systemic reactions (transient fever, headache, fatigue), lasting 1-2 days (3,4). With the quadrivalent vaccine used in Canada, fever was reported in less than 1...

Nonpolysaccharide group B meningococcal vaccines

Considering the poor immunogenicity of polysaccharide group B vaccines, different vaccines have been devel-oped a Norwegian outer membrane complex group B vaccine and a Cuban vaccine in which the group C poly-saccharide is added to a mixture of high molecular weight B outer membrane proteins and proteoliposomes. Both vaccines have been used in clinical trials, mainly in Latin America, but more conclusive studies with these two products are awaited. Adverse reactions with the Cuban vaccine have been studied. Among 16 700 vaccinees, mostly older than 4 years, local reactions were observed in 62 , and systemic reactions in 4.3 . From studies in 370 infants and children and 171 adults aged 18-30 years, who received three doses of outer membrane protein meningococcal vaccine developed in either Cuba or Norway or a control vaccine (Hib vaccine), the vaccines are promising candidates for the control of epidemics caused by homologous epidemic strains (5). However, the vaccines would not...

Diphtheriatetanus vaccine

To avoid increasing reactogenicity of booster doses, diphtheria-tetanus vaccines or other combination vaccines that include the diphtheria component, used either for primary immunization in young children or for booster immunization in school-children, adolescents, and adults, contain different amounts of diphtheria toxoid. The formulations used in most countries are a childhood formulation containing 25-30 Lf (flocculating units) of diphtheria toxoid (D) and an adult formulation containing 2 Lf of diphtheria toxoid (d). In a prospective cohort study in Italy, 380 children aged 6 years were randomly assigned to receive either the DT or the Td vaccine as a booster dose in order to determine whether a booster dose of Td (diphtheria-tetanus vaccine with a reduced amount of diphtheria toxoid, adult formulation) would produce comparable diphtheria antibody titers but lower reactogenicity than DT (childhood formulation). The frequencies of symptoms within 3 days of vaccine administration...

Human papilloma virus vaccine

Cervical cancer is the second most common cause of cancer deaths in women world-wide. It is almost invariably associated with human papilloma virus (HPV) infection. HPV type 16 is found in about 50 of cervical cancers, and types 18, 31, and 45 account for a further 25-30 of HPV-positive tumors. The development of a safe and effective HPV vaccine could prevent premalignant and malignant disease associated with HPV infection. There has been a trial of a papilloma virus (HPV16) virus-like particle vaccine in 72 healthy volunteers, aged 18-27 years (33C). The vaccine was well tolerated and highly immunogenic. Clinical studies with a recombinant vaccine (using vaccinia virus expressing HPV 16, 18 E6 and E7 proteins) in patients with pre-invasive and invasive cancer have been reviewed (34R). Influenza vaccine (SED-14,1072 SEDA-23, 347 SEDA-24, 375) In addition to reports on the immunogenicity and safety of inactivated intranasal influenza vaccine (SEDA-25, 386), this subject has been...

Japanese encephalitis vaccine

Immunologic Allergic reactions to Japanese encephalitis vaccine have been reported. In Japan, children who had immediate-type allergic reactions to Japanese encephalitis vaccine had antigelatin IgE in their sera. However, the immunological mechanism of non-immediate-type allergic reactions that consist of cutaneous signs developing several hours or more after Japanese encephalitis immunization is not yet clear. Serum samples taken from 28 children who had non-immediate-type allergic skin reactions have been compared with serum samples taken from 10 children who had immediate-type reactions (39C). All the children who had had immediate-type reactions had antigelatin IgE and IgG. Of 28 children who had had non-immediate-type reactions, one had antigelatin IgE and nine had antigelatin IgG. These results suggest that some children who develop non-immediate-type allergic reactions have also been sensitized to gelatin. Measles vaccine (SED-14,1076 SEDA-23, 348 SEDA-24, 377)...

Manufacture of Vaccines

Approximately 75 of the current cancer vaccine pipeline is comprised of generalized or off-the-shelf vaccines based on specific carbohydrates, proteins, or other easily replicated structures that are capable of being mass produced. The remainder consist of personalized, vaccines (i.e., based on antigens harvested from an individual patient's tumor cells). This trend reflects the fact that generalized vaccines are simple to manufacture and commercially viable on a large scale. However, mainly due to their limited range of relevant antigen expression, they are associated with a higher rate of clinical failure than personalized approaches. To date, despite concerns relating to the complexity of manufacture and formulation, as well as product sterility and distribution problems, the personalized dendritic cell-based vaccine approach has provided the most convincing clinical evidence of efficacy. For example, Den-dreon's Provenge is based on patient-specific dendritic cells loaded with a...

Examples of Vaccines in Development

There are too many experimental cancer vaccines in early-stage clinical trials to discuss here in detail. Instead, some examples are listed below to provide insight into the range of clinical studies presently underway. It is important to note that, for vaccines, the promise observed in early-stage clinical trials, which often enroll only a small number of patients, is not always sustained in larger trials. For example, in one recent trial of a melanoma vaccine, the early findings suggested that the vaccine might help prevent melanoma from recurring in patients at high risk from this. However, in a subsequent larger trial that include approximately 750 patients who were at high risk for melanoma recurrence, high-dose interferon proved superior to the vaccine in preventing return of the disease.

Pneumococcal conjugated polysaccharide vaccines

Pneumococcal polysaccharides are not immunogenic in infants, but improved immunogenicity of polysaccharide-protein conjugates has been demonstrated. One of the major problems in developing a successful vaccine against S. pneumoniae is the large number of different serotypes involved. More than 83 serotypes of the bacterium are known to cause disease, although about 10 of these account for up to 70 of disease in young children. The frequency of the serotypes can vary from year to year, from one age group to another, and on a geographical basis. Various conjugated vaccines that include different serotype variations are already licensed (the heptavalent conjugated vaccine Prevnar Prevenar), under development or undergoing clinical trial (9- and 11-valent conjugated vaccines). If the vaccines prove to be successful, it is estimated that their use could reduce child deaths from pneumococcal pneumonia by up to 25 , saving over 250 000 lives a year worldwide. The development of conjugate...

Drug Drug Interactions Influenza vaccine

In a study of the interaction between 23-valent pneumococcal polysaccharide vaccine and influenza vaccine, 152 adults with chronic respiratory disease were randomized to receive both vaccines either simultaneously or at an interval of 1 month (24). There were no significant differences in serological responses between the groups. The incidence and severity of both local and systemic adverse effects were also similar there were mild local reactions in 38 and 36 and systemic reactions in five and three of the vaccinees respectively.

Inactivated poliomyelitis vaccine

Inactivated poliomyelitis vaccine produced by improvements in manufacturing technology (potency-enhanced IPV-elPV was licensed in 1987) is used for routine immunization in an increasing number of countries (for example in Finland, France, Germany, Iceland, the Netherlands, Norway, Sweden, and certain provinces of Canada) and is recommended in other countries for certain specific purposes, for example for persons with underlying immunological disorders or non-immunized adults exposed to high risk. A few countries (for example Denmark, Hungary, Italy, Lithuania, and Israel) use a mixed schedule, starting primary immunization with IPV followed by OPV. The US 2000 childhood immunization schedule, proposed by the Advisory Committee of Immunization Practices (ACIP), the American Academy of Pediatrics, and the American Academy of Family Physicians, recommended an all-IPV schedule for routine use in the USA, aimed at the elimination of the rare vaccine-associated paralytic poliomyelitis (1)....

Dosage and vaccination schedule

There are several vaccination schedules. For information, for travellers 3 injections on Day 0, Day 7 and Day 28 a booster dose every 3 years if risk persists. An accelerated schedule is possible (3 doses on Day 0, Day 7 and Day 14) but this is likely to result in lower antibody levels than the standard schedule.

Combined diphtheria tetanus pertussis vaccination

An overview of clinical trials with a special diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine has been published (1). The vaccine contains as pertussis components purified filamentous hemagglutinin, pertac-tin, and genetically engineered pertussis toxin. The vaccine induces high and long-lasting immunity and is at least as efficacious as most whole-cell pertussis vaccines and similar in efficacy to the most efficacious acellular pertussis vaccines that contain three pertussis antigens. The vaccine is better tolerated than whole cell vaccines and has a similar reactogenicity profile to other acellular vaccines. A vaccine containing diphtheria and tetanus toxoids and acellular pertussis with reduced antigen content for diphtheria and pertussis (TdaP) has been compared with a licensed reduced adult-type diphtheria-tetanus (Td) vaccine and with an experimental candidate monovalent acellular pertussis vaccine with reduced antigen content (ap) (2). A total of 299...

Vaccine Adverse Event Reporting System

The Vaccine Adverse Event Reporting System (VAERS) is a national vaccine safety surveillance program co-sponsored by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA). VAERS collects and analyzes information from reports of adverse reactions after immunization. Anyone can report to VAERS, and reports are sent in by vaccine manufacturers, health care providers, and vaccine recipients and their parents or guardians. An example of the VAERS and instructions for completing the form are found in Appendix F. Any clinically significant adverse event that occurs after the administration of any vaccine should be reported. Individuals are encouraged to provide the information on the form even if the individual is uncertain if the event was related to the

National compensation programs for vaccinerelated injuries

The need for some form of compensation when an individual is seriously injured by vaccination, particularly when the immunization has been compulsory or recommended by the health authority, has been accepted in many countries. Table 6 shows details of compensation programs in Canada (the province of Quebec), Denmark, France, Germany, Italy, Japan, New Zealand, Norway, Sweden, Switzerland, Taiwan, the UK, and the USA (37). In the USA, the National Childhood Vaccine Injury Act of 1986 established the National Vaccine Injury Compensation Program as a federal no-fault compensation system for individuals who may have been injured by specific vaccines. This compensation program relies on a Vaccine Injury Table that lists the vaccines that are covered by the program, as well as injuries, disabilities, illnesses, and conditions (including death) for which compensation may be awarded. To better reflect current scientific knowledge about vaccine injuries, the Vaccine Injury Table was revised in...

Diphtheriatetanus or diphtheria tetanuspertussis vaccines in combination with other vaccines

DTaP or DTwP vaccine can be combined with other antigens, such as Hemophilus influenzae type b (Hib), inactivated poliovirus (IPV), and hepatitis B vaccine. In children DTaP or DTwP vaccines are the basis for such combinations, while in adults it is mostly Td vaccine, Current safety concerns regarding combination vaccines have been defined and reviewed (17r). The author concluded that there is no evidence that adding vaccines to combination products increases the burden on the immune system, which can respond to many millions of antigens. Combining antigens usually does not increase adverse effects, but it can lead to an overall reduction in adverse events. Before licensure, combination vaccines undergo extensive testing to assure that the new products are safe and effective. Cardiovascular Myopericarditis has been attributed to Td-IPV vaccine (19A). Sensory systems Optic neuritis has been attributed to Td-IPV vaccine (20A). Ten days after receiving Td-IPV vaccine a 56-year-old woman...

Vaccines immunoglobulins and antisera

Antituberculous vaccine (BCG) Diphtheria-Tetanus-Pertussis vaccine (DTP) Hepatitis B vaccine Japanese encephalitis vaccine Measles vaccine Meningococcal vaccine A + C Meningococcal vaccine A + C + W135 Oral antipoliomyelitis vaccine (OPV) Rabies vaccine Tetanus vaccine (TT) Yellow fever vaccine

Polio vaccines as a possible cause of AIDS

There is a hypothesis that the HIV virus might have jumped the species barrier from monkey to people via a contaminated polio vaccine because the vaccine was manufactured in primary monkey kidney tissue known to be sometimes contaminated with monkey viruses. The existing evidence, including tests of poliovirus seed stocks, more than 20 vaccine lots, and serum samples from vaccine recipients makes this hypothesis highly improbable (6,7). Contamination of polio vaccines with simian papovavirus 40 (SV40) The problem of early polio vaccines produced in the 1950s and early 1960s, and, in some instances, contaminated with the monkey virus SV40 (simian virus 40) has been discussed (8). From 1954 to 1962, millions of people were immunized with polio vaccines, which during that period contained SV40 as an unrecognized contaminant. Some studies sought to investigate possible causation between the receipt of the vaccine and the development of tumors. The results were not convincing (SEDA-15,...

Pneumococcal polysaccharide vaccine

The question of whether revaccination with 23-valent pneumococcal polysaccharide vaccine (PPV) at least 5 years after the first vaccination is associated with more frequent or more serious adverse events than those after the first vaccination has been studied in patients aged 5074 years who had never been vaccinated with PPV (n 901) or who had been vaccinated once at least 5 years before enrolment (n 513) (8). After one dose of PPV, local injection site reactions and prevaccination concentrations of type-specific antibodies were measured. Those who were re-vaccinated were more likely than those who received their first vaccinations to report a local injection site reaction of at least 10.2 cm (4 in.) in diameter within 2 days of vaccination (55 513 versus 29 901, or 11 versus 3 ). The reactions resolved by a median of 3 days after vaccination. The highest rate was among revaccinated patients who were immune competent and did not have chronic illnesses 15 (33 228) compared with 3 (10...

Conjugated meningococcal vaccines

Success with the protein-conjugate formulations of Hemophilus influenzae vaccines has facilitated research and development on conjugated meningococcal vaccines with preference for monovalent group C or bivalent group A group C vaccines. Conjugated meningococcal vaccines of serogroup C made by various manufacturers were first licensed in 1999 in the UK and then (at the end of 2000) in many other countries, including some other member states of the European Union (Belgium, Germany, Greece, Luxembourg, Ireland, Portugal, Spain). Field trials in the UK and the Gambia have shown immunogenicity not only in adults but also in toddlers and even infants. Except for local tenderness in 30-75 of vaccinees, no conjugate vaccine evaluated to date has been associated with significant adverse effects (1). Vaccine containing oligosaccharides derived from group C meningococcal capsular polysaccharide coupled to CRM197, a non-toxic mutant diphtheria toxin (manufactured by Wyeth Lederle Vaccines and...

Types of Cancer Vaccines

At present, there are two major categories of cancer vaccines. The first represents vaccines designed for prophylactic use (to prevent cancer), and the second represents vaccines used to treat existing cancers. Both T cells and B cells can be activated as part of an immune response for the purpose of either cancer prevention or treatment. With preventive vaccines targeted against infectious agents that are known to cause cancer (e.g., hepatitis B and HPV), the activated B cells produce antibodies that bind to the infectious agents and interfere with their ability to infect cells. Because the agents must infect cells to transform them, this lowers the chance of the cancer occurring. For vaccines designed to treat cancer, antibodies specific for cell-surface antigens on cancer cells can target the antigens and, by a number of indirect mechanisms, cause the cell to die. Part of the challenge of developing vaccines in either category is that the immune system has the almost impossible...

Vaccines

Chloroquine 300 mg week adversely affected the antibody response to human diploid-cell rabies vaccine administered concurrently. The mean rabies-neutralizing antibody titer was significantly reduced on each day of testing (SEDA-13, 806) (8). In contrast, retrospective studies of the response to pneumococcal polysaccharide in patients with systemic lupus erythematosus taking chloroquine or hydroxychloroquine, and of the response to tetanus-measles-meningococcal vaccine in a region of Nigeria where malaria is endemic, did not show an effect on antibody production. However, it was pointed out that the altered immune status of patients with systemic lupus erythematosus makes it difficult to compare their response to that of young healthy adults receiving rabies vaccine. Illness and nutritional state could have influenced the findings in the Nigerian study (SEDA-13, 807) (53).

Cholera vaccine

The cholera vaccine contains inactivated vibrios of the serotypes Inaba and Ogawa. There are no studies on the use of this vaccine during pregnancy. Protection is incomplete and only short-term. Antibiotic treatment of a cholera infection is obviously the choice during pregnancy, it should, however, be considered that there is already a high antibiotic resistance among vibrios. Thus, no universally valid recommendations for infection prophylaxis in pregnancy can be made, because the appropriate procedure depends on the situation of the individual case (e.g. length of the trip, destination, housing conditions). Pregnant women who must travel in epidemic areas should, in any case, strictly adhere to the basic hygicnic measures boil it, cook it, peel it or forget it. Recommendation. If compellingly indicated, assuming that travel to an endemic area cannot be postponed, vaccination should also be performed during pregnancy.

Hepatitis A vaccine

Hepatitis A vaccine contains inactivated hepatitis A viruses that are cultivated from human cell cultures. Its use in pregnancy has EJ not been systematically investigated. However, there is no indica- tion of developmental toxicity. Recommendation. Pregnant women without immunity to hepatitis A need protection before traveling to developing countries. Based on the experience with other inactivated viral vaccines, hepatitis A vaccine can be given to the pregnant woman at high risk of infection. Immune globulin is safe and effective in preventing hepatitis A, but immunization with one of the hepatitis A vaccines gives a more complete and prolonged protection.

Hepatitis B vaccine

A biotechnologically produced non-reproducible surface antigen is used as hepatitis B vaccine (HBV), It is therefore a non-infectious vaccine, and no risks to the fetus have been reported following vaccination of their mothers in pregnancy (ACOG 1993). Immunization of groups at risk is recommended if possible, it should be given after the twelfth week of pregnancy. Ayoola (1987) described a series of 72 pregnant Nigerians who were seronegative for hepatitis B and were given two intramuscular doses of vaccine in the third trimester. One month after the second dose, 84 were anti-HBs positive. No significant adverse effects were observed in the mothers or their newborns. Passive transfer of anti-HBs occurred in 59 of the newborns. The antibodies disappeared rapidly in these infants, and by 3 months only 23 had detectable antibodies (Ingardia 1999, Reddy 1994). No 11 BsAg carrier status developed in this g1 group. In contrast, the infants born to HBsAg-positive mothers had a cumulative...

Influenza vaccine

Pregnant women are supposed to have an increased risk of influenza infection and complications. Evaluation of more than 2000 pregnancies exposed to influenza vaccine could not demonstrate an increased risk of maternal complications or adverse fetal outcomes associated with the vaccine (Waleway 2006, Munoz 2005). The selected vaccine should be the vaccine advised for that influenza season. The American College of Obstetricians and Gynecologists (ACOG) (1991) recommended that the vaccine should be given only to pregnant women with serious underlying diseases (chronic diseases or pulmonary problems). In contrast, the Advisory Committee on Immunization Practices recommends standing orders, programs or reminders for patients and providers as strategies to improve vaccination rates during pregnancy, which are estimated to be less than 10 . The Joint Committee on Vaccination and Immunisations (JCVI 2006) in the UK agreed in June 2006 that pregnant women were at an increased risk of morbidity...

Rabies vaccine

The rabies vaccine contains attenuated live virus matter, which is produced nowadays from human cell cultures. This vaccine, which has been available since 1980, has, in contrast to earlier vaccines, virtually no side effects. Case reports on active and or passive immunization during a pregnancy indicate an uncomplicatcd course of pregnancy (Chutivongse 1995, Chabala 1991, Fescharek 1989). A study was published regarding the safety and immunogenicity of purified vero cell rabies vaccine (PVRV) during pregnancy (Sudarshan 1999). Twenty-nine pregnant women exposed to rabies were vacci natcd with PVRV, and none of the women experienced any adverse side effects to the vaccine. The intrauterine growth and development monitored by ultrasound examination was found to be normal, and the outcome of pregnancy was satisfactory. There were no congenital anomalies in any of the infants born, and they were healthy with normal growth and development during the 1-year follow-up period. The...

Rubella vaccine

Rubella immunization uses attenuated live virus vaccine. Antibody levels of 10-15 international units IgG ml are considered protective. Naturally acquired rubella generally confers a lifelong and usually high degree of immunity against the disease for the majority of individuals. Rubella immunization is contraindicated shortly before and during pregnancy (Tookey 2001), despite the fact that in all surveillance studies to date (including more then 700 pregnancies) no child has been born with congenital rubella syndrome after vaccination of its seronegative mother during pregnancy (see, for example, Hamkar 2006, Enders 2005, Best 1991. Tookey 1991). A study led by the Motherisk Program of Toronto in Canada, quoted by Josefson (2001), compared the rates of fetal malformations in the infants of 94 women who mistakenly received rubella vaccinations while pregnant with 94 pregnant women who were not vaccinated during pregnancy. The rate of fetal anomalies was similar in both groups. In...

Yellow fever vaccine

The yellow fever vaccine contains attenuated live viruses. Fifty-eight pregnancies followed by the European Network of Teratology Information Services (ENTIS) gave no substantial indication of embryo-or fetotoxic effect after first-trimester vaccination (Robert 1999). In a small number of women who received this vaccine during various stages of pregnancy there was no evidence of transplacental passage of the attenuated virus, although in most mothers who produced neutralizing antibodies these antibodies either crossed the placenta or were transferred to neonates through the colostrum. No adverse effects associated with prenatal exposure to this vaccine were observed at birth or during a 3- to 4-year follow-up period (Nasidi 1993). There is one report on congenital infection after first-trimester vaccination (Tsai 1993), but no other report has confirmed this potential risk. Finally, a small casc-control study conducted in Brazil (Nishioka 1998) compared 39 women who attended a...

Diphtheria vaccine

A vaccine containing diphtheria and tetanus toxoids and DTaP with reduced antigen content for diphtheria and pertussis (TdaP) has been compared with a licensed reduced adult-type diphtheria-tetanus vaccine and with an experimental candidate monovalent DTaP vaccine with reduced antigen content (ap) (5). A total of 299 healthy adults (mean age 30 years) were randomized into three groups to receive one dose of the study vaccines. The antibody responses (antidiphtheria, antitetanus, antipertus-sis toxin, antipertactin, antifilamentous hemagglutinin) were similar in all groups. The most frequently reported local symptom was pain at the injection site (62-94 ), but there were no reports of severe pain redness and swelling with a diameter of 5cm or more occurred in up to 13 . The incidence of local symptoms was similar after TdaP and Td immunization. The most frequently reported general symptoms were headache and fatigue (20-50 ). The incidence of general symptoms was similar in the TdaP and...

Tumor Vaccines

The development of cancer vaccines, aimed to enhance the immune response against a tumor, is a promising area of research. A better understanding of both the molecular mechanisms that govern the generation of an effective immune response and the biology of a tumor has contributed to substantial progress in the field. Areas of intense investigation in cancer immunotherapy include the following (1) discovery and characterization of novel tumor antigens to be used as targets for vaccination (2) investigation of different vaccine-delivery modalities such as cellular-based vaccines, protein- and peptide-based vaccines, and vector-based vaccines (3) characterization of biological adjuvants to further improve the immunogenicity of a vaccine and (4) investigation of multimodal therapies where vaccines are being Various strategies have been used to design peptide-based vaccines for cancer (24). DNA vaccines are typically comprised of plasmid DNA molecules that encode an antigen(s) derived from...

Cocaine Vaccines

An alternative pharmacotherapy for cocaine dependence currently under investigation is use of a cocaine vaccine to blunt the reinforcing effects of cocaine.51-60 The basis of this pharmacotherapy is to decrease the rate of entry of cocaine into the CNS (and therefore the onset of action), by either binding cocaine with antibody generated by active immunization with a stable cocaine conjugate or by using an enzymatically active antibody specific for cocaine. Because cocaine is a small molecule (MW 303 g mol) it is unlikely that it will be immunogenic and therefore must be conjugated to a carrier molecule such as KLH (keyhole limpet hymacyanin), polyethylene glycol, diphtheria, or tetanus toxoids to enhance its immunogenic-ity.53-55 While early attempts to make a cocaine vaccine did not demonstrate significant efficacy for blocking the effects of cocaine in the CNS,55 recent studies have been more successful.56,57 Active immunization with a stable cocaine-KLH conjugate lowered cocaine...

Other vaccines

When recombinant hepatitis B vaccine was given together with DTP vaccine and oral poliomyelitis vaccine, there was no evidence of increased reactogenicity after simultaneous administration compared with hepatitis B vaccine alone (86). In 40 children born to HBsAg-positive mothers who had received second and third doses of hepatitis B vaccine simultaneously with DTP vaccine and inactivated poliomyelitis vaccine, immunogenicity and reactogenicity were comparable with non-simultaneous administration of the different vaccines (87).

Mumps vaccine

Live mumps virus vaccine is available in monovalent (mumps only) form and in combination with measles (MM vaccine) and with measles and rubella (MMR vaccine). Vaccines based on the following mumps vaccine strains are in use The Jeryl Lynn strain is used mainly in vaccines prepared in the USA. The virus was isolated from a female patient in 1963. Vaccines based on Jeryl Lynn strain are mostly used worldwide. The Urabe Am9 strain was attenuated in Japan and has been used for the preparation of MMR and other mumps-containing vaccines in Japan and Europe. The Rubini strain was isolated in Switzerland and was attenuated by passage in human diploid cells for use in vaccine production. The L-3 (Leningrad) strain was derived by combining five isolates of mumps virus from sick children. The attenuated strain is used for vaccine production, especially in Russia. The L-3 strain was further attenuated in Zagreb, Croatia, by adaptation and passage in SPF chick embryo fibroblast cell cultures...

Viral Vaccines

Hepatitis B vaccine (SED-14,1067 SEDA-23, 345 SEDA-24, 374) Nervous system Two episodes of leukoencephalitis occurred in a previously healthy patient after a second dose of HB vaccine and re-challenge with a third dose (24A). A 39-year-old woman developed a complete right homonymous hemianopia and severe dyslexia 4 weeks after receiving a second dose of HB vaccine. Brain MRI showed a large lesion that occupied most of the left occipital lobe and extended into the splenium of the corpus callosum. Histolog-ical examination with immunoperoxidase staining, although not pathognomonic, was consistent with demyelinating disease. She underwent surgery and 1 week later there was marked improvement in her condition. Three months later (4.5 months after the second dose), she received a third dose of HB vaccine and 11 days later developed a left hemiparesis and acute progressive deterioration in vision. Brain MRI showed a new large lesion in the right parieto-occipital region, with the...

Activity of Vaccines

Studies in laboratory animals have demonstrated that cancer vaccines show the greatest promise in situations where they are used to prevent a cancer from returning after the primary tumor has been eradicated by chemotherapy, radiation, or surgery. One interpretation of this finding is that the immune system is more likely to be successful when it has to deal with a smaller number of cancer cells. Conversely, attempting to shrink existing tumors using vaccine therapy is more problematic because the immune system is likely to be overwhelmed and ineffective when matched against a larger number of cancer cells. At present, the most success has been achieved with preventative vaccines targeted toward causative viruses (e.g., hepatitis B and HPV). Experimental cancer vaccines as a treatment for advanced cancers have been far less successful and are presently recommended to patients only when all other therapies have been exhausted. Combination treatments are also being investigated, and...

Polio vaccine

Oral polio vaccine (Sabin) is live attenuated vaccine combining three strains of the virus. The transfer of these vaccine viruses to an unvaccinated contact person, i.e. via a smear infection, can lead to a normal vaccination reaction and immunity against infection with the wild virus. However, it is also possible that the person will become ill with contact vaccine poliomyelitis. This complication -occurring once in 15.5 million immunizations - is very rare. In two cases, it has been reported in infants Mertens 1983, Heyne 1977), When immunization is urgent for the mother, the killed virus vaccine can be given to her intramuscularly. In the immunized mother, polio antibodies are present in the milk at a level comparable to the mother's plasma levels. High concentrations of anti-polio virus antibody in the milk could theoretically interfere with the response of the breastfeeding infant to immunization, but no such outcome has ever been reported. Recommendation. Live oral vaccine...

Combination vaccines

The safety, immunogenicity, and lot consistency of five-component pertussis combination vaccine (DtaP + IPV + PRP-T-Hib) in infants have been compared to those of a whole-cell pertussis combination vaccine (DTwP + IPV + PRP-T-Hib), as have separate and combined injections of DTP + IPV and Hib. The combination vaccine DtaP + IPV + Hib were comparable or superior regarding safety and immunogenicity to the combination vaccine containing the whole cell pertussis component. There was no interaction between acellu-lar pertussis and PRP-T-Hib, a feature that distinguishes this combination vaccine from some others, which depress anti-PRP responses. The combination vaccine DtaP + IPV + Hib produced significantly lower rates of local and systemic reactions than did the combination vaccine containing the whole-cell pertussis component. Local reactions, such as redness, swelling, and tenderness occurred two to three times more often after combination vaccine containing whole cell pertussis than...

Biological Response Modifying Agents

Many so-called biological response modifiers (BRMs), or biologicals, are either in use or development. These include agents as diverse as antibodies, antibody-drug conjugates, interferons, interleukins, enzymes, vaccines, and other types of immune stimulants (see Chapter 8). For example, several tumor types, including some types of breast cancer, have been found to produce specific tumor antigens on their cell surfaces, and this has led to the development of monoclonal antibodies specific for these tumors (e.g., Herceptin see Chapter 5 and Chapter 7 ). Tumor-specific antibodies can also be used to selectively deliver a cytotoxic agent (e.g., Mylotarg ) or a radionuclide (see Chapter 7) to the tumor site. An antibody-enzyme conjugate designed to release an active form of a cytotoxic agent from a nontoxic prodrug selectively at the tumor site (i.e., antibody-directed enzyme prodrug therapy ADEPT see Chapter 7) is presently being evaluated in clinical trials. Finally, research is ongoing...

Factors Affecting Treatment Outcome

It has long been known that the level of host immunity acquired through long-term exposure to infection affects the response to drug treatment (Mayxay et al. 2001 White 2002). In Bandiagara, Mali, a site where malaria vaccines are being tested, the median age of persons presenting to clinic with symptomatic uncomplicated falciparum malaria is 10 years (Djimde et al. 2001a). In this setting of moderate malaria transmission, immunity as reflected by age plays a critical role in the host's ability to clear chloroquine-resistant parasites when treated with chloroquine persons aged less than 10 years cleared chloroquine-resistant parasites at a rate half that of persons aged 10 years or older. The age pattern of the ability to clear chloroquine-resistant parasites mirrors exactly the acquisition of clinical immunity (Fig. 1). Infants aged less than 1 year who are still protected by maternal antibodies or other mechanisms that prevent disease in young infants are able to clear resistant...

Susceptibility Factors

BCG reactions in HIV-positive and HIV-negative children have been compared in African children. The rates of local adenitis were equal (104,105). These results have been confirmed by a number of other studies, among them one in Haiti. The Haitian investigators found that the risk of complications after BCG vaccination in HIV-infected children is low and that the risk does not outweigh the benefits of BCG vaccination in populations at high risk of tuberculosis during infancy and childhood. Mild or moderate adverse effects occurred in 19 (9.6 ) of 166 infants born to HIVseronegative mothers as compared with 4 (31 ) of 13 HIV-infected infants (106). Organisms of the Mycobacterium avium complex (MAC) commonly cause disseminated bacterial infection among patients with AIDS. There is evidence that immunoprophylaxis against MAC infection may be possible. A heat-killed Mycobacterium vaccae vaccine was given in a three-dose schedule to 12 HIV-infected adults with CD4 cell counts below 300 x...

General Information

Cholera vaccines consist of live attenuated or heat-killed Vibrio cholerae organisms. They can be given orally or parenterally. Following the administration of live oral cholera vaccine (containing the attenuated strain V. cholerae CVD 103-HgR, prepared from V. cholerae 01 strain 569B), there were significant rises in serum antitoxin concentrations and only few mild adverse effects (SED-13, 925). There was protective efficacy in 82-100 of healthy adult volunteers and no difference in adverse effects between 25 recipients of the vaccine and 26 controls (1). A randomized, double-blind, placebo-controlled trial using a live oral cholera vaccine (strain CVD 103, derived from the V. cholerae 01 classical Inaba strain 569B by deletion of the genes encoding the A subunit of cholera toxin) was conducted in 50 healthy Swiss adults. There was a significant rise in serum antitoxin titers in 76 of the volunteers. Two vaccinees reported watery stools after immunization (2). When an oral...

Drug Administration Drug formulations

A parenteral cholera vaccine consisting of a heat-killed, phenol-preserved, mixed suspension of the Inaba and Ogawa subtypes of V. cholerae, Serovar 01, has been used subcutaneously or intramuscularly, or for booster doses intradermally. About 1 of vaccinees develop mild local skin lesions comprising transitory soreness at the injection site within 5-7 days after injection, characterized by erythema, swelling, pain, and induration, and rarely resulting in ulceration. More general reactions are allergic as a rule, these amount at most to slight pyrexia, headache, and malaise. However, considering the low protective efficacy and high reactogenicity of this vaccine, the World Health Organization and many national health authorities do not recommend it anymore and most manufacturers have stopped producing it.

Attitudes to immunization

When 1593 visitors to a health fair'' were surveyed on their use of complementary medicine, it emerged that elderly users were significantly less likely to use influenza immunization (41). Students of a Canadian chiropractic college were questioned about whether they agreed with immunization in general. The longer they had attended college, the less favorable their attitude toward immunization became (42). An analysis of the contents of 22 leading anti-immunization websites showed that about 70 of these sites claimed that homeopathy represented an alternative to conventional vaccination (43). In a similar study it was found that 39 of the anti-immunization websites claimed that natural lifestyle conveys immunity to infections, thus allegedly rendering immunization unnecessary, and 45 claimed that alternative health'' is superior to immunization (44). In another study homeopaths and chiropractors were specifically asked about their advice regarding MMR immunization 40 of the homeopaths...

Combined diphtheria tetanus pertussis immunization

An overview of clinical trials with a special diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine has been published (4). The vaccine contains as pertussis components purified filamentous hemagglutinin, pertac-tin, and genetically engineered pertussis toxin. The vaccine induces high and long-lasting immunity and is at least as efficacious as most whole-cell pertussis vaccines and similar in efficacy to the most efficacious DTaP vaccines that contain three pertussis antigens. The vaccine is better tolerated than whole-cell vaccines and has a similar reac-togenicity profile to other acellular vaccines.

Prevalence and Aetiology of Anaemia in the Developing World

Menendez and colleagues performed another trial, giving sulphadoxine-pyrimethamine or placebo at the same time as routine vaccinations delivered through WHO's Expanded Program on Immunization (EPI). All children received iron supplementation between 2 and 6 months of age. This simple intervention reduced severe anaemia by 50 compared to the placebo group, while serological responses to EPI vaccines were not affected by the intervention (Schellenberg et al. 2001).

Ocular Chlamydial Infections

Ocular Chlamydia trachomatis occur in two forms, that is, trachomatis (chronic keratoconjunctivtis) and inclusive conjunctivitis. Trachoma is the most common cause of ocular morbidity and blindness (91). Inclusive keratoconjunctivitis is a sexually transmitted disease. It is a common cause of conjunctivitis in neonates. Infants are generally exposed to C. trachomatis from the infected cervix of mother. It is usually treated with antibiotics and if necessary they are administered systemically (94). Oral azithromycin is also recommended as a cost-effective means of controlling endemic trachoma (95,96). Novel vaccine delivery systems have also been evaluated for trachoma treatment (97).

Decreased resistance to infection with bacteria

Klein et al. (1994) reported that THC induces significantly increased mortality in mice infected with Legionella pneumophila, the causative agent of Legionnaires' disease. In their experiments, the investigators tested whether the cannabinoid altered secondary immunity to Legionella since such immune responsiveness is critical for host survival upon challenge with this pathogen and formulates the basis for vaccine prophylaxis. Legionella-primed mice challenged with a secondary lethal dose of Legionella survived the secondary challenge infection. In contrast, significantly increased mortalities were obtained for animals subjected to the same Legionella infection and challenge regimen but receiving THC three weeks prior to the Legionella challenge. Klein et al. (1994) concluded that THC administration at the time of primary infection suppressed development of secondary immunity to Legionella. Furthermore, in a separate study, Klein et al. (1993) reported that THC induces...

Emerging Cancer Therapies Gene Therapy

The utilization of combined gene therapy is another important area for future research. In terms of cancer treatment, the identification of tumor rejection antigens and the defective immune response observed in cancer patients are important topics for future studies. Additionally, new approaches for formulating and delivering plasmid DNA and alphaviral replicon vectors have resulted in increased potency of gene-based vaccines (15).

Future Directions and Conclusion

After many years of relative obscurity, the study of the clinical, experimental and animal models of malarial anaemia is attracting renewed interest. This is primarily fuelled by the realization that the problem of malarial anaemia will be with as drug resistance increases and if vaccines giving partial immunity but not complete immunity promote chronic infections. In addition, safe treatment of severe malaria remains problematic in the absence of a ready supply of safe blood. At the same time, the research infrastructure in Africa has improved for linked epidemiological-clinical studies and, more generally, the tools to study molecular and cellular pathology have become much more powerful Finally, we must ask what is the purpose of ever more powerful descriptive studies Some have suggested that descriptive studies are low priority in the race to define new vaccines and find new drugs. However, for malarial anaemia, it is becoming increasingly plain that these descriptive studies are...

Parasite Specific Immune Responses

Taken together, the studies of placental parasites and acquired immune responses suggest a model to explain malaria susceptibility and resistance in pregnant women. Women lack immunity to placental IEs before their first pregnancy. This would account for the susceptibility of primigravid women to malaria (Fried and Duffy 1996). Exposure during first and subsequent pregnancies elicits specific immunity that confers protection to multigravid women. Antibodies and possibly cellular responses against placental parasites prevent infection (Fried et al. 1998b) and the poor pregnancy outcomes associated with malaria (Duffy and Fried 2003 Staalsoe et al. 2004). This model of protective immunity suggests that a vaccine against placental parasites could be delivered before a woman's first pregnancy, and exposure during pregnancy would boost her protective responses and prevent poor outcomes for both mother and fetus.

Drug Administration Drug additives

To increase immunogenicity, the hepatitis A vaccines commercially available are coupled to adjuvant aluminium phosphate or aluminium hydroxide. However, alum precipitates provoke inflammatory responses at the injection site. Immunostimulating reconstituted influenza virosomes have therefore been used as an alternative adjuvant. In 1994, a hepatitis A vaccine using the new adjuvant was licensed in Switzerland, and it was later approved for use in other countries the vaccine was well tolerated and highly immunogenic (SEDA-20,290) (SEDA-22,344). Nine people with a history of ocular sensitivity were immunized with hepatitis B, without untoward reactions. However, this result in such a small series should not be overestimated (75). There have been reports of three cases of inflammatory nodular reactions after hepatitis B immunization aluminium allergy was confirmed (76-78). Four cases of reactions to thiomersal in hepatitis B vaccines (both plasma-derived and recombinant) have been...

Drug dosage regimens

Revaccination is sometimes necessary because only 5070 of immunocompromised persons, especially dialysis patients, develop antibodies, and the anti-HBs titers in these cases are low. In revaccinated non-responders to primary hepatitis immunization using either 20 mg of plasma-derived vaccine or 10 mg of recombinant vaccine, depending on the vaccine used for previous doses, the revaccinations were well tolerated (81,82). Only 6.6 of the vaccinees reported slight irritation at the injection site, tenderness, minimal pain, or swelling lasting for a few hours up to 2 days.

Drug administration route

Aiming at cost reduction of hepatitis B immunization programs, the administration of low doses (2 micrograms) of vaccine given intradermally had by 1987 been evaluated in clinical trials in health-care workers (83) and children (84). The resulting seroconversion rates were 96 and over 90 , respectively. A minimum of local side effects occurred. In a comparison of antibody responses and adverse effects after intradermal or subcutaneous administration of 2 micrograms of a plasma-derived hepatitis B vaccine and intramuscular administration of 20 mg, the intradermal and intramuscular routes gave the highest seroconversion rates (100 and 96 , respectively) and the highest mean titers of anti-HBs (85). The aluminium adjuvant in the vaccine was assumed to cause a substantial number of local reactions (37 discoloration, 17 itching, and 13 nodule formation) after intradermal administration other routes of administration showed adverse effects only rarely. Correct intradermal deposition of the...

Disparaging disparities

Unfortunately, the government has taken part in many different abusive research campaigns over the years, including the deliberate exposure of over 16,000 people, including disabled children and soldiers, to radiation and as guinea pigs for vaccines and a host of different chemicals in toxicity studies. For example, children with cerebral palsy were used for radiation experiments at Sonoma State Hospital. There are currently over 1,400 patients buried in unmarked graves at the hospital, many of who had their brains removed for further study before they were buried. Today, our society has a much clearer understanding of the scope of human rights and informed consent for human experimentation preventing further atrocities NOT

Areas for Future Research

Barring the eradication of malaria, the long-term solution to pregnancy malaria will require vaccines. Studies performed in several countries support a model of protective immunity pregnant women who acquire antibodies against placental parasites are resistant to infection and disease. This knowledge will guide the identification of the antigens required for a pregnancy malaria vaccine, but several questions remain. Are antibodies sufficient for protection We need a better understanding of cellular immune responses against placental parasites. Are there receptors other than CSA that support parasite sequestration in the placenta Vaccines may need to target more than one parasite subpopulation. How many IE surface antigens mediate binding to CSA, or elicit protective antibodies The best vaccine may comprise several surface antigens of placental parasites. Research into pregnancy malaria will also yield important insights that illuminate other research areas, such as the normal...

General adverse effects

Local adverse reactions after flu immunization are few and infrequent. Slight to moderate tenderness, erythema, and induration at the injection site lasting 1-2 days occur in 15-30 of recipients. Fever, malaise, myalgia, and other symptoms of toxicity are rare (about 2 ) and most often affect persons with no prior exposure to the flu antigens in the vaccine, for example young children. These reactions usually begin 6-12 hours after immunization and can last 1 or 2 days. They have been attributed to the vaccine, although the virus is inactivated. On the other hand, cases of respiratory diseases among vaccinees are coincidental. Although current flu vaccines are highly purified, they can cause hypersensitivity reactions such as hives or angioedema, perhaps due to residual egg protein (8,9). Notwithstanding the fact that the egg protein content is small, asthma or anaphylactic reactions with vascular purpura and encephalopathy can occur in those who are sensitive to the material (10,11)....

Drug Administration Drug dosage regimens

Current recommendations for the use of influenza vaccine in adults are based on a single injection. This may not be valid in case of a new pandemic caused by an antigenic shift of the influenza virus. Currently, the only group for whom a second dose is recommended comprises children who have never been immunized. However, when two-dose regimens in adults have been studied, the second dose of vaccine has not been associated with higher rates of reactions than the first. People who have a stronger local reaction after a first injection are more likely to have another such reaction after a second injection (31).

Organs and Systems Nervous system

Postmarketing surveillance data of adverse events after Japanese encephalitis immunization in Japan and the USA have been compared (7). The rates of total reported adverse events were 2.8 per 100 000 doses in Japan and 15.0 per 100 000 doses in the USA. In Japan, 17 neurological disorders were reported from April 1996 to October 1998 (0.2 per 100 000 doses), whereas in the USA there were no serious neurological adverse events temporally associated with Japanese encephalitis vaccine from January 1993 to June 1999. Rates for systemic hypersensitivity reactions were 0.8 and 6.3 per 100 000 doses in Japan and the USA respectively. A 6-year-old girl and a 5-year-old boy had drowsiness, paresthesia, and gait disturbance 14 and 17 days respectively after immunization with Japanese encephalitis vaccine. Treatment with prednisolone improved the clinical findings (8,9). Another report included seven cases of acute disseminated encephalomyelitis after administration of Japanese encephalitis...

Public Assistance Recipients

Each year roughly 97 percent of American school children are vaccinated against childhood diseases as a precondition to attending school.87 Almost 100 years ago, the United States Supreme Court ruled that there was nothing in the Constitution or elsewhere to prevent a state from mandating compulsory vaccination88 today almost every state has laws requiring that children be vaccinated prior to entering the public school system. Parents who refuse to have their children vaccinated have been charged with neglect and even child abuse.89 Many parents would undoubtedly rise in protest to any effort to include pharmacotherapy vaccines in the childhood vaccine program because drug use is not an infectious disease however, government rhetoric is already laying the groundwork for responding to such parental objections. According to the 2001 National Drug Control Strategy, drug addiction, like infectious and biological diseases that can weaken a person's immune system or bodily integrity, can...

Antineoplastic Antibiotics

Plasma digoxin levels may decrease when the drug is administered with bleomycin. When bleomycin is used with cisplatin, there is an increased risk of bleomycin toxicity. Pulmonary toxicity may occur when bleomycin is administered with other antineoplastic drugs. Plicamycin, mitomycin, mitoxantrone, and dactino-mycin have an additive bone marrow depressant effect when administered with other antineoplastic drugs. In addition, mitomycin, mitoxantrone, and dactinomycin decrease antibody response to live virus vaccines. Dactinomycin potentiates or reactivates skin or gastrointestinal reactions of radiation therapy. There is an increased risk of bleeding when plicamycin is administered with aspirin, warfarin, heparin, and the NSAIDs.

Pyrimethamine plus sulfadoxine

In a study of chemoprophylaxis for malaria, 701 Tanzanian infants were assigned to intermittent pyrimethamine + sulfadoxine (under 5 kg, a quarter of a tablet 5-10 kg, half a tablet over 10 kg, 1 tablet each tablet contains pyrimethamine 25 mg and sulfadoxine 500 mg) or placebo alongside routine childhood immunizations and iron supplementation at 2, 3, and 9 months of age (34C). Pyrimethamine + sulfa-doxine was well tolerated, with no reported adverse events. Episodes of clinical malaria fell by 59 (95 CI 41, 72) and the incidence of severe anemia by 50 (95 CI 8, 73 ) in the first year of life. Contrary to previous studies involving continuous prophylaxis in infants, there was no increase in the frequency of rebound episodes of malaria up to 18 months of age, suggesting that the development of malaria-specific immunity was unimpaired. Responses to vaccines were unaffected.

America Death To Israel Allah Is Great

This was most certainly the appropriate approach during the Cold War, since we know that the Soviet Union had a very sophisticated bioweapons program that concentrated on anthrax, smallpox and other agents. Their anthrax program has been well-documented by ex-Soviet scientists now working in the US and through a disastrous event in 1979 when anthrax was accidentally released from a Soviet military facility, resulting in at least 94 deaths. We also know of or suspect at least 18 other countries of having biological weapons or biodefense programs. Research into countermeasures to the agents being developed in these countries is a prudent strategy. The question is do we need to make weaponized versions of an agent to make a vaccine or antibiotic to fight them Most people in the drug-making business would say no. But to test vaccines and other countermeasures, you have to know how they will act, and thus many believe that weaponizing them was necessary. ized medications that are designed...

Organs and Systems Immunologic

Immediate-type hypersensitivity reactions (acute, systemic urticaria after the third immunization) occurred in two of 39 volunteers immunized with a synthetic multi-antigen peptide vaccine (PfCS-MAP1NYU) against P. fal-ciparum sporozoites, with detection of serum IgE MAP antibody (8). Immediate pain at the injection site was associated with the adjuvant QS-21, and delayed local inflammatory reactions were associated with high titers of circulating IgG anti-MAP antibody. Skin tests using intradermal injections of diluted MAP vaccine, to identify those who were sensitized to the vaccine, were negative in seven volunteers tested 27 days after the first vaccination, but six of these developed positive wheal and flare reactions when tested 14 or 83 days after the second vaccination IgE MAP antibody was detected in only one of them. Skin tests may help in identifying individuals who have been sensitized to malaria peptides and who are at risk of developing systemic allergic reactions after...

Second Generation Effects Pregnancy

Live measles vaccine should not be given to pregnant women. This precaution is based on the purely theoretical risk of fetal infection (134). The risks of rubella infection to the unborn child are well known, and necessarily the question has arisen as to whether rubella vaccine is safer. Based on careful analyses by the CDC since 1979 and evaluation of reports from Germany and the UK showing that infants born to susceptible mothers did not develop the congenital rubella syndrome, the Immunization Practices Advisory Committee (135) has concluded that Continued surveillance in the USA (data collected through the Vaccine in Pregnancy Registry) has not shown evidence that RA 27 3 rubella vaccine, administered during pregnancy, can cause the congenital rubella syndrome (136).

Targeting Virulence and Pathogenicity

The suppression of virulence does not kill the bacteria. It could have a synergistic effect when used with antimicrobial therapies. Balaban et al. 112 investigated a novel way of interfering with virulence factor synthesis by vaccinating mice with an autoinducer called RNAIII-activating peptide (RAP). RNAIII is a regulatory RNA molecule responsible for the synthesis of virulence factors in S. aureus and it is induced by RAP. Vaccination of mice with RAP increases their resistance to S. aureus challenge from 30 to 70 and decreases the size of lesions. The regulatory mechanism involving autoinducers may be targeted in other bacteria.

Psychological psychiatric

There is continuing debate that there is an association between autism and thiomersal-containing vaccines. Some authors believe that review of the literature supports the hypothesis that mercury in vaccines may be a factor in the pathogenesis of autism (65). The World Health Organization's Global Advisory Committee on Vaccine Safety (GACvS) has also kept this issue under review and concluded in November 2002 that there is no evidence of toxicity in infants, children, or adults who have been exposed to thiomersal in vaccines. The CSM is also keeping the issue under close review and studies of the possible toxicology of thiomersal continue to appear (66). The usual dose of ethyl mercury in pediatric vaccines is small (about 12.5-25 micrograms of mercury). However, the metabolism of ethyl mercury in infants who receive vaccines containing thiomersal is unknown. The mean doses of mercury in 40 full-term infants exposed to thiomersal-containing vaccines were 46 (range 38-63) micrograms in...

Surveillance of adverse events following immunization AEFI

Perspectives on pre-licensure trials The recent withdrawal of tetravalent rhesus-based rotavirus vaccine from the market illustrates an important problem regarding pre-licensure testing and its ability to identify rare vaccine-related adverse events. A sample size of 10000 volunteers may provide excellent estimates of reactogenicity (local and systemic reactions) and efficacy but be inadequate as a denominator for ruling out rare adverse events. Table 1 shows how trial size determines the ability to detect frequent and rare events. Plans for future large pre-licensure trials, e.g. for newly developed rotavirus vaccines, therefore include 10000-60 000 volunteers. These large trials can be seen as a bridge between pre-licensure and improved post-licensure surveillance (1R, 2R). Improving monitoring of vaccine safety through post-licensure studies Gaps in current vaccine safety monitoring methods have been analysed and the needs for improvements outlined (3R, 4R). The well-known...

Bioterrorism and prevention through immunization

The fatalities reported to the federally administered (US) Vaccine Adverse Event Reporting System (VAERS, described in SED-14, 1049) have been examined (6C). A total of1266 deaths were reported to VAERS between July 1990 and June 1997. Table 2 shows the numbers of deaths by age, and Table 3 shows the causes of death. Anthrax vaccine (SEDA-23, 336 SEDA-25, 378) Anthrax continues to be a significant threat as a biological weapon for use in both military and domestic acts of bioterrorism. Currently, three human vaccines against anthrax are available, produced in Russia (a live attenuated spore vaccine) and in the UK and USA (vaccines using filtrates of attenuated strains of anthrax bacillus). In 1970, an anthrax vaccine, derived from a sterile filtrate of an avirulent non-encapsulated strain of Bacillus anthracis and adsorbed on to aluminium hydroxide, was licensed by the Food and Drug Administration (FDA) to protect people who might be exposed to anthrax. The Advisory Committee on...

Bacille Calmette Gurin BCG

Vaccine (SED-14, 1056 SEDA-23, 337 Six months after BCG vaccination, an 18-year-old boy developed lupus vulgaris on his right shoulder. He was successfully treated with rifampicin, isoni-azid, and ethambutol. He had had lupus vulgaris after BCG vaccination on his left shoulder 8 years before.

And another thing the coming pandemic

But H5N1 is not just spreading in birds and other animals it is also mutating. This is the start of a process of adaptation for the virus. Influenza viruses do not proofread their genome when it replicates, so they acquire mutations faster than animals or even other types of virus, which is precisely why the flu vaccine must be updated every year. That adaptation appears to have continued, as there are now birds and people who are catching this flu who are not dying, indicating that it is becoming less virulent. On the surface, this sounds like a good thing, but as viruses go this is actually a very bad sign. It indicates that the virus could be on its way to acquiring the ability to pass more easily from human to human. Even though a lower percentage of infected people would die from it, it would spread very quickly. The most deadly influenza strain on record, the 1918 flu that killed between 20 and 50 million people worldwide, only killed 1-2 of people infected, so lower virulence...

Contraindications Precautions And Interactions

When xanthine bronchodilators are administered with sympathomimetic drugs (see Chap. 22), additive CNS and cardiovascular effects may occur. If a patient eats large amounts of charcoal-broiled foods while taking the xanthines, a decrease in the therapeutic effect of the xanthines may occur. Certain foods contain xan-thine (eg, coffee, colas, or chocolate) and may increase the risk of cardiac and CNS adverse reactions. Cigarettes, nicotine gum and patches, barbiturates, phenytoin, loop diuretics, isoniazid, and rifampin may decrease the effectiveness of the xanthines. There is an increased risk of xanthine toxicity when the drugs are administered with influenza vaccination, oral contraceptives, glucocorticoids, p-adrenergic blockers, cimeti-dine, macrolides, thyroid hormones, or allopurinol.

Direct Use of Tumor Antigens

This approach involves the identification of unusual or unique cancer-related molecules (i.e., tumor antigens) that appear on the surface of cancer cells but are rarely present on the surface of normal cells. These tumor antigens then form the basis of vaccines. More than 60 of research and development in the vaccine area is based on this approach. Apart from this being the most logical path to cancer vaccine development, other advantages include higher specificity, ease of production, lower cost of manufacture, and reduced levels of concern related to product contamination.

Enhancement of Immunogenicity of Tumor Antigens

A second general approach is to develop a vaccine capable of making tumor antigens more visible to the immune system. This can be done in several ways, including Altering the structure of a tumor antigen slightly to make it look more foreign, and then administering the altered antigen to the patient as a vaccine. One way to alter an antigen is to modify the gene needed to make it. immune system. Cells can also be infected with the viral vector in the laboratory and then given to patients as a vaccine.

Buyanghuanwu Decoction

Buyanghuanwu decoction (BYHWD), a traditional Chinese herbal prescription, has been used clinically for hundreds of years to treat stroke with a yang-tonic effect. The component herbs of BYHWD are Astragalis Radix, Lumbricus, Angelicae Sinensis Radix, Ligustici Chuanxiong Rhizoma, Paeoniae Radix Rubra, Persicae Semen, and Carthami Flos. BYHWD shows an antioxidant effect by raising the decline of superoxide dismutase and GPX activities in a rat model induced by pertussis vaccine 199 . BYHWD improves recovery of neurological function, reduces infarction volume, stimulates neural proliferation, and modulates VEGF and Flk1 expression in transient focal cerebral ischaemic rat brains 200 . BYHWD protects neurons from hypoxia-induced apoptosis, the mechanism of which may lie in the elimination of NO and oxygen free radicals produced during hypoxia, and also by up-regulation of Bcl-2 expression 201 , and down-regulation of p53 and p21 gene expression 202 .

Other features of the patient

The immunogenicity and safety of pneumococcal polysac-charide vaccine have been studied in renal allograft recipients, dialysis patients (19), children and adolescents with sickle-cell anemia (SED-11, 682) (SEDA-12, 277), people with diabetes mellitus (SED-11, 682), and children with nephrotic syndrome (20). When comparing the results with healthy persons there were no significant differences. The problems connected with pneumococcal disease and its prevention in HIV-infected individuals have been reviewed (21). Pneumococcal disease occurs significantly more often in HIV-infected individuals, with pneumococcal pneumonia rates 5.5-17.5 times greater than population-based estimates in the USA, and the increasing rate of penicillin-resistant strains of S. pneumoniae highlight the need for improved prevention strategies. Studies of pneu-mococcal disease in HIV infection have repeatedly shown that over 85 of the isolates from bacteremic patients, in both the USA and Africa, are of...

Global eradication of poliomyelitis and immunization

Using oral vaccine, the global campaign to eradicate polio achieved a more than 90 reduction in the number of polio cases worldwide in the 11 years since it was launched, and is on track to eradicate polio (18). It is to be expected that in a few years both poliomyelitis and polio vaccines will be confined to history books and science museums. Polio immunization will stop for good. When the final goal of global eradication is achieved, a decision on when and how to stop polio immunization will be necessary. Such a decision has not yet been prepared. Different scenarios are under discussion continuation of universal immunization programs, sequential removal of one or two of the Sabin strains of OPV, change to an all-IPV program, and discontinuation of OPV immunization simultaneously worldwide or selectively country by country (19). The Technical Consultative Group for the World Health Organization on the Global Eradication of Poliomyelitis has the task of elaborating a proposal for...

Maternal immunization

A woman who has not received all the recommended immunizations before or during pregnancy may be immunized in the postpartum period even though she is breastfeeding. The presence of live viruses in the milk does not present a problem because the viruses have been attenuated. According to the statement of the American Academy of Pediatrics Committee on Infectious Diseases (2006), breastfeeding women may be immunized with both killed and live vaccines. All vaccines and immunoglobulins used for mothers are considered safe for the infant during breastfeeding. Lactating women can be A lactating woman can be given inactivated poliovirus vaccine, for instance, if necessary. The administration of live vaccine (oral vaccine) should be delayed in the mother (or parents) of a young infant until the infant has been vaccinated with killed virus regardless of the feeding mode. With some vaccines, i.e. against meningococcal or pneumococcal disease (Shahid 2002, 1995) and cholera, there is discussion...

Pyrimethamine sulfadoxine

In a placebo-controlled study of chemoprophylaxis for malaria, 701 Tanzanian infants were assigned to intermittent pyrimethamine + sulfadoxine (under 5 kg, a quarter of a tablet 5-10 kg, half a tablet over 10 kg, one tablet each tablet contained pyrimethamine 25 mg plus sulfa-doxine 500 mg) alongside routine childhood immunizations and iron supplementation at 2, 3, and 9 months of age (4). The combination was well tolerated, with no reported adverse events. Episodes of clinical malaria fell by 59 (95 CI 41, 72) and the incidence of severe anemia by 50 (95 CI 8, 73 ) in the first year of life. Contrary to previous studies involving continuous prophylaxis in infants, there was no increase in the frequency of rebound episodes of malaria up to 18 months of age, suggesting that the development of malaria-specific immunity was unimpaired. Responses to vaccines were unaffected.

The Development Of Modern Medicine

Even at the beginning of the 20th century, average life spans were almost three decades shorter than life spans of today. Infant mortality rates were heartbreakingly higher. Only a few generations ago, parents routinely named several sons after their father in the hope that at least one son would survive to adulthood to pass the father's name on to the next generation. Improvements in public health and nutrition have made big differences, but it was the development of vaccines and the introduction of effective antibiotics during the middle third of this century that reduced infant deaths and lengthened life spans. Infections that had commonly been lethal in the early part of the century were tamed. Now, they are easily treated and have become little more than mere annoyances.

Organs and Systems Gastrointestinal

Observed in patients who receive the tetravalent rhesus-based rotavirus vaccine. During the period from 1 September 1998 to 7 July 1999, 15 cases of intussusception among infants who had received rotavirus vaccine were reported to the Vaccine Adverse Event Reporting System (VAERS). Of the 15 infants, 13 (87 ) had developed intussusception after the first dose of the three-dose RRV-TV series, and 12 had developed symptoms within 1 week of receiving any dose of RRV-TV. Thirteen of the 15 had received other vaccines concurrently. Intussusception was confirmed radio-graphically in all 15 patients. Eight infants required surgical reduction, and one required resection of 18 cm of distal ileum and proximal colon. Histopathological examination of the distal ileum showed lymphoid hyper-plasia and ischemic necrosis. All the infants recovered. The dates of onset ranged from 21 November 1998 to 24 June 1999. The median age of patients was 3 (range 2-11) months. Ten were boys. Topographically the...

Viruses The Acellular Parasite of Cellular Hosts

Viruses are ultramicroscopic, acellular, metabolically inert nucleoprotein particles containing bundles of gene strands of either RNA or DNA, with or without a lipid-containing envelope 10 . Unlike free-living bacteria, viruses are obligate intracellu-lar parasites. They utilize the host cell machinery to propagate new viruses and can cause ailments as benign as a common wart, as irritating as a cold, or as deadly as the bloody African fever. The viruses that cause Lassa and Ebola fever and AIDS spread easily, kill swiftly, and have no cure or vaccine. Viruses have numerous invasion strategies and each strain has its own unique configuration of surface molecules 10, 11 , enabling them to enter into host cells by precisely fitting their surface molecules with the molecules of target cell. The genetic variation, variety of transmission, efficient replication and the ability to persist within the host are the major evolutionary advantages of viruses. As a consequence viruses have adapted...

Recombinant DNA technology using Vaccinia virus

Vaccinia DNA can tolerate large insertions into non-essential regions of the genome, and this opens the door to the making of polyvalent live Vaccinia recombinations. A major obstacle to their use as vaccines is that severe complications can occur after vaccination, especially in immunodeficient individuals. On the other hand, there is evidence that recombinant Vaccinia viruses have reduced pathogenicity. A genetically engineered Vaccinia virus expressing murine interleukin-2 has been described (10), and it has been shown that athymic nude mice infected with the Vaccinia virus recover from the virus infection rapidly, whereas mice infected with a control virus develop progressive vaccinia. One attempt to develop safe and efficacious live recombinant vaccines is the use of low neurovirulent strains of vaccinia virus LC 16 m O (m O) or LC 16 m 8 (m 8). A recombinant Vaccinia virus vaccine (RVV) expressing hepatitis B surface antigen likely to form the basis of a safe live RV vaccine...

Protection of laboratory workers exposed to orthopoxviruses

In 1980, the US Public Health Service first recommended the use of Vaccinia (smallpox) vaccine to protect laboratory workers occupationally exposed to orthopoxviruses. In 1991, the Centers for Disease Control, Atlanta, Georgia, published recommendations on Vaccinia vaccine. From 1983 to 1991, 4649 doses of smallpox vaccine were administered, of which 57 were given in 1989-91. The proportion of primary vaccinations increased from 4 in 1983-88 to 14 in 1989-91. Of vaccinees 93 reported no signs or symptoms after vaccination. Reported adverse reactions were mild lymphadenopathy, fever or chills, and tenderness at the site of vaccination. No severe adverse effects were reported. However, one vaccinee reported a spontaneous abortion 5 months after primary vaccination (16). A somewhat different note has been sounded from the Committee on Occupational Medical Practice of the American College of Occupational and Environmental Medicine. The committee pointed out that risks to laboratory...

Smallpox and bioterrorism

The threat of bioterrorism has made it necessary to consider again prevention and control strategies through vaccination and the potential hazards associated with the administration of smallpox vaccine. Guidelines for prevention and control of smallpox have been elaborated in many countries. The guidelines distinguish between pre-event vaccination programs (worldwide no re-emergence of smallpox) and postevent vaccination programs (re-emergence of smallpox confirmed). Taking into account the risk of smallpox vaccination, most countries have elaborated plans for postevent vaccination programs. During the US pre-event vaccination program, in 1 per 20000 members of the military who received primary smallpox vaccination, cardiac inflammation (myocarditis and or pericarditis), including one death (myocardial infarction), has been reported. Compared with the rate reported in an unvaccinated military population during 1998-2000, the rate of myocarditis pericarditis was substantially...

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